Recovery From Schizophrenia: Psychiatry And Political Economy

290 DESEGREGATING SCHIZOPHRENIAboard, several advisory boards and the board of the agency’s fundraisingfoundation. The center’s vocational workshop is being converted into a businessenterprise in which the consumer workers have input into and authority oversuch issues as working conditions, career ladders, fringe benefits and budgetarychanges. Throughout the agency, consumers are employed as case managers,residential counselors, rehabilitation staff, records department and office workers,consumer organizers, research interviewers and in a variety of positions inconsumer-employing enterprises set up by the agency, such as a property repairbusiness and a consumer-oriented pharmacy (see Chapter 11). Other mentalhealth agencies have also found the position of peer research interviewer to beone which can be successfully filled by a consumer even when he or she suffersfrom persistent psychotic symptoms. 53 Increasingly, the experience of havingcoped with a serious mental illness comes to be seen as a hiring advantage, similarto being bilingual. At the Mental Health Center of Boulder County most of theentry-level staff position announcements are posted in the lobby of the agency’soffices and clients are encouraged to apply.THE DEATH OF DAY CAREDevelopments in consumer-run programs and community treatment andrehabilitation programs have made traditional day care more or less obsolete. Daycare programs are in essence a transfer of the institutional setting to thecommunity. Writing of British practice, psychiatrist Mounir Ekdawi concludes,Severely disabled people attending a day unit have often led dependent,institutional lives for many years; nevertheless, it often seems that their pasthospital experience was, if anything, richer and more socially stimulating. 54For many patients, day care offers close observation, daily medication monitoringand a welcome release from an otherwise aimless existence. These advantages,however, can be achieved, with much greater empowerment and rehabilitativepotential, through a combination of intensive outpatient treatment (describedabove) and a Fountain House style of clubhouse with consumer involvement.Organizations such as Fountain House, in New York City, and Thresholds, inChicago, have gained international prominence for establishing a model in whichpeople with mental illness are involved in running a program that meets many oftheir recreational, social and vocational needs. In these pro-grams, clients arecalled “members” and work with staff in running the operations of the clubhouse—putting out the daily newsletter, working in the food service, staffing thereception desk or serving in the clubhouse thrift shop (second-hand clothesstore). The clubhouse is open in the evenings, on week-ends and on holidays,providing a refuge for people who may live in cramped, cheerless housing andsometimes cannot fit in well in other social settings. Psychiatric treatment is