Recovery From Schizophrenia: Psychiatry And Political Economy

256 WORKcatering, and picture framing and operates a café. 37 Such ventures appear possiblein the economic context of North America and the British Isles, depending onthe extent to which the mental health service is willing to subsidize them, but asyet they have been little developed and do not offer work to more than a few ofthe potential users.How can their range be expanded? To give a competitive advantage toconsumer-employing businesses, contracts with mental health agencies and otherpublic organizations can be developed. New York State agencies, for example, areobliged by the state finance law to purchase new equipment from consumeremployingprograms of the Office of Mental Health whenever possible. 38 NISH,formerly National Industries for the Severely Handicapped (www.nish.org), is aUS national nonprofit agency that assists affirmative businesses in obtainingcontracts to provide services to federal agencies under a congressional initiative toenhance the employment of the disabled.At a more local level, a mental health center can shift services that are currentlycontracted to outside enterprises (such as courier services or secretarial help) to aconsumer enterprise. Janitorial and cleaning services are often thought of in thiscontext, but these jobs, in fact, are not popular with many mentally ill people; thework is menial and does not pay well. More clients, especially men, are interestedin construction and property repair jobs such as plumbing, wiring, painting,roofing and so on. In a survey conducted at the mental health center in Boulder,Colorado, less than a quarter of the male clients expressed an interest in janitorialwork; more than a third, however, were interested in property repair. 39Consequently, in 1993, the agency started a small property repair businessemploying a non-disabled lead contractor and a number of part-time consumerassistants. The business took over the property maintenance that previously costthe agency $30,000 (£20,000) a year. It has since expanded and is saving theagency money. Other consumers are employed at the agency in the records office,and as research interviewers, vocational and residential staff, therapists and casemanagers.Another program, a consumer-oriented pharmacy, has been started at theMental Health Center of Boulder County with the specific intent of providingemployment and other benefits to the agency’s clients. An economic surveyconducted in 1992 by the author and Paul Polak, a Canadian psychiatrist andThird World economic development expert, revealed that medication is one ofthe largest markets controlled by people with serious mental illness. (More detailsfrom this survey are presented below.) James Mandiberg, at that time director ofthe Mental Health Bureau for Santa Clara County, California, proposed that aprofit-sharing pharmacy could create consumer employment opportunities andgenerate capital for other consumer-oriented activities. A feasibility study 40 ledeventually to the development of such a pharmacy. Profit from the pharmacy ischanneled to a $50,000 consumer-managed fund for consumer projects in theBoulder mental health center’s Office of Consumer and Family Affairs. There areadditional benefits to the specialty pharmacy. Consumers are employed as