Making the Climb with Chrystal

Making the Climb with Chrystal

By Chrystal Woodson

Proving the Impossible

Before I was diagnosed with an Axis I mental illness, I took a job working for Outward Bound as an urban outdoor wilderness instructor. I had never camped, rock-climbed or taught anything. This was called “experiential education”; learning by doing.

One day, during my training period, I was told that I was going to have to learn how to climb a 65-foot-tall tower in order to teach youngsters how to do the same. Of course, you can’t tell someone to do something if you haven’t first done it yourself.

I was terrified. But I learned how to harness myself and I learned how to manipulate the rope and ensure that I had enough slack so that I could move forward and how to pull the slack so that I could safely descend. And I learned how to communicate with the belay team so that we could establish trust.

I learned that even though someone is telling you not to look down, doesn’t mean that you’re not going to do it. And maybe looking down is essential at some point to show you how high you’ve gotten. You may learn something by doing what you’re told, but it’s up to you to create a fingerprint and stamp that action to make it your own. You can perfect yourself by learning and interpreting your experience and communicating with others what you need and promoting yourself to others to build their confidence in you that you can get the job done. By the time that summer job was over, I ended up climbing that tower at least four times!

My point is this: You can’t be afraid of doing something you must do simply because you’ve never done it before. Maybe your purpose in growing is to advance so that others may follow in your footsteps. As consumers, we must learn that our progress is not merely ours alone. We must be responsible and lead the way for others who may be lost and struggling because they may not feel empowered to find a way to overcome their illness.

There are those of us who prosper and we must remind our observers (those who are consumers and those who aren’t) that success is possible. We must not be ashamed of who we are, including our diagnosis. We shouldn’t use our illness as a crutch or an excuse for why we feel limited.

I’ve had to learn things the hard way. I’ve been unemployed in my life many times. I’ve quit jobs, been fired, went on unemployment, enlisted in the Navy, 9/11 occurred, I had a breakdown, hospitalized, discharged from the Navy, got on Public Assistance, SSDI and started vocational training, worked as a peer (not certified) and found myself working in mental health agencies now for fourteen years.

There are so many lessons I’ve learned and I feel so blessed that I have the ability now to ask the right questions and find teachers and mentors who will guide me along the way. I have a master’s degree in public administration which I earned in the midst of my recovery process. And my current job is a non-peer clinical position. From time to time I question myself and ask, “What is all my climbing for?” And I realize within my soul that I have an urgent need to prove the impossible. And I remember my first psychiatrist telling me, “You will never work again.” I just had to prove her wrong.

I am proud of my accomplishments and I still strive. Knowing that God will see me through any obstacle and believing that to climb is to cling to the heights of the Earth in an effort to grasp at Heaven and conceptualize the Eternal.

Pullout: “…I question myself and ask, ‘What is all my climbing for?’ And I realize within my soul that I have an urgent need to prove the impossible.”

The NYC Peer and Community Health Workforce Consortium

By Lori Tannenbaum, PhD, Director, Peer Workforce Consortium
Seeking to Support the Expansion of Peers in Programs Across NYC

The idea for the Peer and Community Health Workforce Consortium began May 2016 at the Mental Health Workforce Summit in New York City. A group of community health and peer workers, researchers, trainers, and representatives from managed care and the Department of Health and Mental Hygiene met for the day and came up with a new initiative to improve mental health services in New York City by expanding the use of peers and community health workers to connect New Yorkers to services and promote recovery.

The Peer and Community Health Workforce Consortium is part of Thrive NYC, the $850 million plan to make sure New Yorkers get the mental health assistance they need. The Consortium will develop pipelines and career ladders for peer support and community health workers, including peer specialists, family- youth- and recovery-peer advocates. These workers provide support outside of a typical service hierarchy. We believe the Peer Workforce Consortium will impact service users and providers, as well as peers and community health workers because: 

The model works
Studies show that individuals with mental health problems benefit from having a team including peer support workers. People who use peer support better manage treatment, substance use and family problems in the community, and have fewer hospitalizations. Peers and community health workers can also help navigate health care systems, develop natural supports and lead a healthier lifestyle. 

The time is right
Changes to health care provision have come to New York City. People need more information and assistance to take advantage of the opportunities for individualized care that are now available. The Health and Recovery Plan (HARP) is a new type of insurance plan for some individuals with Medicaid who have a serious mental illness. If a person is in a HARP insurance plan, they may be able to receive Home and Community Based Services (HCBS) such as individualized vocational, educational or rehabilitation services. Medicaid redesign also aims to improve outcomes at reduced costs and with improved satisfaction with care. Through these initiatives, certified peers in mental health and substance abuse services can now provide Medicaid-funded services.

The field of peer services is growing in New York City. Many organizations are hiring peers to work in programs such as Assertive Community Treatment (ACT Teams) and Crisis Respite Centers which aim to reduce the need for inpatient hospital stays. There are more than 600 certified mental health peer specialists in New York City, and that number is growing. The On-Track programs use peers to help people with a new mental health diagnosis to get back “on-track” with tasks like work and education. Peers also staff warm-lines and crisis hotlines for people to get the support and referrals they need. 

It is sustainable
Peers and community health workers can be found in almost any kind of inpatient or outpatient program, whether it’s for family and youth, substance abuse or mental health. As someone from a service user’s neighborhood, community health workers are uniquely positioned to understand a person’s needs and concerns, while having knowledge to navigate a variety of services. 
The Consortium will share resources to enhance peer services for all New York City residents. They will meet with groups throughout the city to learn about the role of peers and community health workers, certification, workforce development issues and the integration of health, mental health, and substance abuse services. 

How you can get involved?
1) Use peer services.
If you use mental health, substance use, youth or family services and don’t yet work with a peer, please consider talking with a peer or other staff member to explore how working with a peer may benefit you. If there are no peer staff where you receive services, consider suggesting that program leadership add peer services to help create a stronger recovery focus and better health outcomes.
2) Train to become a peer
There is currently free training available through Thrive NYC for mental health peer specialists, recovery peer advocates and family peer advocates. 
More information about training to prepare to become a Certified Mental Health Peer Specialist can be accessed through Thrive at Work at: 
http://www.communityaccess.org/our-work/educationajobreadiness/thriveatwork

Learn about upcoming training dates for Certified Recovery Peer Advocacy training by emailing Lila Boyer at lboyer@health.nyc.gov or calling her at 347-396-4992.

The Parent Empowerment Program (PEP) helps to prepare for Family Peer Advocate work and can be accessed for free in October through www.ftnys.org or by calling Nancy Craig at Families Together NYS at 716-432-6238. The next PEP will be held 10/30/17-11/3/17 at the FRC Eastern Queens at St John’s Hospital, 148-45 Hillside Ave, Jamaica NY. Updated information and Registration can be obtained at http://www.ftnys.org/upcoming-pep-trainings/.

3) Peers and Community Health Workers--Please take our survey!
If you are currently working as a peer in health, mental health, substance use, youth or family services please take our survey by copying and pasting the following address into your Internet browser: https://www.surveymonkey.com/r/PCHWSurvey17
This survey will help identify where peer and community health resources can be found, and will help determine current wages, working conditions and satisfaction in these areas. Results are confidential and there is a small incentive to participate. 
4) Contact us
If you have anything you would like to add to the conversation around developing the peer workforce, please contact Consortium Director Lori Tannenbaum at ltannenbaum@health.nyc.gov or by calling 347-396-4995.

Harsh Experiences in the Workplace

Harsh Experiences in the Workplace
By Anne Percy
The Challenge of Returning to Work After a Setback

I am bipolar. This seems to threaten some people. In reality I am one of the gentlest, kindest-hearted people you could ever meet, someone who has never harmed anyone. I have had a variety of diagnoses in the past, including OCD, severe depression and schizoaffective disorder, until I was diagnosed as bipolar I.

I have tried a litany of psychiatric medications to manage my symptoms, some with terrible side-effects and others which worsened my symptoms. Stable on my current meds the majority of the time, I realize they are not a cure, nor am I symptom-free. I attend weekly group therapy, which helps, but individual therapy would help more. Unfortunately, right now, it is beyond my financial means.

I am currently unemployed, due to the effects of bipolar. A vocational rehabilitation counselor has been assisting in my search for a suitable job since April 2013, when I lost a job as a health insurance claims processor, which I held for seven months. My firing was due to a lack of concentration and attention to detail, resulting in too many financial errors when paying claims. I believe more accommodation could have been made on my behalf, since I had just completed six months of training when I was let go.

Prior to that job, I had been unemployed for nearly two years following my resignation from a previous position I held for nearly 11 years. The reason? A hostile work environment created by malicious coworkers. They were aware that I had mental health issues, and, in an effort to get me fired, were trying to cause a mental breakdown. Even though I had done nothing, they became convinced that I was a danger to them because of my mental illness. Eventually, the environment became so toxic, with my employer unwilling to intervene, that I had no choice but to resign and remove myself.

What was said to me would have been considered slander and harassment, but because of my mental illness, it was tolerated and apparently acceptable. Ironically, my employer at the time was a health insurance company that boasted the best health interests of its clients and claimed to promote diversity in the workplace. Apparently, that didn’t apply to those of us who suffer from mental illness. It took months before I could put the experience behind me. It still makes me question what kind of environment I will find at a new workplace. I did what was best for me mentally and emotionally, but at the expense of my finances and employment. In terms of finding work with the financial and other benefits of the job I left, I have never recovered.

When I apply for jobs now, I have been advised not to reveal I have mental illness, which makes explaining what occurred at my last two jobs difficult. I would prefer to honestly admit to having a disease, so as to explain when symptoms inevitably appear and not be such a surprise to my employer and coworkers. It would also be easier to ask for accommodation, if and when I need it, if my condition is known.

It makes me sad to think that if it were a physical disease, there would be no problem admitting to it. Also, I am worried about going through the same things with coworkers at another job should I find one.

In desperation, having had no income or health insurance since April 2013, I applied for Social Security Disability. My attorney filed for a hearing in June 2014, but we have heard nothing since then. Applying for disability was a last resort. I would gladly work, but no one will hire me. Even while waiting for a hearing, I still apply for jobs, hoping that someone will be interested in me and my attributes.

I was not eligible for a subsidy to help pay for health insurance due to having no income, and the state that I reside in did not expand Medicaid, so I am uninsured and pay for medical costs out of pocket. This limits my options for care. Fortunately, the medications I currently take are not as expensive as some I have used previously, which helps.

I am not sure what the future holds. I cannot go on indefinitely without income. I am not looking for a financial windfall, only a means to reach financial stability. Also, there is no guarantee that I will remain mentally stable. I already know that I am unsuited for jobs that I have held in the past. What I am unsure of is exactly what I would be suited for, which even vocational rehabilitation has been challenged to help me discover. I am not opposed to further education, but I would need financial assistance to pay for it, and since I already have one college degree, this seems unlikely. Realistically, several doors are closed to me when it comes to employment.

I hope reading about my experience helps others suffering the same things to realize that they are not alone in this.

The Steps I Took to Get Back to Work

The Steps I Took to Get Back to WorkBy Glenn SlabyPutting Myself Out There Led to Personal Growth

Downfall

As a husband and father with a BS in accounting and an MBA in management, losing the capacity to support your loved ones and the ability to use skills developed over years of work was devastating. It’s as if a piece of one’s soul has been taken away.

Mental illness manifested itself beyond the control of doctors, prescription medications and my willpower. Working as an accountant, before and after my diagnosis, the aggressiveness and specific attitude needed to succeed was not part of my makeup, even though there were accomplishments. Subsequently, unemployment exacerbated my symptoms and brought on hospitalizations. I lost the ability to be a constructive individual. Many fields of employment were available, but I was too focused on the business world, which can be cruel and lack any sense of loyalty.

During my fifth hospital stay, back in 2004, one doctor re-examined my condition. I had been misdiagnosed, on the wrong medications and combinations for the last twelve years. I was lucky. It could’ve been a lot worse. There were many missteps, including thoughts and actions of self-harm, and testing faith, which changed fate. My stable foundation—family, friends, home life, church—withstood the agonizing struggles.

Getting Back

Many things are not taught in the classroom, but through therapy, aptitude tests, IPRT (Intensive Psychiatric Rehabilitation Treatment), DBT (Dialectical Behavior Therapy), etc., I learned the significance of really knowing myself. The skills learned should’ve been taught to most of my managers. Meet others who work in your fields of interest. Never forget the expertise of good therapy.

My priorities, through goal- and skill-identification, led to a better understanding of possible jobs. Goals with the right limits, different for each individual, led to important aspects of a better life, including greater job satisfaction, bringing independence, growth and self-confidence. Many factors will make an employment experience the right one at the right time in one’s life, but no job will have all the right pieces. Compromise. Feeling good at the end of the day or week as if you really accomplished something means you may have a second home. A nice paycheck from a miserable job can be damaging.

There are worlds where creative, imaginative skills can apply. Hobbies may lead to new adventures. I found placement in those new spheres. My primary goals led to jobs where getting out of bed and to work was not a hardship or detrimental to my mental, physical or spiritual health.

What Management Can Do

There are many employee responsibilities, but employers must understand their obligations. W. Edwards Deming, who helped transform/restore the destroyed Japanese industries after World War II, offered 14 key principles to management for improving the effectiveness of an organization. Failure harms the company, the individual and their family. Paraphrasing those principles related to employees:

• Drive out fear;
• Institute leadership: supervisors must aim toward quality, help people do a better job;
• Create constancy of purpose toward improvement;
• Cease dependence on inspection to achieve quality—it should be built into the production process;
• Remove barriers between departments and people—employees must work as a team;
• Eliminate slogans, quotas, and targets because they create adversarial relationships. Most errors are due to the production process lying beyond employees’ influence;
• Remove barriers robbing employees of pride of workmanship; and
• Institute job training programs of continuous education and self-improvement.

Starting off Small

With the correct diagnosis, I began taking small steps toward normalcy. The fog encompassing my mind and spirit was slowly dissipating even though other hidden mental health issues would surface. I have a great interest in books and all those wonderful words, so I decided to walk into the local library and ask for a volunteer position seeking a small haven, a relief from constant painful thoughts. Surprisingly, it did not seem like a humbling, embarrassing step, but a new beginning with new co-workers being welcoming, patient and friendly.

One day, two managers approached me and spoke some words I haven’t heard in years: would I like to become a paid, part-time employee. Words couldn’t describe the joy of being valued, wanted and useful. I stayed a number of years, coinciding with my current job, again part-time, working with fellow consumers at the hospital where I receive mental health services.

Moving Forward

Moving forward as a consumer and returning to work was more enhancing to my well-being than any medications or therapies, which are still needed. Getting there, however, is a long and arduous process. Faith helped greatly. Now, I focus on my health and see where the future takes me. Writing, perhaps? Nothing lasts forever and, with difficulty, I try to be satisfied with the present. Changes can mean nothing, or everything, lead to greater opportunities, enjoyment, or a new job. Have spiritual faith and patience.

Employment is the Best Medicine

Employment is the Best Medicine

By Danielle

Give me a chance and see what I can do for you. A chance is all I want and what I strive for.

I was stuck in the doldrums for countless years, working on how to get out of my own head. I was stuck. My mind was scattered, unfocused, yet yearning for a more positive life. Deeply depressed, suicidal, delusional and conflicted, I told myself, “Have a positive mental attitude and anything is attainable.” I reinforced my daily life with this positive ideal, placing it on each of my emails.

I have been hospitalized over a dozen times. During my last stint, I met people from the Lighthouse Clubhouse, a vocational rehabilitation center for people diagnosed with mental illness, and they gave me a service called Peer Support in Aftercare. It was a free service that helped me transition back into society. I lived in fear for many years, isolating myself at home, consumed by my delusions. My prescription to wellness was a friendly face, a cup of coffee and conversation that began my path to wellness, putting my symptoms into remission. I’d be remiss not to mention the visiting nurses that came five days a week to keep me in check.

Distracted by the work of the clubhouse that needed to be done, I made it my mission to help those who helped me. I joined the Lighthouse. I went to the clubhouse as if it were my job to do so, the first one there and the last to leave. I worked in each unit, diligently trying to better both myself and the units. Job opportunities presented themselves, upon which I pounced like a tiger. Yet fate would have it that I didn’t meet certain criteria or realized the job wasn’t for me, post-panic attack.

One Friday, I attended the group meeting to close the week joining most of the staff. The program director of the Lighthouse announced that a local scanner job was opening, a mere 14-minute commute from my house, and asked if anyone was interested. I eagerly signed up, thinking, “Please give me a chance and see what I can do for you.”

One interview later I was hired. I was going to be the best scanner ever. I must have asked my coworker, mentor and friend Chuck a million questions back then (I still do). By the end of the day, we went from one shred bin to two. The job was short lived, a mere six months. It dawned on me that I really loved working, and that the backlog of scanning was coming to an end.

Unexpectedly, I was offered a full-time position as an administrative assistant in operations. I was ecstatic. It was a hefty job description, but I was up for the challenge. I thought, “Thank you for giving me a chance to see what I can do for you.” Now, my job title reads “Operations Coordinator.” The perks? The company started a free weight-loss program. Within 43 weeks, I lost 97 pounds.

I can’t thank my work-family enough for all the support they have given me. They are my compass, pointing me true north, challenging me mentally and physically. Thank you for believing in me, noticing my talents and exploiting them, teaching me the business, and letting me shine. Can you tell that I love my job? The very best part, my symptoms have been in remission the entire three years I’ve worked.

Working has been the best prescription for me. I’ve tried all sorts of anti-psychotics, yet none of them helped me nearly as much as being a productive integral member of society. In fact, the meds made me more delusional than before. With goals and people standing behind me, I have become very successful and an integral part of the business. If given the opportunity, please give someone else a chance. It could make a world of a difference.

Pullout: “Working has been the best prescription for me. I’ve tried all sorts of anti-psychotics, yet none of them helped me nearly as much as being a productive integral member of society.”

Repeated Tragedies Still Hit Hard

Repeated Tragedies Still Hit Hard

By Regina

Suicide Was My Answer

I have suffered from depression and anxiety for most of my life, but kept it under control by being busy with my family, career and the occasional visit to my therapist. Things came to a head, however, when my husband of twenty-nine years unexpectedly left me.

I was devastated. In spite of the fact that I had my nineteen-year-old son to take care of, I felt as if I did not want to go on living. I started drinking. One night, after several glasses of wine, I took a whole bottle of anti-depressants with the intent of taking my life. Just moments after I took the pills, I realized I wanted to live, and immediately called 911. That was my first suicide attempt.

I kept sinking lower and lower into depression. My performance at work began to suffer. I lost my job and my house. Then my son turned to drugs. But I was fortunate in that I met a wonderful man named Terry who fell in love with me and accepted my son and his addiction as “part of the package.”

Things began looking up. I was able to find another job, though at a much lower level of salary and responsibility. Then six months into that job, my drinking and depression led to frequent absences from work and I lost the position. I still missed my ex-husband and my house, perhaps more because of the lifestyle I led when I was married than because of a broken heart.

When I lost my new job I sank into a deep depression and my drinking became out of control. One evening, when my son and Terry were out, I drank a bottle of wine and took a full bottle of Clonazepam (Klonopin). Did I want to end my life? I still don’t know to this day what my intentions really were, I just knew that I wanted the pain to end.

I awoke one week later in a psychiatric ward on my way back from an ECT treatment. I had been conscious before that moment, but had no memory of it. And I had no recollection of consenting to ECT. I was told afterward that my doctor held a family meeting with myself included to make the decision to go with ECT, as I was unresponsive to other treatment.

The ECT treatments made all the difference and brought me back to some level of functionality. The important thing was that I was happy my suicide attempt was unsuccessful. I realized how my drinking and taking prescription drugs indiscriminately could have resulted in my death. I was taking chances and fortunately was lucky enough that Terry found me in time to save my life.

My life has not improved much since that incident. Terry was diagnosed with bladder cancer and died a year and a half ago. I was left without money, as we had no savings. I did not know where to turn. Fortunately, my sister helped me financially and I was able to find an affordable apartment. My son, unfortunately, continued his heroin addiction and became an alcoholic.

Realizing it had to do with my depression and anxiety, I should have known better, yet I risked my life again by mixing Clonazepam, Ambien and alcohol. I slipped into unconsciousness that would have led to death if I were not rescued in time by my son.

Upon awakening, I realized how fortunate I was to still be alive, even with the emotional pain of living with my son’s addictions and the grief of Terry’s death. I always felt that there was a possibility of having a normal life, and most important of all, being there for my son.

I am still depressed and dealing with issues of loneliness, my son in jail and financial problems. There are days when I escape into my bedroom and just read. I let everything go, my personal hygiene, taking care of my apartment, going out, talking to family and friends.

No matter how bad things become, I have stopped taking chances with my life. I no longer turn to drugs and alcohol for relief from pain. I want to live. Because where there is life, there is hope. And hope is what I have now.

Meet the New Deputy Executive Commissioner

Meet the New Deputy Executive Commissioner

By Dan Frey, Editor in Chief

Crucial Issues to the Mental Health Community Discussed

On January 20^th at Fountain House clubhouse in Hell's Kitchen, members of New York City's mental health community met the new Executive Deputy Commissioner for the New York City Department of Health and Mental Hygiene (DOHMH), Division of Mental Hygiene: Gary Belkin, MD, PhD, MPH. The event was organized by the DOHMH Office of Consumer Affairs whose mission is to ensure that the consumer perspective is heard and integrated at all levels of government. Carlton Whitmore is the director of this office and Teena Brooks, LMSW, assistant director.

Dr. Belkin responded to questions from a planning committee whose members were: Wendy Brennan, Lynnae Brown, Angela Hebner, Carla Rabinowitz, Samene Reid, Rachel Saloman and Moneer Zarou. Topics ranged from housing and criminal justice to employment and managed care. Some topics listed in the evening's program such as cultural competence and the assisted outpatient treatment program were barely touched upon.

Housing

On housing, Dr. Belkin said that governor Cuomo might approve funding for around 5,000 units of housing for New York State's homeless, mental health, HIV/AIDS, substance abuse, and domestic violence populations, including families and youth. The campaign for supportive housing, known as NY/NY 4, requested 30,000 units for these disadvantaged groups in New York City over ten years.

Criminal Justice

On criminal justice, Dr. Belkin said that, in response to the unnecessary death of a mentally ill Rikers' inmate, mayor de Blasio's criminal justice taskforce will address issues of mental illness and substance abuse at every stage of the criminal justice system, including proper discharge planning from jail to the community. He said “drop-off centers” will be created as alternatives to incarceration for people with mental illness, with the first one to roll out in the fall of 2015 in upper Manhattan. These drop-off centers should offer an array of services to help keep our peers out of the justice system. As part of a comprehensive plan, corrections officers and police officers will receive training on “deescalation” and understanding behavioral health issues similar to what other states have been doing with good results.

Employment

The unemployment rate among people with serious mental illness is a staggering 90%. Dr. Belkin said his department funds 15 different employment programs and continues to advocate for more peer hiring. He said that in the future managed care environment, providers will be held accountable for improved employment outcomes and that peer services will be Medicaid reimbursable. He said an “RPC” or regional planning consortium will be created that brings advocates and stakeholder groups together to discuss issues of standardization, performance, service planning, and resource allocation.

Medicaid Managed Care

On the future of service delivery in a Medicaid, managed care environment (see “Medicaid Managed Care: Rising to the Challenge” by Briana Gilmore, Winter 2015 edition), Dr. Belkin said “HCBS” (home and community-based services) will be offered through the “HARP” (health and recovery plans) for individuals with significant health and behavioral health needs. Fully integrated dual advantage plans (FIDA)will be available for people with both Medicaid and Medicare who use community-based long-term care services.

Peer Jobs

There was a concern among those in attendance that peer workers who lacked a GED or high school diploma, which is currently required to become a certified peer specialist, would lose their jobs in this new billing environment, but Dr. Belkin assured us that not all services will be billable to Medicaid and some will continue to receive funding from the city. The smaller provider organizations will receive technical support to help them make the transition to Medicaid billing. He said he was unsure how many city contracts, if any, will be displaced by the shift to Medicaid billing.

Conclusion

Although Dr. Belkin and his senior staff were weary from a long day at the office, we were glad that they made it to the forum that evening. His liberal use of acronyms was a bit off-putting, but he did his best to explain some difficult concepts. The crowd seemed pleased with the event, but I was left wondering how much influence we would have on future policies that will affect our lives. Most of us don't even know how to speak the language that large bureaucracies use, let alone how to affect change within them. For those of us who do, I hope you step up to the plate and get involved. We desperately need representation with sensitivity, intelligence and strength.

Saved by Imagination

Saved by Imagination
By Carl Blumenthal
A Memoir of Depression and Recovery by the Book
“Depression is a double whammy. Negative thoughts and feelings flood in. The positive dissolves in a sea of self-doubt.” During my depression from 2006 through 2011, including two suicide attempts, two hospitalizations, and two years in day treatment, I tried to cope by withdrawing from the world: quitting my job as a peer counselor, ceasing hobbies and volunteer work, avoiding friends, and limiting contact with family, except my wife, Susan.
Most painful of all, I suspended my part-time career as an arts critic. Penning hundreds of articles about writers, painters, dancers, musicians, photographers, and film-makers, I earned respect because unlike most critics I didn’t suck the life out of my subjects. Now writer’s block prevented me from living—vicariously.
My world shrank to the living room couch where lying down was the most comfortable and comforting position, both during the day while I listened to the radio and at night when I retreated farther—into sleep and dreams. It was like clinging to a raft of calm on an ocean of bad thoughts and feelings.
I maintained this fetal-like pose by avoiding as much stress as possible because undertaking the simplest task made me feel as if I suffered from a permanent case of indecision. Thus hygiene went down the drain even though I didn’t shower. Determining what to eat and how to prepare it required an appetite I lacked. And household chores seemed like opportunities to malfunction.
If my living room couch resembled a raft in a storm, I also tried to batten down all hatches to the outside world. I only left our apartment to get the mail before other tenants arose in the morning. Then I would throw away most letters from family and friends. I dreaded checking my email and browsing the Internet for fear I would have to respond to demands on my attention.
I let Susan answer the phone so she could say I wasn’t available. She shopped, cleaned the apartment, washed our clothes, did the banking, paid bills, and generally interceded on my behalf whenever the world seemed too oppressive. She took everything in stride just as she had raised her younger sister and brothers when their parents weren’t around.
If the psychologist at day treatment hadn’t been a book lover, I might never have started reading again. With the lending of a novel to me she overcame my resistance to the written word. Fiction proved too real, too raw, but non-fiction books on nature and history represented safe ground at first and room for growth later.
I also consumed a heavy dose of biographies about such heroes as the existential novelist Albert Camus; the Depression-era photographer Dorothea Lange; Beat poet Allen Ginsburg; radical folksinger Woody Guthrie; Thomas Paine, pamphleteer of the American Revolution; and the Belle of Amherst, Emily Dickinson.
In March of 2011, I was inspired by Jane Campion’s film, “An Angel at My Table.” It is based on the autobiography of Janet Frame, who survived years at mental institutions in the 1950s, enduring more than 200 electroshock treatments (ECT). She became New Zealand’s most acclaimed author of the 20th century.
My outpatient social worker challenged me to write about the movie. Despite my low expectations, I returned to her the following week with 40 pages of an incomplete essay, “Saved by Imagination.”
How I got carried away was as much of a miracle as Janet Frame’s recovery. Even when not pinned to a stretcher for ECT, Frame, like me, spent most of her time prone to despair. Cowering in bed on the verge of being carted away for a lobotomy, she is greeted by the asylum’s director with the news of her release because she has won a literary prize. As if escaping a firing squad she’s bundled into a taxi for the ride home.
Thanks to Janet Frame’s example, I had cracked a five-year writer’s block. She was the medium for the message to me that “recovery is possible.” With this weight lifted, I returned to the Brooklyn Daily Eagle, the newspaper for which I covered the arts. Since then I’ve been able to round out my life by doing the following:
relying on writing and other passions as if my life depended on them;
seeking help from peers who understand my struggles;
finding love in the advice of family and friends;
accepting that how well I do at work isn’t a criterion for manhood;
engaging in politics as a form of community responsibility;
volunteering as a way of counting my blessings; and generally
putting one step in front of the other as Elizabeth Swados recommends in My Depression: A Picture Book.
Editor’s Note: This is an excerpt from a longer essay to appear in the book Coming Out Proud published by the National Consortium on Stigma and Empowerment, Chicago, 2015.

WORK: What’s It Worth When You’re On SSDI or SSI by Carl Blumenthal

WORK: What’s It Worth When You’re On SSDI or SSI
By Carl Blumenthal
Why work? Obviously, to make money for the basics and little luxuries of life. In addition, gainful employment defines social acceptance.

Fortunately, even if you receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), you can earn more with a job because the Social Security Administration (SSA) allows you to work within some limits, to help with the transition to self-sufficiency. Thus, you can add to the average SSDI monthly payment nationally of $1,130 (2013) or $808 (2014) for a New York SSI recipient living alone.

For those on SSDI, nine Trial Work Periods (TWP's) of a month each are allowed over five years, to get your feet wet if you haven't worked in a long time. During those TWP's, you can gain as much income as possible without losing your full benefits. (So, if you become a car salesman, you can keep all those juicy commissions.)

For 2014, a TWP consists of more than $770 per month. Less than that, you don't use up any of the nine TWP's you're allowed. And, you can still make up to $1,070 per month, what's called Substantial Gainful Activity (SGA), and get your full benefits for up to three years, after you've completed the nine TWP's.

For folks on SSI, the Social Security Administration (SSA) basically subtracts $1 from your check for every $2 in extra income. This is a simplification because SSA excludes the first $85 of your earnings when calculating your change in benefits. 

Say your monthly benefit is $808 and you get $1,085 a month at a new job. Your benefit would be reduced by $500 for that period ($1,085-$85=$1,000/2=$500), but given the extra $1,085, that's still a total of $1,393 ($808-$500=$308+$1,085=$1,393), so you come out way ahead.

To be on the safe side, if you want to continue SOME benefits, don't earn more than twice your monthly SSI level. Certainly, that's not as good a deal as SSDI recipients get. But, you'll do better in the in the long run through employment.
Why do the two programs treat people differently?

Because SSDI is based on the amount of on-the-books past employment. To be eligible, you must have earned at least $4,800 for each of 10 recent years. Like Medicare, which SSDI recipients also receive, SSDI is a government-run insurance program, supported mainly by deductions from workers’ paychecks.

SSI is an income supplement for disabled people with little or no money, which automatically qualifies you for Medicaid. Usually, SSI recipients have not worked enough to qualify for SSDI. Because the program is supported by general tax revenues, not Social Security taxes withheld from wages, Congress made the rules less generous for people who work on SSI.
However, money isn't the only reason to work: That's why the federal government's Eight Dimensions of Wellness (for people with mental health or substance abuse challenges) include one dimension for finances and one for employment. You get satisfaction and self-confidence from being employed.

As Sigmund Freud famously said, "Love and work are the cornerstones of our humanness." Plus, the boredom and frustration of doing nothing can lead to all kinds of mischief, not only in your head but also in your home and on the street. So, one of the best ways to get and stay busy is to work, whether for pay or volunteer.

Finally, here are two notes of warning: Report your earnings regularly to your local SSA office to avoid overpayments you might be obligated to return and also inform SSA of an improvement in your medical condition such that you no longer qualify as disabled. In the latter case, enrollment in a Ticket-to-Work or other rehabilitation program could postpone a required SSA medical re-evaluation.

(For information about Ticket-to-Work and other Social Security work incentives, including how to maintain Medicare or Medicaid, see the Coalition of Behavioral Health Agencies’ newly-revised WORKbook: A Guide to New York City’s Mental Health Employment Programs. Call 212-742-1600 for a free copy or see the guide at www.coalitionny.org.)

Note: Carl Blumenthal is a former employment specialist with NetWORK plus, Baltic Street AEH’s assisted competitive employment (ACE) program. He receives SSDI and works part-time at the Center for Environmental Therapeutics (www.cet.org).

SSI, SSD and Employment: What You Need to Know

SSI, SSD and Employment: What You Need to Know

By Tim Deal, Paralegal, MFY Legal Services, Inc.

PART ONE

The Importance of and Barriers to Employment

Entering, remaining in, or returning to the workforce is an important goal for many people experiencing mental illness. In addition to the financial benefits of earning employment income, there are many other benefits to working. For many people, employment is a vital part of the recovery process.

Unfortunately, as they seek to join the workforce, some people find themselves confronted by a variety of barriers. One serious barrier is a fear of losing their Supplemental Security Income (SSI) or Social Security Disability (SSD) benefits. Another barrier is fear of Social Security overpayments. Overpayments occur when the Social Security Administration (Social Security) alleges they mistakenly increased a recipient’s payment and then decrease that recipient’s SSI or SSD payments until Social Security has been recouped, paid back for their supposed overpayment.

MFY’s New Employment Initiative

MFY Legal Services has provided free civil legal assistance to low-income New Yorkers for over 50 years. The Mental Health Law Project at MFY has been helping New Yorkers with mental illness with civil legal issues since 1983. At MFY, we recognize both the importance of employment for people with mental illness and the seriousness of these Social Security-related barriers to work. In response, the Mental Health Law Project started a new initiative to support the employment goals of people with mental illness. We want to encourage employment by letting people know that they can work while receiving SSI and SSD. In fact, if they do, in most cases they will end up in a better financial situation.

Additionally, our employment initiative seeks to address Social Security overpayments in two ways. First, we want to help prevent overpayments from happening in the first place by educating people on Social Security’s reporting requirements. And, for those who have already received notice of an overpayment, we want to assist them in the overpayment appeal process by helping complete the appropriate Social Security form, and when possible, helping to negotiate with Social Security and appearing at Social Security hearings.

In what follows, we hope that readers will gain an understanding of how employment affects SSI and SSD, as well as what they need to do to prevent and fight overpayments. People who receive both SSI and SSD face a more complicated situation, because they have to deal with both sets of rules; SSI rules apply to the SSI money they receive, while

SSD rules apply to the SSD money they receive.

How Employment Affects SSI and SSD

One of the most common questions we hear is, “How exactly does my work income affect my Social Security benefits?” Social Security’s rules for how employment affects SSI and SSD are very complex. However, there are some general rules to keep in mind when going back to work while receiving Social Security benefits.

Employment and SSI

For people receiving SSI, Social Security adjusts their SSI checks every month that they earn work income. Here is how it works: Social Security wants to know how much money SSI recipients receive in total from work each month before taxes. Once they know this amount, they do a few things. In general, Social Security will ignore the first $85 that an SSI recipient earns at work each month. Then they will cut what remains in half. This amount is what Social Security deducts from the SSI check. The key here is that Social Security does not deduct an SSI recipient’s work income dollar-for-dollar from their check so, if they work, they will end up bringing home more money. In 2014, most people who receive SSI can earn up to $1,700 per month and continue to be eligible for at least some money in their SSI check.

Example One: Let’s say Ms. Smith is an SSI recipient who begins earning $685 a month at work. Social Security will ignore the first $85 dollars that she earns, reducing the amount of employment income it considers from $685 to $600. Then they will cut that $600 in half, bringing it down to $300. This $300 is what they will deduct from Ms. Smith’s check. So, if she receive $808 in her SSI check before working, that amount will be lowered to $508. The important thing to remember is that, in this example, Ms. Smith is earning $685 and receiving an SSI check for $508, increasing her monthly income to $1,193.

This article has been split into two parts. In part two, we will discuss how employment earnings and SSD work together, showing in several examples how various incomes and SSD payments add up. We will also discuss preventing and fighting overpayments.

Contacting MFY

If you have any questions about how working effects SSI and SSD, or if you would like assistance appealing an existing work-related overpayment, MFY’s Mental Health Law Project is here to help. Our intake line is (212) 417-3830. That line is opened Mondays, Tuesdays and Thursdays from 10:00 AM to 5:00 PM.

Employment Tips for Job-Seekers:

Employment Tips for Job-Seekers:
By Carl Blumenthal
How To Be Successful Whatever Stage You’re At
Since the age of 16, I've had 26 paying jobs, including full-time, part-time, and summer positions, lasting from one month to five years. Given I'm now 62, that's a lot of employment experience. Those jobs have varied from washing dishes and being a building porter to writing for a newspaper and running a merchants' association. And from 2002 to 2005, I was a job counselor for Network Plus, Baltic Street AEH's assisted competitive employment (ACE) program.
As someone living with bipolar disorder, I'm lucky that my hypo-mania has meant long periods of great energy on the job, and cursed that my depressions resulted in six or seven years of unemployment.
Currently, thanks to Network Plus, of which I'm a client in recovery after my latest blues, I'm a part-time peer advocate at Baltic Street AEH (Advocacy, Employment, and Housing). In other words, for the umpteenth time in my life, I'm starting over; something I never think I can do. This is an important part of my story and I hope it is of yours, too.
Here are my tips for getting hired:
1. The job market is tough enough to face alone, so get help. The Coalition of Behavioral Health Agencies has just revised "The WORKbook: A Guide to New York City's Mental Health Employment Programs." Call 212-742-1600 for a copy, or find it online at www.coalitionny.org. The booklet provides information about services offered throughout the five boroughs. Baltic Street AEH's Network Plus, where I receive help, is one such program, with locations in downtown Brooklyn (718-797-2509) and Borough Park (718-377-8567).
Services at these programs usually include assessment of your readiness to work, and designing a personalized plan to identify employment goals and achieve them, including how to acquire necessary training or education. Support from staff or other consumers is often available for seeking a job that can run the gamut from volunteering and internships to various kinds of paid, part-time and full-time positions, either working with mental health peers, or in so-called "competitive" jobs.
Be advised that participation is not a quick fix. Don't be disappointed if it takes months rather than weeks to find something. Many unemployed people without mental illness have been looking for several years. But, as with everything else, persistence pays off. Then, these same programs can counsel you as you face challenges on the job.
2. Have a passion and follow through. Sure, there's drudgery on every job, and maybe I've been lucky with my choices, but I can honestly say I've loved every one of them, and worked like my life depended on it, which it does.
The question is always: "Well, what's realistic, say if I don't have much education or experience due to my illness or other extenuating circumstances?" Here's where it helps to create short-, mid-, and long-term goals.
For example, you like to grow things on your windowsill. First, you might learn more about new plants you could try. Then, about indoor plants in general. Next, join a community garden, learn from your neighbors how to plant veggies, and save yourself some money. Or try courses at one of the city's botanic gardens. They're more expensive, but have led many people to gainful employment.
Or maybe you're that compulsive person who likes to keep things neat and clean. Try hiring yourself out to relatives and friends as references for a cleaning company. Obviously, neither of these examples represents an overnight solution. But, how long have you been unemployed? You have to start somewhere to get somewhere.
3. It's what you know and who you know. Education, training, or on-the-job experience builds knowledge and skills. That goes without saying. However, knowing the people who either directly or indirectly know about job opportunities is still the best way to gain employment. This is how I've obtained almost all my jobs.
Unfortunately, many people these days spend countless, unsuccessful hours scouring the Internet for openings, and, if they're conscientious, tailoring their applications and resumes to those positions and the companies offering them. So, if you don't have much experience using the Internet for this or other purposes, you may not be at a great disadvantage. The above kind of employment services can help you learn more about the Internet.
Compile a list of everyone you know who is employed and talk to them about who they know who is in the know about job opportunities. Again, a job counselor can help you with this, but you need to do the legwork.    
4. Looking for employment is a full-time job. How many times have you heard this? And who wants to hear it again when they're having symptoms of mental illness that interfere with their motivation, energy, concentration, or articulateness?
Here your treatment team (for both physical and mental health) and any peer support group are all-important. The other wellness dimensions are also key. While you're focusing on the occupational, financial, physical and emotional dimensions, don't forget the others: environmental (especially housing), intellectual and spiritual.
Performing your favorite activities can reinforce the energy needed to tackle the job search. And the more you're meeting people who engage in the same activities (that social dimension), the more likely you'll find someone who knows the right someone for a job.
If all this wellness talk sounds overwhelming, there are aids to help you, such as Mary Ellen Copeland's "Wellness Recovery Action Plan" (WRAP). Network Plus uses a wellness assessment during its initial intake and will make appropriate referrals to assist you.
5. Just as recovery from mental illness is a lifetime process, with many starts and stops, so employment can be here today, gone tomorrow.  This is true for everyone, whatever obstacles they face in life. As I stated above, motivation and persistence are essential.
But, allow me to contradict myself a bit. You may try for a job, succeed in getting one, and decide that this job, or employment in general, is not for you. Please don't conclude this is your fate. Be honest, with yourself and your counselor, about what you liked and disliked during the process, so you can learn some lessons. Maybe devote yourself to other dimensions of wellness to boost your confidence for future job searches.
Most of all, don't give up on yourself, whatever you decide to do. I've done that too many times in my life and it made recovery all that much harder. I'm thrilled now to be part of that stream of humanity from my neighborhood heading to the subway every morning for work.

How to Find Disability-Friendly Jobs on Craigslist.org

How to Find Disability-Friendly Jobs on Craigslist.org
There is a way to find jobs on Craigslist where people with disabilities are encouraged to apply. First, visit Craigslist for the city in which you want to work. Under Jobs, click the appropriate sector where you want to find jobs (for example: admin/office or nonprofit sector). In the search box at top of the next page, type the word “disabilities.” You will get a list of job openings by date. Select one and scroll to the bottom of the page where you will see a number of bulleted items. Look for a bulleted item that says: “OK to highlight this job opening for persons with disabilities.” Although this does not guarantee a friendly work atmosphere for people with psychiatric disabilities or that the employer will provide “reasonable accommodations” to ensure that you are comfortable there—it is more likely that the employer will be sensitive to those issues than those postings that lack said bulleted item.
If you are still not sure how to go about this, send an email to newyorkcityvoices@gmail.com and someone will walk you through it. Thank you Craig, founder of Craigslist, for allowing employers to specify that they welcome disabled applicants. Good luck in your job search. Let us know how it goes.

Are You Ready for the World of Work?

Are You Ready for the World of Work?

By Sharon Goldberg

Consider some things first

There is a lot of talk lately about consumers getting off the disability track and going to work. Well, it is a lot easier said than done. This is especially so if you happen to have an emotional disability like I do. I feel as if I have spent my entire life preparing for work and living my life through work.

After I graduated from college, I found myself ill-prepared for the business world. I needed skills. The type of skills needed to succeed in the business world are as follows: clerical skills be it math, computer, typing, word processing, bookkeeping, accounting, etc. All skills not acquired in a liberal arts college.

More important than the above skills is the ability to deal with people in a personable, social manner. If you are not a people-person, you will have many problems.

You must be flexible and able to adjust your attitude to the politics of the office community. You must be pleasant, non-combative, and able to take criticism without taking it to heart.

You have to be able to combine all these skills into a reliable, likeable, capable and workable employee in order to succeed in the world of work.

What are prospective employers looking for? From my own experience, I recall many an employer's want-ad. “Must be a people-person. Must be diligent and detail-oriented. Must have computer skills. Must be well organized. Must be able to take direction. Must be a self-starter. Must be able to multitask. Must be willing to work overtime.”

Some ideas I would suggest in order to decide whether you are ready to work is to decide what you are good at. Are you good with numbers? Do you like to write? Do you like people? Are you artistic? Are you good with computers?

Do you need some type of skills-training? Perhaps you need to sit down with a job counselor. Maybe you need to take an aptitude test. Perhaps you want to start with a volunteer job. Maybe you want to start working part-time.

All of these suggestions would have helped me a great deal but I did none of them. To make it easier, please do as I suggest.

Are you ready for the world of work? Think long and hard about it before you jump in.

Editor's Note: Please don't be frightened of the possibility of work after reading this article. There are ways of getting your feet wet before you decide whether or not to take the plunge. For instance, you can join a clubhouse and participate in their temporary employment program and get paid for doing work that is at or below your potential. Or, you can go to a consumer-friendly employment program and talk to a working peer who can counsel you about employment based on your needs. Two such programs are Network Plus (718) 797-2509 or Network Plus West (718) 377-8568. Tell them City Voices sent you and receive a wink and a nod.

The World of Work

By Steve Duke, LCSW, CPRP, Director of Employment Services, Baltic Street AEH

Step 3: Goal Setting 

"'Tis the set of the sail that decides the goal, and not the storm of life." -Ella Wheeler Wilcox

So let me ask you a question, What is it that you would like to do for a living?

Ever since we were first asked “What do you want to be when you grow up?” We have all pondered this question at least a million times at different points of our lives. Being a grown-up does not mean that you can no longer have dreams, or “occupational day-dreams” as they have been called in the “biz”. It is never too late to find ways to earn money and be personally satisfied at the same time. So take some time and ask yourself what your dream job is. (Remember, keep it clean, legal and realistic!)  Start there and you are ready to begin the Goal Setting Process.

Setting a first rate and high quality goal takes a lot of time, patience, and thought. It can seem overwhelming and confusing at times and you may find yourself procrastinating about making important decisions because of uncertainty, conflicting values, negative past experiences, and feeling that you lack the skills, supports and resources you need to be confident.  

There will always be times when we need to make important decisions and making these important life decisions will always begin with a goal. The decisions you make will determine the course or direction your life will take. Sometimes, circumstances that are not in our control force us to make decisions that we would not necessarily make if we had a choice. For the most part, however, we are usually afforded the opportunity to make decisions that are born out of a desire to move forward, improve ourselves, and achieve greater satisfaction in our lives.

Setting a realistic employment goal is the most crucial phase of employment planning. A well thought-out goal will steer you true and set you in the right direction. It will help you stay focused on what you want despite the many turns and challenges that may arise along the way.

If you are currently seeking employment, regardless of whether you have a clear goal or not, it is at this point that I highly recommend you contact an employment program to assist you with professional support and guidance. That support will help you stay focused and structured, and assess and organize your thoughts and feelings in a way that will enable you make well informed decisions and begin working on your goals with planned strategies for taking action.

Although I do understand how dreams can sometimes be seen as goals, without a realistic action plan and a lot of hard work, they will simply amount to wishful thinking. "A goal without a plan is just a wish."—Larry Elder.

Remember that when you set a goal, set it based on your preferences and not on your skills. Once you decide what it is you want to accomplish, you can begin planning and getting the essential skills needed to achieve your goal as you go along. Getting to the end zone and attaining your goal will depend a lot more on planning and developing than it will on luck. People who set goals that are specific and realistic are usually the ones who succeed.

A professional employment specialist can guide you through a systematized process of making a goal decision and once you learn this major life-skill, the benefit will be that you can use this method whenever you have to make other important decisions in your life. This process involves exploration into the following areas:

Clarifying Values: Understanding and prioritizing what is most important to you;

Analyzing Past Experiences: Understanding the positive and negative aspects of your past work experiences;

Developing Personal Preferences: Identifying and prioritizing the main factors that will contribute to success and satisfaction;

Exploring Alternative Environments: Finding the best match for you; and

Formulating Your Goal Statement: Knowing what you intend to do, where you intend to do it and, when you intend to do it.

Let me end with some choice words from a Chinese fortune cookie: “If you can imagine it, you can achieve it. If you can dream it, you can become it.”  So follow your dreams and start setting goals that can make them come true.

Note: If you need referral assistance or if you have questions or comments about employment that you would like to discuss, contact us at Network Plus (718) 377-8568 and we will assess your situation and help you get the assistance you need.