In this account, I’m sharing our experience at The Bridge, the New York City non-profit mental health rehabilitation agency, to illustrate the key role that consumers play in moving service providers to a recovery/rehabilitation orientation.
The Bridge was created in 1954 by a group of seriously mentally ill men and women who had been in the hospital together and who were among the first group of “patients” to be given prescriptions for the brand new “miracle drug” Thorazine and summarily discharged from the hospital. The group found that there was little waiting for them back in the community, other than the follow-up appointments they were given at the time of their discharge which directed them to a local hospital to have their prescriptions refilled. They did something unexpected, although perfectly logical given the lack of supportive services; they created their own supportive program, The Bridge.
For 15 years, from 1954 to 1969, The Bridge operated as a kind of psychosocial club, with an emphasis on the “social.” Once a space was leased thanks to the fundraising efforts of some dedicated volunteers, the “members” had a place to socialize together, sharing meals, celebrating holidays and birthdays, playing cards, having invited guest speakers recount their foreign travel adventures. During this time, there were no mental health professionals involved; just the members and supportive fundraisers.
This changed dramatically in 1969 when the group decided to accept its first government contract to provide services to the flood of people being discharged from State psychiatric centers. Located on the Upper West Side, The Bridge was in a neighborhood that was heavily impacted by the deinstitutionalization because it contained many welfare hotels and SROs. By the late 1960s, more than 3,000 people discharged from state psychiatric centers filled the SROs or were homeless in the streets. Little wonder then that the State Office of Mental Health reached out to The Bridge with its offer of government funding to respond to the overwhelming need for services and supports.
With its first contract, a royal sum of $17,500, The Bridge hired its first mental health professionals, including: An Executive Director, Social Worker, Group Psychotherapist and a Psychoanalyst. For the next 20 years the agency was focused on two major activities. From his psychoanalytic background, the Director brought the theory of the day: that mental illness was caused by impaired family relationships (blaming mothers most specifically). Following this theory, the Director developed the idea of the “second chance family,” in which Bridge staff would provide a corrective experience to consumers by being “good parents.” This idea was expressed in a paternalistic way in which staff members were parents and consumers were the loved and cared for children.
The second idea that the Director brought was from social work: the need to focus on and address the consumers’ basic needs: for food, clothing, a safe and supportive place to be, for entitlements, benefits and, beginning in 1979, for quality housing.
This paradigm, in which the consumers were viewed as the children, the staff as parents and the relationship between them consisted of staff nurturing and taking care of consumers lasted for almost 20 years until the late 1980s. The paradigm shift that occurred then was led, not by the staff, but by the agency’s consumers.
In 1987, a group of consumers presented themselves to express a problem: they were bored. According to them, they were benefiting from all that the agency had offered them: securing their entitlements, providing a 365-day-a-year program with a variety of groups and activities that they had participated in, and providing quality housing. While they were certainly appreciative, they were also bored. They asked what else the agency might have for them. When asked what they might want, they became quiet. Finally, a member of the group said “how about work?”
While the concept of work had always been on the radar, the agency had an attitude toward work that reflected its paternalism: we believed that our consumers could be good citizens and worthwhile human beings and not work. After all, the consumers were our children to be taken care of, not even young adults being prepared to go out into the world.
But their request resonated with senior management. It was clear that the consumers, whose basic needs were met during the era of paternalism, were now ready to focus on their next level of needs: to seek integration into the community through work or the achievement of other personally defined goals.
With the consumers taking the lead as champions, management obtained funding from the State Office of Mental Health to develop a vocational program. When a Program Director was hired, we introduced him to the agency community and looked forward to a new, important program initiative.
But nothing happened. Over the first 6 weeks of his tenure, not a single staff member referred a client to the vocational program. It was then that we realized that the consumers were in the lead, more ready than the staff was to move the agency into the next phase of its development. It took many months, in truth years, for some staff to make the shift toward the recovery paradigm.
In making the shift, now happily in full fruition, roles and values at the agency changed dramatically. Instead of paternalism, the core agency value is the self-actualization of our consumers. Instead of being “parents” the staff are now facilitators or teachers and the clients are no longer passive children, they are individuals striving to achieve their own life goals.
Today we are in what I call The Golden Era of Psychosocial Rehabilitation. With the proven evidence-based practices highlighted in the PORT Study (Schizophrenia Bulletin vol. 36 No. 1, 2010, pp. 48-70), and the full blossoming of the consumer and recovery movements exemplified by leaders such as Patricia Deegan (“Recovery and Empowerment for People with Psychiatric Disabilities,” in Social Work in Health Care, vol. 25, No. 3, 1997, pp. 11-24), people with serious mental illness are able to fulfill their dreams and goals. At The Bridge, our consumers clearly led the way; the joy of the work is in sharing and supporting them in their journey of recovery.