Tuesday, September 20, 2011

People Lost Between Institution and Community

Today I want to talk about a group of people who I feel are slipping through the cracks. When I worked in an institution, I met a client who I will call Joe. Joe had been in the institution for many years, and appeared happy there. Whenever there was talk of him leaving, he was against it, as was his treatment team, as they felt he needed the shelter the institution provided.

Joe spent most of his days working in the Vocational Incentive Program. He was an incredibly hard worker. Joe was tormented by voices, and I believe that working hard was his way of coping with them. He also achieved a sense of self-worth and pride as his work was valued. Work was so important to his wellness.

Years later, I met up with Joe again in the community. I saw him at a sheltered work program that he attended daily. I was thrilled to see that he had made it out of the institution, and he seemed happy.

Now that sheltered work program has shut down.

I do not know what has happened to Joe, but I am thinking it is likely not good. Joe did not have the ability to maintain competitive employment. He had significant cognitive deficits, poor social skills, poor hygiene, and talked to himself regularly. He was incredibly institutionalized and did not know how to show initiative, as it had been discouraged his whole life. He is now left without his lifeline.

I understand the reasoning for shutting down the sheltered work program. I have read the articles about how sheltered work does not help a person find and maintain competitive employment. I understand that sheltered work continues and contributes to institutionalization. I fully support deinstitutionalization.

But what is Joe to do?

Joe is not the only person I know in this kind of situation. There is a group of people who have only known institutional living. They are being encouraged to leave the institution, which I think is great. However, any community program that resembles what they are familiar with in the institution seems to be getting its funding cut. This is not limited to work programs - it includes leisure groups as well.

There are people who do not have the skills to fit into community programs and groups that are not specifically designed with their needs in mind. Many people with psychiatric illnesses have cognitive deficits, and are not able to follow what is happening at the speed the groups progress at. Many people do not have the social skills that will lead to them being accepted in these groups. Many people make errors such as coming to group with bad body odour, which leads to them being socially ostracized. Many people are not able to attend consistently, or require a reminder phone call to attend. Many people have lived in institutions so long that it is the only way of life they know.

Just to be clear, many people with psychiatric disabilities do not experience these issues, or else do not experience them to the extent that it impairs their ability to participate in groups and programs. I really believe these people need the opportunity to participate in non-sheltered programming, and sheltered programming would be detrimental to their recovery.

Any kind of program that provides special accommodations for the disabilities I listed above seems to be having its funding cut. There seems to be no room for any middle ground. If we do not provide community programs that this population can realistically use, what is left for people like Joe besides going back to the institution?

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