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An electronic circular of the Coalition's Center for Rehabilitation and Recovery
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No. 60, April 2010
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The Center for Rehabilitation and Recovery provides assistance
to the New York City mental health provider community through
expert trainings, focused technical assistance, evaluation,
information dissemination and special projects.
THE DIRECTOR’S NEW YORK MINUTE WORK IS A “MEDICAL NECESSITY!” In 172 CE (Common Era, the replacement terminology for “AD”), Galen, who was a Greek physician working in Rome on basic questions in medicine, wrote this revealing statement: “Work is nature’s best physician and is essential to human happiness.”(1) Yet for some strange reason, behavioral health made all sorts of assumptions about struggling people and one of them was: persons with serious and persistent illness could not possibly go back to work and if so it would be at marginal levels of functioning. Such persons were wrapped in cotton and treated gingerly around such issues. In the past, many clinicians did not realize that sometimes we “didn’t know best,” and that we were actually inadvertently holding people back from normal adult development and symptom improvement. In fact, we were making people worse! A critical question has been raised by Marrone and Golowka (1999), “if work makes people with mental illness sick, [then] what do unemployment, poverty, and social isolation cause?”(2) Even today, many clinicians think that their own jobs are very stressful and therefore jobs could not be tolerated by persons struggling with hearing voices, or depression or delusions. We forgot that work gets us up in the morning and organizes our day. Work gives us a social support group critical to any recovery process. But most importantly, work gives meaning to our lives. In America, often the very first question posed to another person after saying “It is very nice to meet you” is “What kind of work do you do?” The ability to answer that question provides a definite sense of self-esteem and a feeling of a level playing field as productive citizens. Research has shown us that diagnosed people can and do work in every level of enterprise. It just depends on education which is why utilizing supported education as part of getting people back to work is so important. After an interview with National Public Radio about improvement and recovery in serious and persistent mental illness on their program called “Morning Edition,” I received calls from all over the North American continent. These callers were engineers, college professors, high school teachers, nurses, and physicians. They said: “I once had schizophrenia. Thank you for telling our story. I don’t tell anyone because of the discrimination.” Symptoms can be reduced by working, and research and life stories portray these effects repeatedly. Such a revealing life story comes from Pat. She was a teacher, a mother, a wife living in a nice condo with an Audi to drive. She succumbed to depression, given a variety of psychotropic drugs. In the middle of her efforts to get better, her two children were given to her ex-husband in a custody battle, she lost her job, and her home as well. Fighting back to what she wanted to be has been an arduous process and it involved working as a critical ingredient in her recovery process. She began to participate in Venture House, a nearby clubhouse, where she found a social group and became less isolated. It filled her need to “belong.” She saw people, who were ahead of her in their recovery process, and they became role models. They were working. She began to become involved in short term transitional employment opportunities. First, she tackled a job shelving items in a large chain department store. It was hard but there were others working alongside of her. Then, she worked at a non-profit organization putting together resource books and updating program descriptions, learned new skills on the computer, and one day ran the office by herself. The boss complimented her efforts. The more self esteem she acquired, the less depressed and anxious she became. Pat became worried that she would lose her benefits, especially her health insurance, and there were times she had to battle to keep or correct her entitlements but she now had the energy to do so. She started at a law firm as the inside messenger. With her feet pounding the pavement all day, she got back in touch with her physical self. She began to lose the weight added on from drug side effects. Her energy and health improved. She is now a peer educator helping others learn about and maximize their benefits. She has her own apartment, a dog, friends, and is back in touch with her children. Research has also shown that neither symptoms, nor diagnosis, nor hospitalizations predict the ability to work.(3) What helps are real opportunities to be assessed, trained at some point before or after selecting a job-person match, and provided after work supports. What gets people fired is not that they are unable to do the job but that they have not learned “job keeping skills” such as: not taking enough showers, or not calling the boss when ill, or being rude to customers. The federal definition of “medical necessity” is: “Any medical or remedial services (provided in facility, home, or other settings) recommended by a physician or other licensed practitioner of the healing arts, within the scope of their practice under state law, for the maximum reduction of physical or mental disability and restoration of the individual to the best possible functional level.”(4) It seems to us that given the thousands of stories already reported similar to one described above, work really does qualify as a medical necessity for most people. (1) Harding, C.M., Strauss, J.S.; Hafez, H.; & Lieberman, P.B.: Work and mental illness: I. Toward an integration of rehabilitation process. Journal of Nervous and Mental Disease, 1987, 175(6): 317-327. (2) Marrone, J., & Golowka, E.: If work makes people with mental illness sick, what do unemployment, poverty, and social isolation cause? Psychiatric Rehabilitation Journal, 23(2): 187-193, 1999. (3) Anthony, W.A., Cohen, M., Farkas, M., & Gagne, C.: Psychiatric Rehabilitation (2ND Ed.), Boston, Ma., Center For Psychiatric Rehabilitation, Boston University, 2002. (4) Centers for Medicare and Medicaid Services, www.hhs.gov, 2010. Benefits At Large Enhancing our benefits’ knowledge, courtesy of the Work Incentives Certificate Training offered by the Cornell University Employment and Disability Institute’s intense one week training, kept us both very We look forward to hearing from you, Margie Staker & Pat Feinberg Recovering Through Advocacy And A Little Help From Some Furry Friends
Through RECOVERe-works, he plans to showcase recovery stories he has collected from agencies around New York City in hopes of revealing that recovery from mental health issues is very much possible and expected. For years, it’s been the four legged friends that have provided a dogged devotion to one of their closest friends. Whenever Jody Silver was not feeling well, they were the ones she turned to for companionship and trust. “They accept you no matter what,” Jody mentioned one rainy afternoon as we sat in her office at the Office of Consumer Affairs which is part of the New York City Department of Health and Mental Hygiene. “They don’t care if you’re anxious or depressed. They’re non-judgmental.” She pointed out their pictures on her office wall, a wall covered with photos and drawings of dogs. “People to me are at times scary and complex,” Jody went on, “Dogs are not. They’re very simple and adorable. And they always know when you’re not doing well.” While still a child, spending hours lining pencils up together, rearranging her desk or tying her shoelaces over and over were the small ways that a degree of obsessive behavior began to manifest itself. When she started school, Jody always felt quite anxious and fearful about failing and spent much of her time fixated on her studies, often sacrificing sleep and her health. Although Jody did well in school, graduating near the top of her high school class and making the Dean’s list in college, she continued to struggle with debilitating insecurities. There were periods of time when things got so bad that Jody couldn’t get out of bed in the mornings, couldn’t get dressed, couldn’t leave the house, and couldn’t eat much. She sought help from psychiatrists but as a young adult, often the labels they attached to what she was going through didn’t feel like they captured the whole individual. “That just made me feel nuttier,” Jody remarked. Today, Jody is 54 years old and has spent the past 30 years of her life in treatment for a variety of mental health diagnoses. She has struggled, but step by step through self acceptance, openness with others, support groups and a caring community, Jody has succeeded in ways she never thought possible. While there were times in her working life where she chose jobs that were “low stress” and “repetitive” because that was all she could handle – there have been years of a vibrant professional life that have seen Jody hold a variety of positions in the mental health field. Now, she is the Director of the Office of Consumer Affairs at the City’s Department of Health and Mental Hygiene and spends her time advocating for people with mental illnesses. In fact, ever since she was 13 years old when she volunteered at a summer camp for children with physical and emotional challenges, Jody has always gravitated towards people who struggle. She feels safer, calmer and accepted around them, people whom she can “identify with” – and for whom she can make a difference. What’s remarkable is that although Jody has spent the past 30 years of her life in treatment, she has simultaneously spent the past 30 years of her life helping others. Her personal challenges have, at times, held her back, but they have not crippled her spirit. Working productively with others and witnessing changed lives helps Jody feel empowered. “Being a person with a psychiatric disability is not my main identity. That’s just a piece of me, a component of who I am. I’m probably going to always have some challenges, like most people, but I never thought I was going to work continuously or do something that was productive and challenging. If you look at my history, you can see that I’ve come a long way.” Now that has taken some dogged determination right there.
Manhattan Consumer Educational Forum on PROS Description: Presentation will be geared to the specific concerns of consumers, but providers are welcome to attend. Topics covered include services offered by a PROS program, the individual recovery plan, the current status of PROS in NYC, and the effect of PROS on the services consumers currently receive. Mental Health Parity Conference Description: NAMI-NYC will present on its examination of the impact of Timothy’s Law on New Yorkers’ mental health benefits coverage by conducting the largest consumer interview-based qualitative evaluation of mental health parity law. Palliative Care Conference Description: The events of the conference will focus on the realities of health care and the compassionate continuum of palliative care to the thoughts and actions of the caregivers and those they serve. It has been said that the first step to compassion is competence. The main object of this year’s conference is for the participants to come away empowered to provide professional, competent, empathetic care to patients and their families. At this year’s conference we will provide frontline health and social care professionals with a wide variety of palliative care topics, presented by an outstanding group of speakers. The Geriatric Mental Health Alliance of New York 4th Annual Geriatric Mental Health Conference Description: Caregiving in the 21st Century: Complex Roles, Innovative Practices YAI Network’s 31st Annual International Conference Description: Decade of Decisions: Moving Forward in Developmental and Learning Disabilities Everybody Have Fun Elizabeth Kolbert in The New Yorker discusses fascinating research on happiness and what policymakers can learn from happiness research to improve programs such as mental health care. http://www.newyorker.com/arts/critics/books/2010/03/22/100322crbo_books_kolbert?currentPage=all Global Mental Health An older but important series published in The Lancet about the importance and need for global mental health, drawing together leading experts from various institutions and fields to formulate a call to action. http://www.thelancet.com/series/global-mental-health Is Your Doctor Using A Checklist? Lloyd Sederer, the OMH Medical Director, and Jeffrey Lieberman, the Director of the NYS Psychiatric Institute, report on the reason and advantage of using checklists in our practice of mental health care. http://www.omh.state.ny.us/omhweb/resources/newsltr/2010/mar/ NYS Pilots Program to Promote Recovery from Addiction and Mental Health Disorders The New York State Office of Mental Health (OMH) and New York State Office of Alcoholism and Substance Abuse Services (OASAS), in collaboration with the Center for Practice Innovations at the New York State Psychiatric Institute, have launched a statewide initiative to promote wellness self-management for adults with both mental health and substance use problems. http://www.omh.state.ny.us/omhweb/News/2010/pr_addiction.html Substance Abuse Treatment: Addressing the Specific Needs of Women SAMSHSA published this TIP 51 to assist substance abuse treatment providers in offering effective, up-to-date treatment to adult women with substance use disorders. http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=18244 What’s in the Bill The Wall Street Journal provides a basic outline of key parts of the $940 billion health-care reform bill. http://online.wsj.com/article/SB10001424052748704117304575137370275522704.html?mod=googlenews_wsj |
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focused. Much work and learning still needs to be done with an exam of materials from the training, continuing education, and ongoing support and assessments of our ability to undertake benefits analysis and planning. The funding and supports of all is much appreciated, especially with our goal of increasing the numbers of people with disabilities who return to work. Now on our return, we are catching up with the MBI-WPD questions on barriers and challenges along with requests for presentations. 
Eric Lu is a Junior Fellow in Behavioral Health at the Coalition’s Center for Rehabilitation and Recovery. The Coalition Home | Center for Rehabilitation and Recovery | Site Map
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