Author Archives: Bill Waynor

Work, Choice, and Recovery

Some years back, as a provider of supported employment services, it always appeared that work was indeed a choice for the jobseekers I worked with. On many occasions individuals changed their mind about wanting to go back to work for whatever reason. And I was aware that in probably all cases the person was receiving disability benefits from Social Security. In addition, in most cases the person appeared to be in a reasonable state of wellness or “psychiatrically stable” from a clinical perspective. My position was always that work was a critical component of the recovery process, and I’ve seen people transform themselves from the experience of returning to work. Thus, I felt they may have made an ill-advised choice by not pursuing employment as a recovery goal. However, I was also aware that “choice” is one of the principles of Psychiatric Rehabilitation, and at that point I didn’t think much further about this issue.

One thing is clear, I had never thought about this issue of work being a choice in the terms that my colleague George Brice Jr. stated. George is really clear that if one is healthy, able-bodied and in a state of wellness, that one is expected to work as an adult in our society. In addition, he states work should not be a choice! Further, George makes the point that Social Security benefits should be there for people who need them, and if one becomes well enough, one is obligated to get off benefits. Clearly, George is making a powerful point here, and one that is usually not addressed in the community mental health field.

Consequently, after reading George’s recent blog, I was speaking with another colleague who made the observation that she knows many people in recovery who volunteer at self-help centers, and participate in unpaid committees, all of which take up as much time as a full time job. Again, the point was made that these individuals are clearly healthy, able-bodied and in a good state of wellness. This conversation bought to mind some of the literature on self-help centers and their focus on empowerment. However, in my colleagues and my own experiences with self-help centers, there is often little emphasis placed on career development. And I think this point may bring up the issue that, how can the choice not to work, especially if one is not financially well-off, be empowering?

Clearly, the impact on getting on Social Security benefits help to foster an “illness identity.” In addition, the lack of expectation of work from too many community mental health providers also reinforces an illness identity. In addition, there are numerous barriers to employment for persons with disabilities. Nevertheless, I think my colleagues make a cogent point that perhaps even the self-center movement, for which I have great respect, may need to rethink what empowerment is really about? Can one be healthy, able-bodied and in a good state of wellness and not pursuing some career or employment oriented goal, while collecting Social Security benefits and thus living in poverty, and truly be empowered?

As a provider who is strongly influenced by the person-centered philosophy of Carl Rogers, I am surprised I progressed to the point to even write a blog that perhaps can be perceived as highly challenging to persons in recovery. However, from listening to my colleague’s perspectives, I am forced to rethink the meaning of two important concepts in the field, choice and empowerment. And I am reminded by another principle of Psychiatric Rehabilitation that I adhere too as well, that everyone has the capacity to learn and grow, and that includes me!

Damaging Labels

On more than one occasion while doing trainings on assisting people in recovery with returning to work, I’ve heard participants refer to the people they work with as “low functioning.” I always ask what that means, as we all “function” at different levels at different activities. Some people are better at math than others, so does that mean poor math students are “low functioning?” After processing with the group on what they meant by “low functioning,” the reply is that it is a way to refer to program participants whose impairment from their psychiatric symptoms tend to be more severe than other participants. However, I point out that mental illness tends to cyclical, and often there is great variation in level of symptoms and impairment. Also, the recovery process has been defined as a dynamic, non-linear process.  So ultimately, the term “low functioning” is a meaningless, damaging label.  

Aside from being meaningless, there are other problems with the term. First of all, it is highly disrespectful to label someone as “low functioning.” Also, it denotes low expectations that recovery is possible, thus negatively impacting the quality of services the person is likely to receive. At the typical training, after addressing these concerns with the group, I suggest they bring these concerns back to their programs to change the use of this language. Inevitably, I hear, “then what do we call the low functioning group?” After some reflective listening and responding, the participants are confronted with the fact that they don’t need to label anyone, and their job is to facilitate the recovery process.

Another way to look at their concern is that different individuals may have different support needs among their program participants. However, if someone has more support needs at a certain stage of their recovery, there is no reason to suspect that they will always have higher support needs, because as mentioned above, the recovery process is a dynamic process. Therefore, the consensus is that using language such as low functioning doesn’t ease the recovery process. USPRA has language guidelines which could be a useful resource to bring back to programs,

The point is to always be respectful and assume that recovery is both possible, and the expectation of all service delivery in the mental health field. I am interested in hearing from the blogosphere on the prevalence of the use of the term “low functioning”, and to hear some ideas on how people address the use of this term in order to help the mental health field become more recovery-oriented.

Work and Recovery

In my work as a service provider in the Psychiatric Rehabilitation field in a number of areas, I’ve been fortunate to see the positive impact of PsyR services on the recovery process. Services that help a person in recovery return to living in the community after sometimes spending years in a hospital is both a rewarding and inspiring experience for a service provider. However, in my experience, of all the rehabilitation services, facilitating the return to work has always appeared to have the greatest impact on the recovery process. In a matter of a few months, I’ve seen individuals literally blossom before my eyes! While providing supported employment services, one gentleman comes to mind that was particularly inspirational. I recalled meeting this job seeker for the first time and remember that he appeared a bit disheveled and unsure of himself. Nonetheless, there was a positive energy and determination to get back to work from day one. He worked tirelessly to improve his interviewing skills and update his résumé. He also starting going on job interviews although at first he was really nervous. After about four months he landed his first job in more than five years, and I will never forget the new bounce in his step and the new confidence he exuded. Within a year, he won employee of the month at his job! Returning to work really does wonders for the recovery process