R&R plan fits local conditions

By Robert Landauer – editorial columnist for The Oregonian, April 18, 2000. Not available elsewhere online.

For wartime U.S. generations, R&R is shorthand for “rest and recreation” — a furlough from the fighting at the front.

For younger Americans, R&R means “rehabilitation and recovery” — rescue from mental illness and drug abuse.

Rehabilitation helps people recapture earlier levels of skills and functioning in everyday life. Recovery deals less with getting over an illness than with helping people to manage it so that it has as little adverse effect on the quality of life as possible.

The new-age combat zone’s R&R demands attention because Multnomah County is mulling reorganizations to improve its services for the mentally ill. But shifting bureaus and lines of authority will cause turmoil unless all unite behind a proven plan. Portland State University researchers bring such a tested strategy to the table.

Their proposal is called IPS+. It stands for Individual Placement and Support plus enhancements.

A stubborn myth is that mental -illness treatment just requires patients to take wondrous new medicines. But if chemicals, alone, could move Oregon’s mentally ill toward recovery, their joblessness would be lower than its estimated 85 percent to 95 percent.

Other services are at least as important as medications if the mentally ill are to reach toward meaningful relationships and a sense of usefulness and purpose.

IPS+ combines supported employment with mental health treatment and other wraparound services. These involve strategies geared to the high portion of alcohol and drug abusers among the mentally ill and using mental -health consumers on treatment teams.

This approach has shown that it can help 50 percent to 70 percent of its clients gain employment in fields that interest them — a crucial step toward taking control of their lives.

“We are not just saying that people ought to work because that’s our value system,” explains Rachel Post, IPS+ project coordinator. “We are saying that employment contributes significantly to rehabilitation and recovery, quality of life and sense of self and self-worth, which the research is showing contribute to reducing need for community mental -health services.”

In Multnomah County, though, we have only the equivalent of 6.75 full-time supported-employment staff to serve about 2,400 mentally ill individuals eligible for job assistance. This compares to 15.5 supported-employment workers serving 2,200 in 1997, when staffing already was considered meager.

Put another way, the ratio of staff to clients was one for every 70 in 1997 but climbed to one for every 178 by this year.

Fifty to 70 percent of those with a severe mental illness want and could benefit from supported employment, says Post.

IPS+ would deliver services at caseload ratios of one to every 23 clients, close to the one to 20 that the best-researched mental -health model found would have top results.

IPS+ offers three big lures:

  • It provides the level of coordinated, intensive services that allows its clients to succeed in work and in life.
  • It is expected not to cost more than the fragmented services that now deliver the components of the model.
  • It is expected to get superior results from the spending, based on tests at other sites around the country.

Two agencies in Multnomah County (Unity Inc. and Network Behavioral Healthcare) and one in Washington County (Tualatin Valley Centers) want to field-test IPS+ here.

Each can fund half the staffing to serve 150 patients in its own local demonstration project. Oregon’s state Vocational Rehabilitation Division has said it will become a partner.

The Multnomah County Mental Health Task Force, in its just-issued report, called IPS+ “an impressive and effective program” and urged the state to use an expected increase in its federal mental health block grant to fund the demonstration sites.

Employment is more than work. It is also therapy. This is a compelling chance to prove that Oregon’s mentally ill are more than their illnesses.