Boston University College of Health & Rehabilitation Sciences: Sargent College:
Center for Psychiatric Rehabilitation

Boston University College of Health & Rehabilitation Sciences: Sargent College:
Center for Psychiatric Rehabilitation

Hope for Success


Why hope for success?

There is no simple way to get through the many job applications, employer contacts, and hurdles needed to find a job in today’s economy, and it may be especially difficult to find the right match. Yet, wishing and believing are definitely part of the recipe for success.

When job seekers have people who believe in their ability to work, this helps a lot. Pat Deegan, a woman in recovery, calls this the Conspiracy of Hope – that wonderful circle of “believers”- a sort of “fan club”.

Hope is a belief that things will get better. Hope lets one see that change is possible. Hope is a part of a process that can have many ups and downs along the way. (Farkas) No one is unemployable. To hear why, listen to this presentation by Elisabeth Sanders Park who authored a book on the subject.

Stories of Success and Inspiration

These are the stories of various individuals who have overcome the obstacles that come with psychiatric disabilities. Discover their successes and the stories of their recovery journeys.

Video Stories of Vocational Recovery

Vocational recovery is possible. These real life stories, told by real people, show how.

Recovery and the Conspiracy of Hope

Pat Deegan has lived experience. Through this lecture presented at the Sixth Annual Mental Health Services Conference of Australia and New Zealand, she shares how hope is a key element in the successful recovery from mental illness.

Gifts and Possibilities – Denise Bissonnette

In this YouTube video, Denise Bissonnette explains the importance of “possibility thinking” in her approach to job development – helping job seekers to see beyond their perceived limitations, to discover their own unique gifts, and to open their worlds to new possibilities.

What is the evidence that people with psychiatric disabilities can recover and work successfully?

Many studies show that people with psychiatric disabilities can recover and work successfully. (Drake; UIC/EIDP; McKay)

Other research shows that people can work with the right support. Many people in recovery complete their education and work in a career track.

Self-Determined Career Planning – The Career Visions Project

The Career Visions Project provided young people with mental health conditions with career and job planning assistance. The young adults who participate in CV learn and use strategies to choose a career or job that is a good fit for each of them, to develop plans for moving toward their career goals, and to take steps toward these goals. They also learn other practical skills such as how to do informational interviews and write resumes. The project has a positive outcome.

Center for Practice Innovations Consumer and Family Portal

Explore a variety of recovery-related videos that show how people with mental health conditions really can recover and work successfully.

Does recovery make employment possible? Does employment make recovery possible?

Success leads to more success. When someone feels better and has more hope and support, they are more likely to want to work. As employees in recovery find a sense of purpose at their job, they begin to have more confidence and hope. They start to believe in a future and perhaps a career. Recovery is in progress when the person feels less depressed and experiences higher self-esteem. (Mueser)

Are there potential risks?

There are risks for persons in mental health recovery but many of those risks are similar to those anyone would have in accepting employment. Transitional stress is associated with any important change such as new apartment, new relationship, new job. (Sykes) There can be any number of stressors in employment such as lack of support, ”effort-reward” imbalance or other stresses for which the employee is not fully prepared. (Stansfeld; Siegrist)

The employee can have a good job match but it still takes time and additional skills to find ways to deal with the stress. Sometimes there is a wrong match, and if that is the case, a professional Employment Specialist or Rehabilitation Counselor may be able to help your family member figure out what went wrong. They may be able to prepare for the next job with new awareness, new skills or a better match. The best way to find the elements of the right match for an individual is to get a job and see what work tasks, job environment, type of supervision, or company policies work or do not work. Teaching the worker specific “soft skills”, such as interpersonal skills, manners, time management, and stress management (Robles) can help to prevent future problems. In each job there are specific skills needed to do well in the culture of that job setting.

Will working cause my family member to relapse?

You may worry that employment will involve too much stress for your family member or may lead to relapse. Someone can have a mental health crisis or relapse whether they are working or not. If the person is having problems with managing their mental health, acute mental health problems could occur but they may or may not be related to employment. In many cases, teaching the worker coping skills and assertiveness can reduce or eliminate some of the stress. Typically work does not cause relapse.

The employee should always have a wellness plan, such as WRAP, in place to help guide decisions about how to stay physically and mentally healthy, including times when things are very difficult at work. Sometimes there are early warning signs of mental health difficulties or feelings of being overwhelmed. This does not mean one has to quit the job but it might suggest extra support of even a time out of the job. Here the family can be helpful. The Wellness Recovery Action Plan (WRAP) is a tool to help identify one’s goals, the type of help needed, steps to take and what will happen when the person cannot safely make a decision.

If someone is having work related stress, an Employment Specialist (vocational rehabilitation professional generally working in a rehabilitation or mental health program) can work as a consultant to the employer to make some modifications to the work environment or change the type of supervision. This can at times solve the problem. In some situations the pressures are too much and it may be time to try a different job or a new employer. Below are some resources for your family member. In some cases you and your family member might utilize them together.

DBSA Wellness Toolbox

The Depression and Bipolar Support Alliance (DBSA) has developed this variety of tools that can help people in recovery improve and maintain their well-being.

The 6 Reasons You’ll Get the Job

Elisabeth (Harney) Sanders-Park’s book discusses the job-search & hiring processes from the employer’s perspective. Namely four ways to prove a candidate has what an employer wants, six tools to avoid being screened-out, & strategies for people with barriers to employment.

Wellness Self-Management Workbook

The WSM workbook consists of 57 lessons organized into three major chapters addressing recovery, mental health wellness and relapse prevention, and the relationship between a healthy lifestyle and recovery.

Wellness Self-Management Plus

The WSM+ workbook is a version of the original WSM workbook that has been designed for individuals who are simultaneously dealing with mental health and substance use problems.

What if my family member is anxious about failing at the job?

Many of us have anxiety about working, especially in a new job – this is normal. When a person with a significant mental health condition goes to work the anxiety may be greater. They may have anxiety about struggling to work or concern about disappointing others if the job does not work out. The person may also have other symptoms unrelated to work or aggravated by transitional stress of change at work. Before the start of a new job, the person should reminded that anxiety is normal! However, there should be a plan in place for how to deal with the anxiety when it occurs. (We assume there will be new anxiety.) When the worker has “tools” for dealing with anxiety the job has a better chance of working out. Keep alert for any signs of improvement and it is helpful to focus on what is going right.

One of the strategies for dealing with stress on the job is to build up stress hardiness. Some example strategies include brief meditations, mantras, or breathing techniques twice a day. This is like building a stress hardiness muscle. Once these practices become routine, your family members will be ready to deal with stressors when they occur. (Maddi)

When beginning a new job or getting one’s own apartment or trying anything new, your family member might worry, not only fearing failure but might also fearing success. There can be fear that others will expect more. (McCrory) Often with support and especially with a wellness plan in place, this crisis will likely pass and the new level of expectation will be achieved.

Workplace Strategies for Mental Health

Provides recommendations from the (Canadian) Great-West Life Centre for Mental Health on how to deal with both personal, relationship, and environmental approaches to making the work environment more supportive and less stressful.

What sacrifices might be necessary?

It is normal for employment to cause changes in day-to-day life. One may have to get up earlier, pack meals, change shopping habits, or give up some activities that occur during the workday. This includes those who have challenges with substance use. They will need extra support to abstain from drugs and alcohol to be efficient and productive in the workforce. Family members may help with managing money or providing transportation. They may also take the time to teach the individual about public transportation. Family members could also advocate to state and local agencies for more vocational supports for those with psychiatric disabilities. (Cohen)

Is there potential for mixed messages about work from care providers, clinicians and others?

Yes, mixed messages do happen and it is unfortunate because getting mixed messages about the idea of work, one’s ability to work, or the impact on benefits can create more anxiety, confusion or ambivalence. Team members have different backgrounds, education, professional orientation and views of one’s ability to work so there are bound to be some differences of opinion. However, when the professionals, peers and family members can communicate with the job seeker with one voice, it makes it considerably easier for the job seeker.

It is of the utmost importance that all support persons have correct information about wages and benefits as this is an area of great “fear” and a source of misinformation. One clinician may tell your family member that if they work and earns a certain amount, it will not affect their health benefits. At the same time, another family member could say to that person that working will cause loss of health care. Getting the RIGHT information for the situation is critical. Having the whole team providing the RIGHT information is essential. In most cases, with the guidance from a Benefits Expert, the family member will gain in their overall income by working. A Benefits Expert or Benefits Specialist is a trained individual whose role is to analyze the effect that work would have on public benefits received by people with disabilities.

Some of the research on models such as Individual Placement and Support, a type of Supported Employment (Dartmouth) and Assertive Community Treatment teams (SAMHSA) indicates that there are better employment outcomes when the Employment Specialists are part of a team (and team members work in unison). When the professionals work as a team and the family is a good collaborator, the individual job seeker or worker is less likely to be stressed about employment goals. In an extensive overview of research on services to families of people with psychiatric disabilities 15 major principles were summarized for those models that had significantly better outcomes. The FIRST of these principles was “Coordinate all elements of treatment and rehabilitation to ensure that everyone is working toward the same goals in a collaborative, supportive relationship”. (Dixon)

Is it worth the “hassle”?

Remember that work has enormous value, provides meaning and a sense of purpose. There is a classic article (Marrone and Golowka) which answers the question “Is it worth it?”

The title tells it all: “If work makes people with mental illness sick, what do unemployment, poverty, and social isolation cause?”

Return to the main section on helping your family member Think About Work.

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