There is a mental health agency in New York state with a $720,000 annual budget. This would not be particularly impressive except that every one of its 23 employees—including the executive director—lives with mental illness.
Started 14 years ago by a few patients on the grounds of the Hudson River Psychiatric Center in Poughkeepsie, P.E.O.P.L.e now has an office in Kingston and one in Poughkeepsie.
Last year the agency served 2,400 individuals with severe and persistent mental illness. Most receive SSI or SSDI payments and are between the ages of 30 and 50.
How does the agency serve these individuals, whom it calls "members"? P.E.O.P.L.e offers a wide variety of programs, including a two-year-old job training program that has helped 32 members find and keep jobs, and a peer advocacy program that includes an initiative serving patients in mental health settings.
Regarding this latter initiative, advocates work set hours at Benedictine Hospital’s two psychiatric units and emergency service in Kingston, N.Y. (see box above right). In addition, they work on an on-call basis at Hudson River Psychiatric Center, St. Francis Hospital’s two psychiatric units in Poughkeepsie, and several mental health outpatient clinics in Ulster and Dutchess counties.
Besides providing companionship and emotional support, advocates assess patients’ needs. Patients’ most common requests are to change rooms, therapists, or medications. The advocates then set up a meeting with the treating psychiatrist, other therapist, and case manager to address these requests.
To assist patients in solving their hospital-related problems, advocates may role play the situation with the patients and coach them on controlling their emotions while acting assertively. Also, advocates often stay with patients when they speak with the nurse, psychiatrist, or other staff. The advocates’ long-term goal is to have patients advocate for themselves.
Advocates do not give advice on medication or other treatment.
"There are probably only a handful of programs doing this," said Paul Seifert, director of government affairs for the International Association of Psychosocial Rehabilitation Services (IAPRS). "This is an upcoming part of the consumer-empowerment movement, which we at IAPRS welcome."
Most of P.E.O.P.L.e’s other programs are designed to help members live in the community. They include peer-support groups (about 100 are offered every month), two drop-in centers, social and recreational activities, assistance with housing, and peer advocacy in non—mental health settings, such as problems getting Medicaid.
In addition to offering these programs, last year P.E.O.P.L.e’s staff helped 104 patients or former patients, most of whom were homeless. As a result of their efforts, now some have housing, and most receive Medicaid, food stamps, and SSI or SSDI or welfare, said Executive Director Steven Miccio.
In addition to the programs in Ulster and Dutchess counties (where Poughkeepsie and Kingston, respectively, are located), it has a project in neighboring Orange County. Officials from these three counties have received $720,000 in contracts from the New York State Office of Mental Health to support P.E.O.P.L.e.
"P.E.O.P.L.e serves a vital purpose in the recovery process, and its work helps to destigmatize mental illness," said Kenneth M. Glatt, Ph.D., Dutchess County’s commissioner of mental hygiene. "The agency has helped a lot of people over the years, and we consider it a vital part of the community mental health network."
P.E.O.P.L.e’s Poughkeepsie office is the lead agency in a job consortium of 20 agencies serving individuals with psychiatric or physical disabilities. Kim Bonanno, P.E.O.P.L.e’s job coordinator, finds appropriate jobs for the clients at the Galleria Mall in Poughkeepsie.
In conjunction with these services, P.E.O.P.L.e offers a comprehensive job-training program for members at its Poughkeepsie office.
Has this hard work paid off? Well, in 1999, 12 members began working part-time; in 2000, 20 members did the same. For most members, this was their first competitive job, yet only one of the 32 new employees is no longer working. And about 20 percent of these positions have become full time.
Furthermore, four of the employees have discontinued their SSI or SSDI benefits, and three receive substantially lower SSI or SSDI benefits, according to Miccio.
How are they able to achieve this success? First, the staff helps members find jobs that they truly enjoy, including positions in retail sales, stocking, picture framing, and photo developing, for example.
"We try to get away from the typical jobs offered to [mentally ill individuals] like cleaning or fast food. We focus on empowering them and letting them know they have a choice of where they want to work," said Miccio.
Second, Bonanno helps members every step of the way. This includes assessing the members’ interests and skills, finding them jobs, and arranging for a job coach to accompany them for the first few days. The county provides funding for clothes and transportation. Once employed, members often attend P.E.O.P.L.e’s Working People’s Peer Support Group.
Third, Bonanno and Miccio focus their efforts on the Galleria Mall, which has enabled them to develop a good reputation among store managers.
Miccio explained, "At first, some managers would ask, ‘Are [the members] dangerous? Should I be concerned about anything like stealing?’ But once they began working, these fears went away. And now we can’t meet their demand for employees." Miccio noted that despite their efforts, about 10 percent of the managers refuse to hire P.E.O.P.L.e’s members.
Nineteen of P.E.O.P.L.e’s 23 employees are advocates. One advocate, Lesleigh Ozburn-Miller, devotes all her time to working on large-scale issues such as mental health insurance parity. Although the other 18 advocates also work on large-scale issues, they primarily advocate for individual members.
They work on a variety of issues in a variety of settings. One day they might advocate for a patient on a psychiatric unit, while the next they might advocate for a member at social services offices. Most have about eight years of experience. Twice a year they participate in a six- to eight-day training seminar covering such topics as mental health law, patients’ rights, conflict resolution, and multicultural training. Those working in hospitals participate in on-site training and orientation by the hospital’s staff. ▪