The notion that people who experience mental health challenges can and do recover has garnered a lot of attention in the peer, provider and policy making worlds; it is the subject of international research, practice change, and national efforts to reform our mental health system. In part, this reformation is being led by self-advocates who have shared their experience of recovery despite the services that they have received and are demanding that systems, organizations and practitioners embrace and utilize a truly person-centered, wellness and recovery-based approach to service provision. In response, many organizations have shifted their mission and vision statements to reflect recovery principles and have highlighted their commitment to promoting recovery in their marketing materials. On paper, recovery sounds good, but what does it actually mean and how do we do it? These questions are being debated and discussed at various levels within the field of mental health.
Traditionally, our mental health system and provision of services have been designed around the goals of stabilization, functioning and maintenance. Providers, community members, families and peers have been “taught” to have low expectations and that passivity and compliance are requirements for stability. The notion of thriving and healing have not been part of the equation, let alone recovering one’s identity, confidence, and life. Through the courage of people who have shared their personal stories, and research validating that recovery can be the expectation, we have learned that services can either enhance or deter the individual recovery process. These pioneers have paved the way for people experiencing mental health and substance use challenges to create a better awareness and prompt fundamental changes in the way mental health is viewed, understood and treated. In short recovery goes well beyond compliance and symptom management and is all about quality of life.
For over four decades, CQL | The Council on Quality and Leadership has worked to understand, define and measure the key ingredients to quality of life from the perspective of people who are striving toward recovery and self-determination. Subsequently, CQL has led the effort to connect theory and practice, providing standards around services and supports that lead to recovery. CQL has developed and internationally implemented the use of Personal Outcome Measures®, a valid and reliable approach to defining and measuring quality of life. The tool looks specifically at 21 indicators and through focused conversations measures whether or not those things are present for people. Throughout the many years of speaking directly with people, learning how they define quality, understanding what helps and what hinders their recovery, CQL has learned that one of the key ingredients is employment.
Nationally, there are 3.1 million adults with mental health challenges who are unemployed (The NSDUH Report, March 25, 2014, SAMHSA). This is despite the fact that most people with mental illness express a desire to work. There are many factors that contribute to this statistic. Among them is the fear of loss of benefits and concern about relapse. Additionally, our historical “readiness approach” to employment that requires people to go through pre-vocational training, be treatment and medication compliant, be sober and deemed clinically ready to work has resulted in a large portion of people with mental health and substance use challenges being disqualified from employment services.
In fact, “readiness” does not equate to successful employment. Rather, employment is a path to recovery. Policies such as Employment First initiatives, and approaches such as rapid job search, individualized placement and support and customized employment all have demonstrated effectiveness in improving quality of life and advancing recovery. If people are truly going to move beyond the illness identity and realize their own vocational recovery, we have a lot of work to do to re-educate ourselves and others and assist people in making informed decisions about work incentives. CQL’s Personal Outcome Measures® offer information and data to support this shift in thinking. At the individual level, data about outcomes are linked directly to how the organization provides supports and services – person by person. At the organization level, organizations collect, analyze and use this measurement across groups of people … for both program and organization improvement. CQL looked at 20 years of data and noted that the number of people reporting to have chosen their work was among the outcomes least present – hovering at 40% over the years. Having looked at the data and listened to people’s stories, CQL began to dig deeper. We asked, “which outcomes best predict achieving lots of different outcomes?” The analysis revealed the following outcomes to have the greatest degree of predicting many more outcomes for the person:
- Exercising rights
- Choosing where to live
- Choosing where to work
- Performing different social roles
Organizational efforts to provide supports that increase the presence of these outcomes, can have an even greater impact on recovery and overall quality of life for people.
There are a number of ways to design supports that promote employment and ultimately recovery. Among the advancements that are being made in employment services is the use of Employment Peer Mentors (EPM’s) to provide outreach and engagement, share their stories of recovery through employment, and support others to navigate the internal and system barriers that keep people unemployed and in poverty. Among the states pioneering this effort is North Carolina who, as a part of a Department of Justice Settlement, has included the EPM role as a part of all state funded employment services for people with mental health and substance use issues.
As our community of providers and people who experience mental health and substance abuse issues come together, learn from and with one another, and strive toward improved emotional health and wellness, CQL remains dedicated to understanding and ensuring that personal quality of life remains at the forefront of promoting recovery-oriented supports in the behavioral health service system. For more information about CQL, please visit our website – www.c-q-l.org or email us at info@thecouncil.org.
