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

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

The Value of Work

What is recovery?

Having a recovery “vision” sets the stage for having a vocational recovery vision. What is recovery? The answer to this question varies from person to person. However, here are some common “definitions” of recovery:

  • Recovery is a way of changing one’s attitudes, values, feelings, goals, skills and roles. (Anthony)
  • Recovery is a way of facing the day’s challenges. (Deegan)
  • Recovery is a journey of healing and change allowing a person with a mental health problem to live a meaningful life. (SAMHSA)

A recovery vision helps you see a better future. A future, not as a patient but as a person. A person with hopes, dreams, interests and gifts. Thinking about recovery helps the whole family to see all the possible roles one can have as an adult.

In the section on Achieving Employment Goals, you will find some guidance on family recovery. This part of recovery describes the skills and supports that family members need. As family members learn coping skills, they will be able to help the family member more.

What is vocational recovery?

Vocational Recovery is a personal journey to pursue, meet and achieve meaningful vocational paths. (BUCPR) Vocational recovery is more than getting a job. It is pursuing experiences that give meaning, purpose, and activity to one’s life. (Russinova) Meaningful work experiences can involve a variety of work and school experiences. The key to vocational recovery in particular is “hope.”

“Hope” is the belief that challenges can be overcome, and is the foundation of recovery. As long as a vocational experience provides hope, it has meaning. For some, the right job is their personal medicine. “I have learned that psychiatric medicine is not the only type of medicine that is important to recovery. Personal medicine, or those things that raise our self esteem and make life worth living are vital to recovery.” (Deegan)

Can work add value to my family member’s life?

For many, work provides structure, a sense of purpose, and a source of income. (NAMI) Work can help to reduce symptoms (Saks) and can improve self esteem. (VanDongen) Work can help your family member find meaning. The benefit of work can be as simple as “a reason to get up in the morning”.

Any vocational experience is an opportunity to learn about one’s self. The work environment often helps to break isolation. (Mueser) When the work is meaningful to someone, it can help to shape that person’s identity and lead to improvements in other areas of life. Worker identity is important and evolves with time and experience. It is not something you have or don’t have. (Millner) Different life and work experiences help to strengthen a person’s identity. As worker identity develops, the possibilities for more satisfying work can also develop.

Getting a first job is critical, it doesn’t matter how much it pays or what the duties are. (Zoe) Life and work experience help build a worker identity. As one grows in this identity, the opportunity for more fulfilling work grows.

Many people with mental health conditions work in professional or managerial positions. (Ellison; Cary)

Does work promote recovery?

When there is a good match between the person and the job, work does promote recovery. The worker is also learning new coping skills. Some factors that promote recovery include increased independence and resilience. Employment is on)e good approach to achieving a sense of purpose. (NAMI)

Work helps with recovery, self-empowerment and the idea of work as a part of recovery. Those in employment serve as role models for others who are still struggling. The feeling of contributing to peers is a powerful ingredient in recovery. (Provencher)

People who go to work are less likely to go to the hospital or use outpatient services (Bush; Hoffman). They also have fewer symptoms, are more confident, and have a better chance of recovery (Bell; Miller). Plus, returning to work also means they are more financially stable (Dunn; Hoffman).

How will I know when my family member is ready for work?

There is no checklist that determines when someone is ready to work. Decisions about working can be illustrated in a framework developed by Prochaska about the stages of change.

The stages include:

  • Precontemplation – not considering change
  • Contemplation – thinking about the change
  • Preparation – preparing for the change
  • Action – making the change
  • Maintenance – keeping the change
  • Termination – concerns about the change are no longer an issue

A person can move back and forth through the stages. Understanding which stage of the process your family member is experiencing might be helpful. This is especially true when choosing vocational services.

Services are most helpful if they correspond to the person’s needs. That is, matching the stage of change with the service provided. For example, if your family member is in precontemplation and the program is designed for quick placement in a job (action), it may be that the person needs another service first.

During the stages of change there can be negative thinking or recurrence of symptoms. Yet, these setbacks can be overcome if anticipated and planned for. The important thing is for your family member to understand there will be bad days at any stage of the process.

Does recovery promote successful employment?

An important part of recovery is having a goal and a sense of purpose. Recovery can improve self-confidence which helps make employment possible. Goals may include finding work which can provide a sense of purpose.

Not everyone chooses employment as the road to finding one’s life purpose. Recovery can lead to employment, but it is not guaranteed.

Many people with significant mental health conditions have an undefined or under-defined worker identity. They have also been socialized as a “disabled” person rather than an “abled” person. This and other barriers (Cook; Henry) can lead to outcomes that don’t include employment. This can happen even though the person is progressing and doing well in life.

Would work give my family member a chance to socialize?

Employment does not mean that your family member will have a whole new social life. At least, there will be new people with whom your family member can be friendly and socialize. There are often work/social events that can be enjoyable for the family member. The important thing is that your family member is meeting new people, and is not that lonely.

In fact, research shows that people who are competitively employed are more satisfied with their pastimes than those who are not. (Bond)

How does work affect my family member’s quality of life?

When expectations are low, it is more likely that the family member will accomplish less. (Mitchell) Low expectations are common in persons who have mental health conditions. People who care about them don’t want to “rock the boat” or take risks. This leads to the lack of encouragement to try new things. A person with a psychiatric disability may choose not to work because of their fear of failure. This can come from internalized stigma (low expectations for self) or fear that they will lose health benefits.

Family and friends may see progress in the person once they starts working. You might notice your family member trying to be on time every day and meeting the goals of the job. As a worker the “person” emerges from that label of mental illness.

Your family member who is working may feel better about themselves. Your loved one may feel more confident about money concerns. (Mueser)

The longer someone works, the more likely they will be interacting with others on a daily basis. Employment is linked with increased quality of life as well as income. The reliance on and cost of mental health services usually goes down when the person is employed. (Mueser; Bush; Harding)

What impact will work have on the family?

When one person in the family changes, other members tend to change as well. (Goldenberg) Especially when the family member in recovery is living at home or has close family ties. At first, the worker may feel a great deal of stress which can spread throughout the family. Over time the worker may find meaning and enjoyment in work so stress decreases. The new meaning and energy can be shared with your family and be a source of pride.

Changes in the workplace can cause some stress. Each time an employee advances in life, there can be a return to previous “crisis” behaviors. For example: Depression, Isolation, Headaches, Panic or other symptoms. These incidents can happen when the employee meets a job challenge and feels anxious about it. (McCrory) The worker is responding to new experience, but it is a temporary setback. Much like everyone else who has a job, the worker and the family have to adjust at each turn of events.

The employed person has to be able to cope with new demands and be flexible. It can also mean greater independence for the worker. In some cases it might mean that the individual can move on to their own place, or take on another new goal.

Employment can also help glue the family together. It may even reduce many of the burdens placed on other family members. This often happens once everyone understand the relationship between earnings and benefits.

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

What am I looking to help my family member do?