Online ISSN: 1099-176X Print
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Would You Train Me with My Mental Illness? Evidence From a Discrete Choice Experiment
Eva Deuchert,1* Lukas Kauer,2 Flurina Meisen Zannol3
Assistant Professor, Center for Disability and Integration, Department of
Economics, University of St.Gallen, St.Gallen, Switzerland
Correspondence to: Eva Deuchert, Assistant Professor, Center for Disability and
Integration, University of St.Gallen, Rosenbergstrasse 51, CH-9000 St.Gallen,
Tel.: +41-71-224 2318
Fax: +41-71-220 3290
Source of Funding: Direct financial support was provided by the Emil Zaugg-Fond.
Background: Mental illness is the prime reason for the inflow into disability insurance in many countries. The integration of persons with a disability into the regular labor market is costly and in the case of mentally ill persons, particularly difficult. Supported Education and Employment - a rehabilitation method that directly places patients in a realistic work environment - has been shown to be effective in increasing competitive employment. However, it has not yet been widely implemented.
Aims of the Study: We evaluate ex-ante the willingness to participate in Supported Education and Employment and the barriers to do so from the employer's perspective.
Methods: We conducted a discrete choice experiment implemented in an online survey. The survey was carried out among all Swiss companies which provide standard dual-track vocational education and training for commercial occupations in Eastern Switzerland. We presented respondents (employees who are responsible for vocational training and/or for the selection of applicants) with a sample of five hypothetical profiles. These profiles vary along different medical diagnoses, different illness related (dys-)functions, and other characteristics that may be associated with a company's willingness to accept the candidate (such as school performance, motivation, and illness related absences). Respondents were asked whether or not they would train this person.
Results: 22% of the profiles are accepted. However, our results demonstrate that the hypothetical bias - which is the difference between individual saying what they would do in a hypothetical setting and what they will do when they have the opportunity - is severe. Correcting for this bias using follow-up scales (“Are you sure?”) reduces the overall acceptance in our sample to 9%. Keeping in mind the response rate to our survey of 35%, overall acceptance may be as low as 3%. Non-cognitive dysfunctions (e.g. non-adherence to regulations, difficulties with contacts with others) that are related to mental disorders, are the main deterrents. Patients with psychotic disorders are particularly disadvantaged.
Implications for Health Policy: Although there are no direct costs to the employer, a wide introduction of Supported Vocational Education and Training is likely to fail at the current stage with the unwillingness of companies to train people with special needs. There may be additional incentives needed, for example in form of subsidies or legal requirements. Even though our experiment has been tailored to the Swiss system, our results may also be relevant in other countries with similar dual-track education systems.
10 February 2012; accepted 25 May 2013
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