Program Strives to Help Mentally Ill Cope on the Job

The longest time that 33-year-old James ever managed to hold down a job was two years. But he recently lost it, the 18th he has held since entering the job market in 1978.

“I wasn’t able to handle the stress,” said James (who asked that his real name not be used), who has tried his hand at a variety of jobs, including drafting and clerking. Concentration was an effort. He would become anxious about deadlines and unfamiliar tasks, even while realizing his fears were not justified.

James, who suffers from severe bouts of depression, is now participating in a pilot program at Pacific Clinics East in Duarte that hopes to prepare the mentally ill for further job training or a job.

The 5-month-old program targets people who are ineligible for vocational training because they cannot control their behavior, said Manuel Enriquez, state Department of Rehabilitation administrator. It differs from other vocational programs in its combination of therapy and job training.

Participants are taught to cope with symptoms of their illness that arise at work, said Pacific East Director Christopher Amenson, who developed and administers the program. Although job skills are emphasized, tips on social interaction and coping with symptoms are discussed about 40% of the time, said Maribeth Ekey, a psychologist at the Duarte clinic.

Some clients are taught to carry a notebook to remind them how to overcome their particular problems. For example, Timm Farnsworth, a vocational counselor in the program, advises those who have trouble concentrating to write down instructions.

“Many (clients), if put in a perfectly quiet environment, could type 50 words a minute,” Amenson said. But too often clients become practically paralyzed because “they get so afraid of things happening in the office.”

Program administrators hope that most graduates will be capable of entering job training programs and that some may be ready to begin work.

Nearly 300 applicants for vocational training programs in the rehabilitation department’s West San Gabriel Valley district were turned away in 1988 because their psychiatric symptoms disrupted their ability to work, Enriquez said.

Only 113 of the 253 mentally disabled clients accepted into the programs last year were successfully employed after graduation. Many of those who found work continue to have problems. “They would almost invariably have relapses because of the stress at work,” he said.

Describing the new project as “the missing element all along,” Enriquez said it is the first of its kind the department is sponsoring in the San Gabriel Valley.

In traditional job training programs offered by the rehabilitation department “we don’t do therapy; we do vocational counseling. They’re getting a bit of both” at Pacific clinics, he said.

Twenty people are enrolled in the program offered in Duarte and at Pacific’s other facilities, a clinic in Pasadena and the Asian-Pacific Family Center in Rosemead.

Most rehabilitation programs are conducted in adult or community training centers, but this program, conducted at psychiatric clinics, has medical records and doctors readily at hand. Enriquez said psychiatric support is essential for those in the new program.

The state rehabilitation department pays Pacific $4,000 a month for a vocational counselor who conducts group sessions at all three facilities.

Department counselors visit the clinics each month to monitor the progress of the pre-vocational clients.

“Our point is to take them step by step--all along increasing their independence and capacity to manage stress--so it’s not overwhelming for them when they go to work,” Ekey said. “They don’t need another failure.”

Building self-esteem is a fundamental step, Farnsworth said. At times clients don’t understand why they have been asked to leave a job in the first place. “Losing a job is devastating. That’s rejection in its purest form.”

Clients clock in on time cards every week. Strengths are assessed and counselors help them formulate realistic job goals. They are urged to volunteer.

“It gets them used to being in a schedule and in a different place, but where they are appreciated,” Ekey said. Later some may take on part-time work where they learn to deal with being evaluated.

Some schizophrenics experience hallucinations that turn a regular work day into a nightmare, Amenson said.

For instance, how do you continue speaking to your boss when you think he can read your mind? How do you keep typing when you hear the keys begging you to stop punching them because it hurts? One man who commutes to work has to deal with the delusion that the bus driver is pulling the thoughts from his brain, emptying it.

“We teach them to not pay attention to voices,” Amenson said. In another case, a veterinary assistant was fired from his job because he continually overfed the dogs. Why? The animals kept telling him they were hungry.

“Sometimes I feel like I’m being watched a lot and that puts stress on me,” said Jeanne (who asked that her real name not be used), a 33-year-old schizophrenic who has within eight years held jobs in 10 fields, including dental assisting and being a teacher’s aide.

Her application for a work program with the rehabilitation department six years ago was turned down, she was told, “because I was too ill to do anything,” she said. She has not worked since that time.

According to Amenson, 90% of schizophrenics do not work. He hopes at least 50% of the graduates from his program will.

The pilot project comes at a time when mental health programs are shrinking amid financial crisis. Enriquez said his vocational counselors are also conducting support groups for mentally ill clients in the wake of cutbacks in services last year by agencies such as the Arcadia Mental Health Center.