Though most adult day treatment programs in mental health centers have adopted recovery language, they are still, at their roots, mostly day care. They often discourage, and create barriers to day treatment graduation.
The people themselves are often unwilling to risk reducing or weaning off their medication, losing their benefits, or re-entering the work force, and their providers don’t want to help them, don’t know how, or don’t want their clients to risk having setbacks the clients clinicians will have trouble dealing with..
But many studies have shown that supported employment programs move people toward recovery, jobs, and day treatment graduation faster and cheaper than day treatment groups and activities.’
Many providers think that working is too stressful for a person with a mental health diagnosis, but what about the stress of isolation? The stress of poverty? Of lack of purpose and feeling useful and productive?
The supported employment programs found that people with jobs had no increase at all in symptoms or hospitalization rates overall.
Day Treatment Graduation Mean Taking Risks
Sometimes recovery involves taking risks, doing things people hadn’t thought were possible for them. So sometimes an increase in problems simply means that a person is finally finding the courage to move forward into unknown territory. Independence and uncertainty can be stressful. But uncertainty and stress are essential parts of an independent life.
The question is, “Do people who end up with mental health labels have a different chemical, genetic, or structural process than people who don’t get labels.” I think the answer is no.
Certain inputs can cause certain stress responses for anyone. Who gets ulcers vs. psychosis vs. arthritis in response to stress depends on their culture, their personality, the family patterns they’ve observed, etc.
But stress is not a disease, and once better responses to stress, like wellness techniques, have been developed, then the maladaptive response can subside.
My thought is that some people are in group homes because they are intellectually or physically disabled. As far as I know, that is, for the most part, permanent, and some people may need that level of living assistance long term.
For the ones who don’t, permanent dependency is one of the tragedies of our mental health care system’s paradigm. Someone can have an existential crisis and need help. But the help they get says the emotional crisis was really an illness. Then they get meds that increase the chance of further illness.
The Mental Health System Keeps People Dependent
Anti-psychotics cause psychosis. Antidepressants increase the risk of violence, more depression, and other mood swings. Then people have to balance the”benefits and risks of psychiatric medication,” help vs. the chance at freedom for the rest of their lives. It’s awfully tough to leave a bird in the hand for two in the bush.
The advocates say we need to “redefine disability” as “a barrier to the workforce,” instead of “swearing on the Bible you can’t and won’t ever work again.”
Tons of homeless people I’ve worked with refused to look for jobs because their disability hearing was pending. But telling diagnosed, medicated people how they were duped by this whole system doesn’t cure them overnight.
Many of them are damaged by the medications, which cause brain shrinkage and physical harm. Also, the institution itself is designed to beat out any spirit of resistance. And it takes a long time to detox off medications and find a new life.
Plus, of course, the risk of losing benefits.
What Else Would Help Day Treatment Graduation?
Some day treatment people could benefit most from advice on medication reduction, negotiating with doctors on balancing their needs, on looking for meaningful work, volunteer programs, or community engagement.
When The Chocolate Fairy told people day treatment graduation and jobs are possible, they absolutely perked up the most. I think the best thing a program can do is get some of the people out of it via supported employment.
But they won’t since it’s a cash cow for the mental health center. They bill all those people $80 an hour for psycho-social rehab even though there are only three staffers.
That makes day treatment graduation even more difficult and unlikely — but still possible if a resident believes and wants it enough to overcome the barriers, be assertive with their providers and themselves, and take the risks.
What is the hardest barrier to day treatment graduation?