Persons with a serious mental illness, a substance use disorder, or both who have employment opportunities are better able to achieve daily functioning and recovery goals. Competitive work without support or disclosure of illness is an option for persons with these disorders but is often difficult to accomplish. There are several manualized models of supported employment and work options—such as sheltered work, work enclaves, and work crews (for maintenance or gardening, for example) or businesses, such as coffee shops—set up by community agencies to allow consumers to try out work skills. Opportunities to access employment models are typically tied to participation in the community mental health agency. The wages attached to sheltered work typically fall below the national minimum or living wage. This report highlights an option for competitive employment that stands apart from agency-based vocational models.

Harbor City Services (HCS), founded in 1987 in Baltimore, is a nonprofit business affiliated with but not dependent on a community mental health agency, Harbor City Unlimited (University of Maryland Medical System). Although it began as a vocational service of a psychiatric rehabilitation program, HCS is now a self-sustaining social enterprise with two main goals: to generate earned income by providing services to customers and to accomplish a social aim or mission. HCS is successful at both; it has generated over $600,000 per year while meeting its mission to "create vocational opportunities, treatments, and supports for individuals with mental illness and substance use." A workforce of 12 permanent and 35 temporary employees provide four key business services: document management, data destruction, general warehouse services, and commercial moving. This medium-sized enterprise now has 192 regular customers, including prominent medical centers, law firms, and social service agencies.

HCS hires workers who have experienced periods of relapse in the typical course of mental illness and who have knowledge of the difficulties that adults with remitting and relapsing disorders face. All employees are cross-trained for most positions so that they can fill in when fellow workers need days off to manage their illness. This flexibility allows HCS to function without disruption of service to customers. HCS does not provide mental health services to its employees but arranges for their treatment and assists with transportation to and from health care facilities. HCS invites social service providers to conduct on-site sessions with an employee when the employee permits. The HCS philosophy simply states that people should not lose their jobs because of relapse; rather, they should get treatment and come back to work.

One innovative benefit for all HCS employees is the optional (yet regularly attended) "morning wake." This is a ten-minute, on-the-clock meeting that begins each day at 8 a.m. with an inspirational reading. It offers employees an opportunity to express their concerns and successes, with topics ranging from the morning news to personal stories of recovery. This checking-in enables the development of collective, informal workplace support. For example, an individual having financial struggles or providing care for an ill relative has the freedom to express these issues in the workplace, which can be a workplace taboo elsewhere. Coworkers can suggest resources to the employee or lend a hand themselves. Because all staff members are invited to "morning wake," the message is that everyone has issues; focusing on customer service is a good way to put issues aside temporarily.

Early signs of relapse can be detected and addressed within the workplace by peers or by the one mental health professional on staff. If needed, the treatment system can be activated.

HCS employees attribute their increased success to the unique benefit of being allowed to continue employment, whether as a salaried, part-time, or seasonal worker, despite difficulties and relapses. A further marker of success is the tally of at least 17 employees who have used HCS as a stepping-stone to higher-paying positions; some have been hired by HCS customers. More traditional supported employment models provide support that clearly helps people on their path to securing competitive work, but job tenure remains an issue. At HCS individuals may experience extended relapses that result in rehospitalization or incarceration, but they usually return to the same job and continue their tenure. A core group of employees maintains regular employment without relapse and helps HCS meet its financial and social missions.

HCS is a business model and social enterprise model that has a place on the continuum of vocational opportunities for persons with serious mental illness and substance use. Social enterprise models have been underutilized as an option to increase the numbers of people with mental illness, substance use disorders, or both to find competitive employment success.