Self-Employment for People with Psychiatric Disabilities: Advantages and Strategies

  • Laysha OstrowEmail author
  • Patricia B. Nemec
  • Carina Smith


Self-employment is an alternative to wage employment and an opportunity to increase labor force participation by people with psychiatric disabilities. Self-employment refers to individuals who work for themselves, either as an unincorporated sole proprietor or through ownership of a business. Advantages of self-employment for people with psychiatric disabilities, who may have disrupted educational and employment histories, include opportunities for self-care, additional earning, and career choice. Self-employment fits within a recovery paradigm because of the value placed on individual preferences, and the role of resilience and perseverance in business ownership. Self-employment creates many new US jobs, but remains only a small percentage of employment closures for people with psychiatric disabilities, despite vocational rehabilitation and Social Security disability policies that encourage it. This commentary elucidates the positive aspects of self-employment in the context of employment challenges experienced by individuals with psychiatric disabilities and provides recommendations based on larger trends in entrepreneurship.


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Social Security Administration. Annual Statistical Report on the Social Security Disability Insurance Program. Baltimore, MD: Social Security Administration; 2013.Google Scholar
  2. 2.
    Danziger S, Frank RG, Meara E. Mental illness, work, and income support programs. American Journal of Psychiatry. 2009;166(4):398–404.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    O'Day B, Kleinman R, Fischer B, et al. Preventing Unemployment and Disability Benefit Receipt Among People With Mental Illness: Evidence Review and Policy Significance. Psychiatric Rehabilitation Journal. 2017;40:123–152.CrossRefPubMedGoogle Scholar
  4. 4.
    Cook JA. Employment Barriers for Persons With Psychiatric Disabilities: Update of a Report for the President’s Commission. Psychiatric Services. 2006;57(10):1391–1405.CrossRefPubMedGoogle Scholar
  5. 5.
    Bond GR, Drake RE. Making the case for IPS supported employment. Administration and Policy in Mental Health and Mental Health Services Research. 2014;41(1):69–73.CrossRefPubMedGoogle Scholar
  6. 6.
    Sevak P, Khan S. Psychiatric versus physical disabilities: A comparison of barriers and facilitators to employment. Psychiatric Rehabilitation Journal. 2017;40(2):163.CrossRefPubMedGoogle Scholar
  7. 7.
    Salzer MS, Baron RC, Brusilovskiy E, et al. Access and outcomes for persons with psychotic and affective disorders receiving vocational rehabilitation services. Psychiatric Services. 2011;62(7):796–799.CrossRefPubMedGoogle Scholar
  8. 8.
    Wehman P, Griffin C, Hammis D. Is self employment a cop-out. Journal of Vocational Rehabilitation. 2003;18(1):143–144.Google Scholar
  9. 9.
    Parker Harris S, Renko M, Caldwell K. Social entrepreneurship as an employment pathway for people with disabilities: exploring political–economic and socio-cultural factors. Disability & Society. 2014;29(8):1275–1290.CrossRefGoogle Scholar
  10. 10.
    Salkever DS, Gibbons B, Drake RE, et al. Increasing earnings of Social Security Disability Income beneficiaries with serious mental disorder. Journal of Mental Health Policy and Economics. 2014;17(2):75–90.PubMedGoogle Scholar
  11. 11.
    Swarbrick M, Stahl P. Wellness and recovery through asset building services. Occupational Therapy in Mental Health. 2009;25(3–4):335–342.CrossRefGoogle Scholar
  12. 12.
    Mandiberg JM, Edwards M. Business Incubation for People with Severe Mental Illness Histories: The Experience of One Model. Journal of Policy Practice. 2016;15(1–2):82–101.CrossRefGoogle Scholar
  13. 13.
    Hielscher E, & Waghorn, G. Self-stigma and fears of employment among adults with pscyhiatric disabilities. British Journal of Occupational Therapy. 2017;80(12):699–706.CrossRefGoogle Scholar
  14. 14.
    Corrigan PW, Larson JE, Ruesch N. Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry. 2009;8(2):75–81.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Griffin C, Hammis D. Making self-employment work for people with disabilities. Baltimore, Maryland: Paul H. Brookes; 2003.Google Scholar
  16. 16.
    Freeman MA, Joshnson SL, Staudenmaier PJ, et al. Are Entrepreneurs “Touched with Fire”? 2015;, 2015.
  17. 17.
    Martin E. Bipolar expeditions: Mania and depression in American culture. Princeton, NJ: Princeton University Press; 2007.Google Scholar
  18. 18.
    Jamison KR. Touched with fire. New York: Simon and Schuster; 1996.Google Scholar
  19. 19.
    Saks ER. Successful and schizophrenic. The New York Times. 2013.Google Scholar
  20. 20.
    Herron J. Recovery Lessons Learned from Individuals with Psychiatric Disabilities. Journal of Policy Practice. 2016;15(1–2):116–132.CrossRefGoogle Scholar
  21. 21.
    Schwarz G. INCube Inc. and the TAP Programme — An Innovative Programme for Consumer-Run Business Development in New York City. A Life in the Day. 1998;2(3):6–11.CrossRefGoogle Scholar
  22. 22.
    Parker Harris S, Caldwell K, Renko M. Entrepreneurship by Any Other Name: Self-Sufficiency versus Innovation. Journal of social work in disability & rehabilitation. 2014;13(4):317–349.CrossRefGoogle Scholar
  23. 23.
    Leff HS, Chow CM, Graves SC. No Magic Bullet: A Theory-Based Meta-Analysis of Markov Transition Probabilities in Studies of Service Systems for Persons With Mental Disabilities. Psychiatric Services. 2016;68(3):278–287.CrossRefPubMedGoogle Scholar
  24. 24.
    Drake RE, Whitley R. Recovery and severe mental illness: description and analysis. The Canadian Journal of Psychiatry. 2014;59(5):236–242.CrossRefPubMedGoogle Scholar
  25. 25.
    Psychiatric Rehabilitation Association. About PRA: Defining Psychiatric Rehabilitation. 2017; Accessed July 1, 2017.
  26. 26.
    Substance Abuse and Mental Health Services Administration. SAMHSA’s Working Definition of Recovery. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2013.Google Scholar
  27. 27.
    Croson DC, Minniti M. Slipping the surly bonds: The value of autonomy in self-employment. Journal of Economic Psychology. 2012;33(2):355–365.CrossRefGoogle Scholar
  28. 28.
    Rindova V, Barry D, Ketchen DJ. Entrepreneuring as emancipation. Academy of Management Review. 2009;34(3):477–491.CrossRefGoogle Scholar
  29. 29.
    Mandiberg JM. Social Enterprise in Mental Health: An Overview. Journal of Policy Practice. 2016;15(1–2):5–24.CrossRefGoogle Scholar
  30. 30.
    Ostrow L, Adams N. Recovery in the USA: From politics to peer support. International Review of Psychiatry. 2012(1).Google Scholar
  31. 31.
    Linhorst DM. Empowering people with severe mental illness: A practical guide. Oxford University Press; 2006.Google Scholar
  32. 32.
    Chamberlin J. Citizenship rights and psychiatric disability. Psychiatric Rehabilitation Journal. 1998;21:405.CrossRefGoogle Scholar
  33. 33.
    Tomes N. The Patient As A Policy Factor: A Historical Case Study Of The Consumer/Survivor Movement In Mental Health. Health Affairs. 2006;25(3):720–729.CrossRefPubMedGoogle Scholar
  34. 34.
    Markman GD, Baron RA. Person–entrepreneurship fit: why some people are more successful as entrepreneurs than others. Human resource management review. 2003;13(2):281–301.CrossRefGoogle Scholar
  35. 35.
    Martin FH, Walls RT, Brodwin MG, et al. Competitive employment outcomes of vocational rehabilitation. Journal of Applied Rehabilitation Counseling. 2012;43(1):3.Google Scholar
  36. 36.
    Chow CM, Cichocki B, Croft B. The Impact of Job Accommodations on Employment Outcomes Among Individuals With Psychiatric Disabilities. Psychiatric Services. 2014.Google Scholar
  37. 37.
    Small Business Administration. Frequently Asked Questions about Small Business. Washington, DC: Small Business Administration; 2014.Google Scholar
  38. 38.
    Social Security Administration. The Red Book. Baltimore, MD: Social Security Administration, Office of Research, Demonstration and Employment Support; 2017.Google Scholar
  39. 39.
    Economic Systems Incorporated. Self-Employment for People with Disabilities. Office of Disability & Employment Policy, U.S. Dept. of Labor; 2013.Google Scholar
  40. 40.
    Ostrow L, Hayes SL. Non-profit leadership and characteristics of mental health peer-run organizations nationwide. Psychiatric Services. 2015;66(2).Google Scholar
  41. 41.
    Salzer MS, Schwenk E, Brusilovskiy E. Certified peer specialist roles and activities: Results from a national survey. Psychiatric Services. 2010;61(5):520.CrossRefPubMedGoogle Scholar
  42. 42.
    Cronise R, Teixeira C, Rogers ES, et al. The peer support workforce: Results of a national survey. Psychiatric Rehabilitation Journal. 2016;39(3):211.CrossRefPubMedGoogle Scholar
  43. 43.
    Mojtabai R, Stuart EA, Hwang I, et al. Long-term effects of mental disorders on educational attainment in the National Comorbidity Survey ten-year follow-up. Social psychiatry and psychiatric epidemiology. 2015;50(10):1577–1591.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Hipple SF, Hammond LA. BLS Spotlight on Statistics: Self-Employment in the United States. Washington, DC: Bureau of Labor Statistics; 2016.Google Scholar
  45. 45.
    Pescosolido BA, Martin JK, Long JS, et al. “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry. 2010;167(11):1321–1330.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Barry CL, McGinty EE, Vernick JS, et al. After Newtown — Public Opinion on Gun Policy and Mental Illness. New England Journal of Medicine. 2013;368(12):1077–1081.CrossRefPubMedGoogle Scholar
  47. 47.
    Kessler Foundation. The Kessler Foundation 2015 National Employment and Disability Survey: Report of Main Findings. West Orange, NJ: Kessler Foundation; 2015.Google Scholar
  48. 48.
    Russinova Z, Griffin S, Bloch P, et al. Workplace prejudice and discrimination toward individuals with mental illnesses. Journal of Vocational Rehabilitation. 2011;35(3):227–241.Google Scholar
  49. 49.
    Netto JA, Yeung P, Cocks E, et al. Facilitators and barriers to employment for people with mental illness: A qualitative study. Journal of Vocational Rehabilitation. 2016;44(1):61–72.CrossRefGoogle Scholar
  50. 50.
    Cusack KJ, Grubaugh AL, Knapp RG, et al. Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness. Community mental health journal. 2006;42(5):487–500.CrossRefPubMedGoogle Scholar
  51. 51.
    Cohen AN, Hamilton AB, Saks ER, et al. How occupationally high-achieving individuals with a diagnosis of schizophrenia manage their symptoms. Psychiatric Services. 2016;68(4):324–329.CrossRefPubMedGoogle Scholar
  52. 52.
    National Center on Workforce and Disability/Adult. Customized Employment: Applying Practical Solutions for Employment Success. Office of Disability & Employment Policy, U.S. Dept. of Labor; 2006.
  53. 53.
    Hughes C, Lusk SL, Strause S. Recognizing and accommodating employees with PTSD: The intersection of human resource development, rehabilitation, and psychology. New Horizons in Adult Education and Human Resource Development. 2016;28(2):27–39.CrossRefGoogle Scholar
  54. 54.
    Griffin C, Hammis D. Self-Employment and Microenterprise: A customized employment option. Washington, DC: Office of Disability and Employment Policy, US Dept of Labor. 2004.Google Scholar
  55. 55.
    Small Business Administration. What are the Employment Trends from New Businesses? Washington, DC: Small Business Administration; 2015.Google Scholar
  56. 56.
    Noble JH. Policy Reform Dilemmas in Promoting Employment of Persons With Severe Mental Illnesses. Psychiatric Services. 1998;49(6):775–781.CrossRefPubMedGoogle Scholar
  57. 57.
    Sevak P, Khan S. Psychiatric Versus Physical Disabilities: A Comparison of Barriers and Facilitators to Employment. 2016.Google Scholar
  58. 58.
    Revell G, Smith F, Inge K. An analysis of self-employment outcomes within the federal/state Vocational Rehabilitation system. Journal of Vocational Rehabilitation. 2009;31:11–18.Google Scholar
  59. 59.
    U.S. Department of Education. Randolph–Sheppard Act. In: Rehabilitation Services Administration, ed. 20 USC 107 et. seq. Washington, DC1974.Google Scholar
  60. 60.
    Lucksted A, Drapalski AL. Self-stigma regarding mental illness: Definition, impact, and relationship to societal stigma. 2015.Google Scholar
  61. 61.
    Bazelon Center for Mental Health Law. Getting to Work: Promoting Employment of People with Mental Illness. Washington, DC: Bazelon Center for Mental Health Law; 2014.Google Scholar
  62. 62.
    Corrigan PW, Larson JE, Rusch N. Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry. 2009;8(2):75–81.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Deegan P. Recovery and the conspiracy of hope. Paper, presented at the Sixth Annual Mental Health Services Conference of Australia and New Zealand, Brisbane, Australia. “There’s a Person In Here”: The Sixth Annual Mental Health Services Conference of Australia and New Zealand; 1996; Brisbane, Australia.Google Scholar
  64. 64.
    Davidson L, O’Connell M, Tondora J, et al. The Top Ten Concerns About Recovery Encountered in Mental Health System Transformation. Psychiatr Serv. 2006;57(5):640–645.CrossRefPubMedGoogle Scholar
  65. 65.
    Walls RT, Dowler DL, Cordingly K, et al. Microenterprising and people with disabilities: Strategies for success and failure. Journal of Rehabilitation. 2001;67(2):29.Google Scholar
  66. 66.
    Margolis DN. By choice and by necessity: entrepreneurship and self-employment in the developing world. The European Journal of Development Research. 2014;26(4):419–436.CrossRefGoogle Scholar
  67. 67.
    Kappel RT, Ishengoma EK. Economic growth and poverty: Does formalisation of informal enterprises matter? 2006.Google Scholar
  68. 68.
    Bencsik P, Chuluun T, Graham-Friday C. Are the self-employed happy entrepreneurs? Future Developments 2017; Accessed February 14, 2018.
  69. 69.
    Kelley D, Brush C, Greene P, et al. GEM special report: Women’s entrepreneurship. Babson Park, MA: Babson College, Global Entrepreneurship Monitor (GEM); 2015.Google Scholar
  70. 70.
    Shaheen GE, & Killeen, M. . A ‘primer’ on the StartUP New York 4-phase model. Syracuse, NY: Burton Blatt Institute, Syracuse University. ; 2009.Google Scholar
  71. 71.
    Foster L, Norman P. The Annual Survey of Entrepreneurs: An Update. Washington, DC: U.S. Census Bureau, Center for Economic Studies; 2017.Google Scholar
  72. 72.
    Yamamoto S, Unruh D, Bullis M. The viability of self-employment for individuals with disabilities in the United States: A synthesis of the empirical-research literature. Journal of Vocational Rehabilitation. 2011;35(2):117–127.Google Scholar
  73. 73.
    Opportunity Works. Case for Support: Entrepreneurship for Mental Health Calgary, Alberta: Opportunity Works; 2015.Google Scholar

Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  1. 1.Live & Learn, Inc.Morro BayUSA
  2. 2.Nemec ConsultingWarnerUSA

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