Working Toward Recovery

Larry Watts credits working at Tazo Tea’s Southeast Portland warehouse as his most important therapy.

Larry Watts credits working at Tazo Tea’s Southeast Portland warehouse as his most important therapy.

From the Portland Tribune, June 18 2009

Real jobs, as therapy, garner acclaim for region’s Lifeworks NW

Until now, nobody at Tazo Tea’s Southeast Portland warehouse, where Larry Watts works, knew Watts suffered from acute mental illness.

Watts has worked at Tazo for almost a year, but he hasn’t spoken to co-workers or his supervisor about the life he led before. He hasn’t told them about the career as a Washington County corrections officer that ended in 1995 or the years since then spent in and out of hospital psychiatric units with depression and thoughts of suicide (and one attempt) stemming from his borderline personality disorder.

From 2001 to 2007, Watts, 56, didn’t work at all. He lived in his apartment, “drawing back from people,” as he puts it. Watts, an Army veteran, says he spent a lot of time in bed.

What turned Watts’ life around, he says, was not counseling or support groups or new drugs. It was work — work he enjoys with people he likes. And that work was made possible because LifeWorks NW, a nonprofit that provides community mental health services out of its Northeast Portland and Hillsboro offices, has embraced a new model of therapy based on an old-fashioned principle: that keeping busy, with fulfilling work, can help people feel better about life.

Last month, LifeWorks received one of two national Johnson & Johnson-Dartmouth Achievement awards for its supported employment program — considered by many experts to be a pioneering effort not only to help people suffering mental illness get back to work, but also to use work as the fulcrum of clients’ therapy.

In January 2007, Watts received a letter from LifeWorks, which had begun its participation in a national study on the effectiveness of what is called the Dartmouth model of supported employment. The agency said it would help Watts find a job that appealed to him and provide support through an employment specialist who would help him apply for and keep a job.

Watts, a one-time 170-pound marathon runner who had ballooned to 255 pounds, agreed and was pleased that at his first meeting at LifeWorks, the employment specialist didn’t want to talk about his psychiatric symptoms or potential therapies. He wanted to talk about what type of job might suit Watts.

An interview at placement agency Manpower Inc. led to a job stacking boxes at Tazo Tea. Eventually, Watts was given more responsibility, first in the blending room and now tracking warehouse inventory. And his life has turned around.

Today, Watts attends services at First Baptist Church downtown and on Thursdays volunteers at the church feeding the homeless. He has a routine that he relishes — up at 4:15 a.m., a little reading, breakfast, into the warehouse 30 minutes early so he can sample all the Tazo teas before starting his 7 a.m. to 1 p.m. shift.

The depression has lifted, Watts says. He’s lost 20 pounds. He’s enjoying the company of others. In fact, he says, learning to deal with the stress of working with others has been part of his healing.

“You’ve got to get out,” Watts says. “You can’t just sit there and talk about it and maybe wish you could. You’ve got to do it.”

Deborah Becker, a Dartmouth University assistant professor who is co-director of the Johnson and Johnson-Dartmouth community mental health program, says that nationally, only about one out of 20 sufferers of acute mental illness has access to a program like that at LifeWorks. That’s even though her research says they are two to three times more effective than traditional step-by-step treatment models for psychiatric patients.

The programs are expensive, however, with annual costs of about $3,000 to $4,000 per client. The Oregon Health Plan reimburses some costs for its enrollees, and a combination of state Department of Human Services and federal grant money covers the rest of LifeWorks’ costs.

But LifeWorks officials say that if the projected DHS budget cuts go through, it is likely they will have to shrink the program, possibly removing clients who don’t have health insurance.

This, despite the fact that there are some hard to calculate back end savings, according to Phyllis Maynard, director of adult rehabilitation services for LifeWorks. Some clients, once employed, no longer need to use other government-sponsored mental health services as much. Some eventually go off Social Security disability. And some end up with jobs that include health insurance, thus taking them off Oregon Health Plan rolls.

The Dartmouth model stresses that even sufferers of severe psychiatric disease should be encouraged to work at jobs that they want, in normal work situations, rather than set-aside workshops and that they should earn at least minimum wage. And clients choose whether they want to disclose their mental health history to employers.

Supported employment has its detractors. Critics say placing clients such as Watts in potentially stressful jobs might be setting them up to failure if their symptoms worsen and they get fired. Also, there are concerns that employers may suffer lost productivity, especially those who aren’t told about the psychiatric backgrounds of their hires. Becker says that hasn’t happened.

“We just don’t see those negative consequences,” she says. “There was a great worry from families and consumers and mostly from (Dartmouth) staff that this was going to be a bad thing, people were going to drop out, they were going back to the hospital. None of that happened. People went to work.”

Crystal McMahon, director of the Oregon Supported Employment Center for Excellence, says that for many suffering mental illness, the effects of the supported employment program have been “remarkable.”

“It’s like the life comes back in their eyes,” McMahon says. “Without the work, they just identify themselves as mentally ill.”

Old therapy model: no stress, no help

For Sandra Winchester, working in a safe, controlled environment at LifeWorks NW, before the agency adopted its supported employment model in 2000, was hardly better than working at all.

Winchester, a petite, 55-year-old Hillsboro resident, had for years suffered schizoaffective disorder, battling through depression, paranoia and psychotic episodes during which she would hear voices, or think everyone was angry with her. After graduating from college, and one year as a receptionist, she was unable to hold any job for longer than a month.

When she first came to LifeWorks, Winchester was told she could work in a sheltered workshop, the traditional employment model used by mental health agencies. Workshops are based on the idea that people experiencing mental illness need controlled, stress-free workplaces, at least as first steps toward eventually joining the outside work force.

Winchester found herself in a room with as many as 10 other LifeWorks clients, plugging little pegs into cell phones. She was paid on a piece rate basis that came to far less than minimum wage.

There was little stress, Winchester says, but there was also little distraction from the voices inside her head. And there wasn’t any healing.

In 2003, Miho Shimba, program director of supportive employment and education at LifeWorks, suggested Shimba try supportive employment.

After Shimba asked, Winchester told her about possibly appealing work: She imagined herself pouring coffee. But looking people in the eye was hard; every time she tried to smile at people she felt like she was grimacing.

Eventually, Shimba found a job that seemed right – grocery store food demonstrator. There would be contact with the public, but it would be short term, based mostly on reading from a script.

Shimba helped guide Winchester though the interview process, from a new haircut and clothes to behavior during the interview. In February 2005, Winchester called Shimba and said on her own she had interviewed with a food demonstration company and been offered a job at a local Costco.

On a typical work day, Winchester would serves juice or dips and chips to customers as they walk by.

Some days, Shimba would observe Winchester at work and later offer advice. Always, Winchester says, she knew she had Shimba to talk to if there was a problem at work.

Today, Winchester works about half time and makes $11 an hour. There have been bumps in the road, including the day her supervisor had to call Shimba because the voices inside Winchester’s head had become too loud. Shimba checked Winchester in to the psychiatric unit of Providence St. Vincent Medical Center and worked out medical leave with her supervisor.

But Winchester says she’s mostly gotten over the fear that nobody would like the food she had prepared, or that she was smiling wrong. And despite years of psychiatric care, it is her job that Winchester most credits with her improvement. She sees her co-workers as friends. She says it’s easier to smile back at people when they smile at her, and that has been a revelation.

“I can watch people go in front of me and they talk to me, they keep me distracted, and it keeps me involved,” Winchester says. “They’re not just a distraction, they give me something to focus on.”