We must frame our services around the individual, not the individual framing themselves around a program. Perhaps that’s easier said than done. I offer the following insights into this topic and hope to stimulate your thoughts and perspective and perhaps provide a foundation for understanding on how imperative “work” has become for those who are challenged daily with mental health issues.
As committed as we are in providing as amenable and efficacious an environment as possible to enhance all opportunities for vocational successes, ultimately it is the responsibility of the individual to achieve. This is challenging enough, but we can agree that sometimes the structure, politics, regulations and mandates in how we accomplish these goals is cumbersome at best. There are times when we may feel frustrated or at a loss for an answer.
Similarly, we would agree for those who have entrusted us with guiding their personal recovery have especially difficult challenges before them. I know for myself, it is easy to become distracted at times from their reality v. mine because ‘it’s my job’. But in actuality, it is so much more.
Can you imagine what an individual coping with mental health issues daily is going through? We struggle at times with getting deadlines met, or writing service plans in a particular way, having our charts pass utilization reviews or audits, simply satisfying all of our “other” duties.
How do you combat this? How do we remain true to our mission, to the choice we have all made to have this profession as our vocation? At the same time, satisfy our professional responsibilities. What do you incorporate in practice to accomplish this? Flexibility, creativity, ‘thinking out of the box,’ perseverance, consistency and integration of our services and talents are some of the attributes we exhibit and need to exhibit in order to achieve some of the very difficult outcomes we strive to accomplish.
I witness flexibility and commitment on a regular basis as an integral part of the Recovery service system; that’s great! One primary reason and / or motivator in remaining focused and diligent in safe guarding this responsibility, is the amazing accomplishments I so often observe from those receiving the supports. To hear the anecdotes and life stories of how a person climbed back from the depths of despair and hopelessness, to a vibrant, talented and contributing life style is all we should need to compel us to persevere.
Employment has proven to be a vital part of so many in recovery; sustained recovery; health; hope; and self-worth. It ranks as the number one response to national surveys from those who are in recovery, as the most important value in one’s life.
The Recovery and/or Psychiatric Rehabilitation Model, holds as its tenant philosophy, one which embraces person centered planning predicated on the Skills, Values and Accommodations an individual possesses and requires.
- Our interventions regardless if they are employment related or not, must facilitate the process of recovery.
- Assisting people in re-establishing normal roles in the community.
- Reintegrating into the community, which to date, work is still the number one survey response from our constituents.
- Identifying and developing personal support networks.
- Recognizing that all persons have the capacity to learn and grow.
- Allowing people to direct their own affairs, including the health-related factors.
- Treating people with respect and dignity, eliminating labels and combating stigma wherever you find it.
- Assist individuals with developing achievable and realistic goals, ongoing; emblematic of their values, culture and ethnicity.
- Identify, teach and educate not only the client, but the employer to the strengths and talents that a person possesses. Demonstrating their worth and benefit to hiring such a person.
All of our services both with residential supports, as well as, vocational supports are designed to address the unique needs of each individual, consistent with that person’s values and norms. All these things combined are necessary and lend themselves to the enhanced quality of life all people seek: a “piece of the pie” mentality.
Employment is one element in this journey for life but is one of the most significant. As in the aforementioned section, “work” is still the number one consumer survey result. It encourages and helps protect the integrity of the recovery process. It does so by adding the intangible, human quest to be accepted, purposeful, needed and most of all normal.
Has Our Current Service System Fallen Short on Delivery?
Since 2003 till today, the emergence of the “one stop shopping” mentality was born. PROS (Personalized Recovery Oriented Services), as well as, sub-contracting with the state clinics and hospitals commenced. In theory and in practice, these types of vocational and clinical services attempt to bridge the “Gaps” that are developing throughout the rehabilitation sector, especially for those suffering with mental health issues. For many, a PROS clinic, offers a more convenient way of surrounding oneself with the services one would need, without having to travel to multiple sites throughout the county or to enroll in multiple programs, etc.
Typically, when government tries to solve problems with large bureaucracy attached, someone is left holding the proverbial bag. Such is true in my observations in these past so many years, because one size often does not fit all.
In Putnam County New York for example, there are many who choose to work and want to work, but they require intensive long term supports on the job site for a very long time; years, in fact. Programs like the Vocational Program at Search for Change, Inc., operate a vocational support service, called Supported Employment. This is a wonderful match for many. However, the regulations and funding requirements attached to that county from the state, those who desire to receive long term supports are forced to go without, unless they are lucky to be eligible to be served through the state clinic and receive potential job coaching. Of course, there is the PROS clinic, which can provide similar support, but may not be able to provide the intensive and long-term support necessary, especially on the job site where the real support is needed.
Additionally, programs like the Search for Change program are ACCES-VR (Adults for Continuing Careers and Educational Services – Vocational Rehabilitation) are contracted, whereas the state clinic and PROS are not. This in and of itself is a natural “Gap,” because the individualized and intensive supports that ACCES may provide cannot be accessed if you are not receiving services from a ACCES sponsored provider. This has a direct negative impact on the long-term work supports I mentioned prior.
In fairness, there are specific agreements between various provider agencies and the other county supports to attempt to provide the long-term piece, but these are woefully inadequate.
There are many who have achieved successful and sustained employment and are well along in their recovery, no longer requiring such intensive daily support, but they are forced to consider choices, which limit their ability to continue to grow in the work place, because they are required to attend programs instead. Some have actually lost their jobs as a result.
This is a growing concern shared by many in all levels. Of course, here is where we need to be patient and not give up the ship. We must all continue to track and interview our constituents and advocate appropriately so that perhaps in the near future we will see the enhancements I believe are crucial to meet the needs of all.
The Good News
Shop around and become educated. I truly believe that the vast majority of people in the field are good caring people who want to assist those in need achieve whatever goals they hold for themselves. There are creative ways, collaborations amongst professionals and coordinated efforts to provide the variety of different services needed, which may not be available at the “one stop shop.” Hopefully, the powers that be will recognize these growing “gaps” and fill them with adjunct services meeting the direct need of those who just want to work!
If I have fashioned any concepts or perspective to recovery services, then I have achieved a modest level of success and purpose to sharing my experiences.
Every day I learn something about recovery, how important work is, as well as, the need for independence from the very people I am humbled to be entrusted to serve. It is inspiring and motivating. I hope this is your experience as well.