Step Up on Second Writers' Anthology

Work and the Mentally Ill
By Mark Klein

Work is important for everyone, including the mentally ill. Work is of special interest to me because I am a recovered mental patient returning to the workforce.

I recently interviewed Dr. Robert Liberman, Director of the UCLA Psych Rehab Program and Distinguished Professor of Psychiatry at UCLA. Dr. Liberman believes that work is a key prescription for wellness for people with mental illnesses. Besides providing income, work contributes to our personal sense of identity and self-esteem and provides opportunities for socialization. What we accomplish in a job, no matter how menial or challenging, contributes to our morale and positive feelings. Finally, a job brings structure to our lives—participating in a daily routine combats boredom, apathy, indecisiveness, and “naval-gazing.” The presence of mentally ill people in the workforce also helps break the stigma surrounding mental illness.

Dr. Liberman says that current evidence from vocational rehabilitation programs shows that with the proper help, many individuals with disabilities can find jobs and gain the benefits that come from a working life. When mental health professionals communicate their belief that persons with mental illness can't work, they are perpetuating a myth, increasing the stigma, and undercutting the motivation of the mentally ill for employment. More and more psychiatric rehabilitation experts believe that with the proper help, many people diagnosed with psychiatric illnesses can find a place in the workforce.

A prerequisite to a successful job search is the individual’s motivation to work. Approximately 66% of mentally disabled persons express a desire for work and 50 percent are willing to join a rehabilitation program called supported employment, the most effective approach for obtaining employment in the competitive sector.

Supported employment is a team approach. The person looking for work is called the client. The client, an employment specialist, the employer, the psychiatrist, and the case manager work together to help the client get and keep a job. The employment specialist works closely with the client to identify the kinds of jobs that fit his interests and abilities and to steer him away from jobs that may be too difficult or stressful. The client gets placed then trained on the job, unlike with traditional rehabilitation approaches, which include long periods of "pre-employment" training before job placement. The employment specialist, the employer, and the employee collaborate to develop a training plan and solve any problems that may interfere with success. The employment specialist sticks with the client for as long as necessary, even if he or she loses a job and needs to find another one.

Dr. Liberman cited the case of a man who enrolled in supported employment after 20 years of living in a state mental hospital. During those years, he spent much of his time roaming through the underground passages that connected the various units of the hospital. After discharge, this gentleman was arrested several times for climbing into the city's sewers and walking for miles underground. His employment specialist placed him on a paid job with the city's sanitation department that was tailor-made for his interests, habits, and abilities: changing light bulbs in the sewers. This exemplifies the creative and successful "place, then train" approach of supported employment.

One of the biggest issues mentally ill people face in going to work is their fear of going off public assistance. Over 90% of these individuals never get off these entitlement programs. Long-term reliance on the public assistance can make the challenges facing the mentally ill even worse. Already stigmatized with a label, the feeling of being dependent, or even parasitic, can do even more damage. A blow like this on self-image need not happen. Going to work is part of the solution.

Despite my being diagnosed with schizoaffective disorder, I have successfully held down several jobs. I have worked as a security guard, a barista, social services director at a retirement hotel, and a manager in a retail department store. When I had a job, I felt better about myself and this opened other doors for me. Socialization was easier—work gave me conversational topics to talk about with co-workers, family, and friends. Being able to describe my work life was especially important when I met new people. In addition, the money I earned gave me more freedom to live independently, choose my activities, and increase my comfort.

I am currently devoting my time and energy to my lifelong dream of writing for a living. I encourage others who suffer from a mental illness to hold fast to their ambitions. I believe it is possible to recover. I am a living example.

I feel there is something noble about work and giving back what one has received in life. Those who consistently put in years of employment are my heroes. I have a good friend, for instance, who makes close to 50 dollars per hour and gives a significant portion of his check to others who cannot survive without some extra help. I am turning my own life around and look forward to making such a positive impact.

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