Work as a Pathway to Human Flourishing – How Far Does It Go?
How supportive employment programs can help some of the most disadvantaged.
Posted Oct 29, 2019
Many people have a love-hate relationship with work. It can provide an income, but it can also be tedious. It might give a sense of meaning and purpose, but can sometimes be all-consuming and lead to burnout. The workplace can provide a source of social relationships, but it can interfere with time with friends and family. These sets of trade-offs may lead one to wonder what the net contribution of work on flourishing truly is? Our prior review and survey of the evidence found that, on the whole, the effects of work on well-being are profoundly positive.
On average, work tends to increase one’s satisfaction with life, contribute to mental and possibly even physical health, give a sense of meaning and purpose, allow for character growth, provide an opportunity for social relationships, and of course provide an income as well. This assessment of the effect of work on flourishing is applicable on average, and may not apply for each and every individual. For some, exposure to a hazardous work environment, or excessive working hours, may indeed decrease their flourishing. But on average – averaging all positive and negative experiences – the effects of work on flourishing do seem to be positive.
We might wonder, however, how far these benefits extend. Maybe it is the case that work is good for those who are already well-off, but that for those who are struggling, or who are lower in the socio-economic spectrum, perhaps work ends up being oppressive. One of the recent papers from the Human Flourishing Program at Harvard, published earlier this year, attempted to provide analyses to help answer certain aspects of this question. We used meta-analysis techniques, that combined the results across many studies, to specifically evaluate the effects of supportive employment programs in providing work for those with mental health challenges.
Supportive employment is an approach to help those with some identified disability to find competitive employment. Traditionally, the disability was severe mental illness, but the approach has been expanded in recent years to cover a range of mental and physical conditions such as spinal cord injuries in veterans as well as affective disorders. Important to the approach, individuals are supported in their efforts to find competitive employment right from the beginning and do not have to wait until they have finished some treatment program or training program. Treatment and/or training may be offered, but this takes place concurrently with the employment assistance or employment itself. This is a move beyond previous programs that often had a stepwise implementation wherein “patients” would receive clinical care and perhaps elementary vocational training prior to seeking employment. They would then often receive a time-limited job placement, developed by the rehabilitation agency, where participants would work in preparation for a competitive job. Supportive employment approaches build on the idea that employment itself contributes to well-being and that mental health issues can be addressed concurrently with an employment search. Participants are thus offered help in support of actual competitive positions that they may hope to retain for a longer period of time.
Our study sought to evaluate all of the evidence from rigorous randomized trials of such supportive employment interventions and assess their effects on a wide range of outcomes. We found that those who received supportive employment interventions were 63% more likely to find competitive employment during the study, and they were 79% more likely to still be employed at the end of the study. Those receiving supportive employment intervention were employed on average for a considerably longer period of time and received considerably more income from their employment (about half a standard deviation greater on both of these outcomes).
What about quality of life? These effects were more heterogeneous: it seemed that the interventions improved quality of life in some settings, and perhaps did not have much effect on the quality of life in other settings.
Importantly, however, these supportive employment interventions did not magically “fix” all problems. There was little evidence, for example, that the supportive employment interventions improved the mental health of the participants. Employment is certainly not a panacea to fix all problems. Numerous approaches to improve flourishing, including work, but extending beyond work and employment, are certainly needed. And this study in particular indicated that while the supportive employment interventions improved employment and income, and sometimes quality of life, further help from mental health professionals would generally be needed in order to address the often severe mental health issues of those that enrolled in these studies. On the whole, however, these supportive employment interventions clearly improved several aspects of well-being.
The research has potentially important policy implications. The fact that these supportive employment interventions can be used to help those even with fairly severe disability provides an important tool to help some of the most disadvantaged in society. It is a tool that may be preferable or could supplement more traditional welfare programs. While providing individuals in need with welfare payments can indeed help meet their material needs, the flourishing of a person requires more than that. Flourishing includes also having a sense of purpose, having good relationships, opportunities to develop, and satisfaction with life. Work and employment can be one means to help achieve these other aspects of flourishing. By helping those in need find employment, they are equipped not only with income, but with potentially meaningful work that contributes to society, and can help them flourish in various other ways as well. Work is certainly not the only pathway to flourishing, but it is often an important one.
The Human Flourishing Program at Harvard University aims to study and promote human flourishing, and to develop systematic approaches to the synthesis of knowledge across disciplines. You can sign up here for a monthly research e-mail from the Human Flourishing Program, or follow us on Twitter.
Frederick, D.E. and VanderWeele, T.J. (2019). Supported employment: meta-analysis and review of randomized controlled trials of individual placement and support. PLoS One, 14(2):e0212208.