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Appendix A: Project Examples

III. Including Individuals with Mental Health Concerns or Mental Illness in Service

Building an inclusive service program is about finding ways to include individuals with a variety of disabilities, including mental illness. The following information is intended to provide a basic overview of important facts and resources related to mental illness. Additional detailed information about specific mental health conditions and diagnosis is available on each of the websites listed below. We encourage your program staff and members to become educated about mental health issues so that you can be more inclusive and supportive of individuals in your program that may experience a mental illness. An example of what Operation Fresh Start in Wisconsin has done to better support individuals with mental health disabilities in their service program is provided at the end of this section.

What is Mental Illness: Mental Illness Facts

Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD), and borderline personality disorder. The good news about mental illness is that recovery is possible.

Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.

In addition to medication treatment, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups, and other community services can also be components of a treatment plan that assist with recovery. The availability of transportation, diet, exercise, sleep, friends, and meaningful paid or volunteer activities contribute to overall health and wellness, including mental illness recovery.

Important Facts About Mental Illness and Recovery:

  • Mental illnesses are serious medical illnesses. They cannot be overcome through “will power” and are not related to a person’s “character” or intelligence. Mental illness falls along a continuum of severity. Even though mental illness is widespread in the population, the main burden of illness is concentrated in a much smaller proportion, about 6%, or 1 in 17 Americans, live with a serious mental illness. The National Institute of Mental Health reports that 1 in 4 adults, or approximately 57.7 million Americans, experience a mental health disorder in a given year.
  • The U.S. Surgeon General reports that 10% of children and adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school, and with peers.
  • The World Health Organization reports, that 4 of the 10 leading causes of disability in the U.S. and other developed countries are mental disorders. By 2020, major depressive illness will be the leading cause of disability in the world for women and children.
  • Mental illness usually strikes individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.
  • Without treatment, the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide, and wasted lives. The economic cost of untreated mental illness is more than $100 billion each year in the United States.
  • The best treatments for serious mental illnesses today are highly effective; between 70 and 90% of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.
  • With appropriate effective medication and a wide range of services tailored to their needs, most people who live with serious mental illnesses can significantly reduce the impact of their illness and find a satisfying measure of achievement and independence. A key concept is to develop expertise in developing strategies to manage the illness process.
  • Early identification and treatment is of vital importance. By ensuring access to the treatment and recovery supports that are proven effective, recovery is accelerated and the further harm related to the course of illness is minimized.
  • Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural, and financial barriers to effective treatment and recovery. It is time to take these barriers down.

(Source: National Alliance on Mental Illness [NAMI] http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/About_Mental_Illness.htm).

How to Help:

If somebody told you he had diabetes, how would you react? If you’re like most people, you’d express sympathy and concern, offer your support and reassurance, and feel confident that your friend’s condition would improve with treatment. Now, if that same friend told you he had a mental illness, what would you do?

Too many people respond negatively when confronted with a friend’s mental illness, and this only fuels the stigma surrounding the diagnosis. The reality is, mental illness is no different from physical illness. Conditions like depression, schizophrenia, and anxiety disorders affect a person’s body. The emotional and psychological aspects of mental illness make supportive friends and family even more important to a person’s recovery.

So, now you know you can help just by being there and offering your reassurance, companionship, emotional strength, and acceptance. You can make a difference just by understanding and helping your friend throughout the course of his or her illness and beyond.

Source: Mental Illness: What a Difference a Friend Makes http://www.whatadifference.org/support.asp?nav=nav02_0&content=2_0_support.

Help a Friend:

If your friend tells you he or she has a mental illness, you might want to respond in any or all of these ways:

  • Express your concern and sympathy.
  • Ask for more details about the person’s diagnosis and how he or she is managing. Really listen to the answers and continue the conversation. Make sure your friend understands that you honestly care.
  • Ask what you can do to help. You can leave this open-ended or you can suggest specific tasks that might help your friend in his or her specific situation. Rides to medical appointments (or keeping the person company in the waiting room) can ease some of the anxiety and reluctance that people feel when faced with a life-changing diagnosis.
  • You might also offer to help your friend with errands, but be careful not to patronize or make the person feel disempowered.
  • Reassure your friend that you still care about him or her, and be sure to include him or her in your everyday plans—going out to lunch, catching a movie, taking a jog. If your friend resists these overtures, reassure and re-invite without being overbearing.
  • Remind your friend that mental illness is treatable. Find out if he or she is getting the care he or she needs. If not, offer your help in identifying and getting the right kind of care.
  • If a friend is having a psychiatric emergency, ask them what kind of help they need and respond immediately. It is important to give them hope and encourage them to seek support, including calling a crisis line or the National Suicide Prevention Line at 1.800.273.TALK (8255).
  • Immediate medical attention is also in order if somebody you care about is very weak or ill from an eating disorder.

(Source: Mental Illness: What a Difference a Friend Makes http://www.whatadifference.org/support.asp?nav=nav02_2&content=2_2_helpfriend).

JAN’S ACCOMMODATION FACT SHEET SERIES

http://www.jan.wvu.edu/media/psyc.htm

Job Accommodations for People with Mental Health Impairments

According to the National Mental Health Association (http://www.nimh.nih.gov/), a mental health impairment is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines. There are more than 200 classified forms of mental illness. Some of the more common disorders are depression, bipolar disorder, dementia, schizophrenia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorders, seasonal affective disorder (SAD), and anxiety disorders. Symptoms may include changes in mood, personality, personal habits, and/or social withdrawal. An estimated 54 million Americans suffer from some form of mental disorder in a given year.

The following is a quick overview of some of the job accommodations that might be useful for people with mental health impairments. For a more in depth discussion, access JAN’s publications at http://www.jan.wvu.edu/media/atoz.htm. To discuss an accommodation situation with a consultant, contact JAN directly.

Maintaining Stamina During the Workday:

  • Provide flexible scheduling
  • Allow longer or more frequent work breaks
  • Allow employee to work from home during part of the day or week
  • Provide part-time work schedules

Maintaining Concentration:

  • Reduce distractions in the work area
  • Provide space enclosures or a private office
  • Allow for use of white noise or environmental sound machines
  • Allow the employee to play soothing music using headphones
  • Increase natural lighting or provide full spectrum lighting
  • Plan for uninterrupted work time
  • Allow for frequent breaks
  • Divide large assignments into smaller tasks and goals
  • Restructure job to include only essential functions

Staying Organized and Meeting Deadlines:

  • Make daily To-Do lists and check items off
  • Use several calendars to mark meetings and deadlines
  • Remind employee of important deadlines
  • Use electronic organizers
  • Divide large assignments into smaller tasks and goals

Dealing with Memory Deficits:

  • Allow the employee to tape record meetings
  • Provide type written minutes of each meeting
  • Provide written instructions
  • Allow additional training time
  • Provide written checklists

Working Effectively with Supervisors:

  • Provide positive praise and reinforcement
  • Provide written job instructions
  • Develop written work agreements that include the agreed upon accommodations, clear expectations of responsibilities, and the consequences of not meeting performance standards
  • Allow for open communication to managers and supervisors
  • Establish written long-term and short-term goals
  • Develop strategies to deal with problems before they arise
  • Develop a procedure to evaluate the effectiveness of the accommodation

Interacting with Coworkers:

  • Educate all employees on their right to accommodations
  • Provide sensitivity training to co-workers and supervisors
  • Do not mandate employees attend work-related social functions
  • Encourage employees to move non work-related conversations out of work areas

Handling Stress and Emotions:

  • Provide praise and positive reinforcement
  • Refer to counseling and employee assistance programs
  • Allow telephone calls during work hours to doctors and others for needed support
  • Allow the presence of a support animal
  • Allow the employee to take breaks as needed

Maintaining Attendance:

  • Provide flexible leave for health problems
  • Provide a self-paced work load and flexible hours
  • Allow employee to work from home
  • Provide part-time work schedule
  • Allow employee to make up time

Dealing with Change:

  • Recognize that a change in the office environment or of supervisors may be difficult for a person with a mental health impairment
  • Maintain open channels of communication between the employee and the new and old supervisor in order to ensure an effective transition
  • Provide weekly or monthly meetings with the employee to discuss workplace issues and productions levels

Additional Mental Health Resources:

Operation Fresh Start Project Example:

Background:

Nationwide in 2008, more than 3 million youth between the ages of 16 and 24 were reportedly out of school and jobless. In Dane County, Wisconsin, that number is estimated to be as high as 4,000. These youth, many of whom are juvenile or adult offenders, have been called ‘disconnected,’ because they have severed ties to the mainstream community and have no plans to become reconnected.

Mission:

Since 1970, Operation Fresh Start’s mission has been to help young men and women, ages 16-25, from low-income backgrounds, acquire job skills, complete a high school credential, develop career goals and strategies to achieve them, to enter employment and post-secondary education, and to become and remain self-sufficient.

Services:

Operation Fresh Start is Dane County’s largest youth employment and training organization, annually assisting 80-130 young people to prepare for career-track employment. Their comprehensive program includes:

  • Job skill training and the opportunity to serve the community through the construction or renovation of affordable, green-built homes sold to lower income buyers. With the help of a skilled construction trainer, OFS participants complete all phases of residential construction, except those tasks requiring building trade licenses.
  • Classroom preparation for drop-outs to pass the GED or HSED or complete a high school diploma, study an enriched subject and skills curriculum, and improve basic reading and math skills.
  • Support services, including individual counseling, on-site health care and health education, a nutritious breakfast and lunch each workday, and mental health assessments and referral.
  • Career exploration and guidance.
  • Placement in career-track occupations or post-secondary education and an AmeriCorps Education Award to help pay the costs of higher education.
  • Follow-up for two years to support graduates’ retention and success in employment and higher education.

Outcomes:

In its 39 years, Operation Fresh Start has enrolled over 6,000 young people, 80% of whom have achieved the goals of the program – job placement or graduation to higher education. Long-term follow-up studies show that 70% of graduates remain self-sufficient and free of reliance upon public assistance or involvement in the criminal justice system.

Lessons Learned:

The groups from which Operation Fresh Start (OFS) recruits its Corpsmembers – low-income youth, high school drop-outs, and offenders or ex-offenders – have a high incidence of individuals with mental illness. These concerns arise from many causes including family dysfunction, heredity, inadequate health care, and a chaotic and violent social environment. OFS has done its best to serve young people with a wide-range of mental health concerns. The inclusive crew project has provided OFS with additional resources to improve its ability to include those with mental health disabilities in their program and to help them succeed at OFS and in other social, employment, and educational contexts.

The lessons learned by OFS as part of the inclusive crew project include:

  1. Affirmed that the Youth Corps model has the elements needed to help young people, with and without mental health concerns, to confront personal barriers and make fundamental, positive life changes. Young people succeed at OFS and in other Youth Corps because the adult staff provides what their community has not – the consistent message that they are valuable as individuals and that someone cares about their welfare. Staff members provide constant guidance, support, and direction to Corpsmember who trust and value their opinions. This bond renders training, education, and counseling to be effective.
  2. Within this context, a young person with mental illness can benefit from additional support provided by skilled lay staff, as well as from treatment provided by licensed counselors. OFS provides in-service training to its teachers crew supervisors, and all lay people, on how to recognize and respond to the indicators of mental illness.
  3. Creating an objective way to measure the effectiveness of the Corps experience with members with mental health issues can be difficult. OFS is accessing mental health professionals in the community to help create an evidence-based measurement tool.
  4. Group discussions on the topic of mental health must be conducted with great care. Confidentiality about mental health status must be respected.
  5. Identifying oneself with a “mental health label” is not always the healthiest way to proceed.

Service Model: The Bond Theory

Traditionally, OFS has worked with youth and young adults who have multiple barriers to success. They have been let down by and failed in or been failed by other institutions – the family, schools, and other social service agencies. Typically, they are defiant of adult authority, self-destructive, headed toward increasing dependency on the public welfare system, and involvement in the criminal justice system.

The Bond Theory takes the view that conditions favorable to the violation of law are rooted in the absence or weakness of intimate relations with other persons, especially with adults (such as parents or teachers) who might be “significant others” in the life of a youth. A youth that is closely attached to and respecting of others, feels approval and esteem from others when his/her behavior is in accord with the other’s values and beliefs. If such attachments are absent, the approval or esteem from someone who is not respected has little meaning. Lack of concern for the reactions of “significant others” is thought to generalize as a lack of concern for the approval of persons in positions of authority. The youth who does not have the love and approval of those closest to him will tend not to expect or even desire the love and approval of impersonal others, and will thus be free to reject the normative pattern that society attempts to impose. For the unattached, the only reason to obey rules is to avoid punishment. In the case where attachment does not occur, the youth is assumed to have a low stake in conformity. “Stakes in conformity”, as it is used here, includes both attachment to a significant other and having a stake in one’s past and future achievements within the larger society.

Young people succeed at OFS because the adult staff provides what their community has not – the consistent message that they are valuable as individuals and that someone cares about their welfare. The staff provides constant guidance, support, and direction. In essence, the staff become “significant others” to OFS participants – substitute parents or big brothers and sisters. The participants begin to trust these adults and value their opinions. Once this bond has been established, it is possible for the program of training, education, and counseling to be effective.

Operation Fresh Start provides a positive opportunity for development, a holistic approach utilizing staff and volunteers as significant others, and a work setting that provides real work with significant value to the community.

Particularly for those working on long-term housing projects, this work is a concrete symbol of the rebuilding they are doing in their lives. Each day, slowly and surely, the crew brings the house closer to completion. Participants see the impact of their work and say, “I did that.” For many, the first bond they form at OFS is to the house itself. This may be the first time that many have been a part of something that is positive, the first time they have been successful, the first time that they have given back to their community.

The program emphasis is on positive rewards that come from work and healthy human interaction. For those unaccustomed to success, the staff sets up a myriad of ways that participants can be successful in small ways and then succeed at increasingly larger and more complex tasks. Attainment of goals is always appropriately praised to reinforce the participant’s sense of personal effectiveness. Additional rewards include the living allowance and educational stipend that are received for participating. Eventually, rewards include the promise of a brighter future.

Operation Fresh Start Combines Construction and Counseling:

Operation Fresh Start (Madison, WI) has developed an approach to working with YouthBuild participants so that construction staff act as mentors, teachers, role models, and “significant others” while they teach construction and work skills. This approach emphasizes the development of individual strategies for each participant and collaboration between supervisors, teachers, and other program staff. In this program, construction staff are responsible for the overall development and progress of each of the participants. Although participants construct housing and learn carpentry skills while enrolled in the program, the goal of the construction staff is not to train carpenters, but to develop young people.

Since supervisors and participants work together each day, they have an opportunity to develop relationships and have time to talk about personal issues. Each supervisor manages a work crew of eight participants. Staff are expected to develop relationships with their participants, not just to teach carpentry. Although the program offers traditional one-to-one counseling to participants, they sometimes attend counseling sessions without really opening up. Discussing their issues in a non-traditional setting, with the supervisor with whom they already have a relationship, is more genuine.

Supervisors can bring up issues such as attendance problems or check in with a participant who seems to be having a tough time. The staff believe that better results are obtained when they talk with a participant about alcohol or drug abuse issues while putting up drywall, than in a traditional counseling session.

Developing personal relationships between participants and staff is not something the program leaves to chance; it begins during the application process. Construction supervisors, teachers, the placement coordinator, and co-directors interview participants. The aim is for each participant to get the message that all of the staff is invested in their progress. From the very beginning, participants are told that as long as they are trying and meeting goals, the staff are 100% their advocates and mentors and will find resources to help them accomplish what they need to do.

After a participant is admitted, supervisors and teachers work together to develop an Individual Service Strategy (ISS) for that participant. The ISS ensures that the program meets each participant’s particular needs. Since participants are often receiving services from other agencies, OFS acts as the hub of the wheel to ensure that all programming is coordinated. As participants work their way through the program, staff meets formally as a group and informally to discuss the individual needs of participants.

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