Housing and Employment: Cornerstones of Self-Directed Recovery

I recently heard from a New York State supported housing consumer who said, “Starting over with no place to live, no money, food or furniture can be terribly overwhelming. It was then that my counselor introduced me to Saint Joseph’s Medical Center. I found out their Residential Services department provided housing for people with mental illness. I couldn’t believe places like that existed. After my interview they accepted me into their program. I was now overwhelmed with excitement and disbelief in how my life has changed. The program at Residential Services is set up to help men and women like me get a second chance.”

In the years since I began my psychiatric practice over thirty years ago, there has been a dramatic evolution in our approach to working with individuals with mental illness. Some of this is due to advances in our understanding of brain function, but even more important has been what the recovery movement has taught us about resiliency, recovery and real community integration for individuals with mental illness. Numerous longitudinal studies and research have shown that individuals with a mental illness are resilient and that they can recover. Mental health treatment now goes far beyond the regularly scheduled interactions between provider and patient. Families, friends, employment, and housing are all part of the therapeutic community that helps people become less dependent on external resources and promotes the development of their own internal resources and coping strategies. This person-centered care marks a paradigm shift in the delivery of behavioral health care and allows for success stories like we see above.

The mental healthcare system of today is a holistic and comprehensive service array that addresses the person, their environment and their future, while using the individual as the primary driver of their own recovery. By offering opportunities for life within the community, through housing programs offering community stability or employment programs enabling self-sufficiency, we create the reality of recovery.

New York State has made great strides in developing housing for individuals living with mental illness, but there is much more to be done. Currently, the New York State Office of Mental Health (OMH) has over 37,900 housing units that can be accessed by individuals with mental illness. Our agency is committed to developing and expanding a housing structure that provides a continuum of opportunities which support people with serious or persistent mental illness. We currently have over 9,000 additional units of affordable, accessible supportive housing in the pipeline, with more on the way.

Supportive housing allows consumers to participate as complete members of our communities and society. This vision of recovery includes an understanding that more than health care is necessary—that living independently, securing employment and otherwise making a meaningful contribution to the community can dramatically improve one’s well-being. This vision of recovery allows for individuals to become a collaborative participant in care decisions and an active informed participant in their treatment. This vision is dedicated to promoting access, in every community, to competent mental health care that supports recovery. Supported housing is one of the cornerstones necessary to build a system of care that truly supports recovery.

The second cornerstone in our efforts to create a holistic and comprehensive system of resources is employment. OMH uses employment as a clinical intervention, a needed step in the journey to recovery. In fact, a recent study from Mathematica Policy Research showed that the use of Medicaid services decreased by nearly 50% for people with disabilities who are working. Additionally, competitive employment provides consumers with more personal freedom and independence through increased income. Employment also provides meaning and purpose, socialization and integration into the community.

One program that our agency operates, Personalized Recovery Oriented Services (PROS), is a comprehensive recovery-oriented program for individuals with serious mental illness. The goal of the program is to integrate treatment, support, and rehabilitation in a manner that facilitates the individual’s recovery. Goals for individuals in the program may include developing needed skills, decreasing unnecessary use of inpatient and emergency room services, reducing contact with the criminal justice system, increasing competitive employment, attaining higher levels of education, and securing preferred housing. The PROS program has become one of our most successful initiatives, as more and more New York residents achieve recovery within the community.

John, a PROS consumer from the Hudson Valley region, experienced some of this recovery first-hand. Four years ago, John had a tough time finding and remaining in a job. He described himself as someone for whom social interactions and relationships were “like a foreign language.” Through the PROS program, using New York State’s ACCES-VR employment system, he started training to become an electrician at his local Board of Cooperative Educational Services. Through this training he increased his self-esteem, his sense of competence and ultimately his success at his job. In less than two years, John began working part time at a local business, a position he still holds today. He is considered by his supervisor to be an “excellent employee” and is nearing graduation from his electrician training program.

However, John’s success story was not a straight path; he frequently struggled with re-emergence of depressive symptoms as well as suicidal thoughts. By continuing to use PROS services, such as clinical treatment and wellness self-management, John has been able to successfully overcome each obstacle in his path to recovery. With the support he needed, John has been able to craft a life for himself that now includes friends, employment and personal emotional growth.

John is now proud of what he has created these last few years, going from “suicidal” to a student and model employee. He has created a life which allows him to take on more and more responsibilities, independently. While his recovery is an ongoing process, he has learned that he possesses the ability to recover and has the support to sustain a happy, healthy life.

It is the goal of the staff at OMH to make it possible for all individuals living in New York State with mental illness to have their own unique opportunity for recovery and success in their lives. We are not there yet but we will continue to work with individuals with mental illness, their families and supporters to make it a reality.

Dr. Ann Marie Sullivan was appointed as Acting Commissioner for the New York State Office of Mental Health on November 18, 2013. Previously, she was the Senior Vice President for the Queens Health Network of the New York City Health and Hospitals Corporation. As Senior Vice President, she was responsible for Elmhurst and Queens Hospital Centers, two public hospitals which serve a community of over 2 million New York City residents.

Along with ensuring the seamless integration and coordination of services across the Network, Dr. Sullivan has aligned and helped to implement key corporate programs such as the Care Management Initiative on the inpatient units and in the emergency services; the development of Breakthrough; the launching of best practices to improve patient safety; and the integration of behavioral health and medical sciences.

Dr. Sullivan grew up in Queens, New York City. She graduated from NYU and its School of Medicine and completed her Psychiatric Residency at New York University/ Bellevue Hospital in1978. She has served as Associate Director of Psychiatry and Medical Director of Ambulatory Care at the Gouverneur Diagnostic and Treatment Center and joined the Queens Health Network as Regional Director of Psychiatry in 1990, overseeing the administrative, budgetary, and clinical aspects of the psychiatric services of both Network hospitals. She has enjoyed an extensive career in public psychiatry and has lectured and published on best practices in community care.

Dr. Sullivan is an active advocate for her patients and her profession, is a Distinguished Fellow of the American Psychiatric Association and has served as the Speaker of the American Psychiatric Association’s Assembly and on its Board of Trustees. She is a fellow of the New York Academy of Medicine, a member of the American College of Psychiatrists and the Group for the Advancement of Psychiatry.

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