Thursday, March 17, 2011

Daily Living Skills Series: Leisure and Productivity Interventions

This is going to be the last in a series of posts I have done on interventions in many different areas of daily living. I have been describing some of the factors to consider, and the intervention options available when addressing these issues. As I have worked primarily in mental health, it is from this viewpoint that I am talking about these interventions.

I used to receive many referrals for "leisure linking", but it seems this has slowed down. Leisure and productivity are areas that do not, at first glance, appear related to a person's ability to live independently, so therefore seem to be taking a back seat when competing for health care dollars. However, I feel they are critical to success with independent living, particularly for people with mental health concerns.

So many people I work with complain that they have nothing to do with their time. This is hard to imagine (and some days even sounds blissful!) to the stressed out, over-worked healthcare worker with a family at home. However, the everyday reality of having too much time can be brutal. With nothing to do and no one to see, thoughts spiral out of control. What starts out as a small thought can easily take on a life of its own when there is no stop to it, and no one to provide a reality check. Loneliness leads to depression and lack of motivation to do all the other things a person know he or she needs to do. Having somewhere to go, and people who are counting on you, is key to finding motivation.

My Concerns with the System

There has been a shift in how services are provided. Gone are the days of the sheltered workshops and leisure groups. Now the focus is to integrate people into existing community programs, to help them establish natural supports in a natural setting. I think this is a great idea, but it has not happened quite that way in practice. Some people have transitioned nicely, and benefited from integrating into the community. Others seem to be falling through the cracks.

There still is a core group of people who are institutionalized from having spent most of their lives in institutions, and they have an incredibly difficult time integrating into a non-sheltered setting. Also, many community groups and programs are not welcoming to people with odd behavior such as talking to themselves, or having poor personal hygiene. Many people with psychiatric disabilities have cognitive deficits, which can make participating in community programs difficult or impossible. Many people also do not have the skills or confidence to independently connect with programs.

There are not enough services providers to help people connect with community groups and programs, and service providers find themselves dealing with issues considered more "important" for living independently, such as housecleaning, money management, and medication management.

Productivity

Work is an important part of feeling productive, and useful to society. Nobody I've worked with wants to take advantage of our social systems. They want to contribute and feel useful. However, I don't have a lot of great advice re: helping people find work. If a person is wanting to look for work, I usually refer him or her to one of the vocational rehabilitation programs in our city.

However, not everyone is able to go out and find work, and there are other ways to feel productive. Voluteering often provides more flexibility than work, and can be a great option. Often a client will need assistance finding and connecting with a volunteer opportunity. If a client is interested in volunteering, I usually try to find out his or her interests, and then help search for a volunteer opportunity to match those interests.

It is amazing all the opportunities that are available if you look for them, and ask around. There is an online listing for volunteer opportunities at Volunteer Manitoba. Many people who have difficulty connecting with people connect better with animals, and many animal shelters need volunteers. Helping with giving out food to hungry people can be incredibly rewarding. If there are local businesses that your client uses, they may be able to use an extra pair of hands on an occasional basis. One man I worked with was very interested in cars, and we were able to arrange for him to help out at the garage where he has his car serviced.

One big factor to consider with volunteer opportunities is where they are located, and how the person will get there. I have found that even if the opportunity is an excellent fit for the person's interests, it is often not sustainable if transportation is difficult.

Another way to address productivity is to through schooling and learning. If your client does not want to have the pressure of having to write exams etc., it can often be arranged to sit in on a course. Courses are available through schools, colleges, etc., but also through self-help groups and associations such as the Canadian Mental Health Association and the YMCA. Many schools have disability services that can help with classroom accommodation.

Leisure

The other way we fill our time is with leisure activities. Many people that I work with engage in very few leisure activities. Often they spend most of their time smoking and watching TV. Many of the activities my clients do engage in are solitary activities, leading to social isolation. Lack of money available for recreation often makes it even more difficult to find things to do.

I often question my clients about what activities they currently enjoy, what activities they have enjoyed in the past, and what activities they would like to try. This can provide clues to what activities you might suggest, or help your client connect (or reconnect) with. Often people can think of activities, but may have difficulty motivating themselves to follow through and connect with them. Sometimes it involves encouraging the person to try something first, and to trust that the good feelings will follow.

It is important to find and list activites that are:
  • Quiet e.g. reading, using a computer, doing crafts
  • Active e.g. walking, swimming, riding a bike, exercise class
  • With others e.g. taking a class, joining a club, going for coffee
  • To take care of self e.g. having a shower, painting toenails, shaving
  • To take care of home e.g. cleaning the bathroom, doing dishes, vacuuming
  • To help others e.g. volunteering, calling a friend who may need to talk

Conclusion

Leisure and productivity can be so different between people that you really need to consider individual interests and preferences. Taking the time to find an activity that is meaningful, and doing the activity with the person can make a big difference. Just because a person knows what the options are, does not mean he or she will follow through independently.

Meaningful activities give people a reason to stay well, and impact all other areas of daily living.

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