Action Steps to Real Work
This document is organized according to three different target groups: employers, mental health service providers and consumers of mental health services. It is hoped that the strategies suggested will provide steps for each of these groups to take so that, when working together, they will maximize the possibilities for successful employment.
This publication has been produced by Bonnie Pape with the generous support of Human Resources Development Canada.
When asked what is needed to improve their lives, people with serious mental health problems often rank employment along with housing at the top of their list. This should not be surprising, As the Canadian Mental Health Association’s Framework For Support model illustrates, people who have been through the mental health system, like everyone else, want – and have a right to – the basic elements of citizenship. These include legal tenancy in a home that is permanent and stable, income that is fair and adequate, and the opportunity to be a student in a regular education system or an employee in a real job rather than a client in a training program or a sheltered workshop.
Employment for people with mental health problems is a critical issue which has long been a concern to CMHA National. An early step was to explore its parameters with a discussion document, “Employment Opportunities for Those Labelled Psychiatrically Disabled.” This paper identified key issues and possible options for enhancing the participation of people with mental health problems in the workforce.
As we attempted to understand how to maximize employment opportunities, it became increasingly clear that regular work and education settings may need to be modified in order to accommodate people’s special needs. Our next project looked at just that The research included meetings and focus groups with employers and educators as well as consumers of mental health services. It resulted in the production in 1993 of two guidebooks: one for educators, called Leaning Diversity, and the other for employers, Diversity Works.
Consultations for that project generated an important principle: that valuing the diversity of a workplace or education setting in general will create an environment that will easily accommodate the particular needs of people with mental health problems. Our work also identified some particular strategies that workplaces or colleges and universities can take, and led toward the development of a CMHA policy on employment.
Subsequently, CMHA sharpened its focus on employment with a project called “Access to Real Work.” Funded by Human Resources Development Canada, the project was an attempt to generate mainstream, permanent employment for people with mental health problems, and was implemented in four CMHA branches: Alberta South Region; Thunder Bay, Ontario; Metro Toronto; and Fredericton/Oromocto Region, New Brunswick
The Iearnings from this project are incredibly rich because each of the sites went about the task in a different way. Their different styles have shown us how we can develop partnerships with a generic employment agency or a community college, expand a clubhouse model to include a “real work” component, and connect people to work through individual, community-based initiatives. The sites have also demonstrated some useful strategies related to job development dealing with policies which are disincentives to employment, taking incremental steps that can lead to permanent jobs, and supporting employees and employers throughout the process. A resource manual, Strategies for Success, outlines some of our Iearnings in the form of tips for people with psychiatric histories who are entering the workforce.
This issue of ACTION STEPS is an attempt to summarize the many different Iearnings from our various research activities in the area of employment. It is organized according to three different target groups: employers, mental health service providers, and consumers of mental health services. We hope that the strategies suggested will provide steps for each of these constituencies to take so that, when working together, they will maximize the possibilities for successful employment.
Strategies for Consumer/Survivors
All workers feel the excitement and stress of starting a new job. For people who have experienced the mental health system, the rewards and challenges of a new job are especially great. It helps to acknowledge the stresses of employment, know what your employer expects from you, and develop effective coping strategies.
The following action steps are taken from Strategies for Success: A consumer’s guide to the workplace, and based on the words and experiences of people with mental health problems themselves. Actual quotes from consumer/survivors are in italics.
- Expect to be confused. Your first day at a new job will be crammed with new information. This may seem overwhelming, but don’t panic. As the days progress, the information will sink in and you’ll learn the rules. But don’t expect to remember everything right away.
- Get the answers. Learn what you need to know and who can answer your questions. It is helpful to keep a small notebook to write down your questions as you think of them. There is nothing wrong with admitting you don’t know something as long as you are willing to find out. But remember, while asking questions is important, as a new employee you make a good impression when you follow the rule to listen more than you talk.
- Learn to practise active listening to improve communication. Some active listening techniques are open- ended questions to clarify the message, and re-stating or paraphrasing to make sure you’ve heard the message accurately. Good communication is a key to getting along with your supervisor.
- Celebrate your successes. Keep a list of what you have accomplished as you carry out your job. Not only will this help you keep your resume up to date for future positions, but it will make you feel good about your achievements.
- Accept a student role. Your colleagues expect you, as the new kid on the block, to be willing to work as a team member. Be prepared to do things that are not in your job description. Give yourself time to grow into your position. Follow the lead of your supervisor and co-workers as to how to dress for the job.
- Develop strategies for coping with stress. An important resource in this regard is a support network, which can include family, friends, mental health professionals, self-help peer groups, career counsellors, or your employer and co-workers.
It is important to feel you are not alone in the process, not the first or only person to feel these stresses.
- Know yourself. To do the job well, you may require some modifications or accommodations to the workplace, but sometimes it is difficult to identify what these should be. The first step is to take a good look at yourself. Thinking about your past work, volunteer, social, or educational experiences, what were the conditions that suited you best! In your dream job, what are the working conditions? Are you most productive working alone or with others? How many hours a day would you want to work, and what times of day are better for you? These kinds of questions will help you determine what accommodations, if any, you need in order to perform your best at work.
- Know your rights. Every province and territory has legislation on the human rights of people with disabilities. Apart from this, employees with mental health problems need to believe for themselves that they are valuable employees who deserve the right to negotiate with employers for accommodations.
This is not asking employees to lower their standards or expect less work from you. Changes to the work environment are a legal right that allows all employees to be their best, using their talents to the fullest. Such changes help ensure that a psychiatric disability does not act as a barrier to employment.
It comes down to how I feel about myself. It can be difficult to speak up for myself, but in the end, you have to come first.
- Stick to the facts. If you decide you need workplace accommodations, you will need to disclose your psychiatric disability. This requires discussing a very personal issue, your mental health, in a professional way. Do not go into great ‘detail. Focus on how the disability impacts upon your ability to ‘do the job and what positive steps can be taken to accommodate your needs. You may want to practise with a friend or someone from your support network.
- Become informed of the options available in your workplace. If accommodations are already in place for parents of young children or people with ill or elderly relatives, think about the similarity of these policies to the kind you may need. When requesting your own accommodations, make sure your employer understands that the job will still be done, although perhaps in a different way. Clarify the terms in writing.
Strategies for Employers
Most employers are responsible community members who would be willing to hire people with psychiatric histories, but are unsure of what this entails. Because of widespread misconceptions about the nature of most mental illnesses, they worry about violent or unpredictable behaviour on the job. These fears can be easily allayed with the facts about mental illness. But even a realistic perception of the disability does not necessarily suggest ways to meet a person’s needs in the workplace.
The most uncertainty for employers lies in the area of how to provide accommodations. People with physical disabilities usually require an adjustment that is concrete and well-defined, such as a ramp for a wheelchair, or a special computer for someone with a visual impairment. But what is it that people with mental illness need in the workplace, and how can it be implemented?
The answers to these questions are somewhat fuzzy around the edges, since many accommodations depend on individual differences, and are ongoing or cyclical rather than one-time-only. Nevertheless, there are some general principles that can demystify the situation for employers.
- Think of your workplace in terms of meeting ALL your employees, needs, and value diversity in your workforce. For example, if you allow options such as flex time or permanent part-time for employees who are dealing with childcare or elder care issues, these same kinds of options can work for some employees with mental illness.
- Be flexible in enforcing traditional policies. There may be several different ways to get a job done, and you may want to rethink the way you have always done things. If a task an employee is asked to perform is not essential to the job, can they trade it with another employee? Can the way this task is performed be changed? Is the schedule important? Can the duties be shifted to accommodate a part-time worker? Must all the tasks be performed at your workplace during regular business hours!
Because of my medication, it’s really difficult for me to keep to a schedule. My employer is happy with my work and as long as I put in my eight hours, she doesn’t mind if I don’t make it on time every day.
- Assess the situation with the employee. Together, you can
- determine the purpose and the essential functions of the job
- establish what kinds of job-related limitations the person may have
- determine what possible accommodations could be considered and which ones the employee would prefer.
- Adjust training to the employee’s individual needs, and keep it clear and supportive. During the training period, co-workers can act as peer supports or advocates, and job coaches may be used to help orient the employee. Written agreements for evaluations, performance reviews, time management, and problem solving are useful tools to help employers and employees begin with clear expectations.
- Develop human resource principles that are positive and constructive. These may include allowing telephone calls during work hours to supportive individuals, or designating a private work area for individuals who are easily distracted.
I have difficulty concentrating if there’s any noise around me. I explained it to my manager and now, even though I’m only a junior member of our department, I have my own private work area. It means a lot to me to be able to work without distractions.
Flexibility in policies can take many forms. Workplaces can permit a self-paced workload, the use of sick leave for emotional as well as physical illness, a work-at-home policy, banked overtime, job-sharing, and flexible schedules for medical appointments. To cover the uncertainty that surrounds hospitalization, workplaces could advance additional paid or unpaid leave, and provide back-up coverage while keeping the position open.
- Create a supportive environment. This principle should underlie any activities in a workplace. Offer management training to supervisors to enhance their ability to provide clear direction and constructive feedback, and provide training for co-workers about disabilities and the need for accommodations. Dispel myths by educating all the staff about causes, treatment, and personal experiences of mental illness.
Accommodating me would just be being able to explain my depression in the open.
- Know your limits. As an employer, you want to support your employees to do their jobs, but your role is not to provide counselling or therapy. The best way to handle a problem is to have a plan of action in place before it occurs. Establish written guidelines with the employee as to where the boundaries of accommodations end. Setting clear and precise limits to accommodation strategies leaves no room for misunderstandings, although accommodations may need to be jointly reviewed at times to meet changing needs. Open and clear communication with the employee is the key to success.
I felt intimidated when my supervisor spoke to others around me but did not speak to me about my illness. I would have liked to have been spoken to directly and not singled out like an ‘odd ball”, Honesty, openness, directness, understanding would help.
Strategies for Service Providers
CMHA branches and other service providers have an important role to play in creating an environment where people with mental health problems can find work. Providers can ensure that their agency goals are consistent with the goal of real permanent employment, and that all the services they offer foster community citizenship and integration rather than keeping people as clients.
Specifically, service providers are the ones who can join with other community partners, including other agencies, individual employers, and employer organizations such as business associations, to implement strategies which lead to employment. Following are some tips that CMHA project sites have learned in their efforts to carry out employment projects.
- Network, communicate, and join with other partners. This may be the most important key to a successful employment project. By networking with other agencies as well with informal contacts, you will be able to achieve results that you could never achieve individually. Other voluntary agencies are often the ones who will be most receptive to your goals, and most interested in hiring where they can; using informal channels of friends and family to make the case for employment or flexibility in policies often gets better results than a formal lobbying process.
- Join with your networks to address the need for policy change. Many benefits schemes actually discourage people from seeking a job. People who are dependent on benefits pack-ages for their income or medications risk losing these by attempting employment. This is a frustrating situation, but networking can help. Although you may not be able to achieve sweeping policy change, you will occasionally find a worker who may bend the rules a bit, or an agency with members who are looking for work and willing to take the risk of losing benefits.
- Get creative. Regular, permanent jobs are hard to come by, but there are ways around this. Some employers are willing to hire consumers, but can only pay with canned goods or transit tickets rather than cash. This arrangement may be fine with some employees – like “money in their pocket.” Other people might start off in volunteer opportunities, or with skills training or job trials. You could also look into developing a consumer/survivor-run business. Look for any ways that increase people’s credentials and readiness for work, and help them get a foot in the door.
- Give yourself enough time. It takes time for alternative strategies to lead to permanent jobs. Even for those who are placed in jobs, it is optimal to have ongoing support for the employee and employer for the first while. These are long-term initiatives; do not put undue pressure on all the participants by imposing unrealistic time frames.
- Put together a steering group which includes the various stakeholders. One useful format is a team representing consumers, service providers and employers. The team members can bring the collective wisdom from their own sectors to the effort, thereby keeping the activities dynamic, effective, and accountable. Moreover, they can tap into their own networks to provide support for employment initiatives from a wide range of sources in the community.
- Do your homework. A key to job success is in the groundwork. This includes carefully matching the job to the employee’s skills, interests, and talents and communicating clearly with potential employees about the expectations of the employer. Putting everything in writing helps.
- Get help. You will probably need to hire or allocate staff for professional support, since it is important to have one key resource person available to employees and employers.
This paper summarizes the learnings from several projects of CMHA NationaI in the area of employment. Some of it draws on what people have told us, and some on resources that have been written. The section for employers is based on Diversity Works, and the section for consumers on Strategies for Success, both of which were produced through CMHA projects.
Our experiences in this area can be summed up with some facts that are well established.
For people with psychiatric disabilities, competitive employment is usually only a distant dream. To achieve the dream takes willingness to risk and change on the part of all the different stakeholders, but it can happen. We hope that our suggestions for action steps that employers, service providers and consumers can take towards real work wiIl help bring the goaI a little closer. Although we have divided the strategies suggested in this paper according to different target groups, no group can work in isolation. Only a collective effort by the various stakeholders will ensure successful permanent, mainstream employment for people with mental health problems. Perhaps this publication can help create the environment for that to happen.
We are grateful to Human Resources Development Canada for their present and past support for our projects on employment, and for the funding which has made this document possible.