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CWT Success Story: Supported Employment Program

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Diagnosed Schizophrenia? Me? 

A story about a Veteran who found recovery from Schizophrenia and the Supported Employment Program Team.
By Dr. Linda Boen, VRC, Department of Veterans Affairs Medical Center, Fresno, CA 

Asleep In a White Room 

Dave was sleeping in the Inpatient Mental Health Unit. Approaching the locked ward, my vigorous steps began to hesitate. Eagerness mixed with ambivalence influenced my slow walk. This was to be a visit to the newly established Evidence-Based Supported Employment Program. The sixth floor nurse led the way through a procession of locked doors and finally to the Veteran's door. The door was closed.

The Veteran lay curled in his small white bed and appeared to be sound asleep. Medical records indicated diagnosis of schizophrenia and psychosis. The Veteran was asleep as we gazed through the window door. How could he be motivated immediately to seek work? The new Evidence-Based Therapy for "recovery" requires rapid engagement to employment. How could he even be awakened today, sleeping so soundly?

The Next Day

Today, upon seeing a visitor at his door, Dave quickly got up from the bed with a warm greeting. I introduced myself as the new Vocational Rehabilitation Counselor with the Supported Employment Program. He had been referred by a VA Psychiatrist to seek a competitive job with the Compensated Work Therapy/Supported Employment Program. He looked at me with kind eyes, somewhat dull that day, and described himself as having a mental illness with loud voices that sometimes "controls me and tells me things to do."

Dave shared that this seemed to have all started around the time of his military service. He described his military life as a Gunner: working with heavy artillery pieces as it released rounds of heavy artillery...every part of his body violently vibrating hour after hour with each release...eventually losing hearing in both ears...except for a new sound: like a loud ringing...maybe voices...don't know...ringing all night now...never stops...he bent over...leaned on his arms, saying..." I just don't know...I don't understand what is wrong."

Dave was a man of valor with three awarded Army medals and five ribbons and never asked for help. This was this man's way, often a Veteran's way. But the look in those eyes seemed too long for someone to understand his story. It was unclear how the voices started, and why he felt so sad at times that he began to welcome death as an option. Dave shared that the disease was like diabetes and if he took his medications for the rest of his life, then maybe he could cope.

Dave had no idea at this point, that he could have a working life with employment which later was a great surprise to the Veteran. His fragile hopes for dreams and aspirations for a life with predictable symptoms had crushed his hope for a working life long before. Not only had he been abused by an alcoholic family in childhood, but he had been diagnosed with one of the serious mental illnesses that have traditionally held little hope of recovery.

Medical Model vs. Recovery Model

After the inpatient hospitalization, Veterans with serious mental illness, typically in the traditional medical model, are sent home for rest and with medication. With the dawning of this new recovery model, the Veteran, if referred by a provider with medical privileges to the Compensated Work Therapy Supported Employment Program, can expect options for medication and referral to seek recovery with competitive employment.

The Job and Evidence-Based Recovery from Serious Mental Illness

Dave was surprised while still in treatment at the VA Hospital Inpatient Unit, that the Vocational Counselor offered immediate employment as he could be released to go home. An employer was willing to work with the Veteran on his journey to recovery and hire him after an interview. Later, smiling, dressed in pressed slacks and shirt, we introduced him to this employer. Amazingly, it was just several days after his discharge from the VA Hospital.

The Psychiatrist, made this referral, and today Dave was soon in a new job and working. Work skills from his military and life background made him an easy hire for the employer. In addition, a new hire of a disabled Veteran can give an employer a $4800.00 tax credit, and the employer wanted to help the Veteran. Dave worked as a Forklift Driver and in Shipping and Receiving at this new job. His employer later inquired about additional VA Veterans, like Dave, that need work. Dave and the employer even went fishing on week-ends and became "buddies" as Dave described it.

Dave still had bouts of deep and dark depression from the voices and memories of childhood resulting in hospitalizations. He was hospitalized every other month in 2007 with intent to harm himself before he was referred to the Compensated Work Therapy, Supported Employment Program, and hospitalized three times in 2008 for these rounds of deep and dark depression. No hospitalizations have been necessary since 2009.

Hospitalizations make it difficult, even with a close employee relationship, to maintain a job. The Vocational Rehabilitation Counselor however, visited the employer with the Veterans consent, and asked for accommodations with time away from work due to stress and anxiety. The employer was very willing to comply and help the Veteran retain his employment with the VA. The employer continued to support Dave's occasional medical absences, and Dave continued to grow in self-esteem and recovery.

His visits to Inpatient Mental Health have become less frequent each year, accompanied by increased self-esteem. He has gained personal power and control over his life as it was emerging. He is beginning to manage his symptoms in periods of good and difficult times. The Vocational Rehabilitation Counselor served as a conduit with the employer and the Veteran in difficult cycles. There were setbacks and accomplishments, and times when the symptoms may have been less controlled, but Dave learned that he could bring his symptoms under some degree of control and maintain his job.

Recovery is not done alone and the team; the Psychiatrist, MHICM Coordinator, Local Recovery Coordinator, Suicide Prevention Coordinator, Addiction Therapist, and this writer would sometimes meet daily or weekly and provide support as needed.  The recovery team offered hope to Dave and belief in him as a person, even when he was struggling to believe in himself. It is important to point out that Dave was recovering from the social consequences and societal stigma of mental illness as well as the more direct effects of the illness itself.

Eventually Dave inquired about applying (on his own) for a federal job at a VA hospital as a Motor Pool Driver. He was very conversational and liked talking with and helping fellow Veterans and thought the job would be perfect. Dave brought the many forms to the Vocational Rehabilitation Counselors office. The Counselor was prepared to help him with the tedious task of filling out a federal job application, but Dave already had them completed!

He had only stopped by the Counselors office to share that he was applying for a federal job. Needless to say, being the man that he is Dave, not 'Dave the man with Schizophrenia,' obtained a federal job as a driver for the VA! His military skills, early alliances and support for fellow Veterans had found a niche for his life, a working life!

Today, he continues to work at the VA medical center. He is an avid writer in his spare time writing about his recovery. He hopes to continue his education and is willing to share his story in order to offer the hope of recovery to other Veterans with serious mental illness diagnoses.

For Dave, recovery involves developing resilience to stigma and/or actively fighting against it. Dave has a deepening spiritual belief that he is writing about these days. He is inviting other Veterans with Serious Mental Illness to join him in this march toward recovery.

Dave and his beautiful new wife were married this past year and live in California. He works today as a wheelchair repairer in the motor pool and has been with the VA for two years. His Supervisor, Chief of Motor Pool and Engineering has also made a difference in Dave's life. He supported transferring Dave from his original position as a Driver to a position in Wheelchair Repair. This was an accommodation the VA Chief provided for increasing medical problems with his hearing loss.

Dave's routine task of driving had become hazardous with a severe hearing loss. The transfer resulted in a compatible job match accommodating a person with acute hearing loss. He also continues to allow extended and excused time off for the Veteran as needed to maintain the job. The Compensated Work Therapy team continues to be on call for Dave with Psychiatrist and/or employer to make immediate contact and offer support during the down cycles.

Dave's self-determination, along with supports from his Psychiatrist, his employer, the Supported Employment Program Team, and external contacts, has changed the cycle of despair into one that can be regulated. He has not been hospitalized this past year.

The Evidenced-Based Supported Employment Program offers "recovery from serious mental illness through rapid engagement and hope for a return to meaningful work."

Dave came to my office this week and stated, "I'm in recovery..." whereupon I replied, 

"Yes, Dave...we know... and you are our hero."

Note: The Compensated Work Therapy (CWT) is a vocational rehabilitation program administered by the Department of Veterans Affairs. Initiated by Public Law 108-170 the program has two fundamental goals: to rehabilitate the Veteran to a level of community independence and, hopefully enhance his or her overall quality of life. The recovery for this Veteran is a collaborate effort with the following team: Chief, Mental Health Service, Local Recovery Coordinator, Nurse Practitioner and MHICM Coordinator, Psychiatrist, Addiction Therapist, LCSW and Suicide Prevention Coordinator. This is the team that surrounded Dave with support during his journey to recovery.