The Restorative Value
of Work and the Necessity of Driver's Ed!
by Rick Eddy
Those of us who work in clubhouses operate under the premise that work
is a good thing; that it is health producing and that it enhances people's lives; that it
has restorative properties. Certainly in the general sense for everyone, but particularly
for individuals who have a serious mental illness. We have learned this through our
experience working in clubs and watching people return to work and to more productive,
happier lives for nearly fifty years now.
This premise raises an important question which we must answer for
ourselves, be able to articulate to others and yes, even empirically prove: Why? Why is
this seemingly simple, basic thing which most people do every day of their lives, the
underlying catalyst for rehabilitation and even recovery from an illness so rooted in
biology and brain chemistry? And the next important question for us to consider is: How
can we help other components of the Mental Health and Vocational Rehabilitation systems
It is essential that we answer both of these questions. The first
question, because we don't yet do a complete job at assisting people in rehabilitation and
recovery, and understanding more about what really works and why can only improve our
percentages. The national average of people with a mental illness returning to work is
around fifteen percent. At Baybridge we help over forty percent of our average daily
attendance work, and we think we're doing great things because it is more than twice the
national average. But what about the sixty percent who aren't working? Is that the extent
of our vision for our members? Forty percent? We need to study and identify how and why
work assists people in this process and to better understand the "technology" of
rehabilitation and recovery. And, why it hasn't helped the sixty percent, yet.
We must also answer the second question, as we clearly need financial
assistance to do more of what we do. Doing more is part of becoming better. Obviously,
more money would allow us to increase our staff and expand our TE program--and agencies
like Vocational Rehabilitation (VR) are potential sources of income for your clubhouse.
More work, though, in and of itself, is not enough. We also need the other resources and
expertise that VR and other components of the system can supply. We do not, and should not
exist in a vacuum. There are other parts of the system which are necessary and helpful to
our members. To solicit their support and assistance we must be able to help them
understand why work is the catalyst and why their current approaches have been
historically, less than successful. We must help them discover how best to achieve the
results all of us desire.
Obviously, first and foremost, we need to tell them! We need to seek
and create forums to discuss these issues with VR. More importantly though, I think, we
need to show them. We need to demonstrate this essential role of work in the
rehabilitation of people with a mental illness, in concrete terms. We need to have strong
TE and Independent Employment programs in our clubhouses. The more people we assist in
the more undeniable the success of our way of working becomes. It is not enough just to
talk about it. We have to prove it!
The initial step in answering the first question, Why?, is to identify
the disabling agent for people with a mental illness. I believe this has been the
fundamental error of VR in working with the mentally ill population at a national level. I
think everyone, including VR itself, recognizes that historically this agency has had far
less success in providing long term vocational rehabilitation for people with a mental
illness than it has for other populations. I am convinced this is due to a fundamental
flaw in their understanding of the primary disabling agent that keeps people with amental
illness from being able to work. As a result of this misunderstanding, there is also a
fundamental flaw in the methodology they have employed in trying to assist people with a
mental illness to work.
If we look historically at the development of the VR system, each
population with whom they have worked have shared a common disabling agent: job skills.
And subsequently, every methodology they have developed has been centered around this.
They have all focused on the teaching of specific job skills, working on helping someone
maintain those skills, adapting the environment to minimize the effect on one's ability to
perform those skills, and so forth. It has been based solely on the issues pertaining to
what happens at the job site and acquiring and performing the necessary skills to do the
job. This has worked wonderfully and successfully for these other populations for many
years. When new disabled populations were added to their lists of clients, the current
methodologies were adapted and adjusted to address the specific difficulties this new
group of people faced. However, it is the use of this premise (lack of job skills) as the
disabling agent which has hindered people with mental illness from returning to work.
When VR began to work with people with a mental illness, they did what
they always had done. They attempted to adapt their existing methodologies, still based on
job skills as the disabling agent, to fit this new population. It met with little success
and they wondered why!
As it became apparent that a new approach was needed, they re-invented
a new wheel called Supported Employment. They took TE, and removed every piece of it that
addressed things other than job skills (i.e. the extensive support provided by being
operated out of a clubhouse; the fill-ins for difficult days which protect the job for
members; the unlimited number of work opportunities, in which people are able to take
those essential early steps in building their confidence and generic work skills; time
limited jobs, insuring that people get multiple work opportunities, so that they can
ultimately learn and adapt to any job anywhere and thereby broaden the vision of what they
see as realistic for themselves; etc. Supported Employment was met with slightly more (but
still little) success and they wondered why!
I think it is an easy question to answer. Their mistake is that the
disabling agent for people with a mental illness has nothing to do with job skills. The
primary disabling agent for people with a mental illness is the disempowerment that
results from the illness. That has become a trite almost clichéd word, but it is the best
I can come up with. It is not inaccurate to define it as a lack of confidence, or of self
esteem, or self image. But it is woefully inadequate! I am talking about a core mind-set
that work is an impossible dream and that the idea that it would even occur to them seems
ridiculous. In most
cases this is probably not even a conscious decision but a deeply rooted lack of a sense
of "self." Between the illness and its associated effects, and the system itself
reinforcing this sense of "less than normal" for the individual, most, if not
all people in this situation develop a deep sense of being irreversibly disempowered.
Now I don't mean to minimize the pathology of these illnesses. It is
profound and serious. But I know a number of people with a mental illness, many of whom
still actively experience symptoms, who work. And, have done so for years. What got them
"over the hump" and able to work, in each instance, was addressing their own
disempowerment. That is why work is such a restorative function, and essential in recovery
and successful vocational rehabilitation for most people with a mental illness. Work is
the tool that most effectively addresses disempowerment.
In this context, I am not using the term "work" to
necessarily mean only paid employment. In fact, for this purpose, I prefer the word
"productivity" to work. It is a basic human need to be productive and to have
purpose and value outside of oneself, regardless of illness. One can achieve this through
paid work but it can be gained in a myriad of ways. That is why working in the clubhouse
in a unit has such a restorative effect. It provides that sense of belonging and value to
one's life. It is real work with a real, tangible value. One whose results can be
immediately seen. It is not possible to convince oneself to be confident, or to will your
power back to yourself. You have to prove it to yourself in action; you have to earn it.
Being productive in a unit, at a job or anywhere else, is how this comes about.. Let me
give you an example:
John Simpson is a friend of mine: he is also a member at my club. He is
in his fifties, has a college degree and until last year, has never worked a day in his
life. In fact, he was involved in the VR system several times, but he was never able to
meet their criteria for "work readiness." In the late 1980s he was told by VR,
"You will never work!" When I first met John, he had given up and agreed with
them, as their view so clearly echoed his own deep conviction about himself. He had hoped,
but it didn't "feel" as if he could work, is what he told me. He had trouble
staying focused on tasks. He had trouble remembering all the steps to completing a
specific job. When things got hectic and stressful, he would get frustrated and lose his
temper and leave the area immediately. He couldn't seem to handle the stress. Whenever he
thought about going to work, he felt terrified. And all of these things made him feel
overwhelmed and he would give up. It just didn't seem realistic, nor worth the effort. But
John is also a very bright man with a lot of pluck. Somewhere deep down, John wanted to
work. He knew he needed to address all these things, but it just seemed overwhelming.
James Petcoff is John's staff member at the club. As James and John
talked, it became apparent to James that John "wished" he could work (John's
word). So James brought Jim Bucar, our TE Coordinator, into the picture. The three of us
started to talk to John about working and how we believed John could work if he put his
mind to it. So, we put a plan together to address the things that were getting in the way
of John's working. John began to work in earnest in the Cafe Unit. We weren't working on
specific skills. We knew that John was bright and that when he had some of his power back
and believed it was realistic, he could learn the skills he needed like anyone else- on
the job, in college, and so forth. As John continued to work in the unit, we continued to
encourage him and point out his progress. It is so important to help people mark and see
their progress, no matter how small the steps. As a result of this effort, John
began to believe his
experiences. Maybe James and Jim and Rick were right. It sure doesn't feel like it yet,
but maybe, just maybe they were right.
As a result John began to spend more and more time in the unit. And for
greater lengths of time. The more he worked, the stronger he felt. He began to handle
stress better, he was able stay with tasks longer, and his memory improved. And most
startling, the symptoms of his mental illness actually diminished some. These were the
things that helped him get work ready. Not working on the skills of the job he wanted, or
discussing in a class or group why he hadn't been able to work before, but being
productive and needed and useful!!
I'm happy to report that John is now in his ninth month at Papa Gino's
Pizzeria on a TEP. He is a host and busperson there. His boss would like John to stay on
permanently. But John, who couldn't see himself working at all for most of his life, let
alone being a busperson at Papa Gino's, now is thinking about his career goals.
His career goals! He is currently working with Jim about his
next move, as being a busperson isn't enough of a challenge anymore. John is clear, as am
I, that work is what made John work ready. He didn't need the skills of a busperson, but
the skills of a person.
So, why is work or productivity the catalyst and building block for
vocational rehabilitation for people with a mental illness? We need only look at all of us
for the answer. How we feel, and what we believe about ourselves, sets the expectations
and ultimately, the dreams we are able to envision for ourselves. Whether we have mental
illness or not. It is true for John. But, it is also true for me and for you.
Think back to when you were learning to drive as a teen. Did studying
the driver's manual and even passing the written part of the driving test really prepare
you to drive? Did you feel confident and ready to drive? I didn't. Remember Driver's Ed in
high school? How many of you ran over one, . . . or more, of those cones they mark your
route with in the parking lot? I certainly did. It's how I learned to steer the car
straight and feel confident, and competent enough to take the chance and take the car out
in traffic. We build all of our skills progressively, sequentially, over time. And in the
real world! It is no less true when you add the factor of mental illness. It certainly
becomes more difficult. And it generally takes longer to "take it out in
traffic." But it is no less essential. You learn to drive by driving. And you learn
to work, by working!
Rick Eddy is the former
director of Baybridge in Hyannis, Massachusetts.