Recovery From Schizophrenia: Psychiatry And Political Economy

252 WORKSheltered workshops ordinarily obtain work from industry by bidding forcontracts. The work obtained is often a series of repetitive tasks that would lead tohigh staff turnover under usual economic conditions if performed inhouse by theprivate company’s own employees. When business is in decline, however, suchsources of work begin to dry up. Companies may cut back production, performmore work in-house, or go out of business. Competition for available contractscan become severe. Under these conditions sheltered workshops may simply goout of business themselves, they may lower their bidding rates so far that they losemoney and require a bigger subsidy from the mental health service, or they maycut back operations and lay off disabled employees. In the sheltered workshop inBoulder, for example, the number of clients employed fluctuates with economicconditions between 40 and 70. In hard times the waiting list for placement maybe several months long, and the lowest-functioning clients, who require a greatersubsidy, may be screened out.Supported employmentTransitional employment programs (TEP) were originally developed in the 1970sby Fountain House, the psychosocial clubhouse in New York City (seeChapter 12). Under this model, vocational staff locate jobs in businesses oragencies in the local community. A person with mental illness is trained by a jobcoach, and placed in one of these positions for a period of, usually, six months. Atthe end of that period, a new person with mental illness is placed in the job. Theworker is supported on the job, to the extent necessary, by the job coach and mayattend support meetings or dinner groups on a regular basis while employed. Ifthe patient cannot work at any time, for whatever reason, the job coach will findanother client to work that day or will do the job himself or herself.Consequently, the employer gets a good deal. He or she knows that the job, oftena high-turnover, entry-level position, will be permanently and reliably filled andthat the worker training is done by an outside service.The principle behind transitional employment is that the person with mentalillness learns basic job skills in a “transitional” position that will help the personachieve the ultimate goal—a permanent, unsupported job in the competitivemarketplace. In fact, most of the research does not support the contention thatthose who work in TEP positions are more likely to secure independentemployment 28 and, given the extreme sensitivity of people with disorders such asschizophrenia to the stresses of change, it is hard to believe that transitionalemployment is ideally suited to this population. In fact, one of the main reasonsthat programs such as Fountain House developed the transitional model ofemployment was that they found it difficult to locate enough jobs and providesupport to all of the clients who wanted work.More suitable for the stress-intolerant person with mental illness is the modelof continuous supported employment, originally developed for people withdevelopmental disabilities. This model is similar to the TEP approach except that