Monday, August 16, 2010

Why take a job?

Too much hype about jobs and recovery being promoted by PROS

PROS (personal oriented recovery services) as we know now, has three components and a clinic part to it—comprehensive rehab, intensive rehab and ongoing rehab. The first seems the most flexible to its adherents, letting people with mental illnesses and behavioral problems sign up for stress management and living skills and symptom reduction courses, for example. The other two are job oriented—teaching how to get a job, assisting in one's training and placement, and following up to see he or she stays in the job once landed.

The central idea is to expose people with serious mental illness to the world of work, to force them to focus on their own recovery. And that means for most of them, becoming capable of holding a job of some kind – the PROS minimum is 10 hours a week—but better still, it is to earn them a place in the competitive work world, working over 20 hours a week at a fulfilling job that will make them more self reliant and independent citizens

Now, people say they do want to work. That's okay--we already have existing opportunities for jobs that are part time and temporary. From what I read, PROS designers want more than that. They want these denizens of “smoking and rocking clubs” as one of them puts it, to wake up and go get themselves a real job with good wages and full days work. One wonders if they have any idea at all what serious mental illness is all about.

And if these managers disregard the barriers that someone has with mental illness—like distraction and relapse and sedation from the medicines they're taking; or persistent physical ailments, sleepiness, moodiness, anger—what can we expect from them?

Instead of offering some creative job ideas like apprenticing people in a trade or sending someone to a community college for courses that are tied to a specific job and employer, PROS will put people into the classroom to learn about work in general. The consumers are tired of resume writing and someone asking them what they want to do. PROS won't improve on affirmative businesses that employ consumers now and really do teach job skills and savvy in a protected environment, like Pie in the Sky Bakery in Albany. It has operated for over 30 years. People at RSS say it will have to be restructured to qualify it to continue as a PROS. If it's been good enough to serve hundreds of people until now, why does PROS even want to change it?

And our local providers employ quite a few of the consumers in their programs in-house to answer the phone, do business office functions, drive trucks, clean the rooms. These may need special dispensation from the state nabobs to continue if Reinvestment and Community Support Services funds vanish. With VESID funding, RSS and Northeast Career Planning have trained and placed people in outside jobs and coached them, along with the OMH. This arrangement should survive but it too, may change under federal rules for Medicaid participation. We also have peer assistants who work with patients inside Ellis Hospital and there are bridgers who do liaison work for patients coming out of hospital in other areas.

These jobs don't usually jeopardize social security benefits because people have been counseled and they work fewer hours to stay below the dividing line. That is why they are successful holding these jobs but there is great pressure for them to earn more and give up their benefits.

What the PROS designers want to do is take some of the seriously ill people off the social security rolls altogether. The state and federal agencies have been trying to do that for at least 15 years. They keep rolling out programs like “1619 b” under the Social Security Act and the “Pass” program and “Ticket to Work” under federal labor law, and now “Real Jobs” strategies involving a private employer. Those who are behind these urgent programs dreamed up in Washington want to believe everybody can work and uncomfortable symptoms like hallucinations and delusions, or inability to form speech quickly or avoid distractions in the workplace, are easily overcome.

This is the stickler—it's why in my opinion the push by the PROS enthusiasts to prepare people for paying jobs comes with too great a risk for most of them. The evidence is that too many of the ones with serious mental illness who enter the labor force using their skills and training will have difficulty making it or won't make it and they will lose their benefits. It's not just at the outset, it's what they face along the way, after they've been working for some time and find their illness doesn't disappear. It may recede and be manageable most of the time, but too many in this group have tried working and kept at it for some time and find their illness haunts them over a lifetime. At some point it recurs to the point they can't work and they find they're out of luck, they've lost the safety net.

Of course, it's a personal decision of the individual whether to take a regular job and lose out on benefits. Other workers make a similar choice. For the truly job-capable, it's always been worth the risk. They take their place in society. But for most of the others, it's a poor gamble. Look at the record—very few people with schizophrenia or bipolar disorder or chronic depression hold one of these jobs for any length of time. They would have to have some outstanding characteristics, like computer skills in high demand, and a lot of brains and determination. But even they will exasperate employers by suddenly taking days off or acting socially distant in the office or showing some other behavior that sets them apart. Even job coaches don't help this.

We forget sometimes how hard it is to learn job skills. It takes repeated study in the classroom and practice on the job, and some training courses are far too tedious for people with these disabilities. Someone who hasn't worked for a long time or doesn't possess the energy to focus on the school work isn't going to make it. They have to learn to do it right and they are not used to preciseness in their lives. We should be realistic. Even where there are openings for good jobs, like practical nursing, the training may be too difficult for this group. It's much easier to stick to part time, less demanding work.

And on a simple note, the economy itself is defeating. If people without disability can't find a job after months and years of trying, how can we expect someone with serious mental disability to find one? It's another reason why PROS designers should back off and stop trying to push people into competitive jobs that don't exist. (Roy Neville)

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