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 understand this?

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

successfully working, 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.