I often hear that work is a “choice” for people living with mental illness. This view needs to be actively challenged by stakeholders such as clinicians, families/caregivers, organizations, and even by recipients of psychiatric services. Living in poverty is not limited to finances but can negatively impact overall health, self-worth, and feelings of citizenship in valued social roles. As a person living with bipolar disorder I am angered about my own history on social security for 14 years that began at the age of 26. I am currently 50 years old and have been competitively working mostly full-time the past 10 years and living my life “system dependent free” by planning healthy risk taking. Viewing work as an expectation promotes lives of community inclusion (integration). Employment is our most recognized cultural health tool of “hope and promise” toward wellness and recovery. Here are some common themes I hear:
- Lacking access to public transportation
- I had to get rid of my car since I’m now at a boarding home
- There are no jobs
- I need to work part-time to not interrupt “my” social security benefits
- Professionals/family/caregivers/peers tell me that work will increase my symptoms
- I am volunteering
- I’m pressured not to miss day treatment program to look for a job
- I need the benefits to pay for medication
- I’m satisfied on social security
- I don’t have the energy or physical stamina to work
We need to actively challenge these beliefs, values, and the people created system barriers of misinformation, and underused resources perpetuating this fear to support work. Creating social security exit plans and tailored social security benefits to meet specific needs of individuals. For example, living with my parents I did not need emotional stigmatizing social security check. Those monies could have been utilized elsewhere. I will explore these issues further in future posts. Your comments are welcomed!
George, you outline the many benefits of a working life, yet many struggle to even envision these. How can we get more folks to embrace this vision for themselves and their loved ones?
Thanks Ken- I believe with increased attention and communication of peer role models maximizing their talents in areas such as work/career, education, and life skills will help stakeholders to chip away at the misdiagnosis of chronic unemployment and to view employment opportunities as real health benefits. Here are some examples:
1. Peer workforce transition from part time work to full-time work/career
2. Volunteer experiences as a timely stepping stone toward competitive employment
3. All peer operated services to promote and support competitive employment, peer employment support groups and as needed to use other employment services and resources
4. Practitioners at intake to view and service people as “workers and contributors” to lessen/eliminate community reintegration- feelings of separation from natural community supports and resource linkages
5. Having collaborative stakeholder meetings with service recipients at partial care and outpatient programs, boarding homes, residential healthcare facilities, etc.
6. Regional Psychiatric/Addiction Employment Transformation Public Forums
These ideas are not new though need unwavering support, implementation and oversight and monitoring. My message to all stakeholders resonates; through lenses of hope and pushed by pain; so pardon my temper, but stop babying us and supporting us to baby ourselves!!! Some of us have and will outlive our parents/caregivers and need work and life skills to foster as much system-free independence as possible! Ken- and others I appreciate your follow up thoughts.
In our society, there are several different cultures within cultures. Aside from there being a culture of the mentally ill, there is also a culture of individuals who are unemployed and comfortable. Upon close examination of your list of themes, I noticed several familiar and common reasons individuals give for being unemployed; one theme that I did not see however was that individuals, mentally ill or not, tend to learn certain behaviors from their upbringing. I have heard of people being system dependent because their parents relied on the system (i.e. Welfare; Social Security; Section 8; etc.) and that’s all they know. Taking this theme into consideration, I believe it is necessary to investigate an individual’s cultural backgrounds prior to assessing how one may approach developing a plan to help the individual work towards becoming employed.
Yes, learning about a person’s culture can strengthen the engagement process (therapeutic alliance, building rapport, and by using first person language). This is a resource explaining first person language https://uspra.ipower.com/Certification/2003_Language_Guidelines.pdf. It is important to learn about what the person values and to get a sense of how they think. People do become systematically and personally dependent on social services for a host of reasons, such as a lack of work skills and education, sorting out institutional barriers and policies before considering work when on welfare, Section 8, and or social security. The managing and coping with depressive illness and addiction, seeking approval to work from clinicians/staff, family, peers (learned helplessness) and not encouraged to take healthy vocational risks. I believe that practitioners, families, person served, and supporters need to openly promote work. Employment is in our “collective culture” providing us with the ultimate feelings of belonging and citizenship that should be afforded to the people we serve as well. Furthermore, to better educate people about how they can work and the impact of working while receiving services. In turn, systematically the system improves system policies and regulations to encourage work (work incentives) for decreased dependency on social services. As practitioners to help people develop and maintain feelings of hope, self-confidence and empowerment and literacy to chip away at generational poverty within families and among people living with mental illness and addiction. Thank you for adding culture a term of many definitions to the discussion!
What are cultural barriers that you have faced when helping others and how did you address the challenge?