Joseph A. Rogers

Joseph A. Rogers, a consumer of mental health services and a consumer rights movement activist for twenty-seven years, is deputy executive director of the Mental Health Association of Southeastern Pennsylvania. He is executive director of the National Mental Health Consumers' Self-Help Clearinghouse, funded by the federal Center for Mental Health Services, and the immediate past president of the governing board of Pennsylvania Protection & Advocacy, Inc. He served on the Executive Committee of the President's Committee on Employment of People with Disabilities for six years, and he has consulted throughout the United States and in Poland on the development of consumer-run services and a variety of other issues affecting people with mental illness

Reprinted from the Psychosocial Rehabilitation Journal, 18 (4): 5-10, 1995 with permission of the National Mental Health Consumers' Self-Help Clearinghouse.

Work is a critical element in the recovery of people with mental illness. It offers more than a paycheck; it boosts self-esteem and provides a sense of purpose and accomplishment. Work enables people to enter, or re-enter, the mainstream after psychiatric hospitalization. Unfortunately, too often these individuals are prevented from finding employment because the supports that they require are lacking. The author, who himself has a psychiatric history and is speaking from firsthand experience, suggests some reasons for this, describes a number of successful consumer-run and other innovative vocational models, and promotes the concept of research to prove what works and what doesn't.

    In 1971, I was 19 and had the same abilities and ambitions as any other 19-year-old. I hoped to make a place in the world for myself. But instead I was a patient in a state hospital in Florida.

    One day I was summoned to the office of the vocational rehabilitation counselor. As I entered, he was idly flipping through my chart, which was open on the desk in front of him. Finally, he looked up and said, "Well, there's ~nothing much I have to offer you; I can see from your chart that you'll never be capable of holding a job."

    Tears came to my eyes; I thought all the facts were in. At the age of 19, when most people are eagerly anticipating and planning for the future, I had been told that I had nothing to look forward to but a "career" as a ward of the state.

    Fate intervened when I was released from the hospital and entered a halfway house. Typical of many programs serving people with mental illness, the halfway house was under- funded and short-staffed; so the director conceived the plan of training some of the residents - myself included to fill the gaps. Through this experience, I learned that I could not only receive help but could give it. It opened my eyes.

    Twenty-four years later, I am deputy executive director of the Mental Health Association of Southeastern Pennsylvania, a large and active advocacy agency that also provides services - most of which are consumer-run - to people with mental illness. I am executive director of the National Mental Health Consumers' Self-Help Clearinghouse, funded by the federal Center for Mental Health Services and serving a national constituency. My resume includes a variety of consulting efforts and published articles. I am also the immediate Past president of the governing board of Pennsylvania Protection and Advocacy, Inc., and I have testified before congressional committees and before President Clinton on a variety of issues affecting people with mental illness.

    As my responsibilities grew, I have given more than a passing thought to that vocational rehabilitation counselor, who is probably still down there in Florida telling other 19-year-olds that they'll never work.

    This kind of self-fulfilling prophecy does great damage: when people are told they are worthless, they believe it. By the same token, tell people that they are valuable members of society - at least potentially so - and that is what they will believe.

    I find it puzzling that the mental health system has such difficulty creating programs to provide people with the basic skills they need to survive. Although people need help to deal with their emotional problems, if they don't have some way to make a living they will never truly be able to enter, or re-enter, the mainstream.

    Perhaps this concept is too basic for psychiatrists, psychologists and social workers, who may feel that they have not endured years of professional training and staggering student loans to become job placement counselors. However, this might be the most useful role they could play in the lives of people who want a piece of the American dream.

    My own experience indicates the need for this kind of assistance. When I came out Of the hospital and sought help in finding work, vocational rehabilitation counselors informed me that what they had to offer were Goodwill Industries, sheltered workshops and the like. When I said that I had some ideas for kinds of work that I thought would help me, they offered me the choice of either taking the programs they had available, or not taking them; there seemed no other options.

    Unfortunately, when those of us who are seeking help from the vocational system fail in these cookie-cutter programs, we - or our pathologies - are blamed for our failure. It is routinely overlooked that in order to succeed, even the so-called "normal" population needs employment suited to their interests and abilities.

    Research comparing the outcomes of individualized programs with "one-size-fits-all" programs would be vital in shaping policy around vocational programming; and consumers of mental health services are coming to realize the importance of such research in establishing the effectiveness of various designs in vocational programming. I have heard a number of mental health consumers express their desire to see mental health vocational services move away from a cookie-cutter approach toward considering people as individuals. Developing research to study how to help vocational service providers individualize their efforts at supporting consumers to get jobs would offer hope for a radical improvement in the current system.

    It is not only people with mental illness who need assistance in climbing out of poverty. Addressing vocational training in general, President Clinton recently proposed giving people certificates worth two thousand or three thousand dollars and letting them tailor their training to their needs. Research in empowering consumers to make their own choices by awarding them such certificates or a cash grant would make a fascinating study. Such a plan would also be consistent with the goals of the consumer/survivor movement, which include empowerment and improving the quality of life for people with psychiatric histories.

    Besides the very practical matter of working for food, clothing and shelter, work also opens up other doors. When I was unemployed and living on Social Security, I saw myself as unable, disabled, broken. When I got a job, this picture started to change. My newfound self-esteem increased my ability to cope with my mental illness.

    As a deputy executive director of a regional Mental Health Association, I have helped design and establish many kinds of self-help programs including vocational programs - for people with psychiatric histories, and have seen my experience duplicated in many other individuals.

    If working did not offer enormous rewards quite apart from a paycheck, people would not seek employment so avidly. But they do.

    One reason is the pride that comes with independence. For example, when someone I know who had a history of psychiatric disability was asked why he had given up the security of a government check in order to work for a living, he said he wanted to be the head of his own household instead of being dependent on the state.

    This man was a graduate of ACT NOW - Advocacy Consumer Training for New Opportunities to Work - one of several programs we have created at the Mental Health Association of Southeastern Pennsylvania to help people obtain and maintain employment.

    ACT NOW evolved out of our efforts to help homeless people who were mentally ill through a consumer-run demonstration
project - Project OATS (Outreach, Advocacy and Training Services ) - funded by the Community Support Program of the then National Institute of Mental Health (now the Center for Mental Health Services).

    When Project OATS outreach workers first started reaching out to their peers on the streets, they would ask them what their needs were and provide encouragement, support and concrete connections back into health.

    The project was extremely successful; many people who had been abandoned to the street were connected to some significant assistance. Inevitably, however, we found that in order to break the cycle of homelessness - which is an economic, not a psychiatric, problem - people needed to work. And they wanted to work.

    After people had found a place to live, even had acquired a steady income from a disability check, they wanted more. They wanted a job.

    To meet that need, we created ACT NOW, which takes a simple approach to vocational rehabilitation. First we provide a three-week training in "job readiness." This mostly involves helping people acquire some basic skills, such as putting together a good resume and "cleaning up their act" so that they can be as employable as possible. But after this short training period, we quickly try to place people in 12-week "internships." Placements that may become permanent full- or part-time positions are sought.

    Much of what we do to help people vocationally is based on the simple idea that if people want to work, we should help them get jobs. Offering people a lot of pre-vocational screening and pre-vocational training and pre-vocational work placements only frustrates them.

    We see the results of these programs every day, in the people who get back on their feet and into the mainstream. However, particularly in the current political climate, we need research to prove the obvious, in order to secure support for such innovative programs.

    The research demonstration projects of the Center for Mental Health Services' Community Support Program - some of which are studying models of vocational services - are an important step forward. They are linking service providers and researchers in a joint quest to document the most effective ways to helping people with mental illness live productively.

    Also funded by the Center for Mental Health Services is another of our initiatives with a vocational component: ACCESS - billed as one-stop shopping for social services for homeless people with serious and persistent mental illness. Project OATS laid the groundwork for the Association's facilitation of ACCESS (Access to Community Care and Effective Service and Supports), which got underway in Philadelphia in May 1994. Funded by a $10 million, five-year grant - divided equally between two sites, one of which will be operated by the Mental Health Association - ACCESS provides a diverse array of services, including vocational guidance.

    Other Mental Health Association projects share the goal of helping people get work. For example, Job Link - a demonstration project funded by the Robert Wood Johnson Foundation (and no longer in operation) - linked consumers one-to-one with volunteers who would help them find and/or keep a job. The volunteers, recruited from the community, also served as a network of employment contacts. The consumers benefitted from interacting with the volunteers, who fostered their personal strengths and vocational potential. The volunteers gained the satisfaction that comes from making a crucial difference in the life of another person and growing in insight and understanding.

    Another program, called the Employment Project, provides peer support to mental health consumers seeking employment as well as to those who are already working but need support to maintain their jobs. This project, which operates out of a consumer-run drop-in center in Darby, Pennsylvania, helps people face and overcome their fears - of success as well as of failure.

    The opportunity to fail is part of life for the vast majority of human beings. "If at first you don't succeed, try, try again" is a cliché because people often don't succeed at first; that doesn't mean they never will. But failure seems to be something that people with mental illness are not allowed to do. In my own experience, when the idea of work was even addressed, my counselors seemed to believe that it would be such a struggle for me to get a job that, once I got one, I'd better hold onto it.

    Another concept that many providers find unacceptable for their clients is variety, considered "the spice of life" for everyone else. My bouncing from job to job sent a message to my counselors and - as a result of their attitudes - to me that I wasn't ready for work. But it is not uncommon for people to bounce from job to job. Sometimes this is in the spirit of adventure; or someone might take a job that is wrong for them, so they look for another. This behavior is normal for people investigating the job market for the first time. It is one of the ways you discover what you want to do, and it is considered acceptable behavior - for most of the population, that is. But I had a psychiatric history, and I was given to understand that if I was lucky enough to find a job I damn well better hold onto it - because leaving the job would constitute a failure.

    I wish there were more opportunities for all human beings, not just for those labeled mentally ill, to spend six months as part of their education working at four or five different jobs.

    The work-study program at my college gave me a chance to do this, on a small scale. I worked in the library, in the lab, and on the front desk at the student union. This taught me something about what I might enjoy doing and my aptitudes, or lack thereof, in various areas.

    A work-study program where people can spend three months or six months trying out a variety of occupations seems like an effective model for people with mental illness. I would like to see this idea - which is reminiscent of the Transitional Employment model designed by Fountain House - widely adopted. We are establishing a clubhouse program in Philadelphia to institute a similar concept in vocational rehabilitation. I look forward to creating a place in which people can explore what work means and what they need in order to work.

    I am also interested in the Boston University Center for Psychosocial Rehabilitation's various efforts to create models of support for people seeking employment - in particular, using a local college or university as a setting for people to explore what they want to do with their lives.

    Offering help outside of the context of the real world, where people have to work for a living, seems like trying to deal with mental illness in the abstract instead of dealing with its concrete impact on people's lives.

    I would like to see the mental health system explore new ways to help people work, to enable them to become fully independent.

    While unemployed, I have sought help from the mental health system. I have faced the frustration of keeping one appointment after another in an endless series of sessions supposedly designed to help me, and spending months in the waiting room before anyone began to address something as concrete as my need to work.

    As an advocate for people with mental illness, I hope we can move the system from one in which people are shuffled into the waiting room of life waiting for doctors to evaluate them, psychologists to test them, social workers to refer them - to one in which the first priority is helping someone who wants to work get and keep a job.