when i was in eighth grade i played on a basketball teechl. team. i have to admit i wasn't very good at it. i always aspired to be an nba player. regardless of playing in college or nba, i expect many of you have be leading us because of the leadership because of the leadership skills you are learning on [music]

hello, i'm ivette torres, and welcome to another addition of the road to recovery . today, we'll be talking about obtaining and retaining employment for people in recovery. joining us in our panel today are david berns, director, district of columbia department of human services, washington, dc; dr. gary bond, professor of psychiatry, dartmouth psychiatric research center, lebanon, new hampshire; peggy burns, eap counselor, employee assistance program, university of maryland medical system, baltimore city, maryland; neli vasquez-rowland, president, a safe haven, chicago, illinois.

of those individuals that are unemployed, there was about a 15.7 percent rate of drug dependency among them. of the ones that are employed with a drug dependency, there were 23.3 million people overall, and about 49.8 percent of them were employed. and from the mental health community, there were 6 million people who were served by mental health authorities across the nation, and roughly 21 percent, or about, of the 6 million, were employed. what does that tell us? what types of challenges, david, do these individuals present as they approach the employment marketplace? well, that's telling me that, actually, most people that are, that are served by my agency, which provides welfare or

tanf services or homeless services, do not have mental health or substance abuse problems. there- but the percentage is a lot higher than the general population. so probably 20 percent of the people that we're serving in tanf have substance abuse problems and a similar type for the homeless programs. but, when they have both substance abuse and poverty issues, their problems are much, much higher and really need a much more concentrated effort. yeah, for them to get help. and, neli, for, for individuals who are dealing with substance use disorder, let's take them first. what do they present as they come into the marketplace? the underlying issue of drug and alcohol addiction is the underlying issue. the real barrier as to employment are some of the criminal justice backgrounds that people have established

along the way that prevent them from getting a job: their financial history, the fact that they may be homeless and don't have a base to operate from, the fact that they might have children in tow. and, you know, education can be a barrier, if, you know, there's a very high likelihood of drug and alcohol addiction and failure to complete a formal education. so the barriers, basically, just go on and on, with the underlying issue being drug and alcohol addiction. so what we do at our program is, at a safe haven, is that we find out why people are in crisis, if it's chronic or if it's for the first time. and if it is a drug and alcohol problem that's keeping them from the workforce, let's solve that first. and then let's move them through a continuum of care that's going to be unique to their specific challenges so that we can really pave the way so once they do get employed, they're going to be retained and they're going to be successful. and that's, i think, at the end of the day what all employers want. and, gary, does this change much for those who have

mental health problems? well, i think the situation for people with severe mental illness, and by that i'm referring to schizophrenia and bipolar disorder. but it includes a wide range of psychiatric disorders. that their challenges certainly overlap with the, the two populations that, that dave and neli just mentioned. and, oh, about half of them have substance abuse problems of the severe mentally ill group. the, the challenges that they have are, are not what you might expect. the first thing that pops into people's heads might be, or often is, that they have psychiatric symptoms that prevent them from working. and that turns out not to be the biggest barrier. there are a range of things that really interfere with their getting into employment. they want to work. the majority of them want to work.

our statistics suggest over two-thirds want to work. even though, as you indicated earlier, a very small percentage, maybe as little as 10 percent in some of our surveys, are actually working at a given time. there's a big gap there. and the reasons, the barriers, include the lack of encouragement and help from the mental health community, from mental health professionals. and, certainly, we think of stigma as another big barrier, that the public and employers may have misconceptions about how violent people are with mental illness, even though, you know, they are, you know, the findings are way blown out of proportion by, you know, by the media. and another huge barrier is fear of losing benefits. okay.

folks with severe mental illness are living on the edge. they're living in great poverty, and they don't want to lose their health care benefits and other benefits that- so let's go a little bit into that. that would mean that an individual is getting a specialized consideration on their x programs, and, if they became employed, they're afraid of losing those benefits? that's the number one reason that people with severe mental illness don't look for work, and often it's based on misconceptions. so a big piece of this, as we'll get to later, is how to intervene and how to get people accurate information about what really are their benefits and what are the consequences if they go back to work. but i'd go back to the first point, and that is the importance of hope and optimism on the part of the individual who's looking for work, having that belief that they can succeed, that is supported by the folks around them.

that's so terribly critical. and, peggy, we've talked about substance use disorders. we have talked about mental health problems. what other, let's take a look at your work within the eap realm. what other presenting issues have you faced, you know, as an eap counselor? i work for a medical system and with medical professionals as well as everyone that's employed by the system. what often happens is we have nurses, doctors, who have an issue with substance problems, and then they're in a position where it's very easy to divert. then, if they get caught, and they usually do, they'll come, via employee health, where they get a evaluation, and then the employee health sends them to eap. we assess the situation, evaluate, and then send them to

a outpatient treatment center for further evaluation, and then follow with those recommendations as to whether or not they're going to be sent to an inpatient facility or outpatient. in most cases, it starts out with outpatient because of the different insurance companies that are out there are not ready, willing, or able to want to put someone in a 30-day program, or an inpatient program. so which, which avenues, then, you're talking a little bit about what one does once one identifies the problem that actually comes in. but, in terms of the challenges that come before you, are, do they come because there's individuals within the workplace that notice that someone is not really working up to par and then they bring them in? or do they come because of a boss or a supervisor may have a concern? all of the above. all of the above. plus, they also self-refer.

rarely, but they do. so usually, what happens is the manager or the supervisor will send them for a fitness-for-duty. if their observation is that they're not functioning; oftentimes they miss days, mondays and fridays particularly, and when they are on the job, there may be some physical impairment that can be observed. i recently had a case where an r.n. was sent to me because she was falling asleep on the job, which is, of course, highly unusual. and as the situation evolved, it turned out that she had a very serious problem with a prescription medication. so they come from all different angles, there's no specific way. and you, yourself, have an experience because you, you're a person in recovery. that's exactly right. want to talk a little bit about your own experience? yes. i've been in recovery for a little over 33 years. i was 34 years old when i came into recovery.

and when i came into recovery, at that time i was not employed outside the home. i was at home, taking care of my children. and this is a disease, and the disease continued to progress. it's also a family disease. i come from a family where it's not only, runs in the family, it gallops in my family, both sides. all the way around. i i didn't recognize that i haa disease called alcoholism until i went into an aa meeting right off the street. and that's how i got sober. and you were employed at the time? i was not. i was employed-well, i was, but not outside the home. okay. i was employed in the home. but as the years went on and i got involved in this field, i began doing a lot of work with women who were employed and who had issues, barriers to even looking to get treatment, seeking treatment. because of taking care of their children, that type of thing. and, this is a question for the entire panel,

let's talk a little bit about why employment is such a critical factor in recovery. david, we'll start with you. okay. and, of course, i work with unemployed people, that's my focus, people who are in shelters, or receiving welfare benefits. when we find out that they have substance abuse issues, then we find that the substance abuse is a barrier to the employment, but a lack of employment is a barrier to their recovery. so a lot of times, you don't start out with just getting somebody a job, but actually the first thing we find is getting them into safe and stable housing. because they can't be successful with a job and they can't be successful with treatment until they have a place. so it's an issue of housing first? it is an issue of housing first, but then the job that

they often need is often just a part-time job, just to get them stabilized, get them a little extra money. give them some hope, some sense of self-esteem, and it gives them the resources then to maybe be able to take a class or two that will prepare them for a career. so it's get a job, get a better job, get a career. and, at the same time, addressing all of their barriers, whether they're mental health or substance abuse. and, when we come back, we'll be able to continue with the rest of the panel and get their views. we'll be right back. [music] the perspective, when a person in recovery, is seeking employment, is sometimes difficult. people are sometimes concerned about whether they should be forthcoming with where they are in the process.

lots of times they will have breaks in employment that they'll need to explain. i think, generally speaking, being honest and forthright about the situation, and being proud about being in recovery and where they are, and, and what they need to move forward, and the importance of the relevant employment, and the fact, frankly, that they've overcome the issues they've been struggling with, i think is a very important and positive thing to say when you're seeking a job. and, frankly, the more people who are willing to say they're in recovery, the more people who are willing to say they've had these histories, i think is better for everyone. when we are talking about the importance of employment and some of the complexities associated with getting a job, there is another alternative. and that alternative is to volunteer. what volunteering does, similar to a recovery job, it allows that person to offer service, to get to be known, to provide some skills, depending upon what skill set

they bring to the situation, to demonstrate reliability, to be able to show that they can be accountable. and to acquire personal references that can be of use to others in the community. i had no idea it was going to be so hard. i didn't know what to expect. you hear the stories, but i never took any of it seriously until i found myself here. and then i realized i was going to have to work hard for my recovery. if you or someone you know has a drug or alcohol problem, you are not alone. call 1-800-662-help. recovery was the hardest job i ever had, and the most important. brought to you by the u.s. department of health and human services. [music]

you do not have to be in recovery to be an effective counselor, i want to make that clear. however, the fact that i am in recovery, and i've been counseling for over 30 years, it helps me because when i share and self-disclose with people who are sitting there filled with shame and guilt and remorse, and they don't understand that they're sick, and that they have a disease. when i share with them that i've walked that walk, i've walked in their shoes, i know what it's like, and i know that you can walk through it, they really listen. they really pay attention. because they look at me and say, if she could do it, i can do it. so, gary, let's continue. is employment a critical factor in the whole scheme of recovery? we say in the mental health field that work is the key to recovery. and building what, what dave said about substance abuse, many of the same themes you'll see there, in terms of,

of giving people a sense of self-worth, a sense of direction. what are you going to do when you get up in the morning? you know, work really structures people's lives. it's a normal adult role. it gives great meaning to people's lives. and as we hear the stories of people who have recovered from mental illness or in recovery from mental illness, almost invariably one of the key ingredients is that they have found a way to find meaningful activity. and most often that means competitive employment. and so, we believe that supported employment, which is a program to help people get employment, is the best therapy around. and actually the research shows it's the most effective of any of the psychosocial interventions,

any of the things that we do. and more effective, actually, than medications. and i'm not saying that we don't need medications. but if you look at a single ingredient that makes the biggest difference, it's helping people find their niche in, in the workplace. that's one key ingredient to, you know, a meaningful life. i want to come back to that supported employment because i want to really look at the, all the components of that. and, neli, when individuals come into your center for assistance, what do they really ask for, you know, in terms of do they primarily want to be retrained? or do they, do they basically say just try and get me a job first? what is their initial contact? well, the initial contact is really to get them a job. and what's different about a safe haven, and i agree with both of you, and it really was great to hear, you know, that housing is a, is a critical piece.

you know, you cannot begin the process of even looking, or having a job, without having a place to live. and i do- i can imagine someone filling out an application and it says, you know, what is the address, and there's no address. exactly. i suspect, though, that someone might put a temporary housing for, you know, in terms of a halfway house or some other type of, of residence, but that is a residence. exactly. and i agree with gary, that, you know, work is definitely a critical piece. however, where i disagree with both of them is that it's part of the process. you know, what we do at a safe haven is as people come to us and say we hear you get people jobs, we do. but we assess the individual situation, and we tell people, at a safe haven, here you have an opportunity to reinvent yourself. let's find out why you're in the position that you're in. is it chronic or is it for the first time? is there education barriers?

is there drug and alcohol involved? let's solve those pieces first, and then let's move you to the next steps. so for an individual, for example, a woman coming out of the prison system that has been in and out of the prison system for years, or, you know, maybe for the first time, and her children are in the dcfs system. a job would be nice, but first we've got to get her in a position to be stabilized, to be reunited with her children, and in our program can be reunited with her children, and then take on the responsibility of possibly taking on a job. and, you know, taking the next step forward. so, it really is individualized, you know, people are not one dimensional, you know? and a job isn't a solution for everybody. at the end, goal is, you know, to get people a job. the end goal is to get people permanent housing. but for each individual, the path to getting there is different, you know, and that's what we do is we look at the individual situation. and by doing that, we literally achieve very high

retention rates for people coming through our programs. just to give you an example, we've had a 3-year contract with the department of labor for job placement and retention, and our 3-year retention rate has been about 85 percent. very impressive. and what's great about that particular statistic is that that's been with ex-offenders. very good. gary? if i could respond to a couple of points that neli made. i certainly agree that services need to be individualized, and you need to look at the whole person, and you need to look at housing, and you need to look at the family situation. but in our supported employment model, the model that's been adopted around the world i might add, we have looked at the timing of employment, and this is counterintuitive, many people wouldn't think this would be true. but we have a score of studies that show that when a person says i'd like to go to work, that you

help them, that, what's called a rapid job search approach. you don't wait until they stabilize, but you move ahead in looking for that search. and that employment can be part of the recovery process for people with dual disorders, with mental illness and substance abuse. that is, that their improvements and changes often come in the employment area before you see abstinence and some of the other important changes in their lives. i think the trajectory for each individual is very different, but the key thing that i'm saying here is that you don't go to somebody with schizophrenia who is, you know, struggling with a myriad of problems and say, well, listen, you have to go to day treatment for a while until we get you stabilized. you don't say that. the evidence is very, very clear that you're better off listening to what the person says they want and working around that, building the program, individualized, making some sensible decisions about housing and medications

and other things as well. that's all terribly important and the mental health clinicians need to work closely with the employment people. so that part is, i think, similar to what you're saying. but the key thing that i want to say is that we do not delay the search for employment based on any notion that we know best. there is no evidence that clinicians know when somebody is ready for employment. no evidence. it's been studied for 50 years, no evidence whatsoever. if someone's a substance abuser and they're still drinking and you find them a job or assist them to get a job, what impact does that have on them being able to keep the job? i mean, i would think it would be a set up to fail, almost, in the substance abusing case. if i went and got hired for a job and then i couldn't get there or i was missing time. well, how we think about it is, and we're certainly not opposed to people getting good help for their substance use.

that is part of the, of the whole package, the whole deal. so that that certainly is not what i'm saying at all. but in looking for a job, very much you depend on the natural consequences of passing the drug screens and you making some sensible, you know, decisions. i was just going to say, gary, because there are some, i mean, certainly samsha has the workplace program where people are tested while they're in the workplace. employers can avail themselves of these services and they provide not only help with assessing employees but they also certify the labs, etcetera, etcetera. so there is a point where, in any job placement program, an individual has to be told, of course, you know, we will help you look for a job, but there's some prerequisites in terms of what you will be facing as you enter that workforce.

correct, peggy? yeah, that makes sense, perfect sense. well, when we come back, what i'd like to do is really, we already have the dynamics of, of the timing, of when someone ought to look for a job and some of the conditions, preexisting conditions that need to be in place. but there's also an aspect of some of the barriers that they will face as they go into that workplace, and that's what we're going to deal with when we come back. we'll be right back. [music] before, addiction and depression kept me from living my life. and now, every step i take in recovery benefits everyone.

there are many options that make the road to recovery more accessible; it begins with the first step. join the voices for recovery. for information and treatment referral for you or someone you love, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] if you can get up every morning to take the a, the b, or the c train to come down here, you can turn out to getting paid. we have a lot of families that are living well, well below

poverty line, and i believe that if we are able to give people jobs that they enjoy doing and they want to go to every day, they'll go, they'll succeed, and, hopefully, they'll be able to make the money that they need to provide for their families. and what happens is, when families are able to provide for their children, you're helping someone to create self-esteem. you're helping someone to become more motivated. so you want to be able to focus and being positive at all times. all times, okay, never let that circle in front of you be negative, always got to be positive. for somebody in recovery, you need to feel like you're someone. like, this place is called wecare. i care now. you get people that care, you start caring, and when you start caring, it transposes to everything else in your life. wecare stands for wellness, comprehensive assessment rehabilitation and employment. it's a program under the human resources administration of new york city, and it serves approximately 50,000 public

assistance recipients each year-those who have indicated that they have some medical or mental barrier which prevents them from reengaging in the workforce. public assistance is meant to be temporary, it's not meant to be something that is long term and lifetime, you know, so we're hoping that as our clients come into our program they recognize the need and urgency to want to do better. we work with our clients to provide job placements. we work with them to get their ged, to help them get their resumes together, and we work with them to find the jobs that are suitable for them. whatever their skills are, we use their skills and look at their limitations and help them to apply for those specific jobs that are suitable for them. our mission is about respect and care, and it's about making sure that all individuals become the best person that they can be, being able to become self-sufficient. when a customer first comes into the wecare program, they go through a comprehensive,

what's called a bio-psycho-social assessment. so all aspects of their medical and their mental health and their social environment are assessed to understand what are the key barriers preventing them from reengaging the workforce. so that we can understand their entire health picture holistically. having these skills that you have in front of you right now is so important that some of us don't even realize it. that how listening skills is so important to us. individuals with mental health and substance abuse have many challenges. the most important one that they encounter is generally that society tends to be very judgmental and stereotypical and think that people with mental health or substance use can't be productive members of society, or that they can't work. well, i chase this life now, probably even more so than i did my drugs, you know, because i want it, i really want it. i want it just as bad as i wanted that heroin and that crack. i want this life just as bad. so now what i want you to do, i want you to type in,

i am learning microsoft word 2000. i hope to learn at least one new thing in this training session. now, the only thing i know about a typewriter or computer was asdf, jkl, semicolon. i'm typing, in some cases, 20 words a minute and not looking at the keyboard. people that recover from mental health and substance abuse, they really are an asset, and the asset is that you're getting someone who's going to be very committed. and the reason is because they've been through a trying time in their lives. just 'cause we're recovering addicts doesn't mean that we don't want to work. we're recovering addicts that want to work. you know, we want to be a productive member to society. whether it took us 35 years to do it, it really doesn't matter. but if somebody's going to give me the opportunity to go out there and be productive, then let me do it. you know, don't judge me because of my past, you know, it's not who i was, it's who i am.