No. 13, Fall/Winter 2001

BC’s Mental Health Journal Employment editor’s message

main focus of this issue of Visions is how to help people with serious mental illness choose, get and keep employment that is meaningful to them. In the field, this is known as “sup- A ported employment” or “supported competitive employment,” the extra word in recognition of the fact that our expectations for people’s abilities have historically been too low and that, with BC’s the right kind of support, we can significantly raise the bar. Mental Helping people attain their employment aspirations has not traditionally been thought of as part Health and parcel of mental health services. The evidence is clear, though, that work of whatever Journal definition — whether paid, competitive, or more recreational or volunteer — is integral to an individual’s well-being, whether they have a serious mental illness or not.

In this issue, we’ll look at some of the key issues relating to the employment needs of people with serious mental illness and at some of the latest, most innovative thinking about how to design supports that are genuinely effective. We’ll also consider some issues that cut across the popu- is a quarterly publication pro- lation of people with mental illness, whether serious or not. Specifically, we’ll look at some of the duced by the Canadian Mental Health general issues relating to work and well-being, looking more closely at the mental health risks Association, BC Division. It is based on associated with certain occupations and work settings. Another overarching issue we’ll exam- ine is discrimination in the workplace relating generally to employment practices, and specifi- and reflects the guiding philosophy of cally to things such as health and disability-related employee benefits. the CMHA: the “Framework for Support.” This philosophy holds that a mental health consumer One key issue in this regard is disclosure (i.e., telling employers about one’s mental illness) so (someone who has used mental health services) is that one can be eligible for relevant benefits and supports. Another related issue that we’ll at the centre of any supportive mental health sys- focus on is accommodation which hinges on disclosure and entails restructuring the job or work tem. It also advocates and values the involvement environment in ways that enable people with mental illness to optimize both their workplace and perspectives of friends, family members, ser- contribution and their health. The dilemma for people with mental illness is that disclosure vice providers, and community. In this journal, we enables accommodation but also makes the individual more vulnerable to discrimination. hope to create a place where the many perspectives on mental health issues can be heard. For this edition, we are especially fortunate on two fronts. One is the opportunity for our readers to learn from the thoughts of guest editors Marianne Farkas and Judi Chamberlin — true pioneers in the field. The other is to hear a message from the Honourable Gulzar Cheema, The Canadian Mental Health Association invites our Minister of State for Mental Health in this province, and his commitment to the vocational readers’ comments and concerns regarding the aspirations of people with mental illness. articles and opinions expressed in this journal. Eric Macnaughton Please e-mail us at [email protected] or send your letter with your contact information to: „ This issue of Visions is dedicated to the memory of Garry Long. Many of us here at Eric Macnaughton CMHA BC worked with him while he was an employee of our organization, before he Visions Editor went on to become the Executive Director of Action Research and Advocacy, based in CMHA BC Division the downtown eastside of Vancouver. We will well remember his intelligence, his 1200-1111 Melville Street love of language, and perhaps above all, his determination. It was this quality that Vancouver, BC V6E 3V6 enabled him to overcome the obstacles in his own life, and that made him such an effective advocate for people with a mental illness. Subscriptions are $25 a year for four issues. To subscribe, purchase back issues, or inquire about „ Editorial Board ...... Nan Dickie, Dr. Rajpal Singh, advertising in Visions, call us at (604) 688-3234 or if you are calling from outside the Lower Main- Dr. Raymond Lam, Victoria Schuckel land, call toll-free: 1-800-555-8222. Editor ...... Eric Macnaughton Staff Contributors ...... Barbara Bawlf, David Wells, Jenny Simpson The opinions expressed in this journal are those of Design / Production Editor ...... Sarah Hamid (with assistance from Vanessa Chu) the writers and do not necessarily reflect the views Printing ...... Advantage Graphix of the Canadian Mental Health Association, BC Division, or its branch offices. „ The Canadian Mental Health Association is grateful to the BC Ministry of Health Services which has assisted in underwriting the production of this journal.

Editor’s Message ...... 2 Guest Editorial ...... 3 Background...... 5 Consumer Experiences and Perspectives ...... 9 2 oNTENTS Service Provider Perspectives ...... 16 C Alternatives and Approaches ...... 21 Occupational Profiles...... 33 Disclosure, Accommodations and Protections ...... 40 Resources ...... 47 Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 guest editorial Supported Employment: An Idea Whose Time Has Come

n North America, Supported employment is Marianne Farkas work is an integral Marianne Farkas, Director of designed to help those in- and Judi part of one’s identity. the World Health Organization dividuals who have the Chamberlin Historically, the men- Collaborating Center, Boston desire to work gain and Ital health system has viewed University, Center for keep competitive employ- work as a form of therapy Psychiatric Rehabilitation ment. Supported employ- or treatment rather than ment assists people, who viewing it as a meaningful may not have strong sup- outcome of service. Predict- port systems of their own, ing who is likely to benefit take advantage of a very from vocational services or natural human tendency who is likely to achieve vo- to seek help and approval cational outcomes among Judi Chamberlin, Consultant and from others. Good support- individuals with severe Consumer-Survivor Advocate ed employment models be- psychiatric disability has gin from the premise that proven to be somewhat of an mensurate with their skills, cations and therapy, and the work that is commensurate illusive exercise2,7 as evi- education, experience and loss of housing subsidies with an individual’s talents, denced by the ongoing low interests. which make decent housing skills, education and inter- rates of employment among a possibility. Many rehabil- est level is a prime contrib- people with serious psychi- Baron and Salzer describe itation programs are not utor to a sense of well-being atric disabilities. Nearly a “culture of unemploy- adequately funded to pro- and purposefulness in life, 70% of those with long-term ment” among consumers, vide the array of vocation- as well as being one path to psychiatric experiences in policy-makers and provid- al rehabilitation services regaining respect from oth- the United States are almost ers that is both pervasive needed to even obtain an ers in the society. Supported entirely dependent upon and persistent.4 In this entry-level position. With employment can help indi- Social Security programs for culture, mental health pro- such obstacles facing an in- viduals maintain their mo- financial and medical sup- fessionals are used to be- dividual’s desire to regain tivation for work because port and few ever leave the lieving that work may be so the valued role of a worker the approach helps individ- Social Security roles to move stressful that it is thought in our society, it is simplis- uals first gain competitive into competitive employ- to threaten the consumer’s tic to perceive an indivi- work and then learn what ment.9 Nearly 50% of those possibilities for progress. dual’s readiness for work they need to learn “on the who do obtain jobs through Many mental health pro- as simply a function of the job,” rather than being in rehabilitation programs fessionals and vocational individual’s capacity to long training programs that lose them within a one-year rehabilitation counselors perform work adjustment may or may not result in gain- period.5 No more than 30% view consumer’s personal skills and control his or her ing real work. of those who do work have work goals as “unrealistic.” symptoms. In fact, there is been able to move beyond Baron points out that the some evidence to suggest Supported employment is entry-level positions that national system of sup- that many of the predictors neither about placing peo- keep people with serious ports, such as Social Secu- that have traditionally ple in “work slots,” nor about psychiatric disabilities near rity Disability Insurance, been thought of as predic- creating “busy work” to the poverty level.6 health care and housing tors of unsuccessful voca- break up a boring routine. subsidies create strong dis- tional rehabilitation — The model is a method for People with serious psychi- incentives for anyone who poor employment history; assisting individuals to atric disabilities, however, wants to return to work. poor work adjustment quickly obtain the kinds of who are within the age Similar disincentives exist skills; more hospitaliza- work that they want and group of those who typi- in Canada.3 tions; receiving benefits; have the ability to perform, cally work in our society, being black, unmarried or through a system of individ- for the most part, do want Returning to work, usually unskilled — are not related ualized, flexible, ongoing 3 to work.8 Most also find se- in a low-paying, entry-level to outcome if a person seeks supports. While many work- rious obstacles to obtaining position, can threaten a per- and is engaged in a voca- ers, disabled or not, may and keeping competitive son with the loss of good tional program.1 have problems with an in- employment at levels com- medical coverage for medi- sensitive supervisor, too

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 guest editorial — cont’d

heavy a workload or un- ment may be a part of the References friendly colleagues, these career exploration plan, it 1 Anthony, W. A. (1994). Characteristics of people with psychiatric difficulties may appear over- usually serves people who disabilities that are predictive of entry into the rehabilitation pro- whelming when a person is are ready to take a position cess and successful employment. Psychosocial Rehabilitation Jour- nal, 17(3), 3-13. returning to work after a in the immediate future. period of unemployment Temporary Employment 2 Anthony, W. A., Rogers, E. S., Cohen, M., & Davies, R. R. (1995). Relationships between psychiatric symptomatology, work skills and/or is unsure of his or programs, for example, may and future vocational performance. Psychiatric Services, 46(4), her own abilities. In such help individuals to make a 353-358. circumstances, a support career choice that can then 3 Baron, R. (1997). Hearings before the subcommittee on social secu- person can mean the differ- be followed up by a Support- rity of the committee on ways and means / House of Representa- ence between long-term ed Employment program to tives. Washington, DC: US Government Accounting Office. success or immediate fail- maximize the possibility 4 Baron, R. C. & Salzer, M. S. (2000). The career patterns of persons ure. The “job coach,” who is that the individual can gain with serious mental illness: Generating a new vision of lifetime ca- available by phone or in meaningful employment. If reers for those in recovery. Psychiatric Rehabilitation Skills, 4(1), person to deal with the there is only one vocational 136-156. workplace difficulties and model available within a 5 Cook, J. & Rosenberg, H. (1994). Predicting community employ- pressures, can negotiate with service system, service sys- ment among persons with psychiatric disabilities: A logistic regres- sion analysis. Journal of Rehabilitation Administration, 18, 6. supervisors where appropri- tem pressures tend to force ate and can assist the indi- individuals into the one 6 Kirszner, M., Baron, R., & Rutman, I. (1992). Employer participa- tion in supported and transitional employment for persons with vidual to persevere in the job. available program, wheth- long-term mental illness. Final Report to the National Institute on The job coach can be a pro- er or not they want to work, Disability and Rehabilitation Research. Philadelphia: Matrix Re- fessional (e.g., nurse, teach- know their interests and tal- search Institute. er, occupational therapist) ents, or are even ready. Sup- 7 Rogers, E. S., Anthony, W. A., Cohen, M., & Davies, R. R. (1997). or may be a paraprofession- ported employment is a Prediction of vocational outcome based on clinical and demo- al (e.g., entrepreneur, con- powerful and indispensable graphic indicators among vocationally ready clients. Community Mental Health Journal, 33(2), 99-112. sumer-survivor). A good job tool in the struggle to tran- coach is able to listen, nego- sition from being a client 8 Rogers, E. S., Walsh, D., Danley, K. S., & Smith. (1991). Massachu- tiate and problem solve and of a mental health system setts client preference assessment: Final report. Boston, MA: Center for Psychiatric Rehabilitation, Boston University. do so in as unobtrusive a way to being an employee and as possible in order to reduce all that being a tax-paying 9 United States General Accounting Office. (April 1996). SSA disabil- ity: Program redesign necessary to encourage return to work. Report workplace stigma. member of a community to the Chairman, Special Committee on Aging and the US Senate. implies. Washington DC: General Accounting Office (GAO/HEHS 96-62). Supported employment is most successful when it is used to assist people who have had some fairly recent past work experience that they would like to regain. While the concept of sup- ported employment can be used to support people in managerial or professional positions, it has been most often used for those who are looking for entry-level po- sitions. Supported employ- ment serves the needs of people best when there is an array of other vocational re- sources available. Some in- dividuals may need or want to try volunteer jobs, intern- ships or a variety of job shad- 4 owing opportunities before they are ready to choose a ca- reer path.

While supported employ-

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 BACKGROUND Ministerial Thoughts on Employment

s many readers will know, I have recently been ap- Traditionally, the approach to employment for people with Hon. Gulzar A pointed by Premier Gordon Campbell to the newly- long-term mental illness has been to create separate, iso- Cheema, MD created portfolio of Minister of State for Mental Health for lated environments that provide repetitive work, low ex- BC. It is a portfolio that I feel was needed in our health care pectations for career development, low job satisfaction, few system — one that will place greater attention on mental employment choices, less than minimum wage and segre- health services, mental health care and mental health plan- gation from the mainstream population. Relatively new ning. As minister, my goal is to ensure that mental health is findings are challenging this approach and evidence indi- granted equal status in health care services in British Co- cates that given the appropriate services and support, Dr. Cheema is the lumbia, so that mental health care becomes part of the main- people with long-term mental illnesses can succeed in newly-appointed stream of health services. Giving equal status to mental the workplace. Minister of State for health care will help remove the myths and misunderstand- Mental Health. He is ings that surround mental illnesses. Communities will be- People with mental illness want to work and can work, also a family come knowledgeable and more accepting of mental illness, and rehabilitation programs play a key role. The challenge physician. To read his allowing sufferers to seek and receive assistance without is to utilize our current knowledge to move toward a fu- full biography, go to fear of judgement. It is time to take mental illness out of the ture in which people who want jobs have the opportunity www.gov.bc.ca/prem/ dark and into the light — time to let mental illness be ac- to get them. This may require support at a variety of em- popt/exec/ cepted by the public with compassion and understanding ployment stages — interviews, job offers, learning new skills cheemag.htm so that people with mental illnesses can become full partic- — in order to benefit from the positive experiences em- ipants in their communities. ployment can provide.

While I will work hard to support all aspects of mental Our role is to continue working with the government of health, an area of particular interest for me is helping peo- Canada, the Canadian Mental Health Association and ple with mental illnesses participate in the workforce within British Columbia health authorities which have many their communities. Employment is a key to well-being for innovative employment programs to promote consumer- all of us, providing financial gains, a source of personal centred models identified in the Best Practices report on identity and the opportunity to make meaningful contri- vocational and educational support. We also need to work butions to community life. together developing and implementing a wide range of new initiatives that provide the sustainability needed by people It wasn’t that long ago that society generally accepted that with mental illnesses. people with mental health issues were unemployable. And that wasn’t just the opinion of the public; it was a view As Minister of State for Mental Health, I will be working shared by service consumers, family members, provider with the Adult Mental Health Policy Division of the Minis- agencies, advocacy organizations and legislators. But times try of Health Services and will liaise with all other areas of are changing, as are the roles of mental health clients in the government that can support services for all British Co- workplace. I want to support that change to improve em- lumbians with a mental illness. I will focus on the full range ployment opportunities for people with mental illness. The of services provided to the mental health consumer. Are rates of unemployment for people with a diagnosis of schizo- services available when and where they are needed? What phrenia, bipolar disorder or clinical depression are far too services in the province are working? Which ones are not high. A diagnosis of serious mental illness should not be working? Are there new, innovative initiatives that show used to determine whether or not someone is capable of promise and, if so, what are they and what kind of time- being employed. It may mean that employment of a mental lines are we considering in taking these new programs to health client might require accommodation in the work- the consumer? place, but it does not preclude employment. A recent pub- lication of the Matrix Research Institute and the University I am reviewing existing information and will seek further of Pennsylvania reports that people with a mental illness input from policy-makers, health care providers and insti- who are employed generally have a stronger sense of self- tutions, mental health consumers and their families in the esteem, more independent functioning skills and less need coming months. It is imperative that people who are seek- for emergency hospitalization. Those who take part in em- ing mental health services have a say in how those services ployment programs, with the appropriate support, make are delivered and which services are delivered. They, more less use of the most expensive mental health services. A than anyone, know what has to be done to meet individual 5 study in this review also reports that 70% of employers needs so that forgotten mental health consumers within expressed willingness to continue working with rehabili- the system receive the care and respect they deserve. tation programs that place and support people with a seri- ous mental illness.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 background Just Doing It: Helping People with Mental Illness Get Good Jobs

Joe Marrone n the past, placement focusing on the following them. It is up to the indiv- “Readiness” Concepts efforts for individuals elements is needed: idual and the agency to Frequently, individuals with disabilities, in- „ Needs: A need can be create an atmosphere of with mental illness are la- cluding mental ill- characterized as an openness and honesty so beled “not job ready” but: Adapted from Iness, have often been based issue, situation or that concerns can be dis- „ One cannot reliably Marrone, J., Gandolfo, on appeals to altruism. No problem which cussed comfortably. Objec- predict who will be C., Gold, M., & Hoff, D. real business needs of the requires a solution. tions posed by an employer successful in employ- (1998). Just doing it: employer have been met „ Features: A feature is can be dealt with from two ment Helping people with and such efforts continue what a product or perspectives: the individual „ Community settings can mental illness get good to reinforce stereotypes deliverable consists of. and the agency. Therefore, accommodate a wide jobs. Journal of Applied of individuals’ needing „ Benefits: A benefit is when an employer raises range of skills and Rehabilitation Counsel- charity, not opportunity. what is gained as a an objection, it can be ad- behaviour ing, 29(1), 37-48. Employment efforts con- result of that feature. dressed by calling attention „ People do not always tinue to be viewed in terms to the strengths of the indi- generalize skills and of convincing the employ- To identify how agency vidual or by calling atten- behaviour, i.e., they may For reprints, contact er to hire that person, a features translate into tion to the services available not be able to perform Joe Marrone, strategy based on the con- benefits for the employer, from the agency that provide in one job, but be able Institute for cept of finding what job it is vital that staff gain a solutions to the objection. to perform well in Community Inclusion openings exist in the job well-rounded picture of another context 4517 NE 39th Avenue market and finding individ- the consumer. The agency Disclosure is an issue in „ Problem behaviours and Portland, OR 97211 uals to fit those openings. staff should work with in- developing relationships skill deficits cannot be Tel: (503) 331-0687 dividuals on identifying with employers, partic- improved in segregated E-mail: Such strategies make the their interests, skills, posi- ularly in responding to settings [email protected] assumption that the job tive personality traits, ca- objections. There should „ Real situations can only market is one arena, with reer goals, likes, dislikes be a clear idea of what a be simulated to a limited flexibility, under and the kind of environ- job entails, in order to as- limited extent, so it is the employer’s total power ments in which they are sess whether it’s necessary important that people and authority. most comfortable. Fur- to disclose the disability. be exposed to “real The reality is thermore, in representing Prior to disclosing any in- world” integrated job consumers first that employ- the individual to the em- formation concerning dis- settings.

consumers first consumers ers’ needs are ployer, the features and ability, this issue should be flexible; they benefits of the agency’s discussed with and ap- Waiting to get all disability are growing services should be clearly proved of by the consumer related issues under con- CAREERS increasingly understood. (see follow-up article on p. trol may mean that the con- accustomed 40). Any disclosure should sumer is never perceived as to meeting the The individual and the be accompanied by an ex- “ready.” Having a parallel demands of a agency should communi- planation of the implica- focus of employment, sup- diverse work- cate with the employer in tions of the information port and work on disability force. Employ- a way that creates a posi- being disclosed. Depending issues is reasonable. All in- ers may have tive impression. Prior to on individual needs, disclo- dividuals must find jobs consumers first only incom- discussing a job with an sure of such information that they can do and work plete infor- employer, potential objec- may include emphasis on cultures in which they can consumers first mation about tions (and how to address the availability of assis- fit. “Job readiness” can be their labour them) should be discussed tance from the rehabilita- summarized as creating a market, and job develop- with the person. Employers tion provider. Maintaining match among the skills, ment involves brokering an should be provided the op- confidentiality on sensitive interests, values and needs exchange process, providing portunity to raise objec- issues is of paramount im- of a person with the de- 6 usable information to both tions, in order that they can portance, but questions and mands of a specific job and job seekers and employers. be countered. Employers fears should not be created the values and needs of a In order to increase the may have a fear of asking in the employer’s mind that particular employer. As chances for long-term em- the wrong question, and so are left unanswered. such, to create a good job ployment success, a strategy may be hesitant to voice fit, staff must:

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 background

Understand the consumer’s 2. The level of involvement Whenever disability relat- abilities, then structures abilities, values and needs and support in the job ed information is shared, it and frameworks built must Understand the employer’s hunt needs to be should be presented in a reflect a shift from vocation- needs and values matched to the abilities way that focuses on what al programming to helping Understand the job — What and preferences of the the job seeker has to offer people find and maintain skills are required? What is job seeker and how past problems employment and careers. the work culture? 3. Involvement is not all have been resolved. or nothing; the impor- Consumer Involvement tant thing is the ability Follow Up in the Placement to re-adjust supports as Obtaining a job interview is National Process needed to promote it not the final step in the pro- An essential element of 4. The issue of disclosure cess. Job seekers should be Depression helping people with mental of a disability is a encouraged to take an active illness in the job hunt is the decision that is made by role in following up on in- Screening Day job seeker’s direction of the the individual, based on terviews through letters, job search and involvement a particular situation phone calls and checking October 2001 in all aspects of the process. 5. Understand that formal with references. Profession- Successful employment, like professional supports, al support should include any other aspect of personal as opposed to informal reviewing with the job seek- change, requires that the supports, have both er what occurred during consumer take an active role potential benefits and the interview and follow- which, in turn, helps to en- drawbacks. up strategies. The job seeker sure satisfaction with the must be able to accept crit- outcome and investment Disability Disclosure ical feedback while main- by the worker in staying An often difficult and emo- taining a polite manner employed. tionally charged issue for with the employer to keep This year, almost 4000 people attended the many job seekers with future opportunities alive. 7th annual depression screening and edu- Figuring out job/career mental illness is how much Due to negative stereotypes cation event in BC. The Canadian Mental goals is perplexing for most to tell a prospective em- of people with mental ill- Health Association’s BC Division would like people and made more chal- ployer. Drawing attention ness as being dangerous or to extend a huge thank you to the over 600 lenging when dealing with to the mental illness may out of control, it is impor- staff and volunteers across BC who made this event possible at 40 sites. We’d also a mental illness. Fears make lessen chances of getting tant for such job seekers to like to thank our gold and bronze sponsors many job seekers with men- the job. Below is a template handle the negotiation pro- listed below for their generous support: tal illness reluctant to seek that can be used to assist the cess in a manner that dis- employment and prone to job seeker to decide what to pels such stereotypes. give up early in the job seek- tell an employer regarding ing process. Past failures, mental illness: Conclusion lack of skills and/or expe- „ Personal ethics of the General components of rience, and manifestations job seeker related to effective job marketing of the disability itself can put non-disclosure strategies are relevant for job seekers with mental ill- „ Is the truth better? anyone regardless of the ness at great disadvantage „ Is the truth relevant? presence or nature of a dis- when competing with other „ Can the facts be ability. The specifics of the job seekers. The prevalence checked? approach can be adapted in of discrimination and the re- „ What are the effects on the case of a mental health quired skill and persistence the job seeker and the impairment, especially in- needed to advocate success- employer of non- sofar as societal fears and fully can be an overwhelm- disclosure? stereotyping are more in- ing challenge for the person. tense than for people with If the job seeker does most other disabilities. Skill Five guidelines are offered choose to present infor- and comfort in working in thinking about designing mation on disability, it is with people facing these services that actively pro- preferable to present that problems will determine mote involvement by indi- information in person so effectiveness in easing em- 7 viduals with mental illness: that the individual can ployer anxieties. If better 1. Involve the job seeker gauge how the information employment outcomes are as an important is perceived and address to become a reality for peo- member of the team any concerns immediately. ple with psychiatric dis-

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 background Mental Illness + Workplace Violence

Dr. Nancy Hall his spring, BC residents were greeted with concern- to be the rule rather than the exception. People with mental Ting news of people with mental illness in the school illness can and do work in supportive environments. Yet I system. In one local case, a BC teacher was remanded for am not aware of many large or small employers in British psychiatric assessment at the Forensic Psychiatric Insti- Columbia that have taken a proactive approach towards men- Nancy wrote this piece tute for setting fires in her school. The teacher had a his- tal illness. In most cases, people report that owning a label when she was the tory of mental illness and had worked in other school of a mental illness is used to disqualify people rather than provincial Mental districts where people had noticed her symptoms and, it support them. Indeed, I attended an inquest recently of the Health Advocate of seemed, encouraged her to move on to another job. It ap- death of man whose symptoms of depression were seen as BC. The office was peared she went to another job without substantial assis- reason for management to discipline him rather than sup- closed November tance to address her health concerns. In the other case, a port him into treatment. 2001 former school janitor in Ikeda, Japan had a breakdown and allegedly took the lives of eight children in a bizarre Consider what the Department of Psychiatry at the Uni- killing spree. The man has a history of mental illness and versity of British Columbia does to address the situation had been arrested previously for allegedly putting tran- of a doctor with a mental illness. Each year, the Hospital quilizers in the tea that he gave to teachers at a school Department Head conducts an annual performance ap- where he was employed. praisal of doctors. Where previously, doctors were asked if they had a mental illness, now doctors are asked if dur- What’s to be done? Some suggest the way to avoid these ing the past year, they have “any emotional problems that unfortunate circumstances would be to ban people with might interfere with them doing their job.” If someone mental illness from the workplace. Indeed, a recent Su- says yes — and some do — the manager and the employee preme Court decision overturned the BC Human Rights plan a support program for the person that might include Tribunal where a man with bipolar illness was banned regular letters from the person’s doctor indicating how the from working as a fishing guide. The Court felt the em- person is doing and compliance with treatment. In turn, ployer had a bona fide concern for the safety of the clients the College of Physicians and Surgeons requires every doc- of the fishing lodge — even though the man is now in tor who treats a doctor with a mental disorder to report that treatment with his symptoms in remission. Another solu- individual to the College. The College has a variety of em- tion proposed in a recent National Post editorial was to ployee assistance programs to support the individual who force all people with schizophrenia to take their medica- is then required to attend treatment as a condition of em- tion. Unfortunately, that wouldn’t solve the problem be- ployment. The thing about this approach is that it is posi- F A C T cause people with schizophrenia do not create all societal tive and supportive and is done with the assumption that 80% of homicides violence. A recent study reported in Psychiatric Services many of us will have emotional problems during the year at work are the by Drs. Stuart and Alborleda-Florez of the University of and that help is available. direct result of Calgary found that only 3% of criminals arrested for vio- a robber or felon. lent crime have a mental disorder. In other words, 97% of The reason many people with a mental disorder don’t re- admissions to prison were so-called “normal” people. port it to their employers is that studies show that eight out — Kraus, J. F., Blander, B., & of ten people experience discrimination once their diag- McArther, D. L. (1995). Incidence, risk factors and Another more proactive approach would be to understand nosis becomes known. People assume violence and then prevention strategies for work-related assault that mental illness and addiction are extremely common. increase their distance from consumers. Help and support injuries. Annual For a variety of reasons — workplace productivity, work- evaporate as the troubled person’s friends and co-workers Review of Public Health, 16, 355-79. place safety and employee satisfaction — it makes sense not vanish. The person’s health deteriorates and symptoms to wait until a problem arises. We need to be able to recog- emerge that are no doubt objectionable. In my opinion, the nize when someone is mentally ill or showing signs of current situation in BC is that people are more likely to be chemical dependency. Workers and managers alike need disciplined for the symptoms of their illness, than they are to know how to support people in getting help. It shouldn’t likely to be assisted. take people from three to ten years to just get a label. Nor should people get discriminatory labels with no help. If one in five of us will experience a mental disorder in the next year, it behooves us to get on with addressing our It is in all of our best interests to think about mental illness prejudices against people with mental illness, getting that differently. We need to enlarge our understanding and com- much-promised treatment system in place and among oth- 8 passion. Those who are charged with the responsibility need er things, developing supportive workplace policies for to get on with creating a treatment system that works. employees with mental health concerns. It makes more Workplaces, particularly those which employ “profession- sense to get used to the possibility of mental illness in our als,” need to be much more proactive in their approach to friends and co-workers and work with it than to continue mental illness. We should expect employee mental illness with the present approach of keeping our head in the sand.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 CONSUMER EXPERIENCES AND PERSPECTIVES Navigating Workplace Minefields

y first expe- of mental instability. The leave, I complied. I now had to be morally righteous, Tanya rience with experience was isolating, no income and a car and an that indeed she had. Very mental illness and became part of the cy- apartment to maintain. I confrontational now, she was at twen- cle of my next relapse. I tried to claim Employment claimed that she did not ty-threeM years old. At the started on another manic Insurance without revealing believe that I could substan- time, it seemed a marauder cycle that eventually dete- I had a mental illness. My tiate my claim of a medical had entered my mind and riorated approximately case was refused and I filed reason behind my resigna- overturned everything re- eight months later into an- an appeal. The tribunal tion. I asked for her address liable; reality itself was in other relapse and institu- convened in response to and forwarded her a copy flux. It was a brutal experi- tionalization. This time, my my appeal was held with- of my entire medical file ence, one that took me supervisors undoubtedly out me because I was only and received a settlement about two-and-a-half years contributed, as they had notified of it after it had within a month. to recover from. Once my become hostile and prov- actually occurred! During feet were planted on the ocative. Whether they were this period, I was hospital- It is difficult to gain any earth again, I sought em- aware or not of the nature ized yet again. I also lost my empowering insights from ployment. I had received of my mental illness is some- apartment and my car due my experiences and I can no financial assistance thing I still do not know. to the financial pressure, as only hope that one day I since my breakdown, so I I was not qualified to collect will have attained some was anxious and nearly My doctor filed the paper- social assistance with a sort of better balance in my bankrupt. work to the group insur- pending EI claim. I would outlook on the world. At ance carrier stating that have been destitute had it some point, I would like to I got a job in a “big bank” I required three months not been for family support. say that my experience has as a cash clerk. The work leave. After only three been personally valuable was a bit mundane, but I weeks, I got a call from the Perplexed, I changed my in that it has allowed me found the routine reassur- insurance company telling EI appeal from a basis of somehow to help others ing. I had not informed me that I had to show up for wrongful dismissal to one overcome their obstacles, anyone that I had a mental work the next day. So I did. of a medical pretext, i.e., my internal or external. Per- illness, not only because I mental illness. I was again haps writing this is a step wanted to protect my pri- In retrospect, I realize that in a stalemate. The authen- in the right direction. vacy, but also because I was the nature of mental illness ticity of my medical claim in denial. I believed that my is very isolating and can be was questioned and con- experience was an isolated dispiriting. Where before sidered to be a gambit of Feeling discriminated one and was one that would the onset of mental illness last resort. Apparently my not occur again. This deni- I was quick to anger at any illness had not been men- against by insurers? al led to my next relapse. I injustice or evidence of tioned by my former em- eventually stopped taking prejudice, I had eventually ployer at the tribunal, as medication, believing that become submissive. I had they were probably in- Do you feel that you have been it was unnecessary. I ended run the gamut from anger structed not to do so. I was the victim of discrimination by an up in the hospital and was to resentment, from resent- very resentful, so when I insurance company due to a on paid leave for about two ment to bitterness, and finally received a letter mental health disability claim? months, recovering. from bitterness to resigna- from the EI office person- If so, tell us your story! Contact tion. I came to expect dis- ally signed by a case work- the Canadian Mental Health After my leave, I returned respect and adopted an er there, I called her. When Association BC Division and to work. Obviously, my su- apologetic manner. I asked her what the obsta- become part of the Workplace pervisors now knew of my cle was in my claim and ex- Insurance Project. mental illness, but my fel- Later, after my early return plained all the financial low employees were anoth- to work, my supervisors chaos I had suffered as a er matter. It seemed to me, seized any opportunity to result of my appeal, she Lower Mainland: disoriented as I was, that pressure me to resign. They was unmoved. Hardened, I 604-688-3234 everyone was treating me began to manufacture pre- asked her if she had been Toll-free across BC: 9 differently. To this day, I am texts for complaining about handling my case from the 1-800-555-8222 not sure if they did or did my work. I was disoriented beginning and she assert- not know, or if there was and feeling like an outcast, ed, with the bravado of Email: [email protected] perhaps not some rumour so when they asked me to someone believing herself Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 consumer experiences and perspectives

Getting Behind and PLEASE TAKE A NUMBER Beyond Counters 78 Catherine Bryson ounters have acquired a symbolic significance for me over the years — symbolic of the world between those who have jobs and those who ning up the down escalator, a childhood game but now a C don’t. I have stood behind many counters in my rather serious reality. For I have read that once you enter the Cday: mental health centres, community agencies, health poverty trap, it is very difficult to get out — hence the esca- clinics. And I would presume that, after a while, the per- lator feeling. And of course, if you add the somnolent effect son behind the counter would get to know my face. Would of the medications, you have to work twice as hard. they classify me as belonging to a group or class (recipient of services, poor woman, welfare bum, etc.) or would they Still, it’s worth it in the long run: to earn one’s bread, (or resist that temptation and see beyond such rigid lines and part of it). Truth to say, nothing could have been sweeter see the real person? I wonder. For sometimes, our roles are than the first pay cheque since I became ill, back in 1994. deeply entrenched. And certainly I had a lot of practice I struggle against fatigue and somnolence — but I really playing my role, which mainly consisted of waiting. Oh treasure my place behind the counter. I treasure it all the the hours I spent in waiting rooms; if I added them all up, more now, having stood in front of it for so many years. I I could have written novels. suppose it’s nice to have both perspectives now — but ac- tually I think I’d like to get beyond counters altogether. I currently spend less time waiting — about half as much Eventually I’d like to see less “behind” and “in front of” as I work part-time. How difficult was the climb, just to get and more “side by side”: less role-playing and more just where I am now (though my pay cheque remains small). being. That day may come, and I hope to be a part of it. In There were tears in my eyes at my college graduation, the meantime, I continue my flight up the down escalator. stunned tears. How often the effort had seemed like run- At the very least, it keeps me in shape. My Struggle Toward Film School

Patricia Duncan, t has been a permanent lay in achieving my artistic ing School “to have some- British Columbia to study BSpEd challenge in my life to ambition can be directly as- thing practical to fall back for a teaching degree in Ihave been born a cre- sociated with what I see as on.” I found office jobs very Special Education. One of ative artist with an active interference by staff of the boring and I had a spirit for my professors nominated imagination into a family Vocational Rehabilitation adventure. I decided to get me for the AJ Dauphinee which valued practicality Services (VRS) of what used a job that would give me Award, which was a bursa- and judged my creativity as to be called the Ministry money to travel. ry given to “an outstanding something I could only ex- of Social Development and female student in the field press as a hobby. This con- Economic Security. The It is important to note that of teaching children with Patricia is a flict led to years of justify- name of this Ministry has I always tried hard to be learning disabilities.” consumer-survivor ing traits that I inherited. changed several times over very good at whatever pro- advocate and the nine years that I have fession for which I got The birth of my son inspired recipient of a I first saw the film The Wiz- been entangled in the red training. When I graduated a career switch from nurs- Lorne Fraser ard of Oz when I was nine tape of VRS bureaucracy as a Licensed Practical ing to teaching, because I Educational Fund years old. My family and I and what I feel to be their Nurse at age 21, I received recognized that it would be bursary from were living in Northern Ire- discrimination. the award for Best Bedside difficult to get child care CMHA land, and I was determined Nurse. In those days, it was while doing shift work as to somehow get to the place Although I wanted to go to significant, because practi- a nurse. For a few months, I that could make such a fan- art school on the recommen- cal nurses were responsible had actually attempted 10 tastic film. Finally, at age 54 dation of my art teacher for all bedside care of hos- training to become a Regis- after many trials and tribu- when I graduated from high pital patients. Many years tered Nurse, but gave up. lations, I am able to plan to school, my parents insisted later, after my son was born, attend Vancouver Film that I take a Clerk/Typist I transferred from Langara I became a consumer of School in Fall 2001. The de- course at Vocational Train- College to the University of mental health services in

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 consumer experiences and perspectives

1987. It was not until I had to my becoming a film mak- Gastown Vocational Servic- which I’ll be able to com- been unemployed for a year er: one time it happened es’ tests indicated that I plete part-time courses in in Nanaimo in 1992, that I while I was actually hold- should be working in the producing and production found out about VRS. I had ing a book on female job op- field of visual and perform- planning at Vancouver Film a growing child with med- portunities in BC which ing arts. School as of September ical, dental, nutritional, and included openings in the 2001. I have already begun clothing needs to support; BC Film Industry. Something marvelous hap- to do research for my first thus, parenthood became pened that saved my sanity script in — what else? — the driving force behind my In attempts to escape the MENTAL HEALTH! determination to recover and regain socioeconomic security. In my opinion, the chronic poverty that my son and I have been forced to endure — and which con- tinues to this day — is a di- rect consequence of the lackluster performance of oppressive control over all my VRS contacts whose my career choices that VRS behaviour sabotaged my has imposed, I have sent recovery many times. out resumes to all the school boards in the Low- Looking back, I can now say er Mainland, resulting in I had just as with certainty that there one horrible interview. ““ much chance is distinct discrimination Now it has been eleven against people with mental years since I taught and I of succeeding illness by consultants who would have to go back to and helped me realize that as anyone, work in VRS. For example, university for refresher one way or another, I will even though my psychiatrist courses or a Masters De- be taking film study cours- and it was time in Nanaimo wrote a letter gree to get rehired; VRS es in Fall 2001. I received a for me to get stating that there was no doesn’t fund either. letter from the BC Division medical reason why I could of Canadian Mental Health help to go not work full-time, my VRS Over the years, I have been Association that informed to film consultant withheld fund- asked to provide numerous me that I had been award- ing because he decided that letters from my doctors con- ed $500 from the Lorne school. I did not handle stress well! cerning my competence to Fraser Educational Fund, ”” That initial note on my VRS work. The heroine of my which would go to the reg- file has haunted me all the VRS meetings is my case istrar of the school that I way down the line through manager, Diane Krane. Af- will be attending. I have every consultant who has ter a delay of two years to been accepted by Vancou- handled my case. give me financial assistance ver Film School and have to study motion picture applied for a student loan. During the nine years that production at Capilano Col- I have been involved with lege, Diane bluntly told Ultimately, Student Serv- VRS, I have been referred to VRS that she had observed ices awarded me a Student other agencies for related that they always seemed Loan that fell $9,000 short support services including to “have an agenda hidden of the $23,000+ tuition of Gastown Vocational Servic- under your agenda,” that I Vancouver Film School. I es, PACT Employment Ser- had just as much chance of seriously had to review my vices of Coast Foundation, succeeding as anyone, and plans! VRS had insisted I and THEO BC (when it was that it was time for me to complete part-time cours- formerly known as Arbutus get help to go to film school. es to “prove” my aptitude Vocational Society). I did for film. In the end, my fam- gain better computer skills VRS had insisted on me be- ily encouraged me to use 11 as a result. However, I have ing assessed by an occupa- their help in combination been exposed to constant tional therapist who said in with the CMHA bursary I references to my age and her report: I can do it! As had already been awarded. gender as being “barriers” long ago as Spring 1996, This means a compromise in

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 consumer experiences and perspectives On the Road Again Victoria Maxwell ost of my life, I’ve further debt and illness or Mtaken work for accept the disorder and granted, along with the begin to eke out a living Victoria speaks on cynicism, apathy and and a smarter lifestyle. It ‘Wilderness Tips for boredom — took it for was my choice, of course. I Bipolar Illness,’ granted until I couldn’t chose the latter. My deci- ‘Depression in the work at all. Four years sion though was not moti- Workplace’ and ‘The after a diagnosis of vated by virtue. No. My Power of Humour and rapid-cycling bipolar decision was propelled Healing’. She is disorder, I was unable to WORK in no small way by fear: currently writing a volunteer, let alone work. AHEAD basic, unadulterated creative non-fiction fear; and by the loving en- book and play. To In 1992, my former vital couragement of wise par- reach her, contact — albeit chaotic — life as ents and a good doctor. her at healthyliving2 a working actor came to a @hotmail.com startling halt. After a brief psychotic reaction following a I moved back in with my folks — God bless their willing period of intense meditation, I was diagnosed with bipo- souls. Next I quit my Safeway job (this part wasn’t so hard. lar illness. At this point, I split my time between cashier- Leaving polyester behind was one of the few things I could ing at Safeway, decked out in their signature polyester actually look forward to). I went on social assistance and uniform, and acting on local film sets, lured by the dream applied for disability benefits. And I left the world of act- of fame and infinite access to good shoes. After the first ing to others who had a higher tolerance for rejection. psychosis, I had an all-inclusive stay at ‘Club Medication,’ also known as A2: Lion’s Gate psych ward. Then, after I now faced a new frontier: what the hell to do with the several manic episodes, four psychotic breaks, innumera- rest of my life? Dr. Dillon, my ‘meat and potatoes’ men- ble bouts of depression and three hospital stays, I sat in my tor, had the uncanny ability to make the practical sound psychiatrist’s office. seductive. He came from the school of psychiatry that was simple, strong and unequivocally caring. His suggested It was now 1996. My illness still hadn’t stabilized and I goal? Learn to support myself and stay that way. Find a was unable to return to work. I stood at a painful cross- career, get a job, and move out on my own. roads. What was my next step going to be? It had to be a realistic one. And the ones I’d made so far obviously The first of many fears that surfaced was that I’d discover weren’t working. Dr. Dillon, my psychiatrist, didn’t en- that the one and only talent I had was that of acting. Not a courage or even suggest I leave acting. I did. I needed to. readily marketable skill. During the following time of ca- For the sake of my sanity and dignity, I needed to walk reer exploration, I had the assistance of countless people away. Acting is a punishing career regardless of your re- behind me, cheering me on toward my coveted target. The silience. At best, it’s unpredictable; at worst, it’s down label ‘mental illness’ can, all by itself, dismantle the stron- right dangerous. I didn’t need stardom; I needed stability. gest sense of self. Support is not a luxury in recovery, it is a necessity — at least it was for me. In the four years after the initial psychosis, I had accumulat- ed a hefty debt, and was getting very little work as an actor. I started with the Vocational Rehabilitation Services (VRS) Both my financial and artistic reserves had been tapped dry. and underwent testing at Youngs-Ferris Vocational Agen- I could continue living in denial and quickly spiral into cy. The very act of taking this almost overwhelming bat- tery of aptitude and interest exams helped me recapture some of my former chutzpa. After several weeks, the tests were complete. Yes, I had a knack for acting, but I also had strengths in areas I hadn’t even considered: market- ing, media, and interior design. I narrowed it down to marketing.

I hadn’t worked in over four years. I was unsure if I could 12 even work a full eight-hour shift. At the downtown Mood Disorders Association office I happened upon a brochure: GVS — Gastown Vocational Services, a pre-employment program for those with a mental disorder. I decided to investigate. A wait list. A long one. But lo’ and behold…a

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 consumer experiences and perspectives loophole. I lived on the North Shore. I wouldn’t have to The couple I worked for was remarkably patient. They wait as long; something about regional quotas. GVS was helped me travel the terrain from what I only thought I the most pivotal factor in getting me on my employment could do to actually doing it. When I began, I wasn’t what feet. It was a three-month program, six hours per day, you would call computer competent, so VRS sponsored me three days per week. Its purpose: to help people return to to take a basic course. I am proud to say I am now only work — whatever kind of employment that may be. moderately computer illiterate.

The format of the program forced me to be punctual, reli- As my time on the clock accrued, so did my confidence. I able and committed. It gave me a routine to schedule my belonged. I was making a contribution — however small I other activities around as my illness stabilized. Bipolar felt it to be — and getting paid for it. I discontinued welfare disorder, especially the depression, has an insidious way and settled my debt. My dream of self-reliance was immi- of making structure seem pointless, and goals unfathom- nent. In 1998, I moved into a house with two other women. able. When I had fellow students and instructors expect- About a year later, I bought a used car. Then in October of ing to see me, I became more likely to show up, even if it last year, I moved into my own apartment. I had wheels, a was only not to disappoint myself. pad and I was single. Sex In The City: look out.

The work placements available through GVS were invalu- As I reassessed my goals, I decided to return to writing and able, not to say the least bit nerve-racking. My job coach, acting. I vowed it would be different. I pledged to maintain Peter, was a godsend, my touchstone. When anxieties the healthy quality of life and financial stability I’d fash- reached their typical zenith and I wanted to walk, he was ioned. It was essential to my sanity — literally. my bridge to reality. He would calmly listen to my panicked cries of ‘I can’t do this’…or ‘what the *#%! do I do now?’. He Last May, I co-wrote a play, began a novel and started would gently ask me to take a breath and slow down. We’d giving speaking presentations on the very illness that put then tackle the problem at hand — if there was a problem me in this position. These events marked my initiation at all. Usually it was a case of insecurities running amok. back into the world of theatre and film. I make the ma- jority of my money working part-time as a mental health During one of my work placements at a small marketing worker and as a ‘background performer’ on local film company, the owners offered me a full-time position. I sets. It doesn’t always feel secure or even smart, but the didn’t know whether to jump for joy or run screaming in self-esteem I’ve recouped by returning to the work I love the other direction. With calm reassurance from my par- makes it all worthwhile. ents, Dr. Dillon, and Peter, I accepted the job. This was a test. This was definitely a test. I built my challenges slow- I appreciate being able to be bitter about working on a ly: working first three days per week, then shifting to five. sunny day. I’m happy just to be able to go to work. Period.

personal and institutional Darren Campbell Consumer Education problems that face me and many other consumers. Education, training, work- and Employment tion to Computers course. I place practicums and em- felt comfortable at the school ployment counsellors are used to take education illness has placed between because it has created a great, but until issues such Darren is a I and employment for me and my career goals, I try consumer-friendly environ- as funding, old student loan consumer living granted. If I worked hard to stay motivated and hope- ment. Tuition was free, class debts, and money manage- in Vancouver and applied myself, I knew ful. Unfortunately, I have sizes were small, and the ment are straightened out, that my education and train- struggled to translate my workload was manageable. consumers will continue to ing would lead to a good job academic success into satis- I found the staff to be pro- find their educational op- and a great life. That was fying employment. fessional, understanding portunities limited. Lately, back in 1995, when mental and knowledgeable about the transit strike and labour illness did not dominate my My education as a consum- the barriers that consumers action have forced consum- life. Since then, learning and er took place at the BC So- face. The structure, support ers to delay their education working have become much ciety of Training for Health and flexibility of the school and lose their jobs. This up- more complicated. A diplo- and Employment Opportu- helped me to succeed even sets me tremendously be- 13 ma or a degree is no longer nities (THEO BC). While at during my darkest days. cause the chronic nature of a given, and a high-paying, THEO BC, I graduated from my illness means that I need stable job is just a dream. De- a Building Service Worker While attending school, I to learn and work when my spite the obstacles that my program and an Introduc- learned about many of the mental health is peaking. If

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 consumer experiences and perspectives

always felt supported and dards Act, unions, disability Our next issue of Visions (due out in early spring) respected. rules and regulations, geo- is on Anxiety Disorders in Children and Youth. If graphic isolation, a lack of you have a story idea you want to share, contact our editor Eric Macnaughton at (604) 688-3234, It felt great to contribute to transit, and so on and so on. toll-free at 1-800-555-8222 or via e-mail at society by earning some There are so many barriers [email protected] money of my own. I made to employment for consum- some excellent connections ers that I sometimes wonder I miss my window of rela- a part-time job for nine with my co-workers and I what the point is of getting tively good health I may not months. Eventually, my men- enjoyed the structure, re- educated and trained if be healthy enough to attend tal health becomes so poor sponsibility, and extra in- there are no suitable jobs af- school or work for months, that I have to leave. Unlike come that my job provided. ter graduation. and an opportunity is lost. many consumers, I worked I know that I was lucky to for an employer that created find a good job with a great All of society’s stakeholders When it comes to my at- a consumer-friendly work company; many consumers need to create a consumer- tempts at employment I’ve environment. I didn’t have to aren’t so fortunate. friendly job market. This is had to learn to judge my worry about disclosing the major challenge, but if success according to the my illness to my employer Consumers’ employment op- employers and consumers effort invested rather than because they already knew portunities are limited by are willing to be creative the results obtained. I’ve about my health problems. personal mental health, stig- and flexible, I am sure that only been able to hold on to There was no stigma and I ma, the Employment Stan- great strides can be made. From Devastation to Dedication

Kathy Smith am a mental health consumer who runs her own home- maybe it was my attitude toward my situation — my own based secretarial/communications business. I am also stigmatization — that was holding me back. I a freelance writer, specializing in mental health is- sues. Three years ago, at the age of 37, I found myself out of I have always been a very resourceful person, and this Kathy is the work due to a mental health issue from which I continue to skill is what has helped me get as far as I am today. I have founder of Smith suffer. It was a completely unexpected turn of events in an excellent ability for networking with others and being Secretarial & my life as I have always had the ability to work, starting able to research solutions for myself. Recently, I was suc- Design Services from the age of 16. To suddenly find myself ill and unem- cessful in obtaining a business loan through the ABLED in Victoria ployed was devastating. (Advice and Business Loans for Entrepreneurs with Dis- abilities) Program. This loan is much larger than the grant Having a strong desire to keep working despite my cir- I had previously applied for and has enabled me to fully cumstances kept me going. No matter how awful I felt or furnish my home office with up-to-date computer equip- what was going on around me, I vowed that I would keep ment and supplies, etc. working somehow. After much deliberation, I decided the best Going through the application process was a great learn- thing to do was to work from ing experience. It really made me pinpoint exactly what I home. That way I could have wanted to do. I also had to explain how I was going to more control over my health and manage my disability while working. This was also a very still do the kind of work I loved. good thing for me — to get clear about how I would work In 1997, I applied to a local em- when not feeling my best. ployment agency’s grant pro- gram and was awarded a small For me, having someone else with a similar skill set and amount of money to help with office experience that could support me was the ticket. start-up costs for my secretarial And luckily for me, my sister Vikki fits that bill. Vikki works business. I settled in, waiting for in my office twice a week, and while she’s here, I make the onslaught of new clientele, most of my appointments. When Vikki is unavailable I but clients were few and far be- also have another work colleague and my husband upon 14 tween. Was this due to my ‘dis- whom I can rely to be on hand. ability’ — the inability to leave home? In part, yes, but I have What is also good about Vikki’s help is that if I am having a since learned that that doesn’t particularly bad day, she can look after anything urgent, so have to be a barrier — and that the work gets done and I get some rest or whatever it is I

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 consumer experiences and perspectives Employment for Consumer-Survivors: What I Can See From Here any of the presen- within mental health, if we health. Some of us manage clients” or “my ladies.” Of- Jill Stainsby tations at wish to pursue them. This programs that employ other ten, the most difficult thing the recent does not appear to be limit- consumer/survivors. Some for a peer supporter is to MWorld Assembly for Men- ed to BC or Canada. of us manage organizations maintain a bit of distance tal Health conference in and projects that go from from their client and not Vancouver had to do with Consumer/survivor employ- grant to grant. give him or her their own employment possibilities ment in the mental health home phone number or see Jill is a for consumer/survivors: system or community is on For example, peer support him or her outside the peer Consumer peer support programs the increase. Mental health programs have proliferated support role. Support Worker throughout BC, Gallery support workers who them- throughout BC over the last for Vancouver Gachet artists’ cooperative, selves have diagnoses are few years, and they are of- “Supported employment” Community the Ontario Coalition of commonplace now at many ten staffed by consumer/ initiatives like peer support Mental Health Alternative Businesses, a housing facilities and ser- survivor administrators as are not costly, to say the least. Services, of the self-harm workshop and vice agencies. There are well as peer support work- They work well as top-up Vancouver/ training program for ser- several local self-help orga- ers. This “stepping stone programs for consumer/ Richmond vice providers, a play about nizations, which by defi- approach” to employment survivors who may be on Health Board recovering from mental ill- nition require that their — typically twenty hours a Disability Benefits, but they ness, and many booths employees have a diagnosis. month, on a six-month con- do not replace full-time or staffed by consumer/survi- Advocacy programs are tract — has been steadily even half-time employment. vor employees of several of staffed as far as possible growing. A provincial Peer Transition from peer sup- the local mental health or- with consumer/survivors. Support Resource Manual is port work into other em- ganizations. currently being distributed ployment is still difficult. There are also significant (see p. 30), which will as- Hopefully, several current I believe we are “coming numbers of consumer/sur- sist local communities in de- initiatives in the province, into our own” in terms of vivors who regularly work signing their own programs. including the supported employment in mental on contract doing research competitive employment health. This is an exciting, and building community Peer supporters find their initiative and a consumer- energizing time for con- consensus around different work challenging and ful- run business planning sumer/survivors in many mental health initiatives. filling. They are providing project, may help address ways, both with reference to Some of us write policy. support and/or assisting this gap. our ability to influence pol- Some of us are profession- other consumer/survivors icy and regarding our access ally employed at all levels to accomplish specific goals. When I started work in to employment possibilities within health and mental They often talk about “my mental health in 1994, I felt cont’d bottom of next page need. In the best of all worlds, I’d like to be able to hire my I have been a freelance writer for the past eight years, sister on a more permanent basis and also have home sup- specializing in mental health issues. I write about people To learn more port services available for days when she’s not here, but it and organizations in a sensitive, unbiased manner. Being about the will be some time before I can afford it all. sensitive and diplomatic are qualities I learned from work- ABLED loan ing in the mental health field for over five years with a program Even so, I am coping without all the services I need. Just variety of consumers, families and professionals. Kathy used, getting this loan has been a huge boost to my self-confi- see page 29 dence. Now that my business is finally official and taking I know I will be successful. And I’m learning not to self- on several new clients, I know I’ve made the right choice. stigmatize! Just because I work from home and have this I do what I do for several reasons: first, I have to work for disability, it doesn’t mean I don’t have what it takes to 15 my own mental wellness; second, it’s extremely important make it. I have a wealth of work experience. I have self- to me to give back to society by helping others; and third, determination. I have passion. And I know working in I love doing what I do. mental health is what I was born to do. With support from my family, friends and co-workers, I can’t go wrong.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 SERVICE PROVIDER PERSPECTIVES Getting Back to Work

Allyson Muir t’s a good day in vocational rehab when one of your Preparing for this article, I asked two clients two questions: clients calls to tell you he or she got a job. This is what “How is looking for work different for you now, having Ithe team works toward — occupational therapists, job experienced a mental illness, than it was before you were coaches, psychologists, and most of all, our clients. But a diagnosed?” and “What are the issues that a person with a lot precedes this moment. For people with mental illness, mental illness faces in looking for work that a person with- the road to work can be long. out a mental illness doesn’t face?” Their responses were similar. Both mentioned that they now had to take into con- Allyson is an Clients coping with chronic mental illness face many dif- sideration personal limitations that they had not before: “I occupational therapist ficulties in entering or re-entering the work force. The vo- have to look more realistically at what my limitations are — cational rehabilitation process is not a linear one. We what I’m realistically able to do versus what others think I have had clients “drop out” of the program, only to come should do.” One client, formerly self-employed, noted that Reprinted from OT back a year or two later and tell us they are ready for the she now had to be more conscious of the stability and struc- Line, June 2001 next step. And they are. People who have been out of the ture offered in a job: “Being aware of having to slow down, workforce can be surprised by the new work environment. to be in an environment that supports my health. I wouldn’t Dress codes, social proprieties, interview styles and resume have considered this before.” formats are constantly changing. Time needs to be spent helping people adjust to the new work realities. Many cli- Both had concerns about disclosing their illness to prospec- ents identify an exciting career goal, but find they do not tive employers or co-workers. As one put it, “You feel alien- have the training or education to pursue it and need to ated by the so-called normal people.” The other said, “You access training opportunities. don’t know whether it’s noticeable or not. The amount of energy you spend on trying to look ‘normal’ is exhausting.” Over the years, most of our clients have provided feedback Clients’ self-confidence has often been eroded, and self-doubt as to what they have found helpful in returning to work. is common. One client said, “It’s hard enough having a men- Learning to catch the early warning signs of illness and tal illness when you’re not employed, but all the symptoms having as much control as possible over their symptoms are magnified when you have to perform at work. Now you and reactions to stress helps people to remain stable and have to show up and be responsible to someone other than positive, helps them to get and keep a job. Time manage- yourself.” These are challenging issues, but they can be met ment, goal setting, learning to set personal boundaries, and with perseverance, support and encouragement. The results accepting and giving constructive feedback have all been are well worth the effort. identified as important skills.

What I Can See From Here — cont’d from previous page like a fish in a glass bowl. My analysis, from having deficit in the workplace admit to any frailty, without As far as I knew then, I now come in to two or three than they do — this takes consequences. was one of few consumer/ organizations as an employ- between one and two years, survivor employees within ee with an acknowledged routinely — they relax and The stigma that we all know the system. It had not been mental health diagnosis, is then some of them disclose so well can play a negative something I had planned to one that I have shared with their own mental health role in anyone’s life. I think do after I completed my ed- other service providers at history to me. Typically for that perhaps for service ucation. However, opportu- workshops and casually. this group, they have not providers within mental nity knocked in the form of disclosed this to their em- health, the stigma of self- an ad in the Careers section When I begin work in a ployer. disclosure of a mental ill- of the local newspaper, and new mental health organi- ness might be worse than I was one of the successful zation, the service provid- I find this mostly sad. It for an employee in any oth- applicants for a position at ers with whom I come into seems that even — or per- er industry. To me, this is the Riverview Hospital. Now contact do what they are haps especially — in men- opposite of a healthy work- some years later, I believe I trained to do with their cli- tal health, employees who place. I can only hope that, 16 belong in mental health, ents: they look for any so- are providing support and as more of us with diagnoses given that I was already cial/mental/emotional assistance to clients often do become employed in men- both a family member and deficit. Once they become not feel that they can re- tal health, we will be able a consumer/survivor in my accustomed to the fact that quest this kind of assistance to shift this perspective. own right. I have no more or less of a for themselves or even

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 17

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 service provider perspectives Keys to Success: Get the Job you Want! Cathy Johnson hen I was asked employment specialist. Hav- You can make to write a few ing decided to take the road your wishes Wwords on employ- to employment, here are a come true! ment and the keys to success few tips for job seekers and information on Decide to do from the professional per- those families supporting the types of jobs and something spective, I had to ask myself family members in their em- what they require, and ad- worthwhile! what would be the most im- ployment goals. vice to help you choose and Cathy is the portant steps to get the job plan long-term goals and Employment you really want. How to dis- Approaching work can be how to effectively job search. Programs cover your best skills, ex- daunting for most individu- While you Coordinator plore career alternatives, get als. Where do you start and The specialist can often con- may not be at PACT the job fast and how to do what the dickens do employ- tact employers on your be- able to do everything that Employment well in the new job — all of ers want? What does work half and develop a position you want, good planning Services of these things came to mind. mean to you? Work can be to suit your needs. And the can help you get closer. Vancouver-based Information for job search just a way to earn a living or employment specialist will What can you do now to start Coast Foundation can be found everywhere: in extra money, or something be most helpful to support making your dreams come Society the library, on the internet you have to do to eat and you once you are working. true tomorrow? Take action! and at employment offices have a place to live. Or work Be clear about your goals and and community agencies. can be what you enjoy do- To succeed as a job seeker set up something you can do For more ing and/or a way to help and a worker, you need to to meet them. Get a coach to information There are a number of ques- you do something you feel understand an employer’s help you or find a peer that about supported tions that individuals and is important. However you point of view. Many people is working and knows what employment, please families might want to ask feel about work now, your feel that an employer thinks it is like to look for work. Join contact Cathy Johnson themselves. What natural feelings are likely to change differently than the rest of others who are job seeking. at (604) 877-0033 supports are available? during your lifetime. us, but employers are just There are job programs and or cathyj@ What are the positive and like you and me. Try to think community organizations coastfoundation.com negative influences of the To do well in a competitive like an employer. Consider that will offer you a self- medication I am taking? and rapidly-changing job what you’d want your em- paced introduction to work. What do I know about my market, you need a new set ployees to do and you can fig- illness and the symptoms of survival skills. The best ure out what is expected of You have hundreds of skills. that might present during approach is to sit with a you as a worker. And know- Most people do, yet very few work? What is my need trained employment spe- ing what employers want are able to explain their for income and how will cialist to develop a plan that will help you present your- skills to others. You may take my benefits be affected by suits your individual needs. self successfully when you for granted many things you employment? Am I happy The specialist will guide are looking for a job. do well that others would where I am currently living you through a number of find hard or even impossible and can I look for a job while steps on getting to know No one can know you better to do. One study of employ- living there? These seem- yourself, your interests, than you. There is more to life ers found that three out of ingly simple questions can hobbies and past training than work. While it is often four people interviewed for be discussed with a skilled and skills. They will have an important part of your life, a job did not present the your work is only one part of skills they had to do the job. how you spend your time. Most people don’t have the The ideal job is one that is language to present the skills satisfying. It will help you they have. Knowing what enjoy what you want in life. you can do well is important You need to consider what is because it can help you de- important to you and how cide what kind of work is much time you want to work. right for you and find work 18 Having the natural supports where you ultimately can be around you to encourage you more successful. It is also is an important aspect of the important to do things you job search. enjoy doing because if you enjoy what you do and are

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 service provider perspectives good at it, your job and your life will be more satisfying. Job Coaching 101 Explore your skills with an employment specialist or try to use your skills as a volun- t is hard work keeping a job. Managing a mental illness can add to the demands of Karla Barnes teer to see what you like. And a successful and satisfying career. Studies have shown that “ongoing contact with a when you do get a job, put support person is one of the best predictors of job retention for workers with a your energy into it and do it serious mental illness.” 1 I Karla is a job as well as you are able. The job coach model is a component of supported employment for persons with severe coach at Laurel Surviving on the job takes mental illness. The Capital Mental Health Association Job Coach Program focuses on Enterprises, Capital skill. When starting a new supporting people once they have obtained employment. Job coach support can take Mental Health job you will probably feel place on the job or away from the work site. On-the-job support usually takes place when Association, Victoria a bit of fear. You often don’t an employee is starting a new job or returning to work after a leave of absence. When meeting an employee away from the job, getting an ac- know what to expect and Managing work and mental illness how you will fit in. Not get- curate impression of the climate and demands of the job ting along with other peo- can be difficult. Three strategies to deal with this chal- ple who work there is the lenge are meeting the client on breaks during the work „ have a support person you can talk to about work number one reason people day, being available by phone for support, and provid- „ find a mentor at work leave jobs. Not getting along ing a work journal to the client in which they can note „ look for comfortable socializing opportunities at work could affect your produc- issues as they occur. They can then bring those to the „ plan interesting things to do on your work breaks tivity on the job. Asking for a next meeting with the job coach. „ do not work through your breaks good orientation and train- „ learn to identify early warning signs of stress piling up ing on your new job and When providing employment support, it is important to „ learn as much as you can about your illness talking to your support peo- be aware of the following: „ practice stress management techniques such as meditation, visualization and exercise ple during this adjustment ➊ A job is often a person’s identity and livelihood and „ have a life outside of work period will help with this should not be treated lightly; sensitivity and an em- „ make sure you get enough sleep and eat healthy foods stressful time. powering approach are essential. „ communicate clearly with your supervisor ➋ Providing support during the job loss process is a Enjoy life. It’s sort of the same crucial role of the job coach. as having fun, but lasts long- ➌ A holistic approach as a job coach is important, since personal problems can affect an er and means more. Most employee’s work performance and their mental health. Talking about the problem people don’t find the job can provide some relief and help the employee focus on work. Other times, a referral search to be a fun experi- can be made to the appropriate service. ence. Don’t get discouraged by the rejection involved. To During the four years I have held the job coach position, I have worked with a number of avoid failure, some find lots people employed in a wide variety of occupations. Repeatedly, I have witnessed a great of ways to avoid looking for deal of courage and tenacity by many of these individuals who have struggled with the work; of course, delaying symptoms of mental illness and still managed to remain committed employees. your job search just leaves you unemployed longer Job coach services than you want. Don’t get discouraged! The best way On-the-job support can involve: † meeting with the employer and client to address mental health and performance issues to shorten your job search is † problem solving with the client around work issues to structure your time, have † working with an employee during the orientation phase of the job good supportive people around you and approach Support away from work can address issues such as: your time as if your job † problem solving work-related issues † improving work skills † requesting workplace accommodations † preparing for a new job search is your job. Practice † time management † stress management the communication skills † disclosing the employee’s mental illness to the employer † developing healthy work habits you will need for when you † coping with the symptoms of a mental illness and the side-effects of medication at work start your job. Looking for a job is hard work, so take ______time for breaks. And take Related Resources 19 time to take care of yourself. 1 Steinberg, W. (2000). Making it work! A resource guide to supporting consumer participation in the Someone out there needs workforce. Toronto: CMHA National Office. 2 Furlong, M., Jonikas, J. A., Cook, J. A., Hathaway, L. & Goode, S. L. (1994). Providing vocational you — and will be happy to services: Job coaching and ongoing support for persons with a mental illness. Chicago, Illinois: have you as an employee. Thresholds National Research and Training Center.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 provider perspectives My Work as a Consumer/Provider

Ingrid Olson am an ex-mental patient. I always will be. It’s as at CMHA and served on their board and Gail knew me Mercer much a part of my identity as being Icelandic. I now quite well. She believed in me when I wasn’t sure I be- work in the same clubhouse, Laurel House, (a pro- lieved in myself. Having a mentor or job coach or some gram of Capital Mental Health Association) where support person is a real blessing to someone struggling to I was once a member. One member said to me: “Gee, return to the workforce after suffering bouts of mental ill- Iwhen I get better, maybe I can get a job here too.” I said, ness. A person’s self-confidence has usually been blasted “I certainly hope so.” I believe I offer a model of hope to all to pieces, and fear of recurring illness is always at the others that they can get a job here (or somewhere) too. back of my mind. I went to an IAPSRS (International Asso- ciation of Psychosocial Rehabilitation Services) conference One of my more radical friends feels that I have sold out, in Detroit where I presented the consumer’s point of view Ingrid is a calling me a “mental health prostitute.” I used to work at about CARF (Commission on Accreditation of Rehabilita- recreation a completely consumer-run activity centre, but it was all tion Facilities). It was a big leap forward. I was very ner- coordinator volunteer work. It was valuable work, both to me person- vous and apprehensive, but I’m so glad I pushed myself to at Laurel House, ally and to the community, but it was unpaid. I did a lot of do it. Once again, my mentor Gail gave me the encourage- Victoria unpaid volunteer work and it was all worthwhile, but ment I needed. when I got a chance to get paid for what I do, I jumped at it. Being paid is one way of being valued. I started work at We consumer/survivor/ex-patients have the lived expe- Laurel House in February 1995. rience of mental illness which provides us with knowl- edge and wisdom that is valued by many receptive people I started slow, working one-and-a-half days a week, so in the mental health field. When I presented at another that I wouldn’t become overwhelmed. I sure didn’t want IAPSRS conference in Minneapolis, Gail introduced me to to fail again. After one psychotic episode where I wound Donald Naranjo, the president of IAPSRS, leading me to up in psychiatric intensive care, my employer at the time apply to serve on the Board of Trustees of CARF (I was sent me a letter firing me while I was still in the hospital. elected in December 1999). Donald has been a valued men- I hadn’t done anything wrong on the job, but they didn’t tor as well. Gail also encouraged me to pursue an APRP want me back. (Associate Psychiatric Rehabilitation Practitioner) desig-

nation, which I was granted in June 2000.

I was very lucky this time because the Executive Director ” of Capital Mental Health, Gail My job is Recreation Coordinator at Laurel House. I take Simpson, was behind me all the people swimming, bowling, golfing, camping, on nature way. I had done volunteer work walks, out to coffee houses and libraries. I teach basic com- When I got a puter skills and public speaking. I assist in Qi Gong and Tai chance to get Chi. The beneficial effects of all these activities aid me in my own ongoing recovery as well as my clients. While learning paid for what to understand their illnesses, I learn about my own. They I do, I jumped generously share their wisdom with me. I’m not entirely free at it. Being of symptoms, but I’ve learned to live with a certain level of paid is one discomfort and to never let my stress level get too high. way of being I am very fortunate to work in and help to create a healing, valued. restorative environment. I am part of a five member team with a very supportive supervisor, Terry Miller, who has the ” great talent of bringing out the best in people. I would strong- ly encourage consumers with an interest in psychiatric rehabilitation to pursue a career in this field. There’s an excellent book: Consumers as Providers in Psychiatric Reha- 20 bilitation. (1998). Eds. Mowbray, Moxley, Jasper & Howell and published by the International Association of Psychoso- cial Rehabilitation Services. I was fortunate to attend a one- day presentation by some of the editors and authors of this book. It is an invaluable resource for consumers.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 ALTERNATIVES AND APPROACHES Rehabilitation Resources in BC: Preliminary Findings

he BC Supported that would be appropriate to ties (30,000-200,000), the cooperation, and interplay David Wells Competitive Em- the specific needs of the following challenges have between various em- ployment Initiative mental health community been noted: ployment and rehabili- has three thrusts: the are often incompatible with „ Disability employment ser- tation services and firstT seeks to change policies the limited resources and vices lack the resources funding agencies — that create disincentives to expertise of most communi- and expertise to support ongoing funding and employment for people with ties in BC. Second, as com- people living with men- viability is tied to case- David is the mental illness; the second munity size and resources tal health disabilities — loads and utilization Director of the seeks to disseminate infor- increase, so too does an en- services often lack the statistics rather than BC Supported mation about “what works” vironment of protectionism more direct linkages outcome measures, re- Competitive with respect to creating ef- in which service providers with community health sulting in a protectionist Employment fective programming; the isolate their clients from services. There is not a mentality where indi- Initiative, third seeks to enhance the other service providers in lot of cooperation or vidual agencies operate administered capacity to provide rehab- the community, creating a communication across in a silo protecting their by CMHA ilitation-related services silo effect in which clients the disability communi- caseloads from en- BC Division throughout the province. and programs may not be ties or the employment croachment by other Because of these three ele- ideally matched. services communities service providers. This ments — policy, education, „ Political environment is not conducive to the and capacity —the project is Small communities around resources and ser- creation of a full range known as the PEC initiative. In smaller communities vice delivery — funding of employment and re- (<30,000), the following from federal, provincial habilitation services The first step to enhancing challenges have been noted: and regional health that reach all aspects of capacity is to achieve a „ Few or no mental health sources is often not co- the mental health com- greater understanding of specific employment/re- ordinated, resulting in munity. The lack of the vocational rehabilitation habilitation resources at a situation of unneces- cooperation and com- resources that we already all, beyond the clinical sary administrative munication also means have in the province. So as services offered by the duplication, or con- resources and services part of the PEC initiative, an local health centre — versely, resources are do not go where they environmental scan is being little or no mental not activated as they are are most effective. An done in order to start to cre- health expertise or singly inadequate to individual-based ser- ate a provincial inventory of training with regards support employment vice model is compro- resources. At this point, we to rehabilitation and programming mised by a system can provide some prelimi- employment „ Lack of program evolution where the interests of nary insights into the state „ Single employment re- and competitive change the service agency are of employment/rehabilita- source, responsible for — employment pro- paramount tion services throughout the serving the entire popu- grams often develop „ Missed opportunities province, in relation to the lation — little knowl- ‘favoured child’ status through lack of cross- state of resources in large, edge or expertise in that precludes competi- sectoral communication medium, and small-sized working with people tive ideas or options — greater insights may communities in BC. with any disabilities, let from entering the com- be gained from under- alone psychiatric ones munity. The relation be- standing what has been Trends „ Narrow focus — services tween service and successful with other Each size of community available in those com- funder often becomes disability groups and currently faces various munities fortunate too closely entwined, other employment ser- structural and systemic enough to have mental preventing objective vices. Resources could challenges in the delivery health-specific resourc- performance evaluation. be further maximized if of employment and rehab- es serve only a narrow some of the existing ca- ilitation programming. part of the mental Large Communities pacity could be lever- 21 Thus far, two general themes health population. In larger communities aged for cross-sectoral have emerged from the re- (>200,000), the following service development search. First, employment Mid-sized Communities challenges have been noted: and delivery. and rehabilitation services In medium-size communi- „ Lack of knowledge,

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches The Individualized Placement and Support (IPS) Model: A Pilot Project of CMHA Vancouver/Burnaby

Elizabeth A. strong societal work ethic currently influences Ca- nal IPS program was brought in from Manchester, New Mackie, RRP nadians. The media warns us of the high cost of Hampshire. She provided training and information to the and Jonathan A social programs and the resulting government general public, specific stakeholders, and CMHA-VB’s Oldman debt. We might look to any number of examples in our Vocational Rehabilitation Counsellors (VRCs) around the entertainment and reading materials that urge us to make key principles of practice, which are: money and be successful. Sadly, however, Canadians with ‡ Non-existent entrance criteria — the only requirement for barriers to work resulting from mental illness have seen service is a stated desire by the consumer for paid com- Elizabeth is a little change in their employment status. In order to change petitive work Vocational this, we at CMHA Vancouver/Burnaby branch have adopt- ‡ The service forgoes pre-employment training — job search Rehabilitation ed the Individual Placement and Support Services Model is rapid (a time period for job placement of six months Counselor at the — which follows from the model first developed by Beck- is considered good) CMHA Vancouver/ er and Drake in New Hampshire — and are currently pi- ‡ Assessment is continuous — assessment begins with the Burnaby branch. loting that with mental teams in Vancouver and Burnaby. vocational counsellor’s initial contact and continues on Jonathan is the throughout employment Executive Director There are a number of differences between the new model ‡ Placement is based on a individual’s work preferences — pri- of the branch and the original which, as of October 1996, was known as or findings support that most consumers stated work Supported Employment Services. This original program preferences accurately reflect their work potential and utilized specific intake and assessment staff, facilitated that most consumers keep their jobs longer when they pre-employment skills training groups and employed job work in fields they have chosen developers. One drawback of this model was that con- ‡ The degree of assistance supplied to get and keep work is based sumers were required to meet and influence many staff on each consumer’s skill level (VRCs don’t perform tasks members prior to entering a job search process: first, the that consumers are able to do for themselves) intake and assessment staff member; second, a pre- ‡ Support is without time limit — consumers remain involved employment group facilitator; third, a vocational counsel- with the employment service long-term while employed lor; and finally the job developer. A more significant barri- ‡ The employment process is considered integral to a consum- er was that job developers were expected to “sell” the er’s medical treatment consumers to employers without the benefit of personal ‡ Employment services are integrated with clinical sites, both experience with a client’s skills, presentation, prior work being a part of the rehabilitative and recovery experience and most importantly what job accommoda- process. tions would be required. Other differences include the older model’s lack of coordination with clinical services Benefits to Date: and its emphasis on extended pre-employment process. Impressions from consumers, families and staff Research conducted during the development of the Indi- Integrating employment services with mental health teams vidualized Placement and Support model showed that con- has resulted in a variety of reported benefits by consumers sumers involved in pre-employment training experienced and family, IPS practitioners and clinical staff including no greater success in gaining employment than those not physicians and case managers. Consumers participating in attending training. In fact, those directly accessing em- this service provide encouraging comments: ployment services acquired work faster than those attend- ing training prior to a search for work . „ “The resources, support and encouragement are highly beneficial.” With these factors in mind, CMHA Vancouver/Burnaby „ “I couldn’t have got it together to do it on my own.” branch (CMHA-VB) began seeking a service method to „ “I need the support and encouragement to get out and better meet the employment needs of people with mental look for work.” illness. Having researched varying service models, the 22 branch entered into a partnership with Vancouver Com- A comment by a parent noted that the Vocational Counsel- munity Mental Health Services and the Simon Fraser Health lor is “always there for him, whenever he needs her. He is Board to offer the Individualized Placement and Support doing great, I am so proud of him.” “He is working now, he (IPS) Model of supported employment. In January 2001, a is a man,” said another parent who related that as the trainer/practitioner (Jennifer Marchand) from the origi- oldest employed male in his home, his son’s status has in-

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches creased dramatically. Staffing the IPS service has also presented challenges such Both physicians and case managers at a mental health team as the varied areas of individual expertise among practi- made the following supporting comments of IPS: tioners, the necessary high degree of commitment to the service vision, and the necessary faith in consumers as a „ “Barriers to service have been reduced in a variety of whole to grow and recover. ways.” „ “Team clients no longer have to navigate new bus routes; The term “pilot” may possibly imply a limited future and the clients are familiar with attending the mental may leave referrers, consumers and VRCs with a sense of health team and they can meet with the VRC when uncertainty or lack of confidence in the service. Of final they visit other team staff.” importance is the need to get beyond a few common mis- understandings some participants had regarding support- Clinical staff also spoke about the benefits of integration ed employment such as the belief that there is a formal job with the employment staff, for instance, about the ease of pool for a consumer to choose from. Another issue relates communication with the IPS worker, since informal con- to a lack of understanding about the competitive nature of versations can happen in hallways and offices without the employment experience where, with support, people with need to spend time for phone calls, faxes, and returning mental illness are expected by their employer to produce voicemail messages. VRC can now easily attend case re- results in the same way as would a person without such a views or supply observations about the effects of clinical disability. treatment changes on the individual’s performance at work, or about the individual’s readiness to start the rehabilita- All said, keep in mind that CMHA-VB’s supported em- tion process. Said one case manager, “In the past, when I ployment service has and is continuing to assist people to would refer a client to the old employment services they get and keep jobs. When we started, there were some peo- often were considered not ready.” A physician stated that ple with mental illness who were unsure they would get a “those clients who require more intense initial support job, those unsure of their ability to work, and service pro- could not have made the transition without the employ- viders disbelieving these same people could keep jobs. ment service at the team.” The report of one VRC stated, Those consumers are working now! “there is increased ease in accessing pertinent medical information.” It was also stated that “the vision is stream- Perhaps the most important reason for our success to date lined” and that “our role and task are clear.” A second is the philosophy behind the program: spoke to ease of the vocational rehabilitation process: “all areas of service, from receipt of the referral to job support, „ Work is a structured, purposeful activity are supplied by one staff person” where information is not that is central to our lives lost during communication between staff members. The „ Obtaining work is part of recovery from person commented also about the benefits of maintaining mental illness a coordinated approach once a client has started work, „ Everyone has the right to work adding, “It’s very exciting. I have observed the process, „ One who is motivated to work has the right to be wherein employment and the resulting conflicts and is- supported in their pursuit sues become a treatment focus — involving the case man- „ Everybody is valuable and we all have the right to ager, the VRC and the client.” make our own choices.

Clearly the IPS service has merits, but it has not come into place without difficulties. Change is never easy regard- less of how often we experience it or the benefits we can foresee, and the challenges of transitioning services were varied. We can all imagine the challenge of being sepa- rated from work friends and developing relationships with new colleagues, none of them having the same employer as you. In addition, a challenge is created in that medical treatment practices differ in philosophy and approach from rehabilitation services. Further, clarifying and negotiat- ing the VCR’s role has been an issue, given the clear limits and guidelines of the IPS model, which can seem to con- trast that of a possibly-overworked case manager. Some 23 consumers and service providers have expressed views that the definitions of the IPS model can limit options for service, although this issue may be less pressing once the program moves beyond the pilot stage.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches Gastown Vocational Services: Program Evaluation

Mariella Bozzer Background the wait list compare to participants’ anxiety levels were in work experience Gastown Vocational Servic- the program partici- stayed the same despite the placements, and 6% in vol- es (GVS), based in Vancou- pants with respect to stressors may indicate that unteer jobs. Perhaps if par- ver, was designed to provide the above three they were utilizing coping ticipants were followed a step-by-step vocational questions? strategies taught within the longer, greater employment approach — including as- program. rates would have been sessment, work readiness With the help of the psy- shown since many people Mariella is the training, work experience chologist on staff, we de- Participants were also eval- were still in the work expe- Program Coordinator and job search assistance cided upon the tools and uated by employer/supervi- rience phase. of Gastown — to helping individuals measures we could use to sors before and after the Vocational with mental health disabil- help us to objectively an- program on five key areas In summary, this program Services ities return to work. swer these questions and, of work behaviour: task evaluation demonstrated over a two-year period, we competence, social relation- positive results for the During an earlier phase of collected data on 60 partic- ships, confidence/initia- participants in terms of its existence, GVS staff con- ipants who completed the tive, authority/supervision improving assertiveness, ducted an evaluation of entire program. and work enthusiasm. Re- decreasing depression, im- program effectiveness and sults indicated significant proving work behaviour, published the results in the Results improvement in the par- and, for some, obtaining 1999 Canadian Journal of Results showed that partic- ticipants’ work behaviour jobs. The results demon- Community Mental Health. ipants did improve in their following the program, as strate that a step-by-step This article is a brief sum- assertiveness, while indi- evaluated by the employer/ approach to vocational re- mary of that earlier paper. viduals on the wait list supervisor. These results habilitation can have posi- The results presented here (which functioned as the were maintained at six- tive results, despite the focus on the twelve-week control group) showed no month follow-up. The wait rapid “place and train” ap- work readiness program, significant change in their list showed no significant proach advocated by such which offers modules in assertiveness. change, despite showing researchers as Dr. Gary illness management, asser- better work behaviour Bond. tiveness, self-esteem and With regard to participants’ scores at baseline assess- confidence building, as well level of depression, a simi- ment than the participants. It is apparent to this writer as management of stress lar pattern was evident. The that a variety of vocational/ and anger/frustration. participants showed a de- In terms of employment, supportive employment ap- crease in their symptoms of 22% of participants were proaches can be effective. Study Questions depression, with no change employed at six-month Ensuring individuals have The purpose of the research in the control/wait list follow-up in a variety of choice, adequate access and was to help answer the fol- group. jobs including computer information about pro- lowing questions: programming, advocacy, grams, and the ability to Anxiety levels showed no public relations, auto me- decide on which program ① Does the vocational change either in the wait chanics, bookkeeping, and best suits his or her needs is program help partici- list or the participant group. peer support. Also, 56% of utmost importance. pants to be more It was interesting to note assertive and improve that the anxiety levels of the their work-related latter group did not worsen skills and behaviours? while undergoing active Gastown Vocational Services is a program of the ② Do the program vocational rehabilitation. participants improve in There are certainly stres- their level of depres- sors, both positive and neg- 24 sion, anxiety and ative, involved in attending quality of life? a program and in entering ③ Does the program help new environments such as people to get jobs? work experience place- ④ How did the people on ments. The fact that the

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches Job Readiness and Outcomes Achievements: The Laurel Enterprises Model

Background There has been considerable debate over the past decade Once participants go through the program, there is a bi- Gail Simpson, or more about service models in the vocational rehabilita- monthly ‘graduates’ group (initiated under a grant from Harvey Teal, tion field. Themes have been “Choose-Get-Keep,” “Natu- the BC Division of Canadian Mental Health Association) and participants, ral Supports,” “Transitional Employment,” “ISP” which offers ongoing peer and team support through a Laurel (Individualized Service Plan), and “Place and Train.” Sup- dinner social meeting. A graduate may attend for as long Enterprises ported employment remains a major opportunity for peo- as he or she wishes to be involved; some come back after a ple with a mental illness who want to strengthen their period of time just to check in. community connections, and there are many methods of helping people do so. In my opinion, a lot of time has been About twenty people attend the LE program at a time. There Gail is Executive wasted debating the models. The fact is that probably all are 4 ½ core staff and for the past five years we have been Director of the are needed, and more as well, to achieve the goals of work fortunate to retain the services of half-time job and educa- Capital Mental for those who want that opportunity. tion coaches. The staff in these positions work mostly with Health Association people outside the program, but are also available to con- in Victoria In 1978, Capital Mental Health Association, unaware of sult with participants. any of these controversies, developed a proposal to the Harvey is the Federal/Provincial Work Abilities Program, in response Outcomes Work Experience to numerous requests from members of our modified club- Our contract with Capital Health Region’s Mental Health Coordinator, house, Laurel House, who wanted to become involved in Services lists program objectives as job readiness, return Laurel Enterprises the world of work. (The members suggested the name to educational opportunities and volunteer work. Those Laurel Enterprises to link the new program with its club who completed the initial-month assessment period suc- roots.) Our proposal was approved and became the first cessfully and graduated in the last year achieved the fol- psychiatric rehabilitation program of three in BC to be lowing outcomes: approved for funding under the Federal initiative; Laurel Enterprises was launched in 1980. job search further This article describes the core Laurel Enterprises (LE) pro- education gram, as well as the program component focusing on job and training search. Laurel Enterprises’ job retention services, through 10% the job and education coaches, are described in a separate 22% article on page 19. employment 17% Program Description From the start, we were guided in program development 22% by what the participants wanted and what their goals were. Today, as in the beginning, we have a continuous intake, and a weekly drop-in orientation where anyone who wants to know more about the services can come by. volunteer work

One aspect of the program consists of small-group life Job Search skills classes focusing on work-related topics. Each indi- If you ask a person who is recovering from mental illness vidual then designs a rehabilitation plan, with staff sup- what he or she would change about their life, often the port, based on each person’s goals. We also use simulated first response is “a job.” By that, people may mean they on-site work experiences and community work experi- wish to make a contribution to their community and to be ence in the area of interest of the participant (e.g., a retail recognized for that. Helping people find employment is 25 store, a restaurant, computer repair). Length of program the focus of individualized job search function at Laurel participation is very individual, and may range from a Enterprises. couple of months to a year, with the average length of attendance for ongoing participants being six months. Prior to initiating a search, there are practical barriers to

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches

overcome, such as the fact that a person receiving BC Some Comments from Disability Benefits has to earn more than minimum wage Laurel Enterprises’ Participants to make an equivalent amount; in cities such as ours, however, the economy is over-weighted with hospitality industry jobs which typically pay minimum wage to start. What does the program mean to you? So there are some challenges for the participants who are “The Work Abilities Program is most beneficial and helpful to job-ready and want to work. Several graduates over the persons with mental illness and/or for persons who have years have been able to enter provincial government jobs been out of the workforce for a long time due to a setback of through access programs which are very effective. some type. I am a person who had a “setback” in a time of my life when loss of self-esteem and depression did not help me For eleven years, we had a Federal Government (HRDC) in continuing my job search after completing a diploma program. The program — and especially the facilitators — contract to assist individuals with job search. Under this enable group participants to independently fulfill their career program, many people attained excellent jobs which goals, while being available for support and encouragement. matched their skills and interests. When that program The structure of the program enables participants to experi- devolved to the provincial level, a choice was made to ence what it would be like to work a day. I really appreciate address generic needs, rather than the needs of individu- having educational resources available and to be a part of a wide variety of skills-enabling tasks such as clerical, als of specific disability groups in the program mandate. woodshop, life skills, and a special-activities outing day.” Since then, the Laurel Enterprises’ work experience coor- dinator has offered individualized job search to people “I have found the program to be extremely supportive in with psychiatric disabilities from the general community many ways. After being diagnosed, I found making a career as well as Laurel Enterprises. change a great challenge. I was trying to reconcile a new career path, illness and fear of social stigma. I am able to Some participants merely need a person to talk with who rediscover myself and my options. Laurel Enterprises enabled me to spread my wings knowing I have a soft place understands the barriers that psychiatric disabilities pose to land should I need it.” to the job seeker. Others need and want more aid. This — G.A. might involve help with assessing an individual’s strengths, interests and skills. It could include help with “It gives me a chance to work and get together with others preparing a resume, practicing a job interview or locating that have the same problem as me. It gives me a chance to employers. All want ongoing support while they are look- show what I can do and learn things that I don’t know. Pat is ing for work. What is most important is that each individ- a fantastic instructor who should be here to give her time and energies until she is ready to retire; I have really ual chooses how much help and support they need. enjoyed and learned lots from her in class and out. I learn about looking after the front desk and dealing with the Job Retention people upstairs and going through my own fears and seeing Once a person has started a job, the question arises of ac- what I can do which I thought I couldn’t.” commodations or other supports to make retention more — Ken Williams likely. The role of the job coach is to provide ongoing sup- ports that help people develop and maintain their effec- “As a participant of the Laurel Enterprises Program, I have found that it has enabled me to clarify what I want to do tiveness at work, and to develop strategies to manage their concerning schooling and work. I have also found the illness on the job. program useful in maintaining a schedule, meeting new people and it gives me an idea as to whether or not I could Finally, we would like to take this opportunity to invite participate in a full-time job. What I have come to realize you to visit our programs “in action” if you are coming to while attending the program is that I would prefer to work part-time rather than full-time. I believe that I would be more the Victoria area. Just call (250) 389-1211 to make ar- productive on the job if I had a short work week.” — A.M.T rangements. Or you can check out our web site at www.mentalillnessrecovery.com “The program instills confidence and builds up my self- esteem at handling job-related issues that come up daily. It should help me attain goals over the next few years. I feel it’s helped me cope better with depression; therefore, I feel better about myself.” — Jeff D.

Nan Dickie’s “Laurel Enterprises is a place where I can explore my skills A Map for the Journey: and strengths and where I need improvement. It helps me to Living Meaningfully with increase self knowledge that enhances my life personally Recurring Depression and in a career-related way. I couldn’t do this alone without 26 the support from staff. I really appreciate the support.” — Dawne E. Available now on amazon.com

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches The Self-Employ Three Perspectives Project: on Rehabilitation Work-Creation Innovations Needs everal years ago, Kim Calsiferri, then of Greater Kim is currently Jane Loop Vancouver Mental Health Services, led a review of Director of SSthe rehabilitation services of the Vancouver mental Rehabilitation Jane is the coordinator of the Self-Employ Project health teams. Central to the study was a comparison of the Services for perspectives that three groups — consumers, family mem- Vancouver he National Network ple to identify and achieve bers, and professionals — held about the rehabilitation Community for Mental Health their employment goals — needs of people with mental illness. In the intervening Mental Health T (NNMH), founded in in whatever vehicle they years, the results of the study, which showed that in most Services, of the 1992, is a consumer-run, choose to create — through instances far greater needs for services were expressed by Vancouver/ non-profit society deliver- a coaching and mentoring consumers and significant others than by case managers, Richmond ing a variety of programs support service. have provided the impetus for significant reform. Kim Health Board in Canada. In 1997, this talked to Visions about the study and its impact. self-employment project Key to the service is coach- originated in Nova Scotia. ing participants to build Visions: What was the initial motivation for the study? Through success and some success upon success. Indi- KC: “At the time, there was very little rehab. We were also Human Resources Devel- viduals are encouraged to doing a review of services and there was an opportunity to opment Canada funding, become very clear on what hire staff at two of the mental health teams so it was a good seven sites are now active needs they want to meet in opportunity to do the study. We realized, too, that to deliv- across Canada. Recently, order to feel happy and pro- er services you have to look at what consumers say are the NNMH expanded its ductive. high priorities.” operations to Vancouver, opening the Self-Employ The guiding philosophy of Visions: What were the main findings of the study? Project in January 2001. our program is: “we feel KC: “With the initial study and with follow-ups that we that all individuals, no mat- did, the amount of perceived need was quite different, Some of our bold new ideas ter where they are on the since perhaps the case managers felt that some of the needs are refreshing and unique. come-back trail, have deep were being taken care of elsewhere. In terms of the area We believe that not only reserves of strength and of need, the same results came up again and again: dealing employment, but also the perseverance that can be with stress, living a healthy lifestyle, understanding one’s creation of employment it- tapped into and applied in illness, getting back to work and going back to school.” self, can be fun and reward- all areas of one’s life.” ing. The strong emphasis is Visions: What was the reaction to the findings? on developing a wellness Whether you are looking KC: “There were a range of reactions: some were not sur- plan to deal with the chal- for full-time employment or prised, some were surprised or there was a kind of denial lenges that creating self- a few hours a week, the pro- associated with an old belief system that getting a diagno- employment may bring. gram will help develop an sis, meds, support and a residential facility is all we can action plan that suits your do. Most people, though, were very interested in trying to Creating a wellness plan needs, because no one do something. The research was important because if there and finding employment knows what you need bet- is going to be any change, it’s important to have mecha- can impact other areas of ter than you do. nisms for people to discuss what their beliefs and ideas participants’ lives, bring- are and the research was a systematic way of doing this; ing about many positive So feel free to check out this all the programs we got off the ground were based on changes including high- warm, friendly service. The what had been identified by these studies.” er self-esteem, enhanced program is located at #201- problem-solving abilities 532 East Broadway in Van- Visions: Tell us a bit about the changes in employment and a renewed enthusiasm couver, open Monday to programming that came about as a result of the study? 27 for life. Friday, 9:00 to 4:30 pm. For KC: “THEO BC has refocused all its programs to have more more information, call flexibility with regards to training and supported educa- The program is entirely cli- (604) 707-9005. tion. Gastown Vocational Services has also become more ent driven, supporting peo- flexible and has added placement and on-the-job supports.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches

The Individual Placement and Support model [see article We also need our workplaces to be safe and supportive on p. 22] is being implemented at three of the mental health enough so that people with mental illnesses who currently teams in partnership with CMHA Vancouver/Burnaby work within the system are able to be open up about that. branch. With consumer initiative funds, we implemented This needs addressing in our system as well as the rest of peer support and now have a number of consumers hired society. We need a huge public education campaign to ad- on as staff within the teams. Related to this, we developed dress this. a project on consumer involvement in the workplace which looked at how to do a better job of employing consumers in Another area consumers should be playing more of a role the workplace.” in — and we’re moving in the right direction here — is the area of policy, implementation and evaluation of the ser- Visions: What other changes would you like to see vice system at large. The system also really needs to em- happen in the future? power people around their own care and rehabilitation in KC: “I’d like to see more consumers hired in the mental the services that are in place so that services can be a guide health system, in both the hospital and community sys- or a coach towards recovery. Sometimes people want be tems — if that’s what people choose. Because some people taken care of, but for the most part we have to be able to don’t want that, we need to have the kinds of programs to step back from that.” enable them to go back to school or to work in other areas.

The Self-Employment Option

Nan Dickie mployment is a benefits, and Employment directly by an employer or insurance (medical and necessity for most Insurance (EI). They do not purchaser for a specific ser- dental) and RRSPs. They people. We all need have to market their skills vice or product, not by a sal- generally do not have access money to survive, for each project they un- ary for a range of services. to employment insurance toE put food on the table. dertake, and for some, the The self-employed person (even if they would choose Paid work makes us self- workplace comes with a may sell services or goods to pay premiums for it as sufficient, that is, not reli- ready-made social circle. independently or through full-time people do), short- Nan is a freelance ant on government financial an agency. term or long-term disability, writer living in support whereby we feel People with mental illness- or company pension plans. North Vancouver we become a ‘drain’ on so- es cannot always choose Self-employment may be ciety. Furthermore, paid full-time employment for a full-time contract work, For some of us with mental work improves our quality variety of reasons. If our ill- seasonal (for instance, fish- illnesses who aren’t eligible of life immensely by in- ness is episodic, there will ing or fruit-picking), or an- for nor choose to use gov- Nan has recently creasing our self-esteem. be times when we have di- other type of intermittent ernment-funded employ- authored a highly- minished intellectual and/ work. Generally, it is either ment services, self-em- acclaimed book Fortunately today, paid or motor capabilities. We time-limited, or completely ployment becomes a way called A Map for work can be done in many cannot always take for dependent on the market- to accommodate our illness the Journey: Living ways, from a career-driven granted our constant avail- place. Whether one is in while meeting the need Meaningfully with full-time permanent job, ability for, or ability to, good health or has a mental to financially support our Recurring to part-time permanent work. illness, there is not, for most families and ourselves. For Depression work, to various forms of people, much security in us, there are distinct advan- (AmericaHouse). self-employment. Hence, many of us turn to self-employment. tages to self-employment. Find a review of it self-employment. Self-em- We can often work our own on our web site at Working full-time as a per- ployed individuals are Self-employed individuals hours (and take the break www.cmha-bc.org manent employee means the those who work temporari- must pay their own income or nap we may require, for or purchase it at worker is regularly paid, ly for one employer, or pe- tax (requiring time-con- instance), and work at least amazon.com gets conventional benefits riodically for different suming and often complex part of the time at home (and (including medical, and employers, or “work for accounting procedures). so hide tremours or other perhaps dental, insurance), themselves” offering con- They must frequently mar- physical vulnerabilities). 28 and has access to a pension tracting or consulting ser- ket their services or promote We can choose to work or to plan. Furthermore, full- vices, or a product of some their product. They are re- look for work when we are time employees are often sort (as those with home- sponsible for their own fi- well, and refuse work or re- assured sick leave, short- based businesses do). Self- nancial safety net (for move ourselves from the and long-term disability employed people are paid possible sick time), health workforce when our illness

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches ○○○○ manifests. Self-employed can’t meet the continu- people are able to bid on ous monthly payments. ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ ABLED: contracts that are of inter- „ Facing the possibility est to them. Furthermore, of being dismissed they can sometimes bid on from a contract at any Advice and Business the entire job itself, and not time or finding that we be paid on a per-hour ba- are not able to market Loans for Entrepreneurs sis. The advantage of this for our product properly. those of us with mental ill- „ Being continuously with Disabilities ness is that we can be guilt- responsible for F A C T less about taking the extra employment and health orty guests representing the ABLED Advisory Coun- About 300,000 working- time we may need to do the insurance, planning for cil, the disability community and service agencies age British Columbians job if we are recovering unpaid holidays, saving gathered March 22 for a community launch of have a significant disability. Two-thirds of from an episode or feeling for our retirement, etc. VanCity’s Advice and Business Loans for Entre- these people consider vulnerable to our illness. „ Having to market our preneursF with Disabilities (ABLED), a new source of capital themselves able and services or products and small business development for people with disabili- willing to work. Far too There are special responsi- over and over again. ties. According to Reva Dexter, vice-chair of the VanCity many people with bilities for those of us who This can be very Board of Directors, ABLED was developed with the involve- disabilities encounter obstacles that make it are in the workforce with stressful at the best of ment of community and stakeholder groups with one end in difficult for them to mental illness. We must try times, let alone during mind: “to make it easier for entrepreneurs with disabilities achieve this goal. to understand the pattern of recovery or when we to pursue their business goals and contribute to the eco- — Ministry of Social Development our illness as much as possi- are feeling shaky. nomic growth of the community.” and Economic Security. (2001). ble and monitor each cycle Enhancing Employment Opportunities for People with of mental health (if our ill- As well, we face other spe- “This loans initiative is a tool which the individual can use Disabilities. ness is intermittent). We cial risks by choosing self- for the start-up or expansion of their business,” says Mari- must be realistic about our employment: lyn Neudorf, VanCity’s Enterprise Development Specialist capabilities at all times; we „ If our illness is an who oversees the program. “The focus of ABLED is entre- may sometimes have to ask intermittent or episodic preneurship. It is not a training program or social support ourselves: is it time to quit one, we don’t know — ABLED is a self-employment option, a way to access cap- this contract because of a de- when the next episode ital. Strong referrals from the community are a critical fac- cline in mental health?; am may strike. tor toward the success of ABLED.” ABLED offers a valuable I well enough to return to „ We may have to quit a tool towards supporting people with disabilities achieve work when in the recovery contract or stop selling self-employment and self-sufficiency. For more information phase of an episode?; and, when we are ill on this and other not least of all, we must en- because we are not ABLED provides repayable loans for business start-up or Micro-Credit sure that our own frailties able to meet commit- expansion to entrepreneurs who are self declared as hav- products call and vulnerabilities to epi- ments of the job. ing a disability. The loan assessment criteria stresses the 1-888-VANCITY or sodes do not put other peo- „ It’s difficult to tell when strength of the individual’s character, the strength and via- contact Marilyn ple at any risk. we’re well enough to bility of their business plan, and a reasonable credit history. Neudorf directly at return to work after an Personal investment may be as low as 10% with substantia- (604) 709-6934. The negatives of self-em- episode. We may try to tion. The Enterprise Development Specialist provides busi- Telephone service ployment for people with return to work when we ness counseling and support, along with assistance with for the deaf call mental illness are basically are not yet mentally fit, development of business plans. To date, VanCity has assist- 871-5408 (TTY) those areas that one relin- or wait much longer ed four new businesses through ABLED. Sylvia Anne and Information about quishes when one does not than necessary to Marilyn Grace of “Chariots aLive,” two entrepreneurs with ABLED is available in work full-time. Most poi- market our skills or disabilities, and guest speakers at the launch, both agreed alternate formats gnantly, the disadvantages product again. that ABLED’s focus on reducing barriers and encouraging including Braille, of self-employment may be: ‘ability’ will be a boost to entrepreneurs in achieving inde- large print, Clearly, there are many re- pendence and business success. electronic diskette „ Not being able to count sponsibilities, disadvantag- and audio tape on a guaranteed es, and risks that people A public/private sector partnership with VanCity, Western income stream. This, of with mental illness face in Economic Diversification and Capital Coast Savings, ABLED course, has implica- choosing self-employment. provides entrepreneurs with disabilities who are unable to tions for any financial However, when we are able obtain financing from traditional lenders, access to busi- 29 dreams we may have. to work, we are contribut- ness loans up to $75,000. Loans can be used to start or ex- For instance, purchas- ing, productive members of pand a business, purchase and apply new technology, ing a home may be society. upgrade facilities and equipment, develop marketing and impossible because we promotional materials, or establish working capital.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches Peer Support Providing Employment Opportunities for Consumers

Marquise cross Canada, increas- two consumer-based orga- Societies identified $5,000 port Resource Manual is ap- Beaudin A ingly, the importance nizations. in one-time funding for proved for distribution. of self-help is emerging as mental health peer support a theme in progressive men- There were a number of “infrastructure” which It is the expectation of the tal health reform planning. steps taken in the creation would precede the annual- Ministry that the Peer Sup- Funding paid peer support of the manual. First, health ized funding. port Resource Manual and workers within the mental authorities were sent a sur- associated funding will Marquise works in health system is an integral vey, requesting information The annualized $150,000 help to promote the quality the Adult Mental aspect of this theme. about existing peer support for peer support programs and quantity of mental Health Policy programs and copies of will be made available health peer support pro- Division, Ministry of In recognition of the impor- their peer support training through the health authori- grams throughout the Health Services tance and potential of this manuals. ties, now that the Peer Sup- province. issue, the International Association of Psychosocial Then, the researchers, un- Rehabilitation Services der the guidance of the (IAPSRS) conference on Peer Support Steering Com- peer support in Richmond, mittee, reviewed these ma- November 1999, and the terials and information Hiring Ex-Patients provincial Mental Health from other jurisdictions to: Advocate both identified ‡ identify the values and the need for a provincial principles which as Staff inventory and resource underpin peer support guide on peer support and ‡ collect and categorize hey are a nurse, a social worker and a doctor — all the development of peer the different kinds of Tprofessional mental health caregivers at Eastern Mid- support standards. mental health peer dlesex Human Services in Wakefield, Massachusetts. Their support programs in BC common bond lies in their personal experiences as mental In January 2000, the Min- ‡ identify the key health patients. ister of Health announced elements necessary for $150,000 in annualized success in each cate- Amy, Dan, Deborah, and Linda meet together at least once funding for mental health gory of peer support every three weeks to share support around issues which peer support. In order to ‡ document some of the arise from their ongoing struggle to not only deal with make optimal use of this important consider- their own job-related issues, but to join in creating a model funding, advocacy organi- ations in implementing of treatment “where a patient is accepted as a person rath- zations, health authority mental health peer er than a diagnosis.” Eastern Middlesex is one of a small staff and existing peer support programs but growing number of agencies which actively hire ex- support workers recom- ‡ document existing patients. mended to the Ministry that programs, key features it create and disseminate and contacts. For most of the members of the support group, this was the to health authorities a pro- first job application where they felt safe in honestly an- vincial inventory of exist- The draft Peer Support Re- swering the question, “Do you have a history of mental ing peer support options, source Manual was shared illness?” “I used to deal with it by not letting it out — not which contained a descrip- with the Ministry of Labour completing it on the application. I’d work three or four tion of features of effective to ensure the language and years and then quietly let it out, once they’d gotten to know peer support programs. spirit of the initiative was me without a label,” said one. consistent with the Employ- A provincial steering com- ment Standards Act. For mixed reasons, group members were hesitant to let co- 30 mittee was struck and guid- workers know that they had been patients. One says, “I’m ed the development of the On March 15, 2001 a not willing to set myself up as an ex-patient, with such a “peer support manual” “funding letter” to Region- strong label that if I ever have a problem again, I wouldn’t project. The research and al Health Boards and Com- feel that was okay. For me, it is not something that hap- writing was contracted to munity Health Services pened 15 years ago, it’s an ongoing vulnerability.”

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches

Eastern Middlesex hired Dan in an upper management leaders readily acknowledge that life experience is as cru- position in 1987. They encouraged his being open about cial as academic training. “They never tell us to be careful his experience as an ex-patient. “There’s a positive in re- in what we say. They want us to do retraining with clinical ferring to my experiences as a patient, which breaks down staff. They understand that we are an important resource the role that people see me in as a psychiatrist. I kind of to the agency.” use it as an antidote, or balancing factor. But group members feel they need to be especially wary of Meg Simon Linda was extensively involved in the ex-patient move- being seen as experts. “The greatest challenge to re-en- ment and worked for a time in the first state-funded peer tering the field is in sitting back and not offering to fix support program in Massachusetts. “I was so angry at the everything. I have to constantly check myself.” way I was being treated in the system. I was getting what they had to offer, not what I needed — support not judg- They have been accused of being “too much on the side of ment; acceptance as the person I was, not seen as ‘defec- patient rights.” Does being an ex-patient blur the roles? Reprinted from tive,’ but as needing normal information.” She spent sev- “The difference between client and staff is not that we Resources, a eral years as a “conference circuit” speaker before seek- don’t have the same issues, but that I have boundaries and publication of the ing a position where she wouldn’t have to hide her back- commitment not to act out or burden them with my confu- Human Resource ground “not only in the interview but on the job.” sion. With our consumers, we tell them that their input to Association each other is equally as valuable as ours.” This has been a of the Northeast, Amy works as a psychiatric nurse. “I speak to having been positive experience for all four members of the group, al- Holyoke, MA, USA on both sides. There’s no stigma in having a broken leg or though they have been told that some patients have felt cancerous tumour; a physical breakdown is acceptable. I pressure: “if I had ‘made it,’ they would have to.” think now that we’ve started coming out as professionals in the system, we keep it more alive and present.” They feel that former patients have a great need to use self-disclosure in their work because the experience of Deborah struggled with the conflict in being both a con- being a patient receiving services in the system is in most blurring the sumer and a social worker. “I read an article on a psychi- cases a demeaning one which increases learned helpless- traditional atric rehabilitation program at Boston University that was ness. This disclosure should be used only boundaries supporting individuals to become part of the work world when needed by the patient, and not used of patient, once again. I called them and said I wanted to talk with based on the consumer/employee’s need. professional them, and that’s how I found out about my present job. professional Before that, I would go back to work and have relapses in Some members do not recommend and expert part because I felt that I was not being accepted for who I that an agency hire consumers from was; I was being labeled because of my diagnosis.” within. Clients may consider the person hired as receiving spe- After disclosing that they have been patients, group mem- cial treatment, and other po- bers say that it is not unusual for staff to comment, “Well, tential conflicts are in the you couldn’t have been really sick,” or for consumers to areas of confidentiality say, “You were never as sick as I am” or “You won’t be and peer support, the strong enough to help me.” group says.

Dan, in concert with a former member, started the support What should agen- group. “We decided that if we were going to be an agency cy managers know who hired ex-patients, we had to provide more support. to work towards an This is our dividend.” The group meets regularly and main- effective consumer/ tains regular contact by phone calls. They have no set agenda employee model? The or formal topic from meeting to meeting, believing that group suggests: the topics that come up will spring from issues they are dealing with. „ Be prepared! Recognize that more preparation is need- ed for the person coming in: you can’t just say, “He’s an “Many ex-patients’ groups are political. Anger comes up ex-patient.” An ongoing support group is essential. and they are bound together by their anger. I didn’t want „ Written materials: articles, studies, stories about how the anger of my past to be the only thing that motivated me staff at other agencies (both ex-patient and non-) have to work as an ex-patient. I didn’t want to be stuck in my experienced their work. A serious effort to cull experi- anger. I am angry about things from the past, but I need to ence, ideas and information on this issue is needed. 31 feel more positive.” „ Individual orientation: “Former patients will feel stig- matized on the job in a subtle way unless they accept People in key managerial positions at Eastern Middlesex the idea that life experience is as good as education. are open and supportive. Members of the group say these They may have anger at the way they were treated as

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 alternatives and approaches

patients, which may come out as trying to help people employee, and why providers felt that they provided the by working for their ‘best interests’ rather than ‘ex- services they did, will be invaluable.” pressed wishes.’” „ Exposure: the more dialogue and discussion with con- „ Mentor systems help. Especially important during the sumer/employees that occurs among staff, the greater first period of work is the presence of someone — not the acceptance for all concerned. “Sometimes it’s hard necessarily another ex-patient — the new employee to speak out. I fear that if I disagree, I’ll be invalidated.” can go to within the agency to discuss things. “None of The more people speak from experience, the less anxi- us really got to know well enough what was going on, ety and fear exists for staff ex-patients. the ins and outs. There’s a need to talk to someone else „ Knowledge: the group recommends that agency man- for debriefing if any of their issues get triggered as agers stay abreast of what’s happening in the larger they work.” world of ex-patients who have gone back to work with- „ Staff training sessions on empowerment and recovery in the system. Increasing the network, sharing updates are needed on an ongoing, formalized basis. These in- and workshops with other agencies which employ ex- clude two-way formats where ex-patients can offer patients can increase their success. Several members of points of view, although outsiders hired for the purpos- the group hold outreach meetings in the community es may be better able to deliver those views. “[Presen- where they educate others about returning to a work- tations on] what it felt like to have mental illness and to ing life. receive services from the viewpoint of the consumer/

At-Risk Youth Seek Employment

Jenny Simpson ovenant House street outreach, computer International be- access, and counselling. gan in New York The CSS’ objective is to pro- City in 1972 and vide transitional services Jenny is a former Cnow has over twenty loca- that give youth the best staff member at tions across North America possible outcome whether CMHA BC serving street youth, includ- they are seeking affordable Division ing two Canadian locations housing, employment, re- in Toronto and Vancouver. ferrals to other services, or The Toronto location opened whether they wish to begin its doors in 1982 and Van- a new path. There are 52 couver’s Drake street resi- full-time staff, 7 part-time dence opened thirteen years staff, 20 relief workers and later in 1995. The Covenant over 76 volunteers that House International message work at Covenant House. is best put by its President, Sister Mary Rose McGeady: Each youth that stays within “We try to give (the youth) the Residential Crisis Shel- back what the streets take ter is contacted daily by two away: dignity, health, safety youth workers and helped to and hope.” develop a plan for their future. Often this is where Covenant House Vancouver Employment Services step in. operates as a Resident Cri- sis Shelter that houses 22 There are two ways Em- youth per night and offers ployment Services aid the a Community Support Ser- youth who access their ser- vices Centre (CSS). The vices: through daily drop-in 32 Centre provides recreat- services which help by re- ional and vocational sup- ferring youth to potential port by supplying meals, employers, assisting with offering drop-in hours, as resume work, job search well as a clothing room, skills, lending clothing, and

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 OCCUPATIONAL PROFILES providing message servi- spite the available support ces; and through employ- in the downtown area, there What Ever ment training/internship is a great need for more, es- programs which last six to pecially for transient youth twelve months. and adults. Happened to Bob?: Funded by Human Resourc- Many of the youth depend es Development Canada’s on programs such as the A Challenge to Employers (HRDC) Homeless Initiative, Homeless Initiative to give the program placed over 20 them the support and inspi- and Union Leaders youth in entry-level jobs ration they need to seek em- from manual labour to ployment since many suffer lowly but surely depression, in all its manifesta- Rafe Mair food service in 2000. Hired not only the stigma of being tions, is coming out of the closet — though we’ve a for twelve months, youth “street youth” but also hav- long way to go; and one of the places we have to go gained new skills, on-the- ing a mental illness. The is the workplace. SS Rafe Mair is an job experience, and, in employment counselors and many cases, ongoing em- youth workers often have to Is there any among us who hasn’t wondered about good author and radio ployment. work with these youth very old Bob?: the “can’t miss” guy when he first came into the broadcaster with closely to ensure that they office, always a superior producer and clearly marked to his own show on Youth Build, the intern are able to make the transi- run the whole show, someday. But then it was booze — Bob CKNW. He is an project for 2001, is also tion from street life to stable was an alcoholic. Or perhaps he suddenly became moody Honourary Patron funded by HRDC and in- employment and housing and argumentative and didn’t join in the social activities of CMHA BC volves 15 youth who are despite their obstacles. any more. Or he was absent, it seemed, a day every week. Division gaining construction and Whatever — suddenly Bob was on the carpet and one day carpentry skills through Although Covenant House he was gone. It could have been Jane you watched fall their work with the non- and the given employers are apart. And maybe you were one of the folks that tried to profit organization Habitat aware and willing to accom- find out what was bothering Jane or Bob. Was it trouble at for Humanity. The program modate the youth involved, home? Was it a money problem? Health? You got nowhere. consisted not only of work illnesses such as depression When you think about Bob or Jane, there is, of course, the experience, but life skills can hinder the youth’s suc- personal tragedy involved, but there is also a very signifi- classes and high school cess at maintaining employ- cant loss to the company which trained them and did so education at Convenant ment. Many find it hard to much of their planning around them. Houses’ Gathering Place accept the success they find where many of the youth are and are also without access More and more companies are realizing that there may be completing grade twelve. to services that could help an obvious answer — depression — and that the obvious them through this period solution wasn’t found for two reasons: Bob and Jane couldn’t Many young people that such as support workers, talk about their problems and there was no one available enter Covenant House are mental health counselors, or for them to talk with anyway. The stigma is still there even emotionally vulnerable ei- peer support workers who though the “cure” — and often a 100% recovery — is so ther due to their previous liv- deal with mental illness. often available. Some companies deal with this through a ing conditions — either in human resources department and that’s fine. But there is a their homes or in transient Despite these needs, there better answer. Many larger companies use what’s called living conditions — and due have also been many suc- to poor health. A number of cesses when it comes to them have addictions prob- youth with mental illness lems, fetal alcohol syndrome, or emotional disorders. One on the streets. He was able not only see a future, but are attention deficit disorder, example is a young man to provide himself stability: also given the tools they need depression, and other men- with bipolar disorder who something which medica- to access the future they tal illnesses. Poor mental came to the CSS in search of tions and psychotherapy once envisioned for them- health is often one of sever- employment. He was then cannot offer alone. Employ- selves through the CSS at al barriers impacting the connected with an employ- ment and a sense of purpose Covenant House. search for employment as er who needed a shop help- are highly necessary steps well as safe and affordable er on a part-time basis. This on the road to recovery for If you would like to contact housing. Covenant House position not only gave him those with mental illness: Covenant House for more 33 staff often act as counselors the satisfaction of making especially youth at risk. information, or donate your for youth and also may pro- money and gaining inde- Through access to services, time or funds to their initia- vide referrals to other local pendence but also gave him youth workers and necessi- tives, please call them at mental health workers. De- the confidence he once lost ties, these youth are able to (604) 688-7457.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 occupational profiles

the Employee Assistance Program (EAP), a confidential that I would have found the help I did. I was lucky to have a outside service that guarantees that Bob and Jane need family doctor who had read up on the subject. The world of have no worry that their cases are being discussed by the commerce is getting much better at dealing with depres- brass over coffee. Why not extend this idea to smaller com- sion once diagnosed. The problem remains that it is not dealt panies through their trade or professional organization, so with soon enough. Help is available. Since I was diagnosed, that the cost is borne among many? Such an idea would be I have maintained a highly stressful daily radio show, sever- perfect for professional organizations whose members are al weekly columns and have written three books. Without often small units — such as doctors, lawyers, accountants help, God only knows where I would have been. and the like — and it also should work for trade organiza- tions, business groups and trade unions for that matter. So listen up, employers, professionals and union leaders — that big disappointment down the hall may just need a The biggest single barrier to treatment for depression is the confidential opening to get the sort of help he needs to stigma attached to mental illness. If, when I was diagnosed make your dreams for him come true. Why not create that back in 1989, I’d had to go to a company employee, I doubt opening?

Workplace Stress: A Modern Epidemic

Chris Allnutt hronic stress: apparent end in sight. some individual has poor and Safety committees and it’s one of the coping skills. Job stress is better labour relations. most serious The Hospital Employees’ not caused by individuals or Moreover, these healthier problems fac- Union, in response to mem- by personal qualities. It is work sites had low staff ing workers bers’ concerns about the rooted in the organization turnover and more experi- Ctoday. ever-increasing pressures of the workplace: structur- enced workers with consid- Chris is the Secretary- in the workplace, launched al issues such as the job de- erable seniority. Business Manager of It seems that everywhere we an anti-stress initiative last sign, physical environment, the 46,000-member look, on-the-job stress is out year. The foundation of the organizational culture The research suggests that Hospital Employees’ of control. It’s certainly true initiative is a booklet, the (e.g., “top-down” reporting good labour relations and Union, the BC Health in health care, where front- Workplace Anti-Stress structures), violence and participatory management Services Division of the line workers are paying the Guide, that not only ex- discrimination. Workplace practices can cultivate a Canadian Union of price in injuries, anxiety plores causes and effects of stress is an organizational stable, experienced and Public Employees and conflict. work-related stress, but of- problem that requires an motivated work team — fers tangible solutions to organizational solution. The and these workers will be Canada’s health care sys- this growing problem. only way to stop the damage relatively free of toxic stress, tem is feeling the strain of is to change the workplace. a prime cause of lost time. The Workplace Anti- budget cuts and increased Stress Effects Stress Guide recently patient demands. Downsiz- Normal stress is a fact of Workplace Democracy Workplace stress is pre- received an award for ing and restructuring are life, but ongoing stress at A 1990-92 study of Ontario ventable and fixable. There excellence from the commonplace. Patients and work is not normal; it’s work sites looked at the is plenty we can do togeth- Canadian Association their families are frustrat- dangerous. Studies prove relationship between low- er with co-workers, unions, of Labour Media. ed by delays and diminish- that chronic or “toxic” er Workers’ Compensation employers, government and Copies can be accessed ing services. Employees are stress wears down the im- Board claims and organi- other organizations to cre- on the union’s web site under enormous pressures mune system and causes zational culture. It found a ate safer, healthier and more at www.heu.org under to do more with less. Care physical and psycholog- correlation between lower respectful ways of working. “Publications,” or by providers are working ical problems. Everyone’s claims and management contacting the Hospital short-staffed and may be cheated by work stress. practices that encouraged Who Benefits? Employees’ Union at dragging themselves into workers to use their own Everyone benefits. It isn’t just 2006 W. 10th work even though they are People often think their jobs initiative and participate in workers who thrive when a 34 Avenue, already sick or injured. are stressful because they decision-making. Lower workplace is committed to Changes from the top of the have too much work, or WCB claims were also as- healthy job design and dem- Vancouver, BC organization seem to be they’re fighting with their sociated with lower griev- ocratic principles. The ben- V6J 4P5 or by phone never-ending. There’s just co-workers, or their man- ance rates, high-functioning efits are wide-reaching and at (604) 734-3431 too much stress, with no ager is unreasonable, or Joint Occupational Health extremely significant. In a Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 occupational profiles nutshell, workers have few- What makes a job less stressful? er injuries, illnesses and dis- abilities; job satisfaction Stress is high when a workplace lacks a respectful environment. The opposite is also true. increases; quality of work Workplaces with good labour relations have fewer injuries, less absenteeism and lower turnover. and productivity go up. In In a healthy work environment, you would have: the case of health care, pa- „ decision-making powers and the right to use your initiative tient care improves; employ- „ a reasonable workload „ support from supervisors and co-workers ers and governments save „ maximum use of your skills, plus opportunities for training and growth money due to reduced inju- „ an effective health and safety committee ries, sicktime, rehabilitation „ formal ways to work with management on problems including timelines for action costs, turnover, etc.; and the „ job-sharing, flextime and other options to help with family obligations economy and society as a When you have some control over your job, heavy demands are less stressful. whole are strengthened.

Depression in the School System

epression is widespread among Canadians, partic- struggling to cope with school despite her problems. Crawford Kilian ularly in groups and age ranges typical of teachers Dand older students. A 1995 Statistics Canada survey One Surrey high school counsellor who requested anonym- revealed that among adults aged 25 to 44, 3.5% of men and ity says she often deals with depressed students. “Boys are Crawford is a writer 8.6% of women had experienced a “major depressive epi- more likely to be in self-destruct mode,” she says. “They and instructor at sode” in the previous twelve months. BC teachers with up may drink and do drugs and drive too fast. Girls may drink Capilano College to twenty years experience would fall in that age range. and do drugs too, but they may also just slump or develop in North Vancouver Assuming BC teachers are typical of the general Canadian eating disorders. Boys are more likely to act out their de- population, then, almost two hundred male teachers and pression, girls more likely to be introverted, to shrivel.” almost a thousand female teachers experienced major de- Portions of this pression that year. Told these percentages, the former pres- If we apply the 1995 depression rates to BC post-secondary article appeared ident of the BC Teachers’ Federation didn’t hesitate: “I’d say students, we can estimate that in a given class of fifteen originally in the three to four times that number,” Kit Krieger replied. But he men and fifteen women, one male and two females have Georgia Straight. admits his union hasn’t broken down its statistics on why experienced major depression in the past year. This number They are reprinted teachers go on extended leave for illness reasons. arises partly from the 10.8% depression rate among females with permission of of traditional college age, 18-24. In addition, many part- the author Depression at other levels of education may be more wide- time students are women. Their median age is 25-29 and spread than we realize though, again, few institutions seem their depression rate (if to have formally studied the problem. Simon Fraser Univer- they are typical of Ca- Figure 1: Summary of Depression Rates sity lost a president to depression a few years ago. Most nadian women in that 10.8% college and university faculty can think of colleagues on age range) is 8.6%. By leave for mental health reasons. Others have stayed on the comparison, only 6.6% 8.6% 8.6% job while seeking private counselling, now provided as a of males aged 18-24 benefit by most post-secondary employers. experience depression, 6.3% 6.6% a rate that drops to 3.8% Based on the Statistics Canada survey of the depression rate 3.5% after age 25 (See 3.5% 3.5% in Canada, we can assume that hundreds of BC’s full-time Figure 1 for a summary college and university teachers also deal with depression; of all the above school but post-secondary faculty tend to be in their fifties, and the system statistics). women’s depression rate falls off after age 45 to 6.3%, while men stay at 3.5%. So the problem may not be quite as serious Chances are that very as in the K-12 system. few depressed students seek on-campus counselling or no- tify their teachers. Many may not realize what’s happening What about students? Statistics Canada estimates that to them. Some may see their physicians or seek psychiatric 35 41,050 Canadian male teenagers experienced a major de- help, but most literally suffer in silence. They will find it pressive episode in 1995, and more than twice that number painfully hard to study and to complete assignments. Good of girls — 93,423 or 8.6% of all Canadian girls between 12 grades mean little to them, and their own low self-regard cont’d bottom and 17. That means that about one teenage girl in twelve is will make them dismiss their teachers’ encouragement. of next page

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 occupational profiles Mental Illness in the Workplace: A Nurse’s Story

Anonymous y friend ‘Jane’ has I think what shocked me Jane was pretty open about with Jane, and the LRO sug- been a nurse for the most about all of this, her problems to her col- gested that she immediately M over thirty years. though, was seeing col- leagues. People knew she’d go on sick leave, as she need- She was diagnosed with de- leagues who care so much sought psychiatric help ed to take care of her own pression several years ago about their own patients and that currently her health needs, and also need- and continued to work as a turn on one of their own. It medications for depression ed to be away from a work- critical care nurse, while was quite obvious to a small were altered because they place where every day could trying desperately to find group of us that Jane was weren’t working. Still, none put her in more jeopardy of some happiness and stabil- not okay, but to the larger of us really knew what we being fired. The union then ity in her personal life. Jane group she was now an in- could do to help. We saw her began negotiating with our is a generous, kind and car- convenience, a focus for deteriorating in front of our employer to allow Jane to get ing person. complaints. The entire mo- eyes, while some of our col- the help she needed without rale of a unit was blamed leagues continued to com- losing financially. About a year ago, the medi- on Jane. plain about her behaviour. cations weren’t working As a result, Jane has been and Jane’s depression was People might assume that Eventually, of course, man- allowed to retire early, but overwhelming her. She con- health care workers would agement was watching. I has been ensured financial tinued to work, but was in- be more enlightened about was hoping they would stability, and I can’t believe creasingly stressed out at mental illness, but when the help her. Instead, Jane re- the difference in my friend work, and her colleagues ill person is a fellow nurse, alized that she was being now. She is involved in her began to complain about we’re not always respon- watched and felt even more community, enjoys her life Jane’s negative “attitude.” I sive. In fact, at the same time under pressure. She felt and has many friends who worked with Jane as well. Jane was ill, another nurse everything was being doc- care deeply about her. She Sometimes, it was pretty suffering from a physical umented as evidence against feels gratitude towards the frustrating because she was illness was showered with her, unless she could try to people who stepped in to negative and difficult to support and kindness. put on a happy face. Many help her. Jane still has de- communicate with. of us can fake a happy face pression, but with support when we’re having a bad and less stress in her life, is day, but I’ve come to realize able to cope with it. Depression in Schools — cont’d from previous page that when you have depres- sion, it’s impossible to do Looking back, I don’t think Failure, however, will confirm their low opinion of them- that. It started to become anyone in our work area was selves. obvious to her friends that intentionally mean, but just Jane might be fired. I was had little understanding Depression exacts a cost — not only on depressives and terrified about what she of what it is like to have a their families, but on society and the economy. We still think might do if her job and her mental illness. Whether you of depression as a failure of character rather than as a dis- financial resources were lost. believe in unionism or not, I ease, which is, doubtless, why it carries such a stigma. We believe my friend would rarely think of it as a direct cause of academic failure, alco- One day a Labour Relations have been fired and penni- hol and drug abuse, and suicide within the schools. Officer (LRO) from the Brit- less by now, if the union ish Columbia Nurses’ Union hadn’t stepped in to help. Education is not the only institution contending with both contacted me. The LRO told Although simply ‘having an depression and its denial; but depressed workers from all me that she had knowledge attitude’ at work isn’t very walks of life were all once part of the education system, and that Jane was, in fact, in strong grounds for dismiss- that system clearly failed to recognize their problem. If even imminent danger of being al, Jane was simply too frag- the most educated among us don’t want to confront this fired. I was called because I ile to fight for herself. After disease, then the prospects of those who suffer from it are had just recently become a thirty years of nursing, I do 36 surely that much harsher. When educators do face the prob- steward in the union, but also believe she was about to be lem and take steps to remedy it — not just pep talks and because I was Jane’s friend discarded, and that she real- Prozac, but tackling the social and physical causes of de- and could help support her ly would have just given up pression — then they and their students will be only the through whatever was to rather than fight. first to benefit. All of society will benefit as well. happen. We had a meeting

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 occupational profiles Reducing Work Stress and Improving the Work Life of Staff in Long-Term Care Facilities Introduction Stress in the workplace has been identified as a major cause Occupational stress in long-term care facilities has his- Gail Butt, of workplace injury and staff turnover. Because of intense torically been a significant problem for nursing staff, as a RN, MHSc, downsizing and restructuring of the health care system number of studies demonstrate. Occupational stress in Dr. Susan over the past decade, stress among nurses and long-term long-term care facilities has been linked to high rates of Kennedy, care aides has increased. injuries, high rates of absenteeism, staff burnout and staff Dr. Aleck Ostry, turnover.1, 2,3 It has a negative effect on staff as well as the Vita Kolodny, This article describes a two-year intervention, funded by organization, and more importantly, on the quality of care RN, MSc(A), the Occupational Health and Safety Agency for Health in to residents and their families.4,5,6 Dr. Reva Adler BC, and designed with representatives from the Care Di- rectors Group of the Lower Mainland, the Health Employ- While we know a fair amount about the impacts of occupa- ees’ Union of BC, the BC Nurses’ Union, the Registered tional stress, we know very little about what makes the Nurses Association of BC, and the Vancouver/Richmond work stressful, and thus little knowledge upon which to Health Board. develop programs to address this issue. Such programs, once developed, have the potential to improve services and The intention of the research phase of the project is to iden- to reduce the costs associated with staff illness, injury and tify the sources of stress felt by nursing staff working in turnover. long-term care facilities. During the second twelve-month phase, the research findings will be used to develop an Study Objectives education and problem intervention — involving both The main objectives of the study are to: staff and management — for use in three Lower Mainland 1) Conduct a survey that will identify the most signifi- facilities. cant stressors for front-line nursing staff (registered nurses, registered psychiatric nurses, licensed practi- Background cal nurses and care aides) in a group of long-term care There is an increasing demand for provision of long-term facilities in the Lower Mainland. care services, as the over-85 age group is the fastest grow- 2) Develop and test a program, in three facilities, that ing segment of the population. This growth is producing will use education and problem solving to prevent or pressure for more long-term care facilities. Residents in modify the most significant stressors identified by the long-term care facilities may be physically frail and/or front-line nursing staff in those facilities. mentally frail. The most frequent reasons for placement are 3) Design the project to serve as a feasibility test for fu- changes in brain functioning resulting in forgetfulness and ture randomized controlled trials to be conducted in difficulty managing the basic activities of daily living. other long-term care facilities.

Residents in long-term care facilities require help with Method things such as meal preparation, bathing, dressing, groom- A survey instrument measuring stress levels experienced ing, toileting, walking and socialization. They must rely on by front-line nursing staff in four domains was recently staff and family to do the things they can no longer do them- conducted using a self-administered questionnaire. The four selves. This dependency can be stressful for the elderly per- main areas under investigation are hypothesized to be im- son, their families and the staff. portant in generating stress: stress in general, working with residents, working with families, and working with staff/

Jane had a small group of work have thought about we would all react very dif- themselves in the same sit- people in the unit who how we reacted to Jane’s ferently. There is so much uation. For anyone else in a 37 wanted to help her, but we predicament. I think we all more we could have done to similar plight, though, I really didn’t know what to grew and examined our own support Jane. As co-workers, would recommend enlist- do. Something has changed behaviour. I really do believe there is much we could do to ing the support of the union, though. Many people at that if there is a next time, support others who may find just to be sure.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 occupational profiles

management. The questionnaire was distributed to staff in 35 facilities in the Lower Mainland. Canada Pension

The results are presently being analyzed. During the anal- ysis, the research team will identify major stressors for Plan Policy Changes staff and their frequency of occurrence. The results will be tabulated for individual facilities, as well as for the Karen Hobbs entire group. Once results are available, work will begin Karen is a Rights Advocate for the Mental Health with the three selected facilities to develop a program that Empowerment Advocates’ Program, a program of the will eliminate or modify the stressors identified in the Vancouver Mental Patients’ Association Inquiries about the survey. project should be sent to: Gail Butt, Initially, the three participating facilities will be given a People with disabilities, physical or mental, should always Administrator, report of the overall results of the survey and the specific be given the opportunity to improve their self-esteem. One Prevention and Care results from their facility. The research study coordinator way is by making contributions to society through paid or Management, BC and a skilled facilitator will work with the staff and man- volunteer work. There will always be people with mental Hepatitis Services, agement to discuss the issues, and to develop and carry health-related disabilities on Canada Pension Plan (CPP) 655 West 12th out an action plan. They will plan and facilitate monthly Disability Benefits who are capable of some form of contri- Avenue, Vancouver, meetings at each facility, act as a resource for obtaining bution. The problem has been that many find CPP rules on BC, V5Z 4R4 information, assist in problem solving and developing ed- paid work confusing and fear losing their benefits. ucation/training programs if required. They will also develop a package of resources to assist the facilities in A Bulletin from CPP (May 2001) announced a plan to make meeting their specific needs. it easier for everyone. This new policy is called the Allow- able Earnings Initiative. Basically, if you are receiving CPP Disability Benefits, you will be allowed to earn $3800 in ______2001 before you are required to report it to CPP. That is, if References between January 1, 2001 and December 31, 2001 (and there- 1 Boyd, N. (1998). Gently into the night: Aggression in long-term after) you earn money from paid employment, you do not care. Workers’ Compensation Board of British Columbia. have to inform CPP until you make $3800. At that point, you must call your local Human Resources Development Canada 2 Cohen, M. J. (1989). Sources of satisfaction and stress in nursing home caregivers: Primary results. Journal of Advanced Nursing, (HRDC) office. A case will be opened and a case manager 14, 383-388. will want to talk to you about what kind of work you are doing, how long you think it will last, and whether an as- 3 Holtz, G. A. (1982). Nurses’ aides in nursing homes: Why are they satisfied? Journal of Gerontological Nursing, 8(5), 265-271. sessment needs to be done about your capacity for regular work. There are other programs within CPP, such as the 4 Hay, D. (1972). The Psychological stresses of intensive care unit three-month work trial period, which may be discussed with nursing. Psychosomatic Medicine, 34, 109. you, but none of this starts until after you report to the HRDC 5 Norbeck, J. S. (1985). Perceived job stress, job satisfaction, and office. The policy is unclear at this point but as far as we psychological symptoms in critical care nursing. Research in Nurs- know, you will probably keep your benefits until you start to ing and Health, 8, 253-259. earn more than $775 per month. CPP feels that this new 6 Waxman, H. M., Klein, M. & Carner, E. A. (1985). Drug misuse in policy will prove to be more objective in assessing people’s nursing homes: An institutional addiction? Hospital Community capacity for work. They hope that it will encourage more Psychiatry, 36, 886-887. people on Disability Benefits to try out some paid employ- ment. The Bulletin specifically notes that CPP recognizes that some people will only ever be able to work a little bit, while some are interested in testing the waters to see if they will be able to return to the workforce. Not having to worry about the first $3800 should help out.

For more information, you can call your local HRDC office to ask about ISP Policy Guideline Allowable Earnings Bulletin No. 07/2001-CPP-01. If for any reason your file is being reviewed, or if you are only applying for CPP Disabil- 38 ity Benefits, or you are at the appeal stage and need some help, you may want to call our office at (604) 738-5770 and talk to an advocate. We attempt to stay current on many of the barriers to applications, especially new policy interpre- tations of the legislation.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 occupational profiles Avoiding Executive Burnout oday’s corporation is promotion dwindle. Warning Phase „ excessive irritability Michael no longer a stable or The warning signs are pre- „ emotional outbursts MacDougall Tsecure place. It is an Executives feel that they are dominantly emotional in „ development of uncertain, turbulent envi- at the end of an electronic nature: feelings of vague irrational fears ronment where executives leash, compelled to carry a anxiety, constant fatigue, „ inflexibility in thought often find their compassion beeper and cellular phone, depression, boredom with Michael is the and humanity in conflict and to check their voice mail one’s job, and apathy. Debilitating Phase Director of with the pressures of com- and e-mail messages on a If an executive somehow PricewaterhouseCooper’s petition and ambition. With continual basis to remain in Mild Symptom Phase manages to survive this de- Centre for Career a thrust towards mergers constant “touch.” As a result, If an executive chooses to structive final phase, he or Management in and consolidations to better they have raised expecta- neglect or ignore the early she is rarely able to contin- Vancouver. He achieve global positioning, tions about what the whole warning signals, they will ue working in the same can be reached corporations are involved in purpose of “vacation time” become fixed and begin to field. Careers end prema- at (604) 806-7074 a continual change process should be for both them- intensify. In this phase, some turely as do lives. Sufferers or via e-mail at that creates heightened anx- selves and those individuals physical signs are added to are usually quite sick, both mike.macdougall@ iety for all concerned. that report directly to them. the emotional ones: emotionally and physically. ca.pwcglobal.com Furthermore, they are ex- „ reduced emotional Symptoms include: The prevalent attitude sus- pected to stress teamwork control „ asthma tained by Boards of Di- accountability, open com- „ increasing anxiety „ coronary artery disease rectors, shareholders and munication, respect for di- „ sleep disturbances „ diabetes stakeholders alike is that versity, and coaching over „ headaches „ cancer Portions of this executives are seen as units managing. With all these „ diffuse back and „ heart attacks article appeared of investment who must en- added pressures to per- muscle aches „ severe depression in The Vancouver hance their return on invest- form, the workplace no „ loss of energy „ lowered self-esteem Sun. They are ment on a quarter by quarter longer energizes; it drains. „ hyperactivity „ inability to function in reprinted basis. The focus is on velo- „ excessive fatigue the job or in personal with permission city to generate revenue, It is becoming more appar- „ moderate social affairs from the author reduce costs, improve effi- ent that corporations do not withdrawal „ severe withdrawal ciency and enhance both have as firm an understand- „ nausea „ uncontrolled crying employee and customer ing of the human aspects of spells satisfaction. The question is restructuring as they do on Entrenched Phase „ suicidal thoughts whether executives are role finance and technology. The An executive who has al- „ muscle tremours models exemplifying excel- end result is becoming well lowed a prolonged stress „ severe fatigue lent coping skills, effective known as survival sickness, reaction to become en- „ over-reaction to growth and health manage- or burnout. This is generally trenched will suffer through emotional stimuli ment, and a proper balance caused by prolonged or cu- some of the most painful „ agitation of work and personal life. mulative long-term stress. conditions he or she has „ constant tension Recognition of it is not easy ever encountered. Career, „ carelessness Most executives would pre- since the condition is slow family life and personal „ feelings of hostility fer to be seen as “agents of to develop. By the time it is happiness are all on the „ development of change” as they go about noticed, permanent damage line, and immediate help is moderate to severe their work, restructuring to an executive’s health and essential. Signs include: thought disorders their companies to compete happiness may have been „ skin rashes in a changing environment. sustained. A major reason „ generalized physical Such burnout is almost to- However, many are branded for this is that many execu- weakness tally preventable if corpo- as corporate assassins with tives prefer to remain in a „ strong feelings of rations are prepared to ice water in their veins and state of denial for fear of depression create an environment in a pocket calculator for a being perceived as “dam- „ increased alcohol which executives are en- heart. In addition, manage- aged goods” — a strong sur- intake couraged to take sufficient ment feels pressured as sales vival instinct, but at what „ high blood pressure care of themselves, and if and production quotas con- personal cost? „ migraine headaches individuals know and heed 39 tinue to climb, but operat- „ loss of appetite the danger signs, and are ing budgets, salaries, travel Research has identified four „ loss of sexual desire prepared to keep their work allowances, expense ac- phases of stress reactions „ ulcers and home lives in balance. counts and opportunities for that can lead to burnout: „ severe withdrawal

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 DISCLOSURE, ACCOMMODATIONS AND PROTECTIONS Dealing with Disclosure of Disability: Some More Considerations

Joe Marrone n often-difficult erations to assist the job inform the employer individual find the job (e.g., and emotionally- seeker in deciding what to about the disability. Centre for Mental Health). charged issue for tell an employer regarding ‡ Can the Facts Be If the job seeker does choose many job seek- his or her disability: Checked?: Past to present information on Aers with mental illness is ‡ Personal Ethics?: employment history disability, it is usually pref- how much to tell a prospec- Does the job seeker and school records can erable to present that infor- tive employer about their view non-disclosure be checked by mation in person so that the disability. An employer as lying or simply employers, but other individual can gauge the Joe is with may ask all applicants for a omitting non-essential personal history (such reaction and address any the Institute for busy sales position how they information? as self-employment questions or concerns im- Community would handle stress and ‡ Is the Truth Better?: and medical leaves) mediately. Inclusion, in customer complaints. Al- Can periods of are less likely to be Portland, though this question may unemployment be scrutinized. If there isn’t any need for Oregon seem pretty straightfor- better explained by ‡ Effect on Job Seeker?: special accommodations ward, for the job applicant stating the job seeker Will telling (or not) and the individual can re- with mental illness who is had a problem and cause more or less ceive adequate support out- trying to account for peri- received help to apprehension for the side of work, but still feels ods of unemployment, or overcome the problem, job seeker? it is important to let the em- who will need certain sup- or by other explana- ‡ Consequences?: ployer know about the dis- ports or accommodations tions such as staying What will increase or ability, then the individual to be successful on the job, home to take care of decrease the chances might want to consider not what to say about the dis- family or being of getting and suc- disclosing the psychiatric ability may be less clear. involved in a family cessfully maintaining disability until they are This becomes even more business? employment? beyond the probationary difficult because by draw- ‡ Is the Truth Relevant?: period. Whenever disabili- ing attention to the mental If the job seeker can If the job seeker chooses ty-related information is illness, the job seeker may do the job and doesn’t not to disclose a disability, shared, it should be present- lessen his or her chances of need extensive their references need to ed in a way understandable getting the job. accommodations or avoid inadvertently doing to the employer by focusing support at the work- so, for example by mention- on what the job seeker has Below are some questions place, it is probably ing the name of the disabil- to offer and how past prob- that can be used as consid- not necessary to ity agency that helped the lems have been resolved.

To Disclose or Not to Disclose?

As an agency providing vocational services for people who have a mental illness, we are frequently asked questions by individuals preparing to enter the workforce on the issue of disclosing their illness to prospective employers. A key consideration affecting your decision to disclose, and your decision about the timing of your job search, is the 40 There are many aspects to this dilemma and the decision degree to which your symptoms are under control. This de- needs to be approached according to the particular situa- pends on you having a fundamental understanding of your tion and needs of the individual. However, there are some illness, including an awareness of the environmental fac- ground rules that bear consideration before arriving at tors that may contribute to an increase in those symptoms, your decision. such as undue stress. It also depends on whether you are

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 disclosure, accommodations and protections receiving the right kinds of support, as these will play a critical appointments, taking several “mini-breaks” instead pivotal role in maintaining good health. A supportive men- of a long lunchtime break, or starting later in the day. There tal health worker can act as a sounding board as you consid- are a number of accommodations that most employers Peter Phillips er these issues relating to your degree of wellness, and can would consider for a physical disability and as such should offer constructive feedback as to the timing of your decision be prepared to consider relating to mental health disability. to embark on the arduous task of the job search. The degree of understanding may vary from company to Peter is a company, depending upon the personal experience of key Vocational When you are feeling confident and secure enough about people and their knowledge and attitude towards mental Rehabilitation your career objective and the prospects for entering the illness (e.g., the company may be more supportive if the Worker at workforce, then you are ready to embark upon the next owner of the company has a son with schizophrenia and Gastown critical step of the process. This involves the compilation of attends BC Schizophrenia Society support meetings). Vocational a detailed resume, an ability to market your skills, and an Services in ability to provide convincing responses to questions about Accommodations should not be thought of or presented as Vancouver gaps in your employment history. You are now ready to en- requests for favours, but rather as necessary adjustments to ter into the interview stage, which is when that critical a person’s work environment that enable the employee to issue of disclosure needs to be thought through carefully. carry out his or her duties more effectively. In certain cases, this can be seen as a right, but may need to be handled Gastown Some of the factors that you may wish to consider are: sensitively around co-workers so that is it not seen as the Vocational n Do you have the required skills for the position? new employee receiving preferential treatment. Services can be o Do you have the work tolerance and physical endur- reached at (604) ance for the hours required? It is also advisable that the issues around mental illness be 683-6047 p Do you have the interpersonal skills that would enable approached with caution when talking to co-workers as you to feel comfortable with your co-workers and fit well as employers until some level of trust and understand- into the team? ing has been established. At the organizational level, there q Can you account for any significant breaks in your em- is still not a uniform level of acceptance towards mental ployment history due to illness with convincing re- health issues; therefore, a supportive environment and open- sponses such as a career change, travel, educational or ness for disclosure depends greatly on the awareness and skill upgrading, or even “for personal reasons”? attitudes of individual co-workers.

After strategically weighing up these factors you are now There are two specific situations where disclosure can be a ready to make a decision. Do I need to disclose because I am benefit, even for those individuals who may tend towards feeling insecure about a certain area? Or do I not disclose “non-disclosure” of their illness. The first is in cases where and “attack” the job search game with the same degree of a history of mental illness is considered an asset to the posi- confidence as a candidate who does not have mental health tion, such as in the mental health field, where knowledge of issues with which to contend. mental health services and resources and the ability to em- pathize with others are explicitly valued in the job posting. This choice of disclosure may come down to a specific mo- ment in the interview process when the interviewer asks a The other occasion when disclosure may be advantageous is question such as, “Do you have any health issues that could when applying for a position with a government agency or affect your ability to do the job?” This is that decisive mo- company adhering to the principle of employment equity. ment that could cost you the prospects of being hired! Your In this situation, there may be an opportunity to apply for a response should be weighed accordingly. If you believe that designated position as a candidate from a “visible minori- you have the skills and abilities to do the job, that your ty.” Often this category includes aboriginal people and peo- symptoms are under control, and that you can satisfactorily ple with physical and mental health disabilities as key answer the considerations listed above, then you can hon- groups given preference for such a posting, though some estly answer “No.” If, however, you have some doubts about research may be required to assess how many positions have your level of functioning due to your illness, then it would been allocated and filled for various minority groups. For be unwise to lie and answer “Yes” with the risk of termina- these positions, identifying that you have a disability can be tion should you become sick once employed. If you are not made on the employment application, without giving spe- asked the “health question” during the interview, you may cific details regarding the disability. choose to disclose and negotiate accommodations after you have been offered and accepted the job. So in conclusion, the issue of disclosure of a mental illness in today’s workplace remains an issue of personal choice Should you choose to disclose and you feel confident enough which requires careful consideration and planning. Think- 41 about your core skills, you may wish to enter into negotia- ing through some of the suggestions and guidelines dis- tions around what possible accommodations you may re- cussed above will enable you to make a strategic plan of quire to help alleviate a possible increase in your symptoms. action, which will hopefully lead to successful and ongoing These may be around such issues as flexible time-off for employment.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 disclosure, accommodations and protections Making Disability Accommodations

June Soroskie y name is June and I am a mental health advo- help if I’m in need of assistance. Also, the daily members of cate at the Vancouver Mental Patients’ Associa- the drop-in stop by my office frequently to see if they can M tion. You might be asking: what’s so different do anything for me or to just say “hi” and sit and talk awhile. about that? Well, I have been a consumer of the mental If I have a fax that needs sending, there is always someone health system. I’ve been treated for depression and through willing to run it upstairs for me. that I’ve learned the tools to keep me focused and under- stand the needs of others. My depression can be considered If I have a medical appointment I need to take, there isn’t a an invisible disability and is something that many people problem. There might be a day that I’m feeling a little suffer from, but I’m different because I also have a physical stressed, so I’m able to take a mental health day. We are also disability, which is quite visible. encouraged to take educational training courses that also help us do our advocacy work better, for example, work- June works for I have had a physical disability since birth, a defect that shops on the myths surrounding a mental health disability, the Vancouver restricts the movement of all joints due to a lack of complete on management of a difficult client with a mental illness, on Mental Patients’ muscle development before birth. I am unable to reach above identification of the different mental disabilities and their Association as an my waist or bend my knees, so going up and down stairs can characteristics, or on disability rights and law. It’s also im- advocate be impossible. There are times when I get depressed be- portant to understand that a person with a physical disabil- cause I’m unable to do the things that a physically normal ity can have a mental health disability. person is able to do. The criteria for being employed in this organization as a I’m fortunate that I have an employer who has made my work mental health advocate is having personal experience with environment accessible physically and psychologically. Stairs a mental illness and being able to establish empathy with are almost impossible for me to navigate, so an office was set someone who has a mental illness who is going through the up on the main floor in the drop-in centre for me. At first this system. We also have to be able to “self-identify” (i.e., dis- was difficult for me to adjust to, as I was being separated from close our illness to others), as we deal with persons who a team I had worked with for many years. This feeling of have a mental illness and also, possibly, a physical disability. separation soon lessened when it was suggested that the team meet downstairs every morning where I work to touch The personal pain and discomfort I have experienced have base and keep the communication lines open. There is a hand- not stopped me from assisting others wherever I can. I feel icapped-accessible washroom, and the door handles on the that I can understand and assist others because of my own office were changed to a lever and positioned at a height life experiences. I feel that everyone needs and deserves to that I am able to use. As well, a headset was provided to have people who listen and understand. The support I get at make my workdays easier because I’m unable to use the work allows me to make my experience available every day phone without some difficulty. The staff who work in the to help the people who need it, whether they have a mental drop-in are very accommodating and always willing to disability or a physical disability as well.

Disability Insurance Barriers here have been numer- now make up about 30% of against people who filed most in insurers’ or in em- Tous stories in the news the reasons for long-term claims for mental problems, ployers’ minds. Four situa- lately identifying stress and disability.” Another news as opposed to physical ones. tions I’ve discovered would other mental health prob- story reported that 47% lead me to believe otherwise. lems as a leading cause of of Canadian workers are Given the increasing media disability in the workplace. thought to suffer from stress. attention to workplace stress Donald Mayer An article in the Victoria In 1993, a Saskatchewan in the media as well as this One of the most drastic sce- Times Colonist stated that court ruling reinforced the court ruling, one would narios, where a denial of dis- 42 “mental and nervous condi- need for strengthening the think that equitability of ability insurance ended tions — from depression to position of persons with disability insurance cover- tragically, is the case involv- post-traumatic stress disor- mental disabilities by rul- ing short or longer-term ing Donald Mayer, a Langley der and psychotic conditions ing that insurance compa- loss of work due to mental truck driver whose psychi- such as schizophrenia — nies could not discriminate disorder might be upper- atric history began with mild

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 disclosure, accommodations and protections depression and ended with quest into this death was situation is that he appears the workforce, but because his death. this: if the insurance claim as a sufferer of the disorder he was “only a GP,” it was had been settled, or at least in a WCB-produced train- considered that his opinion The story unfolds in July of if some progress had been ing video educating BC didn’t count. 1999 when Mr. Mayer at- made, could this death have paramedics about this con- Barb Bawlf tended his doctor’s office been prevented? The jury dition. Anna was given 90 days in complaining of anxiety and supported more thorough which to get a psychiatrist’s insomnia, explaining that investigation into stress- “Samantha” report, but could not get to his Workers’ Compensation related disability claims, “Samantha” is a nurse who see one before the end of Board (WCB) claim for work- recommending that “adju- works with Alzheimer’s pa- that time, so was unable to related stress had been de- dicators of apparent work tients in Creston. She wrote get her disability cheques Barb is nied. At that point, his doctor stress claims should inves- to CMHA BC Division about re-instated. Coordinator of recommended that he take tigate the claims to rule out her experience taking time Consumer six weeks off work and pro- the possibility of a larger off from work due to clinical She has since returned to Issues and ceeded with the application problem such as clinical depression. Because short- work, but in a lesser-paid Peer Support process for short-term dis- depression and/or anxiety term disability was not avail- position than her previous at CMHA ability benefits. which has simply been able to her, she had to use all one. It is difficult for her to BC Division triggered by a work stress her sick days and then 21 predict when she is going to Mr. Mayer waited for a related event.” days of unpaid leave. She go into a down time again, decision on this claim, and then had to go on Employ- but she feels that her GP then on a decision on an ap- Richard Voight ment Insurance, which paid should be allowed to treat peal when his initial claim Another incident, quite dif- only 50% of her wages. Also, her and that his diagnosis was denied. While he wait- ferent but equally serious, she had to pay back some of should be validated. ed, his depression wors- involves a paramedic, Rich- her benefits as she had gone ened; by August he was ard Voight, who was de- over the number allowed. Conclusion expressing suicidal inten- nied WCB benefits after be- The commonality all the tions. In December, he was ing diagnosed with post- Samantha compared her above cases share is that referred to a psychiatrist traumatic stress disorder situation to that of a preg- obtaining disability insur- who offered a secondary (PTSD). The Vancouver Sun nant woman who is allowed ance for reasons of a mental medical opinion supporting published part of a letter to take time off from work health problem seems to be the disability claim, but from WCB to the paramedic with pay and benefits, feel- much more difficult than there was a delay in getting stating, “symptoms relating ing that the same treatment for a physical ailment. This that doctor’s report to the to stress or anxiety are not should have been afforded situation speaks to the insurance company. De- generally considered … to her. She could not get dis- broader problems of stigma spite the assistance of the constitute personal injury. ability to cover her time off and misunderstanding. mental health professionals There must be evidence that work of one-and-a-half When someone has a bodi- involved in Donald Mayer’s an injury … arose out of and months; the only coverage ly injury, it is visible, we can case, no progress was being in the course of work.” available was for long-term see it; when an individual made, contributing to his disability of six months or is wounded emotionally, the further deteriorating men- A further barrier is that longer. symptoms are not often as tal health. for post-traumatic stress apparent. disorder to be considered Efforts have been made by On December 17,1999, Mr. by WCB the result of work- Samantha to rectify her The impact of the denial of Mayer was admitted to place stress, there must be plight by writing her MLA, disability insurance claims Emergency where he told just one clear incident that CMHA BC Division and the was devastating to the lives the staff he “wanted to kill caused the disorder. As Nurses’ Union. of the four people featured someone.” When Mr. May- Mr. Voight argues, research here: in one case, death ap- er failed to get the help he shows that PTSD can be cu- Anna peared to be a related con- was looking for, the situa- mulative, that is, result from Anna, also from the East sequence; in the others, tion escalated and he be- a number of incidents that Kootenays, had been receiv- symptoms of mental illness came increasingly agitated happen over time. ing a disability pension for worsened. The record of and upset. Finally, the police two years but was unable providing adequate dis- were called, and Mr. Mayer After his claim was refused, to see her psychiatrist when ability insurance benefits died of a gunshot wound in Mr. Voight tried to return to it came time to ask for an for psychiatric disorders 43 the resulting confrontation. work and lasted only six extension on the claim. Her has not been good. How days: a situation he says was general practitioner wrote many more have to suffer A key question raised by not helped by the refusal of that she was severely de- and die before we see the Coroner’s jury at the in- his claim. The irony of this pressed and unable to join change?

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 disclosure, accommodations and protections Mental Illness and Human Rights

Harinder Mahil iscrimination because of mental illness, or a they must know a system exists and that it is there to help history of mental illness, is a widespread so- them address the discrimination they struggle against. Un- cial problem. While polite society recognizes fortunately, most people with mental illness are so used to that you do not refer to racial groups by racist discrimination that they often don’t recognize it as discrim- Dnames, or that jokes about a person’s physical disability are ination when it happens. They do not necessarily know that considered in poor taste, derogatory references about peo- there is a system that can help. As a result, the number of Harinder is ple with mental illness are constant. Our language itself complaints brought to human rights commissions from peo- Acting Chief uses derogatory stereotypes of people with mental illness ple with mental illness represents just the tip of the iceberg. Commissioner of as generalized insults: “you’re crazy,” “he’s nuts,” and the British “weirdo” are insults we hear everyday. While this article The Commission has experienced an increase in complaints Columbia focuses on discrimination against people with mental ill- filed on the basis of mental disability in the past year. Still, it Human Rights ness in employment, discrimination occurs equally in the is difficult to generalize about the types of employment- Commission provision of services and housing. Clearly, we are at a very based complaints brought by people with mental illness. As early stage of changing society’s attitudes towards people with all forms of discrimination, each complaint is unique, who experience mental disability. as is each potential remedy. When thinking about types of discrimination, what is most important to remember is that Box 1: Frequently Asked Questions all individuals have rights to fair treatment in the work- place. Under the Code, workers have the right to work free What is Discrimination? of harassment, including freedom from harassment based Discrimination is when a person is treated unfairly, harassed or denied something on a mental illness. A person with a mental illness cannot be because of the group they belong to, or because they have a certain characteristic. Under the BC Human Rights Code, it is against the law to discriminate against someone denied employment unless the employer can demonstrate because of any one or more of the following characteristics (these characteristics are that a job has certain specific requirements the person can- called protected grounds): not meet. Once hired, they cannot be denied opportunities „ race (including colour, ancestry or place of origin) and/or promotions unless, again, it can be demonstrated „ political or religious beliefs that they cannot do the job because of their mental illness. „ marital or family status (including being married or single, being a parent, or simply who you’re related to) (For examples of recent complaints brought forward by „ physical or mental disability people with mental illness, see Box 2 on the opposite page). „ sex (being female, male or transgendered; pregnancy; breastfeeding in public) „ sexual orientation (being lesbian, gay, heterosexual or bisexual) In addition, an employer has a duty to reasonably accommo- „ age (where a person is between 19 and 65 years of age) date a person with a disability, including a mental illness, „ a criminal record unrelated to their employment up to the point of “undue hardship” to the employer. To When am I protected from discrimination and harassment? determine undue hardship, a number of factors may be con- You are protected from discrimination and harassment when you are: sidered including the accommodations’ cost, the size of the „ at work company’s workforce and safety considerations. Accommo- „ applying for a job dating a person with a mental illness can mean different „ attending school or some other educational institution things in different situations. It may mean an employer must „ looking for a place to live „ renting or buying property provide additional training, adjust work schedules or even „ wanting to access a service or buy a product that is available to the public re-structure a job. While the Commission is there to address discrimination, there is no question that the human rights Under the Code, the Commission investigates complaints, creates public education enforcement system is difficult to navigate. As a result, many programs and advocates for human rights. The BC Human Rights Tribunal, a separate victims of discrimination, whether because of race, or sex, agency, is responsible for the adjudication of complaints. or a disability such as a mental illness, do not exercise their right to file a complaint (To learn about the process if you The BC Human Rights Code is intended to foster a society do file a complaint, see Box 3 on the opposite page). where everyone enjoys full and free participation in the economic, social, political and cultural life of British Co- To begin with, the human rights complaint process is com- lumbia. As important, the Code promotes a climate of un- plainant driven. This means that victims of discrimination, derstanding and mutual respect where all are equal in or the people who can act for them, must approach the Com- dignity and rights. Under the Code, discrimination is pro- mission to tell us their experience. This requires a level of 44 hibited under a number of grounds, including physical and functioning that a person with a mental illness may not have mental disability, where mental disability is meant to in- at the particular time they experience discrimination. An- clude a person with a mental illness. (See Box 1, above). other barrier is that the system is quite formal, generally requiring a high level of written and oral communication Before someone can use a human rights protection system, skills. Mental illness often interferes with these skills and,

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 disclosure, accommodations and protections although every reasonable effort to assist people is made, Box 2: Recent Canadian Human Rights Cases the system can be frustrating. „ In Mager v. Louisiana-Pacific Canada Ltd., the complainant was a victim of sexual Before a complaint can be accepted, a complainant must be assault. She became morose on the job and experienced a long period of clinical willing to talk to Commission staff about their mental ill- depression. She told her employer and union about the symptoms but did not say she had a disability or a medically-defined condition. The employer took little ness. Naturally, many people are not comfortable talking notice and offered a settlement known as a “technological change permanent lay about their illness to strangers. They have an understand- off” which happened to be available at the time. The Tribunal found that the able reticence about discussing personal experiences with employer ought to reasonably have known there was a serious problem and strangers and a reasonable fear about the stigma attached to provided greater assistance to the complainant within the context of its existing people with mental illness. Added difficulties are created benefit system. With minimal effort, the employer could have provided options to assist the complainant. Failure to do so was discrimination. when investigation requirements may make it necessary to „ In Zaryski v. Loftsguard and Percival Mercury Sales, a complaint at the Saskatch- Box 3: The Complaint Process ewan Human Rights Commission, the complainant had a work history of expressing her unhappiness, lack of concentration, and personal problems. One day, after Inquiry acting in an inappropriate manner with another in Gibbs v. Battlefords and District A complaint must be filed within one year of the last alleged Co-operative Ltd., the complainant developed a mental illness and had to take contravention of the Code. When someone contacts the time off. She was covered by a long-term disability plan. However, the plan Commission with a complaint, an initial assessment of the provided for two years coverage for employees unable to work due to a physical complaint is undertaken to determine whether it falls under disability but only one year for people unable to work because of a mental the Code. If the complaint appears to fall under the Code, a disability. Eventually the case worked its way to the Supreme Court of Canada. complaint form seeking more detailed information is There, the Court said the underlying rationale for the insurance plan was to provide provided to the person making the complaint. income replacement for those unable to work because of disability. The distinction between people with physical and mental disabilities was discrimination. The Court Intake noted that the limit on benefits appeared to be grounded on stereotypical assump- The completed complaint form is reviewed to determine if tions concerning the behaviour of mentally disabled persons. the complaint does, in fact, fall under the Code. If the Commission can assist, the complaint is referred to a Human „ In Thériault v. Outaouais-Hull School Board, a decision of the Quebec Human Rights Officer for investigation. If the complaint falls outside Rights Tribunal, the complainant was a teacher. His doctor advised him to take the Code, the complaint is dismissed. some sick leave because he was suffering depression. After an extended leave, he wanted to return to work. The School Board and his doctor disagreed on the Mediation condition of his mental health. To resolve this, the parties agreed that an independ- The Commission will offer to assist the parties (the complain- ent expert would examine him. That doctor reported his opinion that the complain- ant and the respondent) to settle the complaint through ant had a paranoid personality and his condition should be considered permanent. mediation. As long as the parties are willing to mediate, The School Board terminated his employment. The Tribunal found that the medical mediation can take place anytime during the intake and/or evidence was credible and was such that he was unfit for employment as a teacher. investigation process. If a complaint is settled through The Tribunal found that teachers are in a position of influence and trust in relation mediation, the complaint file is closed and no further action to their students. They are also inextricably linked to the integrity of the education is taken. If a complaint is not settled, it is referred to system. The Tribunal determined that there was no way to reasonably accommo- investigation. date the complainant’s medical condition. The complaint was dismissed. Investigation During an investigation, the Human Rights Officer gathers seek independent medical information about the complain- evidence from the parties and from any other witnesses who ant. Often, the other parties involved in the complaint must may be available. A written report summarizes the evidence be provided with this information. and recommends whether the complaint should go forward to For further the BC Human Rights Tribunal for a hearing or be dismissed. Given the barriers that a person with a mental disability information, or if Both parties have the right to review the investigator’s report to provide comments and any additional information they faces when struggling against discrimination, it is vital that you believe you might deem relevant prior to the report going forward. Once a parents, guardians and advocates who support people with may have a decision is made, both parties are informed in writing. If a mental illness inform themselves about human rights. Sup- discrimination party disagrees with the decision, they can ask that the porters can help the person identify discriminatory actions, complaint, call decision be ‘reconsidered’ or reviewed. do the things needed to file a complaint, and assist the per- (604) 660-6811 or Hearing son to navigate the human rights process. They can provide toll free 1-800- Hearings are conducted by an independent agency called the the moral support victims of discrimination often need to 663-0876 or visit BC Human Rights Tribunal. If a complaint is referred to the press forward with their discrimination complaints. the Commission’s Tribunal for a hearing, the Tribunal informs the parties of the web page at required next steps. Depending on whether they meet eligibility requirements, legal aid services may be available It’s important to remember that the human rights process is www.bchumanrights.org to the parties. one avenue for a person whose rights have been denied; other avenues do exist. Often the most effective outcome Remedies The following are some common remedies in settlements or occurs when the human rights process is combined with when the Tribunal finds that discrimination occurred: a letter support from other organizations and individuals. The 45 of apology; money for lost wages, expenses and hurt feelings; Commission urges people to bring forward their discrimi- job reinstatement, promotion or whatever was denied due to nation concerns. If communities work together, people with discrimination; and/or implementation of an employment mental illnesses will gain much needed and long-overdue equity plan or human rights training by the employer. improvements in human rights protection.

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 disclosure, accommodations and protections Risks and Protections for Employees with Mental Illness: Catch-22s of Getting and Staying Employed

Dulcie nder current legis- who have had a mental ill- SCENARIO TWO: provide detailed documen- McCallum lation and case law, ness and apply for a posi- A person who develops tation to justify the claim Uemployers have a tion and people who become a mental illness as a being paid. With this infor- duty to care for their em- mentally ill while working direct result of working mation, the employer might ployees who become ill should not be refused work conditions then try to fire the person while they are employed. or fired after they are em- The second possibility is while on short or long-term Employers provide short ployed simply on the basis that a person suffers from disability on the basis that Dulcie is a lawyer and long-term benefits to of having an illness such as stress, anxiety or depression the mental well-being of and the former their employees in the event depression, bipolar disor- as a direct result of work the employee is required in Ombudsman of of illness. These benefits are der, anxiety, or schizophre- conditions. This person order to fulfill their obliga- British Columbia. provided under employer- nia. There are three possible may also require leave from tions as an employee or She is also an funded insurance plans of- scenarios to consider where work and could try to make supposedly to protect co- Honourary ten referred to as STIIP for a person with mental illness a Workers’ Compensation workers. Case law helps us Patron of CMHA short-term disability (less tries to gain or maintain ac- claim. The risk of taking understand how these issues BC Division than six months) and LTD for cess to employment; in each this course of action is to may play out in the courts long-term disability (more of these are risks for the appear to be criticizing the in “real life.” than six months). If the ill- (prospective) employee and employer’s workplace as ness or injury, however, legal protections may need an environment that causes The King v. CDI Career De- occurs as a direct result of to come into play. emotional and psycholog- velopment Institutes Ltd. the work, the benefits are ical harm to its employees. tribunal decision out of provided under Workers’ SCENARIO ONE: This may have serious con- Saskatchewan found that Compensation, a compulso- A person with a prior sequences for the employee Ms. King was terminated, at ry compensation scheme es- history of mental illness and his or her relationship least in part, because she tablished by legislation for being denied work with the employer. had a mental disorder (pan- workers injured on the job. The first possibility is that a ic/anxiety attacks). The em- person with a history of SCENARIO THREE: ployer was forced to pay Human rights legislation mental illness may be de- A person who $2,000 in compensation for protects employees against nied entry into the work- experiences mental mental anguish and $2,000 discrimination in the work- place. People who have a illness after they start for injured feelings result- place. This means that peo- disability may be invited to employment ing from the termination. ple are protected against declare the nature of their The final possibility is that There was no order to rein- being refused the opportu- disability at the time of ap- a person experiences men- state her in her job; the rea- nity to work or denied equal plication for work. By law, tal illness while in a job, sons given do not make it treatment in the course of however, this information where the illness is not con- clear why. their employment on the is not to be considered by sidered to be a direct result basis of mental disability. the employer in the course of the working conditions. Watt v. Foster is an inter- Mental disability includes of considering the individ- In this case, the risk for the esting case in BC this year, any diagnosis that can be ual’s application. In more employee is that in making where an employee with a characterized as a mental progressive places of work, an application for disabili- mental health issue was ter- illness. In fact, employers are such information is docu- ty benefits, the individual minated because of the em- under a duty to accommo- mented separately from the is forced to divulge infor- ployer’s claim that mental date an employee’s disabil- hiring process and is not mation on the insurer’s well-being was a “bona ity in their employment so considered until the person required medical docu- fide occupational require- long as that accommodation has been short-listed and mentation that comes into ment” (i.e., that mental does not place the employer the employer is in a posi- the hands of the employer well-being was necessary 46 under an “undue hardship” tion to determine the cost of (or to future employers). In- to do the job). The ruling (see the previous article for making disability-related surance companies who supports a claim for com- a definition). accommodations to the fund benefit schemes are be- pensation for the harm re- workplace or job task. coming increasingly de- sulting from the termin- That means that individuals manding of employers to ation itself. The ruling also

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 disclosure, accommodations and protections indicates that an order for ties continue to stigmatize ty to work; remain silent at or they are too embarrassed. production of medical people labelled mentally ill, the outset or have the onset A comprehensive program records can be given, if and as a result, many people of the illness on the job and of education is required those records relate to the who have a mental illness in laying claim to short or by such organizations as employee’s claim of a his- deny any attachment to that long-term disability, take CMHA to ensure employers tory of mental illness, label and do not ask for ac- the risk of being fired; or understand their obliga- where this is at issue. An commodations in the work- the worst of all, remain si- tions and gain a full appre- interesting counter-claim place. On the other hand, lent in order to try to keep ciation for the true nature by the person claiming others may be upfront about the job, thereby denying of mental illness. Only then discrimination was to ap- the nature of their problem yourself sick-leave benefits will employees rest in the ply for employer records and declare it as a situation or on-the-job accommoda- knowledge that their men- regarding the employee’s they must live with and tion. If these choices are not tal health will be protected supervisor’s mental health trust that employers will already overwhelming for and their rights respected. to gain insight on the le- honour their responsibili- all of us to consider, imag- gitimacy of the employer’s ties to hire or make accom- ine having to try to decide claim, in an attempt to flush modations for them in the when you already suffer out a possible corporate same way they would for a from all-consuming anxi- double standard. person with a physical dis- ety or depression. ability or disease. CONCLUSION: The stark reality is that The ‘catch-22’ of One is quickly struck by the many cases of discrimina- disclosing mental illness seemingly impossible situ- tory practices against peo- Unfortunately, life for a per- ation or catch-22 a person ple with a mental illness go son with a mental illness with mental illness finds unchallenged and unno- doesn’t always unfold fairly her or himself: declare and ticed. This is often because as it would for a person who demand accommodation the people involved are very has a physical ailment. The and take the risk of being ill and not in a position to reality is that our communi- denied even the opportuni- protest, they fear retaliation

Supported Employment Best Practices for BC’s Mental Health Reform: Psychosocial Rehabilitation and Recovery. Report and factsheets available from CMHA BC Division.

CMHA National’s “Routes to Work” Project. The links section features sites on job-search strategies, job postings, skills development, educational upgrading, volunteering and accommodations: www.cmha.ca/english/routes/home.htm

International Association for Psychosocial Rehabilitation Services: www.iapsrs.org

Center for Psychiatric Rehabilitation, Boston University: www.bu.edu/cpr/

The Matrix Institute: www.matrixresearch.org/jsindex.html

Planning Processes for Providing Supported Accommodation for People with Mental Illness. New Zealand Mental Health Commission: www.mhc.govt.nz/mhc_Pubs.htm#2000

Mental Health, Employment and Training: A Report from The UK Mental Health Foundation: www.mentalhealth.org.uk/html/content/employtrain.cfm < The Employment Intervention Demonstration Program Coordinating Center:

s urce List s www.psych.uic.edu/eidp/

National Mental Health Association (US), Fast Track to Employment: Model Program: www.nmha.org/pbedu/schizophrenia/model/fasttrac.cfm 47 Re THEO BC: www.theobc.org

Coast Foundation: www.coastfoundation.com

Visions: BC’s Mental Health Journal Employment No. 13, Fall/Winter 2001 resources — cont’d

Mental Health Works. CMHA Ontario Division: Mental Health in the Workplace Policy Papers. MH Founda- www.ontario.cmha.ca/mhic/MHWorks/mhworks.html tion of New Zealand: www.mentalhealth.org.nz/policy.asp

‘Making It Work’ Policy Framework for Employment Supports for The Economic Burden of Mental Health Problems in Canada. People with Serious Mental Illness. Government of Ontario: Stephens & Joubert, Health Canada: www.hc-sc.gc.ca/hpb/ gov.on.ca/health/english/pub/mental/pfes_e.pdf lcdc/publicat/cdic/cdic221/cd221d_e.html

Employment and Mental Health: Issues and Opportunities. Mental Health and Work. Employment kit based on World New Zealand Mental Health Commission: www.mhc.govt.nz/ Mental Health Day 2001 theme: wfmh.org/wmhday/toc.html Publications/Publications/Employment.pdf Labor Day 2001 Report. National MH Association (US): www.nmha.org/pdfdocs/laborday2001.pdf Job Search and Educational Upgrading Top 100 Internet Sites for Learning and Employment: HRDC: Mental Health and Work Report. International Labour www.jobboom.com/conseils/top-100.html Association: www.ilo.org/public/english/employment/skills/ targets/disability/index.htm YouthOptions BC. Provincial Government: www.youth.gov.bc.ca Mental Health in the Workplace factsheets. MH Association of Opening Doors. A BC post-secondary guide: openingdoorsbc.com Ireland: mhai.healthyirish.com/mentalworkplace.html

Seeking Employment. MIND (UK): www.mind.org.uk/informa- Depression in the Workplace factsheets. NIMH (US): tion/factsheets/E/Employment/Employment.asp www.nimh.nih.gov/publicat/workplacemenu.cfm

Diversity World: Enriching Workplaces and Employment Barriers: Employer Checklist. New Zealand Mental Health Commission: www.diversityworld.com/disability.htm www.mhc.govt.nz/Publications/Publications/ Employment_Checklist.pdf RecruitABILITY! For job seekers with disabilities: www.disabledperson.com/recruitability.asp Canadian Business and Economic Roundtable on Mental Health. Reports: www.mentalhealthroundtable.ca WorkInk. Canadian Council on Rehabilitation and Work’s

< virtual employment resource centre: www.workink.com Recruitment and Accommodations

s urce List s Canada’s Network for Entrepreneurs with Disabilities: Employer Tips on Recruiting People with Disabilities: www.entrepreneurdisability.org www.disabledperson.com/RecruitABILITY/emptips.htm

www.worksupport.com: offering resources connecting employers Tapping the Talents of People with Disabilities:

Re with qualified individuals who have disabilities. A similar service www.conferenceboard.ca/pdfs/disability.pdf offered at worktechsolutions.com The Duty to Accommodate in the Canadian Workplace: Beneficial Realities of Volunteer Employment. National Alliance 216.13.114.21/workink/national/Lynk/lynk.htm for the Mentally Ill: www.nami.org/about/volunteer.html Accommodation Ideas for Persons with Psychiatric Disabilities: www.jan.wvu.edu/media/Psychiatric.html Mental Health in the Workplace Best Advice on Stress Risk Management in the Workplace. Personal Assistance Services for People with Psychiatric Health Canada: www.hc-sc.gc.ca/hppb/ahi/workplace/pdf/ Disabilities: www.worksupport.com/Main/proed10.asp stress_risk_management_2.pdf (part of a workplace health series at www.hc-sc.gc.ca/hppb/ahi/workplace/resources.htm) Directory for Accessibility. Ontario March of Dimes: 209.227.217.26/dbsearch/public/searchpage.cfm Mental Health in the Workplace. UK Mental Health Foundation: www.mentalhealth.org.uk/html/content/bkworkplace.cfm Reasonable Accommodations for Mental Illness: 48 www.bu.edu/cpr/jobschool/whatareRAs.html Employment Advice for Employers or Employees Experiencing Difficulties or People Wanting to Work. MIND (UK): Paths to Equal Opportunity. Government of Ontario: www.mind.org.uk/information/single.asp?topic=Employment www.equalopportunity.on.ca

BC Division 1200 - 1111 Melville St. Vancouver BC, V6E 3V6