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Self-Employment Options for People with Psychiatric Disabilities: A New Program That Places Lived Experiences and Peer Mentoring at Its Center

An interview with the CEO and founder of Live and Learn, Inc. – Dr. Laysha Ostrow

From the desk of Kim Cordingly, Ph.D., Lead Consultant – Self-Employment Team

At JAN, we frequently receive inquiries from individuals with mental health conditions who are interested in becoming self-employed or starting a small business. Over the years, I’ve followed emerging research by Dr. Laysha Ostrow and colleagues exploring why self-employment can be a viable and important employment alternative for individuals with psychiatric disabilities. For this article, I discussed with Dr. Ostrow the approach she brings to this topic and an exciting new program at Live and Learn, Inc. that places peer support as a key component to self-employment success. She brings a unique perspective to this topic both personally and professionally.

The CEO and Founder of Live and Learn, Inc. – Dr. Laysha Ostrow

At the core of Dr. Ostrow’s business and research focus is her lived experience as a person with a psychiatric disability. Her involvement in mental health and disability systems included hospitalizations and residential treatment in her youth, interruptions to her college career due to depression, and receiving disability benefits on and off in adulthood. These experiences all inform the mission of Live and Learn, Inc. Like many people with psychiatric disabilities, she received disparaging messages throughout her life about what she wouldn’t achieve. As she points out, these predictions weren’t true. Dr. Ostrow went on to complete a Ph.D. from Johns Hopkins School of Public Health and set her own path as a business owner by starting Live and Learn. While initially planning to become a writer, she decided she could have a larger social impact. She believes the challenges in education and employment for people with psychiatric disabilities are some of the most important we can help people overcome.

Live and Learn, Inc – Its Mission and Approach

Dr. Ostrow describes Live and Learn as a small for-profit business that provides research, consulting, and knowledge translation and dissemination services to public health and mental health service systems. Their approach is to make sure they work with different types of stakeholders in the behavioral health system on all projects. They uniquely occupy a boundary space between academic research, different levels of government projects, community stakeholders, non-profits, mental health activists, and other small businesses. Their real specialty is to bring the lived experiences and voices of those who have struggled with mental health issues into all their projects, including their self-employment initiatives. Everyone employed at Live and Learn is either someone who has had experiences in the mental health system, faced mental health challenges at work, or has a family member that’s been impacted. This lived experience is considered an asset when working at Live and Learn. Rooted in a social enterprise model, her for-profit business uses market approaches to create a social impact. This is illustrated in the culture of her business, the projects they choose to develop and seek funding for, and the ways they give back to the community.

Currently at Live and Learn, they are focusing on two main programmatic areas:

The first project is a three-year national Certified Peer Specialist (CPS) Career Outcomes Study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) in partnership with the University of Illinois at Chicago Center on Mental Health Services Research & Policy and the Temple University Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities. The study seeks to understand how peer specialist certification affects employment outcomes and opportunities. JAN receives inquiries from individuals with psychiatric disabilities who have received this certification and are now interested in starting businesses as a peer support specialist.

The second project is Reclaiming Employment, which is a three-year grant also from the NIDILRR to develop a website to help people with psychiatric disabilities start or run a small business. They’re currently in the first year of this grant and in the development stage. The website will have 3 main offerings. The first component will include original courses that will be taught primarily by people who have a psychiatric disability and are also self-employed. The initial round of courses will focus on visioning and creating a mission statement, burnout as a person with a psychiatric history, Social Security work incentives and benefits planning, task and time management, and early stage business planning. The second feature will be a resource library that curates and reviews self-employment resources. The final component will be a social network platform where users can get peer and mentoring support from one another. Plans are to create dedicated interest groups around issues such as business planning or personnel management. There will also be dedicated spaces for interest groups such as for people of color, single parents, or people with co-occurring physical disabilities.

The Employment Picture for People with Psychiatric Disabilities

Dr. Ostrow describes and further documents in her research a bleak employment picture for people with psychiatric disabilities. Of all disability groups, this sector has the lowest rate of employment even though research shows the majority of individuals want to work. She points out intersecting factors that may contribute to this including disrupted educational and work histories, discrimination and challenges fitting into workplace cultures, siloed mental health services disconnected from employment programs, and policy disincentives. In research conducted by Live and Learn on peer support specialists in the field of mental health, study participants reported they did not lose their jobs due to being fired but felt compelled to leave due to untenable workplace situations. When I asked Dr. Ostrow if the employment picture was improving with increasing awareness about mental health issues, she wasn’t sure. She did feel the professionalization of certified peer support specialists as a career path did create job successes that could then lead to other educational and employment opportunities.

Advantages and Disadvantages of Self-Employment for People with Psychiatric Disabilities

 “One of the great benefits of self-employment – no matter what your business is – is that you decide what your business is,” says Ostrow.

According to research, a flexible schedule is the most frequently requested accommodation by workers with psychiatric disabilities. With self-employment, these types of accommodations can be built into the design of the business from the outset. Dr. Ostrow points out however that people need to think carefully about the type of business they go into. In the start-up phase, you often need be there all the time. The type of business can really make a difference. For example, if you start a retail business you know there will be regular hours and may not be much flexibility. If you’re working as an independent consultant, you may be able to flex your time more liberally. Another advantage is that for those who may not have a lot of educational attainment or work experience, it’s not necessarily a barrier if you have what is needed to be successful at your business. This is true also for those who have a history of incarceration or involvement with the criminal justice system, which can be a significant employment barrier.  

According to Dr. Ostrow, self-employment allows you to create your own work environment based on your values and what nurtures a successful work experience. In her case as an employer, she chooses employees who in addition to being qualified, are also nice people, and fit into a workplace culture that is positive, innovative, and provides opportunities to learn and grow.

One of the main challenges for people with psychiatric disabilities is financial self-sufficiency. Financial self-sufficiency can be a challenge for anyone starting a business, but for those who have had ongoing economic insecurity, the financial part of a business can be triggering. Interaction with benefits systems, complicated regulations, and fear of losing benefits can also produce barriers. Dr. Ostrow shared that in the early stages of her business, she wasn’t always sure where the next rent or insurance payment was coming from, so it can be a struggle. While her business has experienced much success at this stage, it’s one of the reasons she believes a peer support model, led by those with lived experience and who are business owners themselves is key to successful outcomes for people with psychiatric disabilities.

Research Needed on Self-Employment Options for People with Psychiatric Disabilities

While there is a range of research on self-employment and people with disabilities, there is very little focusing specifically on people with psychiatric disabilities. Most of this research has occurred through the efforts at Live and Learn. While aspects of experiences with self-employment are likely shared with other disability groups, Dr. Ostrow et al. (2021) note in their research that people with psychiatric histories may experience some challenges very differently.

“There’s a theory that people with disabilities who start businesses are more likely to hire other people with disabilities. I did a survey a couple of years ago - 60 people who are self-employed with psychiatric disabilities responded – and 37% were businesses that currently had employees – but 15% said that their employees were mostly or all people with disabilities. And 68% felt it somewhat or very important to provide employment opportunities for their peers. The issue here is if you are self-employed, you’ve created one job for yourself. If we can support these people in growing their businesses…then that creates job opportunities for other people with psychiatric disabilities,” notes Ostrow.

Understanding these more specific lived experiences can help with designing more effective approaches and programs to support these entrepreneurial efforts.

From Peer Support to Peer Entrepreneurship

Reclaiming Employment is an effort to design a program the genuinely meets the entrepreneurial goals of people with psychiatric disabilities. Ostrow et al. (2021) discuss in their research that respondents tended to use informal supports more often than institutional ones. For example, they were more likely to look for guidance and support from a friend, family member, or other business owner with a psychiatric disability. Dr. Ostrow said that in this community there is a lot of involvement in bureaucratic systems – the mental health system, people on disability, and some who have been formally incarcerated. Out of these experiences, there is legitimate distrust. However, entrepreneurs may need to access services in order to learn how to develop and run a business; many of these types of services are available from more institutional programs such as through a Small Business Development Center (SBDC) or vocational rehabilitation (VR) program.

The research on what types of supports people with psychiatric disabilities tended to use contributed to the development model for Reclaiming Employment. The project aims to blend personal networking opportunities and support, concrete skill building through courses, and access to online resources and information. Through this project, they’re trying to meet people where they are – it’s the central principle of peer support and disability services.

In the future, Dr. Ostrow hopes to secure funding to develop a network of peer business coaches who can provide more sustained direct services. Reclaiming Employment will be recruiting inaugural users for its web platform starting later this year. For more information about this project and Live and Learn more generally, visit their website.



  • Supporting business owners with psychiatric disabilities: An exploratory analysis of challenges and supports, Psychiatric Rehabilitation Journal, 2021
  • “It suits my needs”: Self-employed individuals with psychiatric disabilities and small businesses, Psychiatric Rehabilitation Journal, 2019
  • Self-Employment for People with Psychiatric Disabilities: Advantages and Strategies, The Journal of Behavioral Health Services & Research, 2018