Meaningful Work and Recovery

Although you will encounter roadblocks and setbacks on the road to recovery, working at something that is meaningful to you can bring you a sense of purpose that will anchor you. Meaningful activity expands your sense of self-worth by adding to your skills and helping you accomplish your personal goals and feel good about yourself. Meaningful activity, which includes school, volunteer work, part-time work and full-time employment, also enables you to meet new people and make friends.

We all need some form of meaningful activity in our lives and a means of supporting ourselves, but having a mental health condition can be an obstacle. Mental health conditions impact different people in various ways. Some people with mental health conditions may never stop working; others find that their condition interrupts their career, and still others may be able to do only limited work.  As people recover from a mental health condition, they also face varied challenges in relation to work. Some people with mental health conditions find that they are able, with minor accommodations, to work in the same way they did before. Others may have to re-enter work gradually. And people on disability benefits will need to observe back-to-work rules when employed.

No matter your situation and no matter the hurdles you face, hold on to your goals for yourself and keep striving to incorporate meaningful activity into your life. In the past, people with mental illness were often discouraged from working, but today we understand that work is not only a possibility, but it can also play a vital role in recovery.

It's true, however, that having a mental health condition can pose some practical barriers to working, such as having breaks in your career, feeling unsure of yourself, or needing to ask for an accommodation such as time for doctors' appointments. You can figure out strategies to work around these barriers, often with the help of friends, mentors or an employment specialist. Don't give up!  

Supported Employment

Your Work Choices

Work-Related Issues

Supported Employment

Supported employment services assist you in preparing to work, finding and keeping a job and thriving in a work environment. Depending on where you live, you might be offered supported employment help through the local office of your state's vocational rehabilitation service, through the mental health agency where you get mental health services, or through a nonprofit disability employment agency. Because of local differences, be sure to check with all of these sources. Your state's Office of Vocational Rehabilitation should be able to help you find supported employment services.

In supported employment, a vocational counselor will help you assess your career interests, job skills, and work challenges. The counselor may suggest job categories that fit your interests, help you write a resume, coach you for interviews, and prepare you for what to expect if you haven't worked recently. While you will get a lot of help, you will also be expected to work hard on solving problems, planning your career, and looking for jobs. Don't expect to be handed a job or simply placed in work. The main responsibility will be yours.

The prospect of job hunting can seem daunting, and looking for work is like a job in itself. You need to put in regular hours and keep at it. Perhaps the biggest challenge is getting discouraged. In the competitive marketplace for work, expect to be turned down by many prospective employers before landing a job.

An important source of help that many job hunters in your community use is the local public employment office.  These days, such offices are typically called "career one-stop centers". They offer a wealth of self-help resources on preparing for and finding jobs, computers you can use, and trained staff. Many have a staff person trained as a disability navigator who will understand the challenges you face and guide you to sources of help. Find your state's network of employment centers here.

Once you find a job, your next challenge is to keep it. Work is rewarding, but it also can be tiring, so be sure to get enough rest and care for yourself. Give yourself time to get used to the demands of working. Above all, it's critical to use your support system - friends and family, your therapist or case manager and peer support group - so you can talk over your experiences at work and get help if your mental health condition is affected. Be sure to let your doctor know that you are going to work and get help in making any needed adjustments to medications as your situation changes.

Your Work Choices

What comes to mind when you think of a job? Is it working full-time, five days a week? If that prospect feels daunting to you, remember that there are other work choices to choose from. One of them might be more suited to your current abilities and stamina, and might be easier to find than full-time work.

Volunteer Work

While many people want to have a paying job, volunteer work is another form of meaningful activity for many people with mental health conditions. Some people use volunteer work as a stepping stone to paid employment; volunteering can help them re-learn skills and grow comfortable working with other people. Others decide to volunteer instead of work. Volunteering not only gives you a sense of pride, but it can make you feel good about yourself to help out in the community.

If you have a cause that you feel passionately about, you may already know where you want to volunteer. Most organizations that have a lot of volunteers will have a coordinator who can help bring you on board. To find volunteer opportunities, you can contact your city or county information line for the contact information for a coordinator. You can also look for "Volunteer Clearinghouse" or "Volunteer Center" in a phone book. The Internet can be a great tool to search for volunteer opportunities; try visiting http://www.volunteermatch.org/.

Remember that just because you don't receive a wage as a volunteer doesn't mean you aren't entitled to fair treatment and respect. You should feel safe and comfortable in your work environment, and people should treat you like a human being.

Internships

When most people think of internships, they think of college students working for free for credit. Internships aren't actually student specific; they are a blend of education and work. An internship usually involves a close relationship with other staff at a business working on specific projects and tasks. Where a volunteer might answer phones or bring food to homeless people, an intern might help a program staff member develop strategies to bring the food to the homeless. Sometimes the line between intern and volunteer can be blurred. Some internships will offer an hourly wage or a paid stipend, although such internships can be highly competitive. If you are a full-time college student, ask your career office whether they participate in the U.S. Department of Labor's Workforce Recruitment Program. Recruiters interview college students with disabilities early in the year for summer intern positions.

If you are interested in an internship, make sure you ask your employer at the interview about the specific tasks and projects you will work on. You should expect to spend some of your time doing administrative work like filing, but you should also get a sense of a real opportunity to learn on the job. 

Temporary Employment

Temporary employment can be a good bridge to permanent work. You register with a temp agency that can then place you in short-term assignments in companies that need extra help. These assignments could last from a few days to several months and can sometimes lead to an offer of permanent work. By temping, you establish a current resume, sharpen your skills and test your own ability to return to work.

Part-Time Employment

Some people use part-time employment (working less than 35-40 hours a week) to transition to full-time employment; other people find that they prefer working part-time to working full-time permanently. Part-time employment can give you more free time to take care of yourself and your responsibilities. It may be more accommodating if you find that you need more time away from the office to handle your mental health condition. However, part-time employment usually pays less than full-time employment, and part-time work often comes without benefits.

Full-time Employment

Many people with mental health conditions are able to work full-time. Full-time employment usually includes sick leave and may include health insurance, making it easier to handle health problems. Company retirement plans for full-time employees enable you to grow your savings. You may want to look for government work, as local, state and federal employers have a good record of hiring diversity and respecting disability regulations.

Finding employment, whether full-time or part-time, usually involves preparing your own resume and job-hunting in your local employment market. Job hunting can be discouraging for anyone, especially if job openings are scarce and there is a lot of competition. If you are having a hard time finding a job, you can look for help from an employment agency, supported employment services or close family members or friends. It is important to have support while job hunting; seek it from friends, from a job-hunting club, a support group, or a peer-run drop-in center.

Self-Employment

Some people are not interested in traditional employment-working for someone else-but are able to work for themselves. You might want to start and grow your own business. Do you have a product or service that you can sell? Do you have a hobby or skill like jewelry making, baking, or playing and instrument? Can you provide a service such as lawn mowing, pet-sitting, or writing and editing?

Working for yourself enables you to set your own schedule, and avoids the problem of disclosing your condition that sometimes arises in the workplace. On the other hand, it demands self-discipline and for tax purposes, you need to track your expenses and income.

To prepare yourself, develop a simple business plan that outlines what you plan to sell, your customers, your competition, and your expenses. You can get help with starting your own business from local offices of the Small Business Administration, your county or state economic development office or craft guilds and associations. Also, be sure to contact your state's vocational rehabilitation office for help with self-employment.

The Abilities Fund (http://www.abilitiesfund.org/index.php) is an organization that provides assistance to people with disabilities interested in self-employment and entrepreneurship.

Common Work-Related Issues

How will working affect my government benefits?

If you have a mental health condition, you may receive Social Security or other government-funded disability benefits, or private disability benefits from a previous employer. While disability benefits typically pay below a wage you would expect to get while working, they provide regular income. Additionally, if you are on disability and/or below the poverty line, you may receive health care through Medicaid or Medicare. Remember, too, that eligibility for housing programs and the rent you pay may be affected by your income.

Having a paying job or earning other types of income can affect your status in Medicaid or Medicare. This does not mean you should be afraid to work, it means it is important to understand the rules before you work. While the interaction between Medicaid and Medicare can be complicated, under either program, you can earn a certain amount of money without losing your benefits.

Because everyone's situation is different, you should always talk to a trusted and knowledgeable person who can help you understand your work options and how your choices will affect your benefits. A good starting place is reading about Social Security Administration work incentives and reading the SSA manual called the Red Book.  Contact your Social Security office, local Center for Independent Living or Office of Vocational Rehabilitation to find people with special training to help you understand how the rules apply to you. Case managers at your mental health center also may be able to help. 

The Social Security Administration sponsors a program called Ticket to Work. Ticket to Work is a voluntary and free program where people with disabilities receiving social security are helped to go back to work by a local employment network. For information call 1-866-968-7842.

What are some things to watch out for?

If you haven't worked in a while, here are some things you need to pay attention to:

Look out for advertisements that promise large sums of money for small amounts of work, such as making $2,000 a week while learning to buy and re-sell houses or making $3,000 a week sitting at home using your computer. Very few, if any, people make money doing these activities, and it may end up being harmful.

• The possibility of working from home may be very appealing to you. Be sure to look into such opportunities very carefully to be sure they are legitimate.
• When you work, your employer must withhold payroll taxes and Social Security tax. Beware of people who don't ask you to fill out any tax forms or take taxes out of your paycheck. You can get in legal trouble if you don't pay required taxes, and it might keep you from receiving government benefits.
• If you receive Social Security disability benefits, you must report your income regularly. Keep original pay stubs as proof of your earnings in case questions arise.

What are some other things I might need while looking for a job?

Documents - When you apply for a job, you will need certain documents to verify your identity and your right to work in the United States. A U.S. passport usually satisfies all requirements, but if you don't have a passport, you will need other forms of ID, including a state-issued picture ID, a social security card or a birth certificate. If you don't have a driver's license, your state's Department of Motor Vehicles (DMV) office can still issue you a walker's ID. 

E-mail, phone and permanent address - If you're moving around frequently or staying with friends, you will still want an e-mail address, phone number and a permanent address that you can check regularly for your work. A cell-phone enables employers to contact you quickly. If you visit family and friends and trust them, ask if you can use their address temporarily. Otherwise, you might want to consider getting a P.O. Box from a local post office. You can get a free e-mail address from Yahoo, Google g-mail, MSN and other sources.

Transportation - You might also encounter a problem with transportation. If you do not have a car, you should always ask the places you're interested in working for if they are accessible by public transportation. 

How do I explain the gaps in my employment history?

If you have been out of work or changed jobs frequently because of your mental health condition, your resume may reflect that. 

Highlight your skills first. Most people are used to a chronological resume, which shows the jobs you worked with your most recent job first. A functional resume displays your list of skills and qualifications before it shows a chronological breakdown of where and when you worked. Stress your skills, abilities and expertise first.

Be honest. One of the worst things you can do is lie in an interview or on a resume.  If your employer finds out that you lied in the hiring process, he or she can usually fire you and leave you with no unemployment benefits. 

Be prepared. Know what you're going to say if or when your employer asks you why there is a gap in your employment.  You do not have to disclose information about your condition during job interviews or when you are first employed.

How will my mental health condition affect my job?

If you're already working when you are diagnosed with a mental health condition, you may be worried about the effect it will have on your employment. You may wonder how it will be possible to manage your condition and balance your work, or you may worry if you can even keep your job. Many people with mental health conditions lead very fulfilling lives, and work can be a big part of that life.

If your mental health condition affects your ability to work, you may need to ask for a reasonable accommodation under the Americans with Disabilities Act of 1990 (ADA). The Act requires that many employers make reasonable accommodations for employees with disabilities. A disability is legally defined as a physical or mental impairment that substantially limits one or more of the major life activities of a person, or a history or appearance of such impairment. You may have a disability as a result of your mental health condition.

It is illegal to discriminate against an employee in the workplace based on a disability if a reasonable accommodation can be made. However, an employer doesn't have to make an accommodation if it would cause an undue burden-financial, administrative or otherwise-to the company. Asking your employer if you can take two small breaks instead of one large lunch break might be considered reasonable if it doesn't interfere with your ability to help customers. Asking an employer to build you a soundproof quiet space if you work at a train station might not be considered reasonable. Some small organizations may also be exempt from ADA requirements based on their size.

Plan ahead before you bring up the subject of disability and reasonable accommodations. Make sure that you know what elements of your disability are interfering with what parts of your job and what specific steps you can take to address those concerns. Don't assume that because the ADA is the law that your employer will be familiar with its requirements or receptive. Put your request in terms of help you need to keep doing a job for the employer, rather than a demand for an accommodation. It can be helpful to talk about your request with people who support you to get feedback and make you feel more comfortable. For free support, contact the Job Accommodation Network at 1-800-526-7234 or visit http://www.jan.wvu.edu/. 

What if I'm uncomfortable in the workplace?

Despite efforts to educate the public about mental health and mental health conditions, you may still encounter prejudice from people who don't know or understand what you are going through. If you think that your employer has illegally discriminated against you or violated your privacy rights because of your mental health condition, you should ask for help.

However, you might feel uncomfortable in your workplace even if your employer hasn't done anything illegal. Maybe your co-workers are judgmental; maybe your work doesn't offer enough benefits for someone with your condition. Or maybe, you are feeling self-conscious or awkward in a new situation.  

Give yourself time to get accustomed to work and the people you work with. Be friendly, but use discretion in how much personal information, such as information about your condition, you share with others. Remember that the primary relationship at work is with your supervisor; listen carefully to what your boss asks of you, and ask for guidance when you need help or are unsure. Get feedback on the things disturbing you at work by talking with trusted friends or a support group outside of work.

You can suggest that your employer take steps to make your workplace more mental health friendly. Send your suggestions to your human resources department or your management team; many offices will have an anonymous suggestion box. Others might have a reward system in place for offering good suggestions.

What are the qualities of a mental health friendly employer?

A mental health friendly employer might have some or all of the qualities below:

• A Good Track Record - Employers who treat their employees with dignity and respect earn a good reputation. Ask people you know about any positive experiences they may have had with particular businesses that were especially accommodating. Ask your treatment team if they can recommend any local employers that stand out.
• Flexible Time and Scheduling - Businesses that allow employees to work outside of the typical hours of 9-5 have shown that they can balance worker and workplace needs to make employees more comfortable.
• Telecommuting and Part-Time - Employers who allow employees to telecommute and work from home on some or all days or allow people to work part time may be more accommodating.    
• Time-off Benefits - You may want to consider an employer who offers a lot of sick and/or vacation leave or the ability to take "leave without pay."
• Employee Assistance Program - An Employee Assistance Program (EAP) is a benefit that an employer provides where anyone who needs help can talk about his or her problems, confidentially by phone or in person. Some visits may be limited.
• Mental Health Benefits in a Health Plan - You can ask to see what kind of benefits an employer's health plan includes. There may be different payment structures for mental or general health, depending on your employer's size. You also might want to make sure that your mental health condition is covered and understand the process for mental health visits (if the plan restricts medication management or therapy).
• Short-Term and Long-Term Disability Plans - Short-term and Long-term disability can provide you 60% of your salary (including short-term disability) if a doctor decides you are too disabled to work. Some disability plans may also cover mental health conditions.