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Consumer/survivor-run businesses : community economic development and self-help for people with a history… Kerr, David George 1994

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CONSUMER/SURVIVOR-RUN BUSINESSES: COMMUNITY ECONOMIC DEVELOPMENT AND SELF-HELP FOR PEOPLE WITH A HISTORY OF MENTAL ILLNESS by DAVID GEORGE KERR B . S c , Simon F r a s e r U n i v e r s i t y , 1990 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE i n THE FACULTY OF GRADUATE STUDIES S c h o o l o f Community and R e g i o n a l P l a n n i n g We ac c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e ^ ^ l i i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA October 1994 i'^c?"! D a v i d George K e r r , 1994 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. De^j^mefrT of 1 La. - i ^ " ' - ' The University of British Columbia Vancouver, Canada Date _ /V, 1993 DE-6 (2/88) A b s t r a c t C o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s (CSRB's) a r e b u s i n e s s e s i n w h i c h p e o p l e w i t h a h i s t o r y o f mental i l l n e s s p l a y a r o l e i n d e v e l o p i n g and managing t h e b u s i n e s s . Key a s p e c t s o f t h i s t y p e of a c t i v i t y i n c l u d e f l e x i b i l i t y i n w o r k i n g h o u r s , and some form o f d e m o c r a t i c c o n t r o l o v e r t h e b u s i n e s s . C o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s employ a s p e c t s o f b o t h community economic development and s e l f - h e l p f o r p e o p l e w i t h a h i s t o r y o f m e n t a l i l l n e s s . These b u s i n e s s e s a c t as an a l t e r n a t i v e form o f v o c a t i o n a l r e h a b i l i t a t i o n f o r p e o p l e w i t h a h i s t o r y o f mental i l l n e s s . The predominant forms o f v o c a t i o n a l r e h a b i l i t a t i o n , such as s h e l t e r e d work, employment p r e p a r a t i o n programs, t r a n s i t i o n a l employment, and s u p p o r t e d employment a r e o f t e n b e n e f i c i a l , but a r e not w i t h o u t l i m i t a t i o n s . Dependency on p r o f e s s i o n a l i z e d s e r v i c e s , s t a g n a t i o n i n e n t r y - l e v e l j o b s , and a l a c k o f independence a r e some o f t h e l i m i t a t i o n s d e s c r i b e d i n the l i t e r a t u r e . F i v e c a s e s o f CSRB's from a c r o s s Canada a r e a n a l y z e d . From th e l i t e r a t u r e r e v i e w e d and the e x p e r i e n c e s o f t h e s e c a s e s , c o n s t r a i n t s f a c e d by CSRB's and o p p o r t u n i t i e s p r e s e n t e d f o r s u p p o r t t o them t h r o u g h p u b l i c p o l i c y a r e d i s c u s s e d . The c o n s t r a i n t s i n c l u d e d ( i ) b u r e a u c r a t i c r e s t r i c t i o n s t h a t l i m i t what c o n s u m e r / s u r v i v o r s may e a r n on t o p o f t h e i r d i s a b i l i t y p e n s i o n s ; ( i i ) a t t i t u d e s o f t h e g e n e r a l p u b l i c , namely t h e s t i g m a of m e n t a l i l l n e s s ; ( i i i ) a t t i t u d e s o f mental h e a l t h p r o f e s s i o n a l s , who h o l d t o a ' s e r v i c e paradigm'; ( i v ) problems i n h e r e n t i n t h e development o f a l t e r n a t i v e s e t t i n g s , and (v) t h e d r i f t towards p r o f e s s i o n a l i s m o f t e n e x p e r i e n c e d by a l t e r n a t i v e s e t t i n g s . O p p o r t u n i t i e s p r e s e n t e d f o r the development o f CSRB's i n c l u d e : t h e b e n e f i t s t h a t CSRB's h o l d f o r c o n s u m e r / s u r v i v o r s ( f l e x i b i l i t y i n h o u r s , s t a b l e employment, a sense o f s e l f - r e l i a n c e and i n d e p e n d e n c e ) ; the economic c l i m a t e ( h i g h unemployment, h i g h p u b l i c debt, e t c . ) w h i c h w i l l make t r a d i t i o n a l forms o f v o c a t i o n a l r e h a b i l i t a t i o n l e s s v i a b l e . Government s u p p o r t , i n c l u d i n g the p r o v i s i o n o f o n g o i n g f u n d i n g and t e c h n i c a l s u p p o r t f o r CSRB's, c o u l d a i d i n t h e development of t h i s t y p e o f a l t e r n a t i v e s e t t i n g . TABLE OF CONTENTS Abstract i i Table of Contents i v L i s t of Figures v i Chapter One Introduction 1 1.1 Methodology 4 Chapter Two Context for CSRB's 7 2.1 Mental Health Policy 7 2.1.1 H i s t o r i c a l Treatment of the Mentally 111 7 2.1.2 The 20th Century 8 2.1.3 The Canadian Context 8 2.1.4 Problems with D e i n s t i t u t i o n a l i z a t i o n 9 2.1.5 Challenges to Community Care 10 2.1.6 The Development of Psychosocial Self-Help Clubs 10 2.1.7 Canadian Mental Health P o l i c y -The Emergent Picture 11 2.1.8 The Sector-Based Model 13 2.1.9 Summary 16 2.2 Vocational Rehabilitation 17 2.2.1 Employment Preparation Programs 18 2.2.2 Sheltered Work 19 2.2.3 T r a n s i t i o n a l Employment 20 2.2.4 Supported Employment 22 2.2.5 Summary 24 2.3 Community Economic Development 24 2.3.1 The Concept of 'Community' i n Community Economic Development 25 2.3.2 Dimensions of Community Economic D eve1opment 27 2.4 Mental Health, Perspectives on the Disabled, and Planning 32 Chapter Three Consvimer/Survivor-Run Businesses 3 9 3.1 Examples of CSRB's 41 3.1.1 Abel Enterprises 41 3.1.2 A-Way Express Couriers 44 3.1.3 Fresh Start Cleaning and Maintenance 47 3.1.4 Unity Housing 48 3.1.5 Consumer/Survivors' A r t i s t s Cooperative 50 3.2 Aspects of CSRB's 52 3.2.1 Decision-making/ Organizational Structure of CSRB's 52 3.2.2 Composition of Staff 53 3.2.3 Source of Funding 54 3.2.4 Market 55 Chapter Four Consumer/Survivor-Run Businesses: Lessons to be Learned 57 4.1 Constraints Facing CSRB's 57 4.1.1 Bureaucratic Restrictions 57 4.1.2 Attitudes of the General Public Towards Consumer/Survivors 60 4.1.3 Attitudes of Mental Health Professionals; The Service Paradigm 64 4.1.4 Problems Inherent i n Developing New Settings 67 4.1.5 D i f f i c u l t i e s Inherent i n the Operation of Cooperatives 71 4.1.5 The D r i f t Towards Professionalism 73 4.2 Opportunities for CSRB's - Why have the examples studied succeeded? 76 4.2.1 Human Factors 7 6 4.2.2 Economic Factors 78 4.2.3 Broad Community Support 78 4.2.4 Meaningfulness 79 4.3 Large-scale P o l i t i c a l and Economic Factors 80 4.4 Rationale for a Funding Structure 81 Chapter Five Supporting Consumer/Survivor-Run Businesses 82 5.1 Elements of a Pr o v i n c i a l Strategy Supporting CSRB's 84 5.1.1 Funding for CSRB's 84 5.1.2 Aspects of CSRB's to be Encouraged 85 5.1.2.1 F l e x i b i l i t y i n Working Hours 85 5.1.2.2 The Adoption of Organizational Models which Guarantee Control to Consumer/Survivors 85 5.1.2.3 Ensuring that Projects Adopt Organizational Models which Emphasize the Involvement of Employees i n Decision-Making 85 5.1.2.4 Support of Networking Between CSRB's 86 5.1.3 Technical Support 86 5.1.4 Economic Disincentives to Employment 87 5.1.5 Analysis of Expenditures 87 Chapter Six Conclusion 89 Bibliography 91 LIST OF FIGURES F i g u r e 1 The Community Resource Bank 15 F i g u r e 2 P a r a l l e l s Between M e n t a l H e a l t h , P l a n n i n g Theory, and P e r s p e c t i v e s on t h e D i s a b l e d 3 9 1.0 I n t r o d u c t i o n My p u r p o s e i n t h i s t h e s i s i s t o a n a l y z e a new f i e l d , b r i d g i n g community economic development and s e l f - h e l p f o r p e o p l e w i t h a h i s t o r y o f m ental i l l n e s s : c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s (CSRB's) . From a r e v i e w of t h e r e l e v a n t l i t e r a t u r e , and o f Canadian CSRB p r o j e c t s , c h a r a c t e r i s t i c s o f t h i s a c t i v i t y , c o n s t r a i n t s t o t h e i r development, and o p p o r t u n i t i e s w i l l be i d e n t i f i e d . A p o t e n t i a l p r o v i n c i a l s t r a t e g y f o r s u p p o r t i n g CSRB's w i l l t h e n be o u t l i n e d . F i r s t , some t e r m i n o l o g y . 'Consumer' i n t h i s c o n t e x t , d e s c r i b e s someone who, due t o m ental i l l n e s s , has sought h e l p from th e mental h e a l t h system. T h i s term has come t o be p r e f e r r e d by p e o p l e w i t h s u ch e x p e r i e n c e s , o v e r such terms as ' p a t i e n t ' o r ' c l i e n t ' ; t h e t e r m 'consumer' g i v e s t o t h e i n d i v i d u a l who consumes mental h e a l t h s e r v i c e s t h e n o t i o n o f someone who has r i g h t s t o f a i r n e s s and p r o p e r t r e a t m e n t . ' S u r v i v o r ' i s p r e f e r r e d by p e o p l e who c l a i m t h e y have found t h e m s e l v e s i n t h e c a r e o f the mental h e a l t h system due t o t r a u m a t i c e v e n t s i n t h e i r l i v e s , r a t h e r t h a n a m ental i l l n e s s . Such p e o p l e do not c o n s i d e r t h e m s e l v e s as m e n t a l l y i l l p e r se, but as v i c t i m s o f a m e n t a l h e a l t h system t h e y see as o p p r e s s i v e . C o n s u m e r / S u r v i v o r - r u n b u s i n e s s e s a r e e n t e r p r i s e s i n w h i c h p e o p l e w i t h a p e r s o n a l e x p e r i e n c e o f t h e m ental h e a l t h p l a y a g u i d i n g r o l e . Two i m p o r t a n t a s p e c t s o f t h i s model a r e : ( i ) CSRB's attempt t o make the w o r k p l a c e more s u i t a b l e f o r c o n s u m e r / s u r v i v o r s r a t h e r t h a n t r y i n g t o make the c o n s u m e r / s u r v i v o r f i t t h e w o r k p l a c e . F l e x i b i l i t y i s i n c o r p o r a t e d i n t o t h e e n t e r p r i s e ; members may r e p l a c e each o t h e r on t h e b a s i s o f h e a l t h f a c t o r s . Where p e o p l e may not be a b l e t o work f u l l - t i m e , t h e y may be a b l e t o work p a r t - t i m e , o r work a s c h e d u l e t h a t a l l o w s f o r m e d i c a l - and s o c i a l s e r v i c e - r e l a t e d absences. ( i i ) CSRB's, t o a v a r y i n g degree, employ a membership-driven p r o c e s s , e n a b l i n g members t o p l a y a r o l e i n d e v e l o p i n g and managing t h e e n t e r p r i s e . What i s t h e r a t i o n a l e f o r CSRB's? F o l l o w i n g t h e onset o f m e n t a l i l l n e s s , many p e o p l e become l a r g e l y d i s a b l e d , and a r e unable t o work. L a c k i n g a r o l e i n t h e community, t h e s e p e o p l e may become p r o g r e s s i v e l y more withdrawn and i s o l a t e d . To combat such i s o l a t i o n and d e v e l o p v o c a t i o n a l and l i f e s k i l l s , v o c a t i o n a l r e h a b i l i t a t i o n programs have been d e v e l o p e d . The s h e l t e r e d workshop has been t h e most common form o f v o c a t i o n a l r e h a b i l i t a t i o n . Work, i n t h e s e s e t t i n g s , r e q u i r e s a low s k i l l l e v e l ; payment i s a t o k e n sum, u s u a l l y below minimum wage. C r i t i c i s m o f s h e l t e r e d workshops has f o c u s e d on ' i n s t i t u t i o n a l dependency', a l o w e r l e v e l o f f u n c t i o n i n g t h a t comes t o be a c c e p t e d as n o r m a l . W i t h l i t t l e o p p o r t u n i t y t o d e v e l o p s e l f - r e l i a n c e and independence, p e o p l e remain a t a low l e v e l o f f u n c t i o n i n g . T h i s c r i t i c i s m has l e d t o t h e development o f o t h e r models o f v o c a t i o n a l r e h a b i l i t a t i o n , such as s u p p o r t e d employment and t r a n s i t i o n a l employment. S u p p o r t e d employment i s a model i n w h i c h t h e c l i e n t i s p l a c e d i n a ' r e a l ' j o b , and i s p r o v i d e d w i t h a c c e s s t o o n g o i n g c o u n s e l l i n g s u p p o r t . T r a n s i t i o n a l employment r e f e r s t o a model i n w h i c h v o c a t i o n a l t r a i n i n g i s f o l l o w e d by j o b placement and s u b s t a n t i a l s u p p o r t f o r a t r a n s i t i o n a l p e r i o d . W h i l e r e p r e s e n t i n g an improvement o v e r t h e s h e l t e r e d workshop e n v i r o n m e n t , t h e s u p p o r t e d employment and t r a n s i t i o n a l employment models a r e a l s o now f a c i n g c r i t i c i s m . The j o b s t h a t c l i e n t s are p l a c e d i n t e n d t o be e n t r y - l e v e l and low p a y i n g . And dependency may be a problem. D e s p i t e t h e s e v o c a t i o n a l r e h a b i l i t a t i o n measures, the f u l l - t i m e employment r a t e f o r p e o p l e who have been h o s p i t a l i z e d w i t h a m e n t a l i l l n e s s has been e s t i m a t e d t o be o n l y 20% (Canadian I n s t i t u t e o f C u l t u r a l A f f a i r s , 1984). The r a t i o n a l e f o r CSRB's i s t h a t w h i l e e x i s t i n g forms of v o c a t i o n a l r e h a b i l i t a t i o n s e r v e some who have a mental i l l n e s s , a l t e r n a t i v e models w h i c h p r o v i d e f o r a g r e a t e r l e v e l o f s e l f -r e l i a n c e a r e needed. Brown (1989) a n a l y z e d the worker c o - o p e r a t i v e model o f b u s i n e s s o r g a n i z a t i o n , and i t s a p p l i c a b i l i t y t o v o c a t i o n a l r e h a b i l i t a t i o n and t h e development o f employment o p p o r t u n i t i e s f o r t h e p s y c h i a t r i c a l l y d i s a b l e d . Based on a case s t u d y of A-Way E x p r e s s C o u r i e r s , she c o n c l u d e d t h a t t h i s model p r o v i d e d more o p p o r t u n i t i e s f o r s e l f - r e l i a n c e and s e l f - d e t e r m i n a t i o n t h a n o t h e r forms o f v o c a t i o n a l r e h a b i l i t a t i o n . F o r t h o s e c o n s u m e r / s u r v i v o r s who a r e a b l e t o f u n c t i o n i n a b u s i n e s s s e t t i n g , CSRB's a r e an e s p e c i a l l y a p p r o p r i a t e o p t i o n . R e c e n t l y , a s u r v e y was completed i n O n t a r i o t h a t a t t e m p t e d t o measure the impact of CSRB i n v o l v e m e n t on t h e use o f m e n t a l h e a l t h s e r v i c e s by c o n s u m e r / s u r v i v o r s . The s u r v e y found t h a t i n v o l v e m e n t w i t h CSRB's r e s u l t e d i n s i g n i f i c a n t d e c r e a s e s i n t h e number o f days spent i n h o s p i t a l , days spent i n o u t - p a t i e n t programs, and c r i s i s c o n t a c t s ( T r a i n e r & Tremblay, 1992). CSRB's attempt t o r e d e f i n e t h e w o rker's r e l a t i o n s h i p w i t h the employment s e t t i n g . They are c o l l e c t i v e e f f o r t s t o c r e a t e work t h a t i s m e a n i n g f u l by v i r t u e o f the worker's s t a k e i n t h e e n t e r p r i s e . As such, CSRB's a r e a form o f community economic development i n i t i a t i v e . R e c e n t l y , p o l i c y makers and p l a n n e r s have caught up t o the t r e n d o f m e n t a l h e a l t h consumers t a k i n g c o n t r o l o v e r t h e i r l i v e s . Recent m e n t a l h e a l t h p o l i c y s t a t e m e n t s put out by p r o v i n c i a l governments have i n c l u d e d commitments t o s e l f - h e l p i n i t i a t i v e s . I n B r i t i s h Columbia, funds are g r a n t e d v i a t h e Consumer I n i t i a t i v e F u n d i n g program. One o f the B.C. o r g a n i z a t i o n s funded, the West Coast M e n t a l H e a l t h Network, i s i n t e r e s t e d i n CSRB's, and a c o u p l e of e n t e r p r i s e s a r e i n t h e p l a n n i n g s t a g e . O n t a r i o has been l e a d i n g t h e way w i t h consumer i n i t i a t i v e s . I n 1991, t h e p r o v i n c i a l government s e t up the Consumer/Survivor Development I n i t i a t i v e (CSDI) . S i n c e 1991, 34 s e l f - h e l p p r o j e c t s have been s e t up by consumers a c r o s s O n t a r i o . These range from c o u n s e l l i n g , advocacy, and a c t i v i t y g r oups, t o economic i n i t i a t i v e s . F i v e o f t h e p r o j e c t s f unded by CSDI a r e CSRB's. I t would seem t o be b e n e f i c i a l t h a t more e x p e r i m e n t s w i t h CSRB's be d e v e l o p e d . W i t h more examples w i l l come more i n f o r m a t i o n on how t h i s model can work. 1.1 Methodology F i v e examples o f CSRB's were a n a l y z e d i n t h i s t h e s i s . Three o f t h e s e , A-Way E x p r e s s C o u r i e r s , A b e l E n t e r p r i s e s , and F r e s h S t a r t C l e a n i n g and Maintenance, a l l l o c a t e d i n O n t a r i o , were s e l e c t e d f o r a n a l y s i s because t h e y a r e t h e o l d e s t , most e s t a b l i s h e d examples o f CSRB's. The s e l e c t i o n o f t h r e e examples w h i c h have been s u c c e s s f u l c o u l d be v i e w e d as b i a s e d ; on t h e o t h e r hand, l o o k i n g a t s u c c e s s f u l examples a l l o w s the a n a l y s i s o f why t h e s e examples have s u r v i v e d -- why have t h e s e p a r t i c u l a r p r o j e c t s been s u c c e s s f u l ? O t h e r examples i n O n t a r i o were not used, as t h e y were newer, l e s s e s t a b l i s h e d , and t h e r e was not as much i n f o r m a t i o n a v a i l a b l e on t h e s e . The o t h e r two examples s e l e c t e d a r e from t h e Vancouver a r e a . L e s s i n f o r m a t i o n was a v a i l a b l e on t h e s e as t h e y a r e a l s o v e r y new ( U n i t y H o u s i n g h a v i n g been i n o p e r a t i o n f o r a y e a r , t h e Co n s u m e r / S u r v i v o r A r t i s t s ' C o o p e r a t i v e l e s s t h a n one y e a r ) . These were chosen t o g i v e an i d e a o f t h e d i v e r s e n a t u r e o f a c t i v i t y o c c u r r i n g . I n f o r m a t i o n on the f i v e examples o f CSRB's s t u d i e d i n t h i s t h e s i s was e x t r a c t e d from ( i ) e x i s t i n g l i t e r a t u r e on t h e s e examples; and ( i i ) b r o c h u r e s and i n f o r m a t i o n s h e e t s i s s u e d by t h e p r o j e c t s t h e m s e l v e s . P e r s o n a l i n t e r v i e w s w i t h p e o p l e i n v o l v e d w i t h t h e p r i m a r y examples would have been d i f f i c u l t , g i v e n t h e f a c t t h a t t h e y a r e l o c a t e d i n O n t a r i o . And, as mentioned, the two l o c a l examples have j u s t begun o p e r a t i o n . A number o f s o u r c e s were drawn upon t o a n a l y z e A-Way E x p r e s s C o u r i e r s ; t h e s e ranged from Brown's 1989 t h e s i s , j o u r n a l a r t i c l e s ( T r a i n o r & Tremblay, 1992; Ward & Tremblay, 1988), C o n s u m e r / S u r v i v o r Development I n i t i a t i v e p r o m o t i o n a l m a t e r i a l , and newspaper a r t i c l e s . S i m i l a r l y , t o a n a l y z e A b e l E n t e r p r i s e s , a number o f s o u r c e s were used (Canadian I n s t i t u t e o f C u l t u r a l A f f a i r s , 1984; CMHA, 1987; CSDI, 1994; T r a i n o r & Tremblay, 1992). O n l y two s o u r c e s were used f o r F r e s h S t a r t C l e a n i n g and Maintenance (CSDI, 1994; T r a i n o r & Tremblay, 1992). I n f o r m a t i o n f o r t h e d i s c u s s i o n o f t h e c o n t e x t f o r CSRB's ( r e l a t i n g t o t h e a r e a s of mental h e a l t h p o l i c y , v o c a t i o n a l r e h a b i l i t a t i o n , community economic development, and p e r s p e c t i v e s on t h e d i s a b l e d ) was g a t h e r e d p r i m a r i l y from l i b r a r y r e s e a r c h , and from a g e n c i e s i n v o l v e d w i t h mental h e a l t h . Some i n s i g h t i n t o i s s u e s a f f e c t i n g c o n s u m e r / s u r v i v o r s was o b t a i n e d t h r o u g h t a l k i n g w i t h p e o p l e i n v o l v e d w i t h t h e West Coast M e n t a l H e a l t h Network, an o r g a n i z a t i o n r e p r e s e n t i n g c o n s u m e r / s u r v i v o r s , and v o l u n t e e r work w i t h t h e Canadian M e n t a l H e a l t h A s s o c i a t i o n . T h i s t h e s i s does not attempt t o s y s t e m a t i c a l l y a n a l y z e t h e b e n e f i t s o f CSRB's, o r ask whether t h i s model can work. Brown (1989), i n h e r r e s e a r c h , l o o k e d a t t h e s e q u e s t i o n s and found t h a t CSRB's were v i a b l e , and were b e n e f i c i a l t o c o n s u m e r / s u r v i v o r s . T h i s t h e s i s a t t e m p t s t o b r i n g a p l a n n i n g p e r s p e c t i v e t o t h i s a r e a . C o n s t r a i n t s t o t h e development of CSRB's, and r e a s o n s t h a t t h e y have worked, a r e a n a l y z e d from a p u b l i c p o l i c y p e r s p e c t i v e . From t h e l e s s o n s l e a r n e d , a b r o a d s t r a t e g y f o r s u p p o r t i n g CSRB's i s p r o p o s e d . 2.0 C o n t e x t f o r C o n s u m e r / S u r v i v o r - r u n B u s i n e s s e s 2.1 M e n t a l H e a l t h P o l i c y I n o r d e r t o a n a l y z e Consumer/Survivor-Run B u s i n e s s e s and what a s u p p o r t i v e p r o v i n c i a l s t r a t e g y c o u l d l o o k l i k e , i t i s n e c e s s a r y t o r e v i e w m e n t a l h e a l t h p o l i c y , i n c l u d i n g t h e h i s t o r i c a l t r e a t m e n t o f t h e m e n t a l l y i l l , Canada's approach t o mental h e a l t h , and r e c e n t t r e n d s i n m e n t a l h e a l t h p o l i c y . 2.1.1 H i s t o r i c a l Treatment o f t h e M e n t a l l y 111 A r e v i e w o f t r e a t m e n t of t h e m e n t a l l y i l l t h r o u g h h i s t o r y y i e l d s many examples o f h o r r i f i c t r e a t m e n t . E a r l y New E n g l a n d e r s , t h i n k i n g symptoms o f mental i l l n e s s were s i g n s o f demonic p o s s e s s i o n , burned and t o r t u r e d m e n t a l l y i l l p e o p l e . I n l a t e r y e a r s , t h e m e n t a l l y i l l were i n c a r c e r a t e d w i t h c r i m i n a l s , o r thrown i n p o o r houses. However, i n many ca s e s m e n t a l l y i l l p e o p l e were c a r e d f o r a t home by t h e i r f a m i l i e s (Brown, 1990). W i t h t h e advent o f p r o f e s s i o n a l i s m i n t h e 1 9 t h c e n t u r y , the m e n t a l l y i l l were d i s t i n g u i s h e d from t h e r e t a r d e d , e l d e r l y , and i n s a n e . P u b l i c p r o v i s i o n f o r c a r e o f t h e m e n t a l l y i l l was i n i t i a t e d . P h i l i p p e P i n e l , a F r e n c h d o c t o r and s o c i a l r e f o r m e r , worked f o r b e t t e r t r e a t m e n t o f m e n t a l l y i l l p e o p l e ; he b e l i e v e d t h a t p e o p l e c o u l d be r e h a b i l i t a t e d , t h r o u g h r e s p e c t f u l and s y m p a t h e t i c t r e a t m e n t , i n an i n s t i t u t i o n a l s e t t i n g . P i n e l r e f e r r e d t o h i s methods as 'moral t r e a t m e n t ' . H i s asylums r e p o r t e d good r a t e s o f c u r e . As a r e s u l t o f p o s i t i v e developments such as t h i s , asylums f o r t h e m e n t a l l y i l l became more w i d e s p r e a d i n t h e 1 9 t h c e n t u r y . I n c r e a s i n g u r b a n i z a t i o n and t h e l o s s o f t r a d i t i o n a l ways l e d t o more p e o p l e b e i n g t r e a t e d i n i n s t i t u t i o n s i n s t e a d o f a t home. T h i s r e s u l t e d i n i n s t i t u t i o n s becoming more crowded; c a r e became i n c r e a s i n g l y i m p e r s o n a l and b u r e a u c r a t i z e d . H a v i n g f o r m e r l y p r o v i d e d a c u r a t i v e environment, i n s t i t u t i o n s now l o s t t h e i r e f f i c a c y . P u b l i c o p i n i o n t u r n e d a g a i n s t i n s t i t u t i o n s , l e a d i n g t o c u t s i n government f u n d i n g , c a u s i n g c o n d i t i o n s t o become p o o r e r and more crowded (Brown, 1989). 2.1.2 The 2 0 t h C e n t u r y I n t h e 2 0 t h c e n t u r y , a number o f developments l e d t o a r e a s s e s s m e n t o f i n s t i t u t i o n a l i z a t i o n . The o n s e t o f p s y c h o a n a l y t i c t h e o r y c a used a change i n how t h e n a t u r e and causes o f mental i l l n e s s were r e g a r d e d ; e n v i r o n m e n t a l and e m o t i o n a l f a c t o r s came t o be seen as i m p o r t a n t i n t h e t r e a t m e n t o f m e n t a l l y i l l p e o p l e . P s y c h o a c t i v e d r u g s , i n t r o d u c e d i n t h e 1950's, d e c r e a s e d some of t h e symptoms o f mental i l l n e s s . The human r i g h t s movement o f t h e I960's l e d t o an a p p r e c i a t i o n o f p a t i e n t s ' c i v i l r i g h t s . These developments l e d t o a movement towards d e i n s t i t u t i o n a l i z a t i o n o f p a t i e n t s . Governments, s u b j e c t t o f i n a n c i a l p r e s s u r e s , went a l o n g w i t h c a l l s f o r d e i n s t i t u t i o n a l i z a t i o n . But t h e r e was a f a i l u r e t o a p p r e c i a t e t h e r e s u l t r e l e a s i n g p e o p l e i n t o t h e community w i t h o u t new systems o f s u p p o r t would have. 2.1.3 The Canadian C o n t e x t Canadian mental h e a l t h p o l i c y has e x p e r i e n c e d s e v e r a l s h i f t s i n r e c e n t decades. From 1950 t o 1960, t h e i n s t i t u t i o n a l system was expanded and improved. There were l a r g e i n c r e a s e s i n t h e number of p r o f e s s i o n a l , a d m i n i s t r a t i v e , and n u r s i n g s t a f f d u r i n g t h i s t i m e ; 18,000 new beds were p r o v i d e d i n p s y c h i a t r i c and g e n e r a l h o s p i t a l s ( T r a i n o r e t a l . , 1992). The C anadian movement towards d e i n s t i t u t i o n a l i z a t i o n o f p a t i e n t s was s p u r r e d by t h e r e l e a s e , i n 1963, o f t h e Canadian M e n t a l H e a l t h A s s o c i a t i o n r e p o r t More f o r t h e Mind ( G r i f f i n e t a l . , 1963) . S u b s e q u e n t l y , from a t o t a l o f 69,359 beds a v a i l a b l e i n 1963, th e number o f beds were c u t t o 22,551 by 1977 ( S t a t i s t i c s Canada, 1977) . I n a d d i t i o n . More f o r the Mind c a l l e d f o r community p s y c h i a t r i c s e r v i c e s w h i c h would e n a b l e t h e m e n t a l l y i l l t o l i v e i n th e community. 2.1.4 Problems w i t h D e i n s t i t u t i o n a l i z a t i o n The move towards community s e r v i c e s was p o o r l y p l a n n e d . W h i l e p r o v i s i o n was made f o r m e d i c a l and t h e r a p e u t i c s e r v i c e s i n t h e community, no p r o v i s i o n was made f o r o t h e r n e c e s s i t i e s t h a t had been p r o v i d e d f o r i n i n s t i t u t i o n a l s e t t i n g s , such as h o u s i n g , v o c a t i o n a l programs, and income. By 1980, l a r g e numbers o f former p a t i e n t s were e x i s t i n g i n t h e community i n s u b s t a n d a r d h o u s i n g and w i t h i n a d e q u a t e s u p p o r t . Many ended up r e t u r n i n g t o h o s p i t a l . W h i l e t h e l e n g t h o f s t a y a t p s y c h i a t r i c h o s p i t a l s was s h o r t e r , t h e number o f r e a d m i s s i o n s o f c h r o n i c a l l y m e n t a l l y i l l i n d i v i d u a l s had i n c r e a s e d . C l e a r l y , d e i n s t i t u t i o n a l i z a t i o n was not w o r k i n g . Brown (1989) c o n v i n c i n g l y says t h a t d e i n s t i t u t i o n a l i z a t i o n ' s f a i l u r e was due t o t h e f a i l u r e o f p r o f e s s i o n a l s t o p r o v i d e a s y s t e m a t i c p l a n o f c o o r d i n a t e d community c a r e programs t h a t would a s s i s t p a t i e n t s t o make t h e t r a n s i t i o n t o l i v i n g i n t h e community. More s u p p o r t s f o r p a t i e n t s r e t u r n i n g t o t h e community were r e q u i r e d . I n r e s p o n s e t o t h i s s i t u a t i o n , more community m e n t a l h e a l t h c e n t r e s , and a g e n c i e s t o h e l p c o n s u m e r / s u r v i v o r s w i t h n e c e s s i t i e s s u c h as h o u s i n g and v o c a t i o n a l r e h a b i l i t a t i o n , have been c r e a t e d . 2.1.5 C h a l l e n g e s t o Community Care D e s p i t e t h e advances, e x i s t i n g forms of community c a r e a r e i n c r e a s i n g l y b e i n g c h a l l e n g e d . The c h a l l e n g e s i d e n t i f y a ' s e r v i c e paradigm' ( T r a i n o r e t a l . , 1992) . The u n d e r l y i n g a s s u m p t i o n of the s e r v i c e p aradigm i s t h a t c e r t a i n numbers o f p e o p l e i n s o c i e t y w i l l become i l l , and t h a t t h e s e r v i c e system i s t h e r e t o p r o v i d e t r e a t m e n t f o r t h o s e i n d i v i d u a l s ; p l a n n i n g i n t h i s a r e a i s t o be g e a r e d towards i m p r o v i n g th e l e v e l o f s e r v i c e a v a i l a b l e t o t h e a f f l i c t e d . Those who c h a l l e n g e t h e s e r v i c e paradigm suggest t h a t improvements i n t h e h e a l t h c a r e system have not p l a y e d a v e r y l a r g e r o l e i n t h e improvement of p u b l i c h e a l t h ; t h e y p o i n t i n s t e a d t o b a s i c p u b l i c h e a l t h measures and l i f e s t y l e changes. A W o r l d H e a l t h O r g a n i z a t i o n s t u d y o f s c h i z o p h r e n i a d r a m a t i c a l l y u n d e r s c o r e s the p o i n t o f t h o s e who c r i t i c i z e t h e s e r v i c e paradigm: T h i s s t u d y c l e a r l y demonstrated t h a t t h e s o p h i s t i c a t e d t r e a t m e n t approaches of w e s t e r n n a t i o n s a r e no match f o r t h e d r a m a t i c a l l y m a r g i n a l i z e d p o s i t i o n s t o w h i c h t h e s e n a t i o n s r e l e g a t e t h e p e r s o n w i t h s c h i z o p h r e n i a . A l l t h e t e c h n o l o g y and s o p h i s t i c a t i o n o f our t r e a t m e n t methods have been u n a b l e t o produce outcomes w h i c h a r e as good as t h o s e m a T h i r d W o r l d v i l l a g e . ( T r a i n o r e t a l . , 1992, p. 26 ) 2.1.6 The Development of P s y c h o s o c i a l S e l f - H e l p C l u b s I n r e s p o n s e t o d e i n s t i t u t i o n a l i z a t i o n and t h e l a c k o f s e r v i c e s a v a i l a b l e t o c o n s u m e r / s u r v i v o r s , many n o n - p r o f e s s i o n a l s and p a t i e n t s d e v e l o p e d p s y c h o s o c i a l s e l f - h e l p c l u b s . The f i r s t c l u b s . F o u n t a i n House and H o r i z o n House, p r o v i d e d mutual s u p p o r t networks f o r e x - p a t i e n t s , p r o v i d i n g members w i t h the o p p o r t u n i t y t o d e v e l o p s o c i a l s k i l l s , f r i e n d s h i p s , and a s s i s t a n c e i n t h e l o c a t i o n o f h o u s i n g and employment. The p h i l o s o p h y o f such c l u b s i s t h a t members can s u p p o r t themselves i n t h e community w i t h a l i m i t e d degree o f s u p p o r t , w i t h o u t e x t e n s i v e p r o f e s s i o n a l i z e d s e r v i c e s . 2.1.7 Can a d i a n M e n t a l H e a l t h P o l i c y - The Emergent P i c t u r e I n a s u r v e y o f r e c e n t p r o v i n c i a l p o l i c y documents, Macnaughton (1992) r e f l e c t s on some o f t h e needs becoming n o t i c e a b l e i n mental h e a l t h p o l i c y . Macnaughton summarizes t h e s e needs as f o l l o w s : 1. A need f o r e s t a b l i s h i n g c l e a r p r i o r i t i e s as t o whom the me n t a l h e a l t h system s h o u l d s u p p o r t ; 2. The need f o r r e a l l o c a t i o n o f r e s o u r c e s (both f i s c a l and human); 3. The need f o r c o o r d i n a t i o n o f t h e mental h e a l t h system; 4. R e g i o n a l i z a t i o n / D e c e n t r a l i z a t i o n o f a d m i n i s t r a t i o n and s e r v i c e d e l i v e r y ; 5. I n d i v i d u a l i z a t i o n o f p l a n n i n g and s e r v i c e d e l i v e r y ; 6. consumer and f a m i l y p a r t i c i p a t i o n i n t h e me n t a l h e a l t h system; 7. t h e need t o p r o v i d e o p p o r t u n i t i e s f o r s e l f - h e l p and mutual a i d (Macnaughton, 1992, p. 7-10) . The f i r s t p r i o r i t y d e s c r i b e d by Macnaughton, e s t a b l i s h i n g c l e a r p r i o r i t i e s , r e f e r s t o the need t o a l l o c a t e funds t o t h o s e groups who most need the money. The most n o t i c e a b l e a s p e c t of t h i s t r e n d i s t h a t o f i n c r e a s i n g t h e s u p p o r t f o r community s e r v i c e s , and t h e r e f o r e d e c r e a s i n g t h e i n f l u e n c e , and s u p p o r t f o r , i n s t i t u t i o n a l s e t t i n g s . The second t r e n d , t h e need f o r r e a l l o c a t i o n o f r e s o u r c e s , a l s o d e a l s p r i m a r i l y w i t h the r e l a t i o n s h i p between s u p p o r t f o r community s e r v i c e s and s u p p o r t f o r i n s t i t u t i o n a l s e t t i n g s . Once a g a i n , r e c e n t p r o v i n c i a l p o l i c y documents a r e c l e a r l y i n f a v o u r o f community s u p p o r t s e r v i c e s . The l a s t two p o l i c y t r e n d s l i s t e d by Macnaughton have d i r e c t r e l e v a n c e t o t h e development of c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s . Macnaughton d e s c r i b e s a t r e n d toward f a m i l y and consumer p a r t i c i p a t i o n i n t h e mental h e a l t h system. Through t h e i r e x p e r i e n c e s , consumers and t h e i r f a m i l i e s o f t e n become i n t e r e s t e d i n p o l i t i c a l i n v o l v e m e n t aimed a t c h a n g i n g t h e m ental h e a l t h system. New B r u n s w i c k , A l b e r t a , and Saskatchewan have a l l o w e d f o r consumer p a r t i c i p a t i o n on p l a n n i n g b o a r d s . Through w r i t t e n p o l i c y and p r a c t i s e , p r o v i n c i a l governments a r e now t r y i n g t o r e c o g n i z e t h e c o n c e r n s of consumers and t h e i r f a m i l i e s , w i t h c o n s u l t a t i o n p r o c e s s e s i n c l u d i n g consumer and f a m i l y r e p r e s e n t a t i v e s (Macnaughton, 19 92). Most r e c e n t mental h e a l t h p o l i c y documents r e f l e c t a need f o r s t r e n g t h e n i n g o p p o r t u n i t i e s f o r s e l f - h e l p and mutual a i d . ...emerging mental h e a l t h p o l i c y r e f l e c t s a t r e n d away from...the " s e r v i c e m e n t a l i t y " , i . e . t h e i m p l i c i t b e l i e f among many p r o f e s s i o n a l s and p o l i c y - m a k e r s t h a t consumers s h o u l d be s i m p l y p a s s i v e r e c i p i e n t s o f d r u g s , p s y c h o t h e r a p y , o r whatever programs a r e p r e s c r i b e d f o r them (Macnaughton, 1992, p . 9 ) . New B r u n s w i c k ' s M e n t a l H e a l t h Commission funds more t h a n 30 s e l f - h e l p groups o r a c t i v i t y c e n t r e s r u n on t h e s e l f - h e l p model. I n Quebec, f u n d i n g f o r s e l f - h e l p i n i t i a t i v e s i s p r o v i d e d t h r o u g h "Regroupement des R e s s o u r c e s A l t e r n a t i v e s en Santé M e n t a l e " . I n B r i t i s h Columbia, a number of s e l f - h e l p i n i t i a t i v e s e x i s t . The B.C. M i n i s t r y o f H e a l t h p r o v i d e s 'Consumer I n i t i a t i v e Funding' . These f u n d s , $5 M i l l i o n f o r t h e p a s t y e a r , goes t o t h e G r e a t e r Vancouver M e n t a l H e a l t h S o c i e t y (GVMHS). M e n t a l h e a l t h a d v i s o r y committees make d e c i s i o n s about how t h e money w i l l be s p e n t . A t p r e s e n t , t h e r e a r e f o u r p r o j e c t s : U n i t y Housing, The K e t t l e Advocacy, t h e Vancouver-Richmond M e n t a l H e a l t h Consumer C o n s t i t u e n c y p r o j e c t , and the Consumer/Survivor A r t i s t s ' C o o p e r a t i v e . 2.1.8 The S e c t o r - B a s e d Model D e i n s t i t u t i o n a l i z a t i o n , and t h e c r i s i s s i t u a t i o n i t brought on i n t h e e a r l y 1980's, l e d t o t h e f o r m a t i o n , by t h e Canadian M e n t a l H e a l t h A s s o c i a t i o n , o f t h e M e n t a l H e a l t h S e r v i c e s Committee, w h i c h i n t u r n l a u n c h e d a r e s e a r c h i n i t i a t i v e t o a s s e s s how p e o p l e c o u l d b e s t be s u p p o r t e d i n t h e community. T h i s was t o l e a d t o a p o l i c y p o s i t i o n f o r p e o p l e w i t h s e r i o u s mental i l l n e s s . A Framework f o r Support f o r P e o p l e w i t h Severe M e n t a l D i s a b i l i t i e s ( T r a i n o r & Church, 1984) was p u b l i s h e d , o u t l i n i n g a s e t o f p r i n c i p l e s t h a t have g u i d e d t h e CMHA's ongoing p r o j e c t " B u i l d i n g A Framework f o r S u p p o r t " . T h i s p r o j e c t ' s aim i s t o ensure t h a t p e o p l e w i t h mental i l l n e s s l i v e ' r i c h and f u l f i l l i n g l i v e s i n t h e community' ( T r a i n o r e t a l . , 1992). The two b a s i c r e q u i r e m e n t s i d e n t i f i e d t o make t h i s happen were : 1. t h a t i n d i v i d u a l s w i t h m ental h e a l t h problems be empowered t o c o n t r o l t h e i r own l i v e s and t o make c h o i c e s about w h i c h s u p p o r t s t o u t i l i z e ; and, 2. t h a t t h e community be m o b i l i z e d t o use a l l i t s c a p a c i t y t o s u p p o r t p e o p l e w i t h mental h e a l t h problems ( T r a i n o r e t a l . , 1992, p.26) . The movement from i n s t i t u t i o n a l i z e d c a r e t o an emphasis on community s e r v i c e s c o n s t i t u t e d a paradigm s h i f t ; l i v i n g i n the community, s u p p o r t e d by v a r i o u s programs, was seen t o be b e t t e r t h a n b e i n g s h e l t e r e d from the community i n an i n s t i t u t i o n . The p h i l o s o p h y l y i n g b e h i n d t h i s s h i f t was t h a t systems a r e p e r f e c t i b l e - t h a t what was needed was b e t t e r ways o f p r o v i d i n g s e r v i c e s t o p e o p l e . However, t h e r e i s a growing r e a l i z a t i o n t h a t even community s e r v i c e s e t t i n g s may not f u l l y d e v e l o p p e o p l e ' s p o t e n t i a l . W i t h t h e r e a l i z a t i o n t h a t community s e r v i c e s may s t i l l f o s t e r dependency and s e p a r a t e p e o p l e from the community, a second paradigm s h i f t i s becoming a p p a r e n t . There i s a dawning awareness t h a t n o n - s e r v i c e approaches, such as s e l f - h e l p and mutual a i d , may p r o v i d e o p p o r t u n i t i e s f o r p e r s o n a l growth t h a t s e r v i c e approaches do n o t . B o t h as c a t e g o r i e s o f human a c t i o n and i n t h e way i n which t h e y p r o v i d e a s s i s t a n c e , a c t i v i t i e s such as s e l f - h e l p a re not s e r v i c e s . They d i f f e r q u a l i t a t i v e l y i n t h e way t h e y see and c l a s s i f y an i n d i v i d u a l , and t h u s o f f e r o p p o r t u n i t i e s f o r f r i e n d s h i p and b e l o n g i n g w h i c h s e r v i c e s do n o t . They a l s o have s u b s t a n t i a l p o t e n t i a l t o a d d r e s s t h e i s o l a t i o n and a l i e n a t i o n f e l t by many p e o p l e w i t h m ental i l l n e s s ( T r a i n o r e t a l . , 1992, p. 2 6 ) . Through t h e CMHA's Framework f o r Support and o t h e r r e p o r t s , a r e a l i z a t i o n i s e v i d e n t t h a t p o l i c y needs t o r e f l e c t t h e f a c t t h a t consumers now p l a y a c e n t r a l r o l e i n t h e i r own s u p p o r t and community s u r v i v a l ( T r a i n o r e t a l . , 1992). As an a l t e r n a t i v e t o t h e s e r v i c e paradigm, T r a i n o r d e s c r i b e s a Community P r o c e s s Paradicrm, which i n s t e a d o f f o c u s i n g on t h e p r o v i s i o n o f s e r v i c e s , f o c u s e s on the community's o v e r a l l s u p p o r t . I n t h i s paradigm, th e r o l e o f ( i ) f a m i l i e s and i n f o r m a l n etworks, ( i i ) consumers t h e m s e l v e s , ( i i i ) g e n e r i c community a g e n c i e s and groups a r e i n c l u d e d a l o n g w i t h the r o l e o f ( i v ) t h e f o r m a l m ental h e a l t h system. The model - t h a t encompasses t h e s e f o u r components -i s r e f e r r e d t o as t h e Community Resource Base Model ( T r a i n o r e t a l . , 1992) . F i g u r e 1. The Community Resource Bank Consumer S e l f - H e l p G e n e r i c Community A g e n c i e s and Groups F a m i l i e s and I n f o r m a l Networks P e r s o n The Formal M e n t a l H e a l t h System The r o l e o f p r o f e s s i o n a l mental h e a l t h s e r v i c e s i s s t i l l seen as c r u c i a l , but becomes r e c o g n i z e d as o n l y one o f f o u r s e c t o r s t h a t a r e p u t i n t o p l a y i n t h e s u p p o r t o f t h e i n d i v i d u a l . The Framework model, i n p r a c t i s e , would d i r e c t t h r e e fundamental changes i n p o l i c y . 1. Consumers and f a m i l i e s would have a r o l e as f a r as d e v e l o p i n g s e l f - h e l p and mutual a i d i n i t i a t i v e s , and advocacy. Support f o r such i n i t i a t i v e s would be needed. 2. Consumers and f a m i l i e s would have a r o l e i n t h e development o f p o l i c y ; i n p l a n n i n g , d e v e l o p i n g , and m o n i t o r i n g s e r v i c e s ; g e n e r i c s o c i a l a g e n c i e s would a l s o have a r o l e , as a p p r o p r i a t e . 3. The r o l e o f government becomes one o f s u p p o r t i n g a l l the s e c t o r s ; i n s t e a d o f t h e i r f ormer r o l e o f a d m i n i s t e r i n g t h e s e r v i c e system ( T r a i n o r e t a l . , 1992, p. 2 7 ) . 2.1.9 Summary The l i m i t a t i o n s o f i n s t i t u t i o n a l i z e d c a r e l e d t o d e i n s t i t u t i o n a l i z a t i o n and the p r o v i s i o n o f community s e r v i c e s . More r e c e n t l y , t h e community c a r e system has been c r i t i c i z e d . The most r e c e n t t r e n d has been towards s e l f - h e l p and mutual a i d approaches. C o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s a r e p a r t o f t h i s t r e n d towards n o n - s e r v i c e approaches i n t h e mental h e a l t h f i e l d . Recent p o l i c y documents have encouraged t h e development o f such non-s e r v i c e approaches. The CMHA r e p o r t 'Framework f o r Support' encourages a Community Resource Bank, e m p h a s i z i n g t h a t consumers have a p l a c e i n d e v e l o p i n g s e l f - h e l p i n i t i a t i v e s , and t h a t mental h e a l t h p o l i c y s h o u l d r e f l e c t t h i s . 2.2 V o c a t i o n a l R e h a b i l i t a t i o n f o r t h e M e n t a l l y 111 C o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s a r e p r e s e n t e d by a u t h o r s such as T r a i n o r & Tremblay (1992) as an a l t e r n a t i v e t o e x i s t i n g v o c a t i o n a l r e h a b i l i t a t i o n programs. To d i s c u s s t h i s f i e l d , i t s d i m e n s i o n s , and what a p r o v i n c i a l s t r a t e g y t h a t s u p p o r t e d them would l o o k l i k e , i t i s n e c e s s a r y t o r e v i e w e x i s t i n g forms o f v o c a t i o n a l r e h a b i l i t a t i o n . V o c a t i o n a l r e h a b i l i t a t i o n f o r t h e p h y s i c a l l y d i s a b l e d became w i d e s p r e a d a f t e r t h e Second World War, i n r e s ponse t o t h e needs of d i s a b l e d v e t e r a n s . Programs d e s i g n e d t o meet the needs of t h e p h y s i c a l l y d i s a b l e d were used t o meet the needs o f o t h e r d i s a b l e d , i n c l u d i n g i n d i v i d u a l s w i t h a m ental i l l n e s s . W i t h d e i n s t i t u t i o n a l i z a t i o n , the demands p l a c e d on t h e s e s e r v i c e s i n c r e a s e d d r a m a t i c a l l y . The d i f f e r e n c e s between the European and A m e rican approaches t o v o c a t i o n a l r e h a b i l i t a t i o n need t o be c l a r i f i e d a t t h i s p o i n t . The European p e r s p e c t i v e on v o c a t i o n a l r e h a b i l i t a t i o n has tended t o be based on a p h i l o s o p h y t h a t employment i s a r i g h t f o r ' a l l c i t i z e n s ; t h i s has i n c l u d e d a commitment t o f u l l employment f o r t h e p s y c h i a t r i c a l l y d i s a b l e d , and has l e d t o an e x p e c t a t i o n t h a t government p r o v i d e work f o r t h i s p o p u l a t i o n . T h i s commitment has been a c c o m p l i s h e d i n two ways: ( i ) t h r o u g h a system o f quotas f o r d i s a b l e d w o r k e r s , a p p l y i n g t o b o t h th e p r i v a t e and p u b l i c s e c t o r s , l e g i s l a t e d i n most European c o u n t r i e s ; and ( i i ) t h r o u g h th e p r o v i s i o n o f s h e l t e r e d work, w h i c h i n Europe i s v i e w e d as s u b s t i t u t e permanent employment (Brown, 198 9) . I n t h e U n i t e d S t a t e s , where the p r o c e s s of d e i n s t i t u t i o n a l i z a t i o n has o c c u r r e d much more r a p i d l y , p h i l o s o p h i e s and approaches t o r e h a b i l i t a t i o n have been much more p e r s o n - and p r o b l e m - o r i e n t e d t h a n i n Europe. P r o f e s s i o n a l s such as p s y c h i a t r i s t s , p s y c h o l o g i s t s , and s o c i a l w o r k ers have a l a r g e r r o l e i n t h e A m e r i c a n approach t o r e h a b i l i t a t i o n ; r e h a b i l i t a t i o n and j o b placement t e n d t o be made on the b a s i s o f e v a l u a t i v e and d i a g n o s t i c a s s e s s m e n t s . R e h a b i l i t a t i o n c o n s i s t s o f a s e r i e s o f s t e p s , b e g i n n i n g i n the i n s t i t u t i o n , and g r a d u a l l y p r o g r e s s i n g t o d i f f e r e n t forms o f work. R e c e n t l y , t h e r e has been a r e a l i z a t i o n t h a t more f l e x i b i l i t y i s needed i n v o c a t i o n a l programming. T h i s i s based on t h e o b s e r v a t i o n t h a t not a l l p a t i e n t s f o l l o w the same p a t h ; some may r e l a p s e , and need t o f o l l o w a d i f f e r e n t r e h a b i l i t a t i o n s c h e d u l e . European approaches, such as s u p p o r t e d work, have been r e c e i v i n g i n c r e a s e d emphasis i n t h e U n i t e d S t a t e s i n r e c e n t y e a r s . V o c a t i o n a l programs may be d e s c r i b e d as f a l l i n g i n t o f o u r b r o a d c a t e g o r i e s : 1. Employment P r e p a r a t i o n Programs 2. S h e l t e r e d Work 3. T r a n s i t i o n a l Employment 4. S u p p o r t e d Employment 2.2.1 Employment P r e p a r a t i o n Programs Employment p r e p a r a t i o n programs v a r y from work adjustment programs, t o c a r e e r c o u n s e l l i n g , o c c u p a t i o n a l t r a i n i n g , and c a r e e r placement t r a i n i n g programs (Cochrane e t a l . , 1990). Work adjustment programs a r e o r i e n t e d towards a s s i s t i n g p a t i e n t s t o f i t i n t o a c o m p e t i t i v e work environment. T h i s i s done by a s s i s t i n g p a t i e n t s i n t h e development o f j o b - r e l a t e d s k i l l s . Such programs may d e a l w i t h such i s s u e s as p u n c t u a l i t y , m o t i v a t i o n t o work, communication s k i l l s , and a p p r o p r i a t e d r e s s and b e h a v i o u r . Most o f t e n , t h e s e programs a re o f f e r e d i n s h e l t e r e d s e t t i n g s . I n c r e a s i n g l y , t h e s e programs may be o f f e r e d i n community s e t t i n g s , where t h e r e i s a f o c u s on the a c q u i s i t i o n o f j o b - r e l a t e d s k i l l s t h r o u g h d a i l y l i v i n g . O c c u p a t i o n a l s k i l l s t r a i n i n g programs d e a l w i t h t h e a c q u i s i t i o n o f j o b - s p e c i f i c s k i l l s , and u s u a l l y o c c u r a f t e r c o m p l e t i o n o f work adjustment programs and c a r e e r c o u n s e l l i n g . C a r e e r placement t r a i n i n g programs aim a t a s s i s t i n g c l i e n t s i n the development o f e f f e c t i v e j o b s e a r c h and m a r k e t i n g t e c h n i q u e s . Elements o f c a r e e r c o u n s e l l i n g , pre-employment c o u n s e l l i n g , work a d j u s t m e n t t r a i n i n g , m a r k e t i n g and m o t i v a t i o n a l t r a i n i n g a r e employed i n such programs. F o r example, t h e Vancouver-Burnaby B r a n c h o f t h e Canadian M e n t a l H e a l t h A s s o c i a t i o n has two programs t h a t d e a l w i t h employment p r e p a r a t i o n . The CMHA's V o c a t i o n a l S e r v i c e s program o f f e r s v o c a t i o n a l and p r e - v o c a t i o n a l t r a i n i n g t o i n d i v i d u a l s who have o r have had a mental i l l n e s s . T h i s program o f f e r s l i f e s k i l l s , work s k i l l s ( i n c l u d i n g work adjustment as w e l l as s k i l l t r a i n i n g ) , and computer s k i l l s . CMHA a l s o has an Employment S e r v i c e s program w h i c h o f f e r s a range o f s e r v i c e s i n c l u d i n g v o c a t i o n a l t e s t i n g , c a r e e r c o u n s e l l i n g , j o b s e a r c h t e c h n i q u e s , j o b c o a c h i n g , placement, and f o l l o w - u p s u p p o r t . 2.2.2 S h e l t e r e d Work S h e l t e r e d work, u n t i l v e r y r e c e n t l y , has been t h e most common form o f v o c a t i o n a l r e h a b i l i t a t i o n . The r a t i o n a l e f o r s h e l t e r e d work has been t h e e m o t i o n a l and p h y s i c a l b e n e f i t p a t i e n t s d e r i v e from e n g a g i n g i n p r o d u c t i v e a c t i v i t i e s . These f a c i l i t i e s have o p e r a t e d t r a d i t i o n a l l y by s o l i c i t i n g work from i n d u s t r i e s , w h i c h i s t h e n c a r r i e d out by p a t i e n t s . The workshops u s u a l l y p r o v i d e a h e a v i l y s t r u c t u r e d environment, w i t h a r e g i m e n t e d r o u t i n e o f v o c a t i o n a l t r a i n i n g , c o u n s e l l i n g , and r e c r e a t i o n . Workshops such as t h e s e a r e i n t e n d e d t o p r o v i d e an environment where p a t i e n t s can d e v e l o p t h e i r v o c a t i o n a l and s o c i a l s k i l l s , and a s s i s t w i t h t h e t r a n s i t i o n from h o s p i t a l t o community. At t h e s e s e t t i n g s , the work done by p a t i e n t s t e n d s t o be m e n i a l i n n a t u r e . P a t i e n t s o f t e n r e c e i v e d n o t h i n g , o r o n l y a t o k e n sum f o r t h e i r work. At t h e same t i m e , h o s p i t a l s came t o depend on t h i s s o u r c e o f cheap l a b o u r . Work tended t o be based on t h e needs o f t h e i n s t i t u t i o n , r a t h e r t h a n the needs of t h e p a t i e n t (Cochrane e t a l . , 1990) . Most r e c e n t s t u d i e s suggest t h a t t h e h i g h l y s t r u c t u r e d n a t u r e o f t h e s e workshops does not p r o v i d e an environment where p a t i e n t s can d e v e l o p t h e i r s k i l l s , r a t h e r , p a t i e n t s t e n d t o become dependent on t h e s h e l t e r e d s e t t i n g ( T r a i n o r & Tremblay, 1992). Brown n o t e s t h a t a c q u i r e d s o c i a l and p s y c h o l o g i c a l f a c t o r s s u r r o u n d i n g t h e d i s a b i l i t y a r e a c t u a l l y more o f an o b s t a c l e t h a n t h e d i s a b i l i t y i t s e l f . Brown s t a t e s f u r t h e r : . . . s t a f f who have not r e f l e c t e d c r i t i c a l l y upon t h e a s s u m p t i o n s o f t h e i r t r a i n i n g and p r a c t i s e may be u n a b l e t o e n v i s i o n workshop a l t e r n a t i v e s t h a t would t r u l y d e v e l o p th e c l i e n t ' s p o t e n t i a l (Brown, 1989, p. 17) 2.2.3 T r a n s i t i o n a l Employment I n c r e a s i n g d i s i l l u s i o n m e n t w i t h t r a d i t i o n a l s h e l t e r e d workshops l e d t o a s e a r c h f o r a l t e r n a t i v e forms o f v o c a t i o n a l r e h a b i l i t a t i o n . One such a l t e r n a t i v e came t o be c a l l e d t r a n s i t i o n a l employment. These programs p r o v i d e s h o r t - t e r m ( t y p i c a l l y 3 months t o one y e a r ) work placements i n r e g u l a r , c o m p e t i t i v e s e t t i n g s . U s u a l l y t h e s e placements a r e h a l f - t i m e , so t h a t two c l i e n t s can s h a r e one j ob. T r a n s i t i o n a l employment programs t y p i c a l l y b e n e f i t i n d i v i d u a l s who have v o c a t i o n a l s k i l l s , and a r e as such e m p l o y a b l e , but who r e q u i r e a s i t u a t i o n where t h e i r s o c i a l f u n c t i o n i n g and l e v e l o f work a d j u s t m e n t can be improved. I n t h i s way, t r a n s i t i o n a l employment programs can be seen t o d i f f e r from s h e l t e r e d workshops i n t h a t t h e r e i s more emphasis on c l i e n t s ' a b i l i t i e s r a t h e r t h a n d i s a b i l i t i e s . The j o b p l a c e m e n t s t y p i c a l l y a r e e n t r y - l e v e l p o s i t i o n s . Some c l i e n t s upon c o m p l e t i o n o f t h e i r placement, a r e h i r e d on by t h e company. A l t h o u g h t h e placements a r e temporary, t h e p o s i t i o n s a r e n o t ; upon c o m p l e t i o n o f t h e placement, a new c l i e n t w i l l t a k e o v e r t h e p o s i t i o n . The major i n c e n t i v e f o r companies t o use t r a n s i t i o n a l employment programs i s t h a t s p o n s o r i n g a g e n c i e s t r a i n t h e c l i e n t f o r t h e j o b ; and ensure t h a t i f , f o r any r e a s o n , t h e c l i e n t m i s s e s a s h i f t , a backup w i l l be p r o v i d e d . C l i e n t s have a c c e s s t o t r e a t m e n t s t a f f a t a l l t i m e s . Work performance i s o f t e n a c t u a l l y h i g h e r f o r c l i e n t s from t r a n s i t i o n a l employment programs t h a n f o r r e g u l a r employees (Cochrane e t a l . , 1990). An example o f a t r a n s i t i o n a l employment program from t h e Vancouver a r e a i s t h e Coast T r a n s i t i o n a l Employment Program. The Coast F o u n d a t i o n was founded i n 1974 t o p r o v i d e q u a l i t y h o u s i n g . j o b r e a d i n e s s t r a i n i n g , s o c i a l and employment o p p o r t u n i t i e s f o r p e o p l e c h a l l e n g e d by p s y c h i a t r i c i l l n e s s . One o f t h e programs o f f e r e d by Coast i s a Work Re a d i n e s s program t h a t p r e p a r e s members f o r r e - e n t r y i n t o t h e j o b market. The major components o f t h e work r e a d i n e s s program a r e the Work U n i t s where j o b - o r i e n t e d t a s k s a r e p e r f o r m e d on a d a i l y b a s i s . Members d e v e l o p work adjustment s k i l l s , s e l f - e s t e e m , and c o n f i d e n c e (Coast F o u n d a t i o n , 1993). COAST 'S T r a n s i t i o n a l Employment Program (TEP) pjro v i d e s members who have d e v e l o p e d t h e i r j o b s k i l l s a means o f r e - e n t e r i n g t h e w o r k f o r c e . As w i t h o t h e r t r a n s i t i o n a l employment programs, TEP pl a c e m e n t s a r e p a r t - t i m e and temporary, and a r e p a i d a t c o m p e t i t i v e r a t e s . I n i t i a l l y , a COAST employment c o u n s e l l o r works w i t h t h e c l i e n t t o l e a r n the j o b , and ensure t h a t i t i s b e i n g done t o t h e employer's s t a n d a r d s . COAST ensu r e s t h a t s h o u l d a c l i e n t need t o miss a s h i f t , a backup w i l l be p r o v i d e d ; o n - g o i n g m o n i t o r i n g and s u p p o r t a r e a l s o p r o v i d e d . T y p i c a l l y , a c l i e n t w i l l work on t h e j o b f o r 6 months and t h e n move on t o a n o t h e r p o s i t i o n , a l l o w i n g t h e c l i e n t t o g a i n e x p e r i e n c e i n d i f f e r e n t work e n v i r o n m e n t s . Employers who use the TEP program come from a v a r i e t y o f i n d u s t r i e s , r a n g i n g from s m a l l f a m i l y - b a s e d b u s i n e s s e s t o major c o r p o r a t i o n s ; employers i n c l u d e S t . John t h e D i v i n e Day Care C e n t r e , U n i t e d S e r v i c e s C r e d i t Union, Canadian T i r e and G o o d r i c h R e a l t y (Coast F o u n d a t i o n , n.d.). 2.2.4 S u p p o r t e d Employment A n o t h e r a l t e r n a t i v e t o t h e s h e l t e r e d workshop t h a t has become common i s s u p p o r t e d employment. Whereas i n t h e t r a n s i t i o n a l employment model, t r a i n i n g o c c u r s b e f o r e j o b placement, i n s u p p o r t e d employment, placement o c c u r s f i r s t . The c l i e n t i s p r o v i d e d w i t h t r a i n i n g w h i l e on the j o b , e n s u r i n g t h a t t r a i n i n g i s a p p r o p r i a t e and j o b s p e c i f i c . And where t r a n s i t i o n a l employment p r o v i d e s temporary placements f o r c l i e n t s , w i t h s u p p o r t e d employment c l i e n t s a r e p l a c e d i n j o b s t h a t a r e permanent; l i k e w i s e , s u p p o r t i s o n g o i n g . C l i e n t s a r e i n v o l v e d i n i d e n t i f y i n g what t y p e o f work would s u i t t h e i r i n t e r e s t s , a b i l i t i e s , and a s p i r a t i o n s ; work placements a r e u s u a l l y i n e n t r y - l e v e l p o s i t i o n s , though sometimes n o n - e n t r y l e v e l p o s i t i o n s w i t h c a r e e r p o s s i b i l i t i e s may be o f f e r e d . S u p p o r t e d employment i s thought by some r e s e a r c h e r s t o be a p p r o p r i a t e f o r t h o s e who need s u p p o r t i n o r d e r t o f u n c t i o n i n t h e c o m p e t i t i v e m a r k e t p l a c e , but who f u n c t i o n t o o w e l l t o be l i m i t e d t o t r a n s i t i o n a l employment (Cochrane e t a l . , 1990). Other r e s e a r c h e r s have n o t e d t h a t some i n d i v i d u a l s l a b e l l e d 'permanently unemployable' i n o t h e r programs, a r e a b l e t o cope w e l l i n a c o m p e t i t i v e b u s i n e s s environment, p r o v i d e d t h e y have p r o p e r s u p p o r t (Brown, 1989). The r a t i o n a l e f o r s u p p o r t e d employment i s t h a t t r a i n i n g i n a c o m p e t i t i v e work s e t t i n g i s thought t o be more e f f i c i e n t and has a b e t t e r chance o f l e a d i n g t o s u c c e s s t h a n t r a i n i n g i n a s h e l t e r e d s e t t i n g , o r p r e - v o c a t i o n a l t r a i n i n g ; f u r t h e r , s u p p o r t e d employment i s seen t o maximize t h e f i t between t h e c l i e n t , t h e employer, and t h e j o b . S u p p o r t e d employment i s seen t o p r o v i d e f o r g r e a t e r c l i e n t independence, and l e s s e n t h e ' i n s t i t u t i o n a l dependency' t h a t some r e s e a r c h e r s f e e l such programs as s h e l t e r e d workshops and t r a n s i t i o n a l employment c r e a t e . A s t u d y from M a r y l a n d , c i t e d i n Bond (1987) , found t h a t o n l y 5% o f c l i e n t s i n t r a n s i t i o n a l employment went on t o c o m p e t i t i v e employment; the s t u d y s u g g e s t e d t h a t s t a f f i n t r a n s i t i o n a l programs may be r e l u c t a n t t o l o s e t h e i r b e t t e r w o r k e r s t o t h e c o m p e t i t i v e w o r k f o r c e . D e s p i t e the s u c c e s s e s and p o s i t i v e a s p e c t s o f s u p p o r t e d employment, not a l l d i s a b l e d workers f i n d i t t h e b e s t a l t e r n a t i v e . C h r o n i c p s y c h i a t r i c a l l y d i s a b l e d workers may s t i l l f i n d i t d i f f i c u l t t o m a i n t a i n c o m p e t i t i v e employment i n t h e p u b l i c o r p r i v a t e s e c t o r s (Brown, 1989), due t o such i s s u e s as a b s e n t e e i s m , n e g a t i v e s t e r e o t y p e s , and poor work r e c o r d s . These i s s u e s have been u s e d as a r a t i o n a l e f o r the development of a v a r i a t i o n o f s u p p o r t e d employment, t h e worker c o - o p e r a t i v e model. 2.2.5 Summary V o c a t i o n a l r e h a b i l i t a t i o n i n N o r t h A m e r i c a g e n e r a l l y t a k e s the form o f (a) employment p r e p a r a t i o n programs, (b) s h e l t e r e d work, (c) t r a n s i t i o n a l employment, and (d) s u p p o r t e d employment. T h i s range o f o p t i o n s doesn't p r o v i d e f o r a l l m e n t a l l y i l l i n d i v i d u a l s ; new a l t e r n a t i v e s a r e needed. The worker c o - o p e r a t i v e model d i f f e r s from o t h e r forms of s u p p o r t e d employment i n t h a t i t e n a b l e s p a t i e n t s t o d e v e l o p , own, and o p e r a t e t h e b u s i n e s s i n w h i c h t h e y a r e employed. T h i s model w i l l be d e s c r i b e d f u r t h e r i n C h a p t e r 3, "Consumer/Survivor-Run B u s i n e s s e s " . 2.3 Community Economic Development C o n s u m e r / S u r v i v o r - r u n b u s i n e s s e s o f f e r p r o m i s e as an a l t e r n a t i v e model o f v o c a t i o n a l r e h a b i l i t a t i o n . I t i s i m p o r t a n t a t t h i s s t a g e t o put t h i s model i n c o n t e x t , as a s p e c i f i c t o o l o f community economic development. A d i s c u s s i o n o f community economic development w i l l p r o v i d e i n s i g h t i n t o what CED i s , t h e v a r i o u s ways i n w h i c h i t may be o p e r a t i o n a l i z e d , and what i s s u e s r e g a r d i n g CED a r e r e l e v a n t . Community economic development has been d e f i n e d i n a number o f d i f f e r e n t ways. One p a r t i c u l a r l y c l e a r d e f i n i t i o n i s : ... a p r o c e s s whereby p e o p l e i n a community o r g a n i z e t h e m s e l v e s and p o o l t h e i r r e s o u r c e s w i t h t h e a v a i l a b l e r e s o u r c e s from government, c h u r c h e s , and o t h e r groups t o s o l v e l o c a l economic problems ( C a t h o l i c New Times, Dec. 20, 1992, p. 13) . Community economic development i s i d e a l f o r m a r g i n a l i z e d communities, i n t h a t i t has t h e c a p a c i t y t o make use o f u n r e c o g n i z e d s t r e n g t h s of m a r g i n a l communities - p a r t i c u l a r l y a v a i l a b l e l a b o u r and o t h e r unused r e s o u r c e s . CED s t r a t e g i e s p l a c e p a r t i c u l a r emphasis on d e c e n t r a l i z e d , l a b o u r - i n t e n s i v e p r o j e c t s , w h i c h f i n d u ses f o r a v a i l a b l e r e s o u r c e s . P e o p l e who have been h o s p i t a l i z e d w i t h a mental i l l n e s s have a v e r y h i g h r a t e o f unemployment. The a v a i l a b l e r e s o u r c e s t h i s group has t o o f f e r a r e t h e i r a v a i l a b l e l a b o u r and unused t a l e n t s . Community economic development p r o j e c t s c o u l d p r o v i d e an o p p o r t u n i t y f o r t h e s e p e o p l e t o employ t h e i r t a l e n t s and a v a i l a b l e t i m e . 2.3.1 The c o n c e p t o f 'community' i n community economic development D i f f e r e n t a u t h o r s have d i f f e r e n t c o n c e p t i o n s o f 'community' as i t p e r t a i n s t o community economic development. Fontan (1993) makes a t y p o l o g y o f t h e s e d i f f e r e n t c o n c e p t i o n s . 1. A Geographic Base, where community economic development i s a t t e m p t e d i n a s p e c i f i c g e o g r a p h i c a l a r e a , p a r t i c u l a r l y a m a r g i n a l i z e d urban o r r u r a l a r e a ; 2. A S o c i a l Base, where community economic development i s ge a r e d toward a s p e c i f i c s o c i a l group, p a r t i c u l a r l y m a r g i n a l i z e d groups i n s o c i e t y (the unemployed, women, the young, t h e d i s a b l e d , . . . ) ; 3. A Community Base, where community economic development i s d e v e l o p e d i n a l o c a t i o n , where r e s i d e n t s s h a r e a s t r o n g s h a r e d i n t e r e s t ; o r a common h i s t o r y and sense o f b e l o n g i n g . I n t h e case o f c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s (CSRB's), community economic development i s attem p t e d w i t h a s o c i a l base, w i t h a group o f p e o p l e i n s o c i e t y who have been m a r g i n a l i z e d . P e r r y (1987) and MacLeod (1986) a s s e r t t h a t community economic development must be based i n a s p e c i f i c g e o g r a p h i c l o c a l i t y , i n o r d e r t h a t t h e r e be d e v e l o p e d a l o c a l l e v e l r e p r e s e n t a t i v e o f the p o p u l a t i o n as a whole, t o w h i c h power can be t r a n s f e r r e d back. Power o v e r the l i v e s o f c o n s u m e r / s u r v i v o r s has t r a d i t i o n a l l y r e s i d e d w i t h r e p r e s e n t a t i v e s of t h e t r a d i t i o n a l m e n t a l h e a l t h system -- i n s t i t u t i o n s , community s e r v i c e a g e n c i e s , and p r o f e s s i o n a l s . S e l f - h e l p and mutual a i d i n i t i a t i v e s , o f wh i c h c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s a r e an example, may a s s i s t c o n s u m e r / s u r v i v o r s t o t a k e back c o n t r o l o v e r t h e i r l i v e s . Ward & Tremblay (1988) s t a t e t h a t A-Way E x p r e s s C o u r i e r s , a CSRB i n T o r o n t o , p r o v i d e s a u s e f u l model f o r community economic development w i t h 'non-geographic' communities. 2.3.2 Dimensions o f Community Economic Development The a s p e c t s o f community l i f e t oward w h i c h community economic development may be d i r e c t e d can be d i v i d e d i n t o f o u r a r e a s . I n the n e x t two s e c t i o n s , i t i s not my i n t e n t i o n t o g i v e a d e t a i l e d a c c o u n t o f CED's d i m e n s i o n s , and t h e t o o l s t h a t a r e used t o o p e r a t i o n a l i z e CED; r a t h e r , t h i s a s k e t c h o f t h e t e r r a i n , such t h a t we can see where CSRB's f i t i n t o t h e l a r g e r p i c t u r e . 1. Land Use P l a n n i n g : Community i n i t i a t i v e s o r i e n t e d towards g a i n i n g c o n t r o l o v e r l a n d use, o r t o improve t h e p h y s i c a l o r s o c i o e c o n o m i c i n f r a s t r u c t u r e t h r o u g h : ( i ) h o u s i n g ( i i ) z o n i n g , i n which a community a t t e m p t s t o a f f e c t l a n d use i n a g i v e n a r e a ( i i i ) c o l l e c t i v e l a n d ownership, a f f e c t i n g e n v i r o n m e n t a l , r e s i d e n t i a l , c o m m e r c i a l , o r i n d u s t r i a l p u r p o s e s . 2. Employment : I n i t i a t i v e s d i r e c t e d toward the development o f t h e community's human r e s o u r c e s , t h r o u g h : ( i ) t h e development o f e m p l o y a b i l i t y ; p r o m o t i n g the development o f j o b s k i l l s t h r o u g h p r e - e m p l o y a b i l i t y o r v o c a t i o n a l t r a i n i n g . ( i i ) j o b t r a i n i n g ; p r o v i d i n g a g i v e n c l i e n t e l e t r a i n i n g w i t h a community e n t e r p r i s e . 3. P r i v a t e o r C o l l e c t i v e E n t r e p r e n e u r s h i p : I n i t i a t i v e s g e a r e d toward a s s i s t i n g b u s i n e s s development i n t h e community t h r o u g h : ( i ) p r i v a t e o r c o l l e c t i v e b u s i n e s s development a s s i s t a n c e ; t h r o u g h s u c h measures as t e c h n i c a l r e s o u r c e groups, t r a i n i n g i n d i v i d u a l s o r groups t o s e t up b u s i n e s s e s ; ( i i ) t h e development of community e n t e r p r i s e s ; ( i i i ) b u s i n e s s i n c u b a t o r s ; t o o l s used i n c o n j u n c t i o n w i t h new b u s i n e s s development; ( i v ) e a r l y w a r n i n g systems; i d e n t i f y i n g p l a n t s i n danger of c l o s i n g , and i n t e r v e n i n g t o keep them i n o p e r a t i o n ; 4. P r i v a t e o r C o l l e c t i v e Investment: I n i t i a t i v e s t o m o b i l i z e f i n a n c i a l r e s o u r c e s f o r community development. ( i ) p r i v a t e banks, w h i c h have a s o c i a l o r i e n t a t i o n , o r co-o p e r a t i v e banks; ( i i ) community l o a n f unds, a s s i s t i n g t h e community i n managing o f l o a n s o f v e n t u r e c a p i t a l f o r s o c i a l i n i t i a t i v e s . F o n t a n d e s c r i b e s t h e t o o l s o f i n t e r v e n t i o n d e v e l o p e d by s o c i a l a c t i v i s t s t o o p e r a t i o n a l i z e CED (Fontan, 1993). These he d i v i d e s i n t o two c a t e g o r i e s . As e x p l a i n e d below, t h e f i r s t c a t e g o r y i s t h o s e i n t e r v e n t i o n t o o l s w hich t a k e a p l u r a l , o r g l o b a l approach towards community economic development. The o t h e r c a t e g o r y i s f o r t h o s e t o o l s w h i c h t a k e a s i n g u l a r , o r s p e c i a l i z e d , approach. G l o b a l I n t e r v e n t i o n T o o l s The p r i m a r y example of a g l o b a l i n t e r v e n t i o n t o o l i s the community development c o r p o r a t i o n (CDC). A CDC i s a n o n - p r o f i t o r g a n i z a t i o n , w i t h a b o a r d of d i r e c t o r s i n c l u d i n g r e p r e s e n t a t i v e s o f t h e b u s i n e s s and s o c i a l s e r v i c e s e c t o r s , and d i r e c t r e p r e s e n t a t i o n from r e s i d e n t s o f the community. Community Development C o r p o r a t i o n s s h a r e some a s p e c t s w i t h co-o p e r a t i v e s . B o t h a r e s t r u c t u r e s s e t up w i t h t h e i n t e n t i o n o f c o m b i n i n g s o c i a l purpose w i t h economic a c t i v i t y . Yet CDC s u s u a l l y c a r r y out d i v e r s e f u n c t i o n s not f i t t i n g under t h e p r e s e n t laws g o v e r n i n g c o - o p e r a t i v e s . C o r p o r a t i o n s a r e s e t up t o accumulate l a r g e r amounts o f c a p i t a l t h a n a s m a l l b u s i n e s s c o u l d . L i m i t e d l i a b i l i t y encourages r i s k - t a k i n g : w h i l e a c o r p o r a t i o n may go b a n k r u p t , employees a r e s h i e l d e d from l i a b i l i t y . An employee o f a c o r p o r a t i o n c o u l d c o n c e i v a b l y s t i l l end up f i n a n c i a l l y w e l l - o f f , d e s p i t e a c o r p o r a t i o n ' s demise. Such methods as d i v i s i o n o f l a b o u r , c o o r d i n a t i o n , s y s t e m a t i c methods o f u t i l i z i n g c a p i t a l , s u b s i d i a r i e s , and checks and c o n t r o l s a r e used by c o r p o r a t i o n s , d i s t i n g u i s h i n g them from t h e way i n w h i c h a s m a l l b u s i n e s s would o p e r a t e . W h i l e most c o r p o r a t i o n s use t h e s e a s p e c t s t o make money f o r s h a r e h o l d e r s , CDC s attempt t o use t h e s e methods f o r t h e b r o a d e r good o f t h e community (MacLeod, 1986) . As a c o r p o r a t i o n , t h e CDC i s u l t i m a t e l y under t h e c o n t r o l o f s h a r e h o l d e r s t h r o u g h t h e b o a r d o f d i r e c t o r s , n o t t h e s t a f f . The o t h e r g l o b a l i n t e r v e n t i o n t o o l d e s c r i b e d by Fontan i s t h e t e c h n i c a l r e s o u r c e group f o r CED. The t e c h n i c a l r e s o u r c e group, as d e s c r i b e d by Fontan, i s d e s i g n e d t o s u p p o r t t h e c r e a t i o n o f i n s t i t u t i o n s t h a t advocate a g l o b a l approach. Towards t h i s end, t h e t e c h n i c a l r e s o u r c e group may engage i n such a c t i v i t i e s as r e s e a r c h and development, t h e t r a i n i n g o f i n t e r v e n e r s and v o l u n t e e r s , c o n s u l t i n g f o r i n t e r v e n t i o n groups o r p u b l i c a d m i n i s t r a t i o n s , p u b l i s h i n g and documentation, and e n c o u r a g i n g n e t w o r k i n g and c o n s u l t a t i o n between CED p r a c t i t i o n e r s . The t e c h n i c a l r e s o u r c e group may a l s o be i n v o l v e d i n a s s i s t i n g s p e c i f i c p r o j e c t s (as opposed t o i n s t i t u t i o n s ) . A c t i v i t i e s such as p r o j e c t development, management and a d m i n i s t r a t i v e s u p p o r t , f i n a n c i a l s t r u c t u r i n g , and t h e development o f sound a c c o u n t i n g p r a c t i c e s may be u n d e r t a k e n by the t e c h n i c a l r e s o u r c e group t o a s s i s t s p e c i f i c p r o j e c t s (Fontan, 1993). S p e c i a l i z e d I n t e r v e n t i o n T o o l s Fontan's l i s t o f s p e c i a l i z e d i n t e r v e n t i o n t o o l s w i l l be l i s t e d , though o n l y t h o s e t o o l s o f s p e c i f i c r e l e v a n c e t o CSRB's w i l l be d e s c r i b e d h e r e . 1. community l a n d t r u s t s 2. community l o a n f u n d a s s o c i a t i o n s 3. m i c r o - e n t e r p r i s e p r o j e c t s ( i n c l u d i n g p e e r - a s s i s t e d l e n d i n g schemes) 4. community l a n d use c o r p o r a t i o n s 5. neighbourhood boards 6. human r e s o u r c e development i n i t i a t i v e s 7. s c h o o l - b u s i n e s s compacts 8. community b u s i n e s s i n c u b a t o r s 9. e a r l y w a r n i n g systems ( w i t h r e f e r e n c e t o p l a n t c l o s u r e s ) * 10. a l t e r n a t i v e b u s i n e s s e s : An a l t e r n a t i v e b u s i n e s s i s d e f i n e d by Fontan as a b u s i n e s s w h i c h i n c o r p o r a t e s i n t o i t s s t r u c t u r e some form o f d e m o c r a t i c c o n t r o l by i t s w o r k e r s . T h i s may t a k e t h e form o f c o - o p e r a t i v e management; a worker c o o p e r a t i v e i s a l e g a l b u s i n e s s s t r u c t u r e , p r o v i d i n g each worker-member w i t h one s h a r e . one v o t e , and an e q u a l v o i c e i n company m a t t e r s . Or an a l t e r n a t i v e b u s i n e s s may have community management, such as w i t h a CDC; i n a CDC, t h e b o a r d o f d i r e c t o r s i s u l t i m a t e l y r e s p o n s i b l e f o r t h e c o r p o r a t i o n , but employees may be p r o v i d e d w i t h d i r e c t r e p r e s e n t a t i o n on t h e board. * 11. t r a i n i n g b u s i n e s s e s : A t r a i n i n g b u s i n e s s i s a n o n - p r o f i t o r g a n i z a t i o n t h a t combines a s p e c t s o f v o c a t i o n a l t r a i n i n g w i t h t h e o p e r a t i o n o f a b u s i n e s s t h a t p r oduces goods and s e r v i c e s t o the community. Such p r o j e c t s u s u a l l y t a r g e t i n d i v i d u a l s i n u n s t a b l e s i t u a t i o n s -- t h o s e l a c k i n g income, e x - o f f e n d e r s , s t r e e t y o u t h , o r o t h e r p e o p l e who a r e , o r a r e becoming, m a r g i n a l i z e d . A Vancouver example o f such a p r o j e c t i s t h e P i c a s s o Cafe, a b u s i n e s s w h i c h p r o v i d e s o n - t h e - j o b t r a i n i n g f o r y o u t h w i t h u n s t a b l e b ackgrounds. F o n t a n summarizes : J u s t as t h e p r i v a t e v e n t u r e can a c h i e v e economic o b j e c t i v e s r e l a t e d t o p r o f i t a b i l i t y , so t h e community economic development e n t e r p r i s e can, as t h e e v a l u a t i v e l i t e r a t u r e c l e a r l y shows, s a t i s f a c t o r i l y a c h i e v e s o c i a l and economic o b j e c t i v e s when t h e c o n d i t i o n s a r e r i g h t . I t t h e r e f o r e seems t o be a v i a b l e f o r m u l a , but i n a p p l y i n g i t , g r e a t c a r e must be t a k e n not t o reproduce a model o r impose from on h i g h a v i s i o n o f t h e i n t e r v e n t i o n s t o be c a r r i e d out (Fontan, 1993, p. 3 7 ) . 2.4 M e n t a l H e a l t h , P e r s p e c t i v e s on t h e D i s a b l e d , and P l a n n i n g I n t h i s s e c t i o n , the r e l a t i o n s h i p between m e n t a l h e a l t h s t r a t e g i e s and p e r s p e c t i v e s on the d i s a b l e d w i l l be d i s c u s s e d . As w e l l , developments i n mental h e a l t h and p e r s p e c t i v e s on the d i s a b l e d w i l l be r e l a t e d t o developments i n p l a n n i n g t h e o r y . T h i s d i s c u s s i o n w i l l p r e s e n t how the t h i n k i n g on me n t a l h e a l t h s t r a t e g i e s has changed o v e r t i m e , and the changes i n o t h e r f i e l d s t h a t have p a r a l l e l e d such changes. T h i s d i s c u s s i o n w i l l l e a d t o t h e conc e p t o f a 'community v i s i o n ' i n mental h e a l t h . As d i s c u s s e d i n the c h a p t e r on mental h e a l t h p o l i c y , f o r many y e a r s t h e a c c e p t e d way o f d e a l i n g w i t h m e n t a l l y i l l p e o p l e was t o p l a c e them i n i n s t i t u t i o n s . W h i l e i n i t i a l l y a measure t o p r o v i d e humane t r e a t m e n t , l a c k o f f u n d i n g caused i n s t i t u t i o n s t o become l i t t l e more t h a n warehouses f o r t h e m e n t a l l y i l l , p r o v i d i n g s o c i a l c o n t r o l o v e r a p o p u l a t i o n seen as d e v i a n t . The i n s t i t u t i o n a l system has a l s o t a k e n away power from t h o s e who e n t e r i t . They a r e committed t o h o s p i t a l , made t o undergo t r e a t m e n t , t h e n streamed i n t o v o c a t i o n a l r e h a b i l i t a t i o n programs; thus t h e y become consumers o f s o c i a l s e r v i c e s , and dependent on p r o f e s s i o n a l s . These p r o f e s s i o n a l s , whether t h e y be s o c i a l w o r k e r s , p s y c h o l o g i s t s , o r p s y c h i a t r i s t s , s e t t h e agenda f o r r e h a b i l i t a t i o n o f t h e p a t i e n t . John McKnight d e s c r i b e s t h r e e p e r s p e c t i v e s g o v e r n i n g a t t i t u d e s towards t h e d i s a b l e d : ( i ) t h e t h e r a p e u t i c v i s i o n , ( i i ) t h e advocacy v i s i o n , and ( i i i ) t h e community v i s i o n . The t h e r a p e u t i c v i s i o n d e f i n e s p e o p l e i n terms o f needs ( as p r e s c r i b e d by p r o f e s s i o n a l s ), wh i c h i t i s t h e r e s p o n s i b i l i t y o f e x p e r t systems t o meet (CBC Radioworks, 1994) . The t h e r a p e u t i c v i s i o n has s u p p o r t e d t h e i n s t i t u t i o n a l approach t o me n t a l h e a l t h . W i t h i n t h e f i e l d o f p l a n n i n g , t h e dominant p l a n n i n g approach has been t h e s y n o p t i c , o r r a t i o n a l comprehensive, model. W i t h t h i s a pproach, t h e p l a n n e r i s r e s p o n s i b l e f o r ( i ) s e t t i n g g o a l s , ( i i ) i d e n t i f y i n g a l t e r n a t i v e s , ( i i i ) e v a l u a t i n g means a g a i n s t ends, and (i v ) i m p l e m e n t i n g d e c i s i o n s . S y n o p t i c p l a n n i n g has been c r i t i c i z e d f o r i t s b i a s towards c e n t r a l c o n t r o l ; i n t h e d e f i n i t i o n o f problems and s o l u t i o n s , i n t h e e v a l u a t i o n o f a l t e r n a t i v e s , and i n t h e i m p l e m e n t a t i o n o f d e c i s i o n s . I n terms o f i t s methods and b i a s towards c e n t r a l i z a t i o n , t h i s model o f p l a n n i n g has much i n common w i t h t h e model o f i n s t i t u t i o n a l c a r e i n mental h e a l t h . Concerns about the q u a l i t y o f c a r e i n i n s t i t u t i o n s , an i n c r e a s i n g awareness o f p a t i e n t s ' c i v i l r i g h t s , and t h e eagerness o f governments t o save money spent on i n s t i t u t i o n s l e d t o t h e movement towards d e i n s t i t u t i o n a l i z a t i o n o f mental p a t i e n t s . A f t e r a p e r i o d i n w h i c h s e r v i c e s t o t h o s e r e l e a s e d were g r o s s l y i n a d e q u a t e , community s e r v i c e s were s e t up t o p r o v i d e t o t h i s p o p u l a t i o n t h e t h i n g s t h a t t h e i n s t i t u t i o n once d i d , such as s h e l t e r , and m e d i c a l and v o c a t i o n a l s e r v i c e s . The movement towards community c a r e i n me n t a l h e a l t h was based on a r e a l i z a t i o n o f p a t i e n t s ' c i v i l r i g h t s . McKnight, o u t l i n i n g d i f f e r e n t p e r s p e c t i v e s on the d i s a b l e d , d e s c r i b e s t h e advocacy v i s i o n , w h i c h v i e w s t h e d i s a b l e d as t h e b e a r e r s o f r i g h t s w h i c h need t o be defended. The advocacy v i s i o n w i t h r e s p e c t t o t h e d i s a b l e d has p a r a l l e l s w i t h t h e development o f advocacy p l a n n i n g i n t h e r e a l m o f p l a n n i n g t h e o r y . Rooted i n a d v e r s a r i a l p r o c e d u r e s m o d e l l e d upon t h e l e g a l p r o f e s s i o n , t h e advocacy p l a n n i n g movement d e v e l o p e d i n t h e I960's. Advocacy p l a n n i n g has g e n e r a l l y been a p p l i e d t o d e f e n d i n g t h e i n t e r e s t s o f community groups, e n v i r o n m e n t a l c a u s e s , t h e poor, and t h e d i s e n f r a n c h i s e d a g a i n s t the e s t a b l i s h e d powers o f b u s i n e s s and government (Hudson, 1979). The advocacy v i s i o n has been r e s p o n s i b l e f o r g r e a t improvements i n t h e l i v e s o f p e o p l e w i t h d i s a b i l i t i e s . The advocacy of f r i e n d s , p a r e n t s , and concerned p r o f e s s i o n a l s was r e s p o n s i b l e f o r r e l e a s i n g p e o p l e from i n s t i t u t i o n s , and g e t t i n g them i n t o more m o d e s t l y s c a l e d community s e r v i c e s . But r e c e n t l y , t h i s v i s i o n has been c r i t i c i z e d , p a r t i c u l a r l y on two p o i n t s . F i r s t , what John McKnight has r e f e r r e d t o as a ' d e f e n s i v e w a l l o f h e l p e r s ' , who i n p r o t e c t i n g t h e d i s a b l e d i n d i v i d u a l , d i s c o n n e c t her from the l a r g e r community. C l i e n t s u l t i m a t e l y come t o c o n c e i v e of the community as a h o s t i l e , r a t h e r t h a n h o s p i t a b l e p l a c e . Second, i n t r y i n g t o p r o v i d e c a r e i n the community f o r t h e d i s a b l e d , a new i n s t i t u t i o n a l s e t t i n g has been c r e a t e d , complete w i t h a w a l l o f r e g u l a t i o n s and l e g a l s a f e g u a r d s making community s e r v i c e systems n e a r l y as i n f l e x i b l e as t h e i n s t i t u t i o n s t h a t t h e y r e p l a c e d (CBC Radioworks, 1994) . The Community V i s i o n McKnight d e s c r i b e s s o c i e t y as c o n s i s t i n g o f two domains: the i n s t i t u t i o n a l domain, governed by l e g a l , c o n t r a c t u a l , and a d m i n i s t r a t i v e norms and t h e community domain, where p e o p l e come t o g e t h e r f o r t h e i r own p u r p o s e s . McKnight has w r i t t e n e x t e n s i v e l y on what he v i e w s as the n e g a t i v e impact p r o f e s s i o n a l i s m has had on s o c i e t y , c l a i m i n g t h a t t h r o u g h i t s advance, communities have l o s t t h e i r c a p a c i t i e s t o c a r e , c o u n s e l , and c o n s o l e (CBC R a d i o w o r k s , 1994). M c K n i g h t ' s i d e a s p a r a l l e l t h o s e of o t h e r s who c r i t i c i z e the ' s e r v i c e paradigm' on which s o c i a l s e r v i c e s a r e based. These c r i t i c s p o i n t out t h a t s o c i a l s e r v i c e has become a b i g b u s i n e s s i n s o c i e t y , and t h a t p r o f e s s i o n a l s depend on a p o p u l a t i o n o f a f f l i c t e d p e o p l e as 'consumers' o f such s e r v i c e s . As d i s c u s s e d p r e v i o u s l y , t h e r e i s now a movement towards d e c e n t r a l i z a t i o n o f s e r v i c e s , s e l f - h e l p , and a l t e r n a t i v e v o c a t i o n a l programs t h a t p l a c e emphasis on g r e a t e r s e l f - r e l i a n c e and independence. McKnight d e s c r i b e s a community v i s i o n , d e s c r i b i n g a v i s i o n o f c a r e f o r t h e d i s a b l e d t h a t emphasizes b e l o n g i n g , and co n n e c t e d n e s s t o community. I n t h e f i e l d o f p l a n n i n g t h e o r y , Friedmann's t h e o r y o f t r a n s a c t i v e p l a n n i n g , w h i c h c a l l s f o r a d e c e n t r a l i z a t i o n o f p l a n n i n g and i n s t i t u t i o n s , and a p r o c e s s o f s o c i a l l e a r n i n g between p l a n n e r and c l i e n t , has some p a r a l l e l s w i t h M c K n i g h t ' s community v i s i o n . Friedmann f e l t t h a t p l a n n i n g s h o u l d o c c u r as a r e s u l t o f p e r s o n a l c o n t a c t between p e o p l e a f f e c t e d by d e c i s i o n s ; t h r o u g h a p r o c e s s o f ' s o c i a l l e a r n i n g ' between p l a n n e r and c l i e n t would come th e r e l e v a n t i s s u e s t o be d e a l t w i t h . A t an i n s t i t u t i o n a l l e v e l , Friedmann saw t h a t t r a n s a c t i v e p l a n n i n g a l s o s h o u l d i n c l u d e t h e development o f d e c e n t r a l i z e d p l a n n i n g i n s t i t u t i o n s t h a t a s s i s t p e o p l e t o t a k e g r e a t e r charge o f t h e s o c i a l p r o c e s s e s t h a t dominate t h e i r l i v e s (Hudson, 1978). T r a n s a c t i v e p l a n n i n g was t o emphasize t h e human d i m e n s i o n so l a c k i n g i n s y n o p t i c p l a n n i n g : . . . a t t e n t i o n t o the p e r s o n a l and s p i r i t u a l domains o f p o l i c y i m p a c t s , i n c l u d i n g i n t a n g i b l e outcomes beyond f u n c t i o n a l -i n s t r u m e n t a l o b j e c t i v e s - f o r example, p s y c h o - s p i r i t u a l development, enhancement o f d i g n i t y , and c a p a c i t y f o r s e l f -h e l p (Hudson, 1978) . R a d i c a l p l a n n i n g i s a n o t h e r p l a n n i n g t h e o r y t o w h i c h c u r r e n t movements i n mental h e a l t h have p a r a l l e l s . I n d i s c u s s i n g t h i s t r a d i t i o n , Gunton d e s c r i b e s the c r i t i c i s m s o f t h e s y n o p t i c t r a d i t i o n w h i c h s p u r r e d a l t e r n a t i v e models. These c r i t i c i s m s , a t t r i b u t e d t o such a u t h o r s as I l i c h , Grabow, and H e s k i n , i d e n t i f y p o l i c y a n a l y s t s a s : s e l f - s e r v i n g p r o f e s s i o n a l s who s u r r e p t i t i o u s l y impose t h e i r v a l u e s on s o c i e t y by d e f i n i n g problems i n s uch a way t h a t b r o a d p a r t i c i p a t i o n i s d i s c o u r a g e d . P r o f e s s i o n a l s c u l t i v a t e dependency i n o r d e r t o m a i n t a i n power and p r e s t i g e (Gunton, 1981). P l a n n e r s i n t h e r a d i c a l t r a d i t i o n don't b e l i e v e t h a t a s o l u t i o n l i e s i n ' s o c i a l l e a r n i n g ' , w h i c h m e r e l y p e r p e t u a t e s t h e p r i v i l e g e d p o s i t i o n o f p l a n n e r s ; n o r do t h e y b e l i e v e i t l i e s i n r e d u c i n g t h e r o l e o f government w i t h o u t t a c k l i n g t h e problems o f p r i v a t e c o n c e n t r a t i o n o f power, nor r e l e g a t i n g p l a n n e r s t o t h e r o l e o f r e f e r e e s i n an unequal w o r l d . . . . p l a n n e r s must become s o c i a l r e f o r m e r s committed t o f u n d amental s o c i a l change i n v o l v i n g r e d i s t r i b u t i o n o f power and w e a l t h and t h e r e j e c t i o n o f s e l f - s e r v i n g t e c h n o l o g y and c o m p l e x i t y t h a t g i v e s t e c h n o c r a t s power based on t h e i r s u p e r i o r knowledge. P l a n n e r s engaged i n s o c i a l r e f o r m must c r e a t e more d e c e n t r a l i z e d and more s e l f - s u f f i c i e n t s o c i a l u n i t s b ased on worker ownership and community c o o p e r a t i v e s and communes where p r o f e s s i o n a l p l a n n e r s a r e u l t i m a t e l y e l i m i n a t e d (Gunton, 1981). I n t h e m e n t a l h e a l t h f i e l d , t h e r e c e n t movements toward d e c e n t r a l i z a t i o n o f s e r v i c e s and s e l f - h e l p c o u l d be seen t o r e f l e c t a s p e c t s o f t h e t r a n s a c t i v e p l a n n i n g approach. C o n s u m e r / s u r v i v o r -r u n b u s i n e s s e s , s t r u c t u r e s based on worker o w n e r s h i p , and w h i c h r e f l e c t an awareness of t h e l i m i t a t i o n s o f p r o f e s s i o n a l i s m , a r e more r e f l e c t i v e o f t h e r a d i c a l approach t o p l a n n i n g . The f o l l o w i n g diagram ( F i g u r e 2) summarizes t h e p a r a l l e l s between m e n t a l h e a l t h , p l a n n i n g t h e o r y , and p e r s p e c t i v e s on the d i s a b l e d d i s c u s s e d i n t h i s s e c t i o n . F i g u r e 2. P a r a l l e l s Between M e n t a l H e a l t h , P l a n n i n g Theory and P e r s p e c t i v e s on t h e D i s a b l e d P e r s p e c t i v e on M e n t a l P l a n n i n g t h e D i s a b l e d H e a l t h Theory Theory (McKnight) R a t i o n a l I n s t i t u t i o n a l Comprehens i v e T h e r a p e u t i c Care P l a n n i n g V i s i o n Community Advocacy Advocacy Care P l a n n i n g V i s i o n R a d i c a l / S e l f - h e l p / T r a n s a c t i v e Community M u t u a l A i d P l a n n i n g V i s i o n M e d i a t i n g S t r u c t u r e s i n S o c i e t y Of r e l e v a n c e t o c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s i s the c o n c e p t of m e d i a t i n g s t r u c t u r e s . S o c i o l o g i s t P e t e r B e r g e r and l u t h e r a n p a s t o r R i c h a r d Neuhaus wrote To Empower Peop l e : The R o l e o f M e d i a t i n g S t r u c t u r e s i n P u b l i c P o l i c y , i n 1977. B e r g e r and Neuhaus's a n a l y s i s o f modern s o c i e t y i s t h a t t h e r e i s c u r r e n t l y a ' h i s t o r i c a l l y u nprecedented' s p l i t between p u b l i c and p r i v a t e l i f e -- between p u b l i c l i f e dominated by l a r g e i n s t i t u t i o n s , and the p r i v a t e l i f e w h i c h i s o f p r i v a t e s i g n i f i c a n c e o n l y (CBC Radioworks, 1994). S o c i e t y ' s ' m e d i a t i n g s t r u c t u r e s ' -- t h e f a m i l y , n e i g h b o u r s , f r i e n d s , c h u r c h e s , c l u b s , l o c a l b u s i n e s s e s and v o l u n t a r y a s s o c i a t i o n s -- a c t as a b u f f e r between a v a s t and b u r e a u c r a t i z e d s t a t e , and t h e i n d i v i d u a l , whose l i f e i s u s u a l l y o f p r i v a t e s i g n i f i c a n c e o n l y . B e r g e r and Neuhaus b e l i e v e i t i s t h e s e m e d i a t i n g s t r u c t u r e s t h a t p r o v i d e meaning and r e l e v a n c e t o t h e i n d i v i d u a l ' s l i f e . Y e t t h e s e m e d i a t i n g s t r u c t u r e s have not been s u p p o r t e d by p u b l i c p o l i c y . B e r g e r ' s a n a l y s i s i s t h a t t h e d e c l i n e o f t h e s e s e t t i n g s w i l l u l t i m a t e l y l e a d t o t o t a l i t a r i a n i s m - - a n a l l - p o w e r f u l s t a t e a c t i n g d i r e c t l y on t h e i n d i v i d u a l . To B e r g e r and Neuhaus, s u p p o r t f o r such m e d i a t i n g s t r u c t u r e s t h r o u g h p u b l i c p o l i c y i s n e c e s s a r y , and would reduce a l i e n a t i o n and c o n s e r v e meaning. B e r g e r and Neuhaus' concept o f m e d i a t i n g s t r u c t u r e s i s a p p l i c a b l e t o t h e p r o v i s i o n o f s o c i a l s e r v i c e s , c u r r e n t l y p r o v i d e d l a r g e l y by government. I n t h e f i e l d o f s o c i a l s e r v i c e s , t h e y a d v o c a t e c h a n n e l l i n g funds d i r e c t l y t o c l i e n t s o f s o c i a l s e r v i c e s , r a t h e r t h a n t h e i n s t i t u t i o n s now p r o v i d i n g s o c i a l s e r v i c e s . C l i e n t s would t h e n have th e o p p o r t u n i t y t o choose among competing i n s t i t u t i o n s where t o spend t h e i r voucher, o r t h e y c o u l d t h e n s e t up t h e i r own m e d i a t i n g s t r u c t u r e s . C o n s u m e r / S u r v i v o r - r u n b u s i n e s s e s c o u l d be seen as a form o f m e d i a t i n g s t r u c t u r e i n t h a t t h e y p r o v i d e an a l t e r n a t i v e t o the p r o v i s i o n o f s e r v i c e s by government and o t h e r i n s t i t u t i o n s . B e r g e r and Neuhaus' s t u d y o f m e d i a t i n g s t r u c t u r e s and t h e n e c e s s i t y o f s u p p o r t by p u b l i c p o l i c y o f such s t r u c t u r e s , l e n d s p h i l o s o p h i c a l s u p p o r t f o r a p o l i c y t h a t e x p l i c i t l y a d d r e s s e s f o s t e r i n g the development o f , and ongoing s u p p o r t f o r , C o n s u m e r / S u r v i v o r - r u n b u s i n e s s e s . 3.0 Consumer/Survivor-Run B u s i n e s s e s I n t h e 1960's, i n s t i t u t i o n a l c a r e f o r t h e m e n t a l l y i l l was c h a l l e n g e d ; l a t e r , t h e community s e r v i c e system was a l s o c h a l l e n g e d . Community s e r v i c e has i n common w i t h t h e i n s t i t u t i o n a l system t h e i d e a t h a t i t i s p o s s i b l e t o c r e a t e a 'system t h a t c a r e s ' . The p r o v i s i o n o f s e r v i c e s has been seen as t h e o n l y v a l i d use o f m e n t a l h e a l t h budgets. R e c e n t l y , p e o p l e i n v o l v e d i n the f i e l d o f me n t a l h e a l t h have come t o q u e s t i o n whether i t i s i n f a c t p o s s i b l e t o c r e a t e a c a r i n g s e r v i c e system (CBC Radioworks, 1994). T h i s s h i f t i n p e r c e p t i o n has l e d t o major changes i n the f i e l d o f v o c a t i o n a l r e h a b i l i t a t i o n f o r t h e m e n t a l l y handicapped. One o f t h e s e changes has been t h e t r e n d towards c o n s u m e r / s u r v i v o r i n i t i a t i v e s ; t h e s e i n i t i a t i v e s a r e not s e r v i c e s , but a form o f d i r e c t a c t i o n . Such d i r e c t a c t i o n may t a k e t h e form o f advocacy, p e e r c o u n s e l l i n g , o r s e l f - h e l p . I n some c a s e s i t t a k e s t h e form o f economic i n i t i a t i v e s . The i d e a o f b u s i n e s s e s , s e t up i n such a way t h a t p e o p l e w i t h a p s y c h i a t r i c h i s t o r y c o n t r o l t h e b u s i n e s s , i s becoming more w i d e s p r e a d . Support f o r c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s comes on t h e b a s i s t h a t h a v i n g c o n t r o l o f t h e b u s i n e s s promotes s e l f - r e l i a n c e , w h i c h i n t u r n h e l p s t h e i n d i v i d u a l s ' s e l f -esteem and me n t a l h e a l t h . Support f o r c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s a l s o comes on t h e b a s i s o f c o m p e t i t i v e w o r k p l a c e s b e i n g shown t o b e t t e r promote an i n d i v i d u a l s ' r e h a b i l i t a t i o n . A s t u d y o f programs o f f e r e d a t O n t a r i o ' s p r o v i n c i a l p s y c h i a t r i c h o s p i t a l s c o n c l u d e d t h a t c o m p e t i t i v e s e t t i n g s worked b e t t e r t h a n s h e l t e r e d s e t t i n g s i n the r e h a b i l i t a t i o n o f p e o p l e w i t h a h i s t o r y o f mental i l l n e s s ( c i t e d i n T r a i n o r & Tremblay, 1992). I n a c o m p e t i t i v e b u s i n e s s s e t t i n g , r u n by c o n s u m e r / s u r v i v o r s , i n d i v i d u a l s a r e no l o n g e r c l i e n t s , but employees and employers. The f o c u s i s on t h e s e i n d i v i d u a l s u s i n g t h e i r t a l e n t s and s k i l l s t o c r e a t e m e a n i n g f u l work; t h e r e i s l i t t l e o r no i n p u t from p r o f e s s i o n a l s t a f f . Such e n t e r p r i s e s r e d e f i n e the r e l a t i o n s h i p o f t h e i n d i v i d u a l t o t h e employment s e t t i n g ; work becomes m e a n i n g f u l by v i r t u e o f the i n d i v i d u a l ' s s t a k e i n t h e e n t e r p r i s e ( T r a i n o r e t a l . , 1992). Such b u s i n e s s e s have come t o be c a l l e d Consumer/Survivor-Run B u s i n e s s e s , o r CSRB's ( T r a i n o r & Tremblay, 1992). CSRB's a r e an attempt by p e o p l e who have used t h e mental h e a l t h system t o e s t a b l i s h an economic p r e s e n c e w h i c h t h e y can c o n t r o l . By d o i n g t h i s , t h e y have been a b l e t o t u r n a p s y c h i a t r i c h i s t o r y i n t o an a s s e t r a t h e r t h a n a l i a b i l i t y and d i r e c t l y c o n f r o n t a major c o n t r a d i c t i o n i n t h e i r l i v e s : t h e c o n t r a s t between the r e s o u r c e s s o c i e t y i s w i l l i n g t o put i n t o e x p e n s i v e p r o f e s s i o n a l t r e a t m e n t on t h e one hand, and t h e m a r g i n a l i z a t i o n and p o v e r t y o f e v e r y d a y l i f e on t h e o t h e r . ( T r a i n o r e t a l . , 1992, p. 70) F i v e examples of CSRB's a r e r e v i e w e d below t o f i n d answers t o t h e f o l l o w i n g q u e s t i o n s : 1. What a r e t h e d i s t i n g u i s h i n g c h a r a c t e r i s t i c s o f t h i s s o r t o f a c t i v i t y ? i . e what d i s t i n g u i s h e s CSRB's from o t h e r t y p e s o f v o c a t i o n a l r e h a b i l i t a t i o n , and from o t h e r t y p e s o f b u s i n e s s o r g a n i z a t i o n ? 2. What a r e t h e o p p o r t u n i t i e s f o r the development o f CSRB's? 3. What c o n s t r a i n t s do CSRB's f a c e ? These q u e s t i o n s a r e t o a d d r e s s e d by r e s e a r c h i n g : ( i ) e x i s t i n g l i t e r a t u r e on t h e v a r i o u s examples o f CSRB's; ( i l ) i n f o r m a t i o n p r o v i d e d by CSRB's t h e m s e l v e s , i . e . b r o c h u r e s , p r o m o t i o n a l m a t e r i a l . F o r t h e p u r p o s e s o f t h i s t h e s i s , t h i s m a t e r i a l w i l l be s u f f i c i e n t t o d e t e r m i n e t h e d i s t i n g u i s h i n g c h a r a c t e r i s t i c s o f CSRB's, and the o p p o r t u n i t i e s and c o n s t r a i n t s t o t h e i r development. The f i v e examples of CSRB's t o be a n a l y z e d a r e : 1. A b e l E n t e r p r i s e s 2. A-Way E x p r e s s C o u r i e r s 3. F r e s h S t a r t C l e a n i n g and Maintenance 4. U n i t y H o u s i n g 5. C o n sumer/Survivor A r t i s t s C o - o p e r a t i v e 3.1 Examples o f CSRB's 3.1.1 A b e l E n t e r p r i s e s A b e l E n t e r p r i s e s i s a c o n s u m e r / s u r v i v o r - r u n b u s i n e s s o p e r a t i n g i n Simcoe, O n t a r i o . I t has a l s o been known as t h e H a l d i m a n d - N o r f o i k Working Group, a f t e r Haldimand and N o r f o l k c o u n t i e s , t h e r e g i o n i n w h i c h i t o p e r a t e s . The o l d e s t o f t h e CSRB's d e s c r i b e d i n t h i s t h e s i s , A b e l E n t e r p r i s e s began i n 1983. The e n t e r p r i s e began as t h e r e s u l t o f a s t u d y , c o n d u c t e d by H a l d i m a n d - N o r f o i k M e n t a l H e a l t h S e r v i c e s , i n t o t h e i s s u e s f a c i n g p e o p l e w i t h a s e r i o u s mental i l l n e s s i n t h e r e g i o n . T h i s s t u d y , s u p p o r t e d by Canada Works f u n d i n g , found t h a t t h e most p r e s s i n g i s s u e s were l a c k o f employment, poor l i v i n g c o n d i t i o n s , and d e s p e r a t e f i n a n c i a l need. A l s o found t o be o f c o n c e r n was the e f f e c t t h a t p s y c h o t r o p i c m e d i c a t i o n s had on t h e m e n t a l l y i l l . From t h e s e i s s u e s came the i d e a f o r a c o o p e r a t i v e b u s i n e s s . Emphasis was t o be p l a c e d on group p a r t i c i p a t i o n i n d e c i s i o n - m a k i n g ; c o n t r o l , and d i r e c t i o n o f t h e c o o p e r a t i v e was t o come from t h e members th e m s e l v e s (CMHA, 1987). S t a r t i n g w i t h a number o f men who were consumers o f Haldimand-N o r f o l k M e n t a l H e a l t h S e r v i c e s , and w i t h t h e a s s i s t a n c e of a community development worker, A b e l E n t e r p r i s e s was b o r n . From t h e s t a r t , t h e c o o p e r a t i v e has been committed t o t a k i n g advantage o f o p p o r t u n i t i e s p r e s e n t e d t o them by the community; sometimes t h e s e o p p o r t u n i t i e s have been s m a l l i n s c a l e , sometimes l a r g e (CMHA, 1987). As an i n i t i a l p r o j e c t , t h e group d e c i d e d t o b u i l d a 1 6 - f o o t canoe, w h i c h would t h e n be r a f f l e d , p r o v i d i n g some c a p i t a l f o r t h e c o - o p e r a t i v e and p u b l i c i t y from t h e s u r r o u n d i n g community. T h i s p r o j e c t r e s u l t e d i n $700 f o r the group, and awareness f o r t h e p r o j e c t . The group l e a r n e d , from t h e V i c t o r i a n Order o f Nurses, t h a t t h e r e was a need l o c a l l y f o r s p e c i a l t y i t e m s f o r p h y s i c a l l y h a n d i c a p p e d p e o p l e , such as b a t h boards, p o r t a b l e w h e e l c h a i r ramps, w a l k e r s , and amputee boards. As s e v e r a l members o f t h e group had wood-working s k i l l s , p r o d u c i n g t h e s e i t e m s was a n a t u r a l p r o j e c t f o r them. The l o c a l community c o l l e g e , Fanshawe C o l l e g e , was approached t o p r o v i d e space f o r wood-working. T h i s c o n n e c t i o n w i t h t h e c o l l e g e s u b s e q u e n t l y r e s u l t e d i n members b e i n g g r a n t e d a c c e s s t o c o l l e g e c o u r s e s . Through t h i s arrangement, members have t a k e n c o u r s e s i n c a r p e n t r y , j o i n i n g and f i t t i n g , f i r s t a i d , work s a f e t y , f u r n i t u r e r e f i n i s h i n g , h o r t i c u l t u r e , commercial a p p l i c a t i o n o f p e s t i c i d e s and f u n g i c i d e s , commercial f r u i t t r e e s , s m a l l engine r e p a i r , c o o k i n g f o r t h e p u b l i c , and m a r k e t i n g (CMHA, 1987). O t h e r work p r o j e c t s were embarked upon. A f o o d c o n c e s s i o n , run f o r f o u r c o n s e c u t i v e summers, p r o v i d e d employment and de v e l o p e d s k i l l s f o r members. T h i s p r o j e c t was d i s c o n t i n u e d t o f o c u s on o t h e r a c t i v i t i e s . The group a l s o o b t a i n e d a c o n t r a c t f o r p l a n t i n g and weeding a woodlot f o r the l o c a l F o r e s t r y S t a t i o n . T h i s was one p r o j e c t t h a t d i d n ' t work f o r members. The work was s t r e n u o u s , and t h e r e was nowhere t o r e l a x and t a k e a b r e a k ; as a r e s u l t , members a c t u a l l y went on s t r i k e a g a i n s t management. A compromise was r e a c h e d , whereby t h e members agreed t o f i n i s h o f f t h e c o n t r a c t , on t h e c o n d i t i o n t h a t no work o f t h i s t y p e be u n d e r t a k e n . T h i s s i t u a t i o n shows one o f the s t r e n g t h s o f CSRB's -- t h a t workers a c t u a l l y have some c o n t r o l o v e r t h e i r work environment and d e c i s i o n s t h a t e f f e c t them (CMHA, 1987). The c o - o p e r a t i v e has s t r u g g l e d t o f i n d enough work o v e r t h e w i n t e r months t o keep busy. Members have o f t e n found themselves s h o v e l l i n g w a l k s a f t e r s n o w f a l l s . I n an attempt t o f i n d o t h e r w i n t e r employment, t h e c o o p e r a t i v e began t o c r e a t e l a r g e f i b r e g l a s s s c u l p t u r e s , t o be s o l d t o l o c a l b u s i n e s s e s and homes d u r i n g the C h r i s t m a s season. A b e l E n t e r p r i s e s a l s o a s s i s t s members who w i s h t o r e - e n t e r the r e g u l a r w o r k f o r c e . By d e v e l o p i n g v o c a t i o n a l s k i l l s and t h e s o c i a l s k i l l s n e c e s s a r y f o r s u c c e s s i n t h e w o r k p l a c e , A b e l may a c t as a b r i d g e t o r e g u l a r employment f o r members. O v e r a l l , o p e r a t i n g i n a r e l a t i v e l y s m a l l community, A b e l E n t e r p r i s e s has been a s u c c e s s . One i s s u e f a c e d by members has been t h e amount t h e y can e a r n on t o p o f t h e i r d i s a b i l i t y p e n s i o n , b e f o r e i t i s t a x e d back. I n O n t a r i o , d i s a b l e d p e o p l e may e a r n $160 on top o f t h e i r d i s a b i l i t y a l l o w a n c e ; above t h i s mark, e a r n i n g s a r e t a x e d M back a t 75%. W h i l e t h i s p o l i c y p r o v i d e s more i n c e n t i v e t o work than p r e v i o u s r e g u l a t i o n s w h i c h t a x e d back e a r n i n g s more s t r i n g e n t l y , t h e l i m i t a t i o n s p l a c e d on the amount o f income t h a t can be earned do p r o v i d e a d i s i n c e n t i v e towards w o r k i n g more. A n o t h e r i s s u e f a c e d by A b e l E n t e r p r i s e s has been t h a t o f s e t t i n g a s i d e a p o r t i o n o f p r o f i t s t o be used f o r e x p a n s i o n o f the e n t e r p r i s e . A t p r e s e n t , A b e l employs many p e o p l e on a p a r t - t i m e b a s i s ; i f a s u b s t a n t i a l amount o f w o r k i n g c a p i t a l c o u l d be b u i l t up, e x p a n s i o n o f t h e e n t e r p r i s e , f u l l employment, and worker b e n e f i t s c o u l d be d e v e l o p e d (CMHA, 1987). 3.1.2 A-Way E x p r e s s C o u r i e r s A-Way E x p r e s s C o u r i e r s i s perhaps t h e b e s t known example i n Canada o f a b u s i n e s s r u n w i t h i n p u t by c o n s u m e r / s u r v i v o r s . U s i n g t h e T o r o n t o t r a n s i t system, c o u r i e r s d e l i v e r p a r c e l s a t r a t e s c o m p e t i t i v e t o o t h e r c o u r i e r companies. A-Way, a n o n - p r o f i t e n t e r p r i s e , i s r u n by a Community Development C o r p o r a t i o n B oard o f D i r e c t o r s . A-Way came i n t o b e i n g p a r t l y as a r e s u l t o f a 1982 Mayor's t a s k f o r c e t h a t examined i s s u e s a f f e c t i n g c o n s u m e r / s u r v i v o r s . These i n c l u d e d t h e e f f e c t s o f m e d i c a t i o n , h o u s i n g , and f i n a n c i a l s u p p o r t . The t a s k f o r c e was p r e s s e d by some mental h e a l t h p r o f e s s i o n a l s t o l o o k a t t h e i s s u e o f i n c r e a s i n g j o b o p p o r t u n i t i e s f o r c o n s u m e r / s u r v i v o r s . I n 1985, t h e program c o o r d i n a t o r o f P r o g r e s s P l a c e , a day t r e a t m e n t c e n t r e i n T o r o n t o , i n v i t e d a community development worker who had been i n v o l v e d i n t h e c r e a t i o n o f A b e l E n t e r p r i s e s t o meet w i t h some o f t h e p e o p l e who were c l i e n t s a t t h e day t r e a t m e n t c e n t r e . Many o f t h e p e o p l e a t P r o g r e s s P l a c e had s c h i z o p h r e n i a , a d i s e a s e t h a t causes t h e s e p e o p l e t o be c o n s i d e r e d more ' h i g h - r i s k ' and d i f f i c u l t t o p l a c e i n t r a d i t i o n a l v o c a t i o n a l programs. Most were c o n s i d e r e d p e r m a n e n t l y unemployable by mental h e a l t h s t a f f . These p e o p l e a l s o t e n d t o have low s e l f - e s t e e m , poor work r e c o r d s , and have many h e a l t h and s o c i a l a s s i s t a n c e r e l a t e d a ppointments, c a u s i n g them t o need f l e x i b l e work s c h e d u l e s . As has been n o t e d i n o t h e r examples, most w o r k p l a c e s a r e not w i l l i n g t o accommodate the needs o f t h e s e w o r k e r s . Schemes such as s u p p o r t e d employment, w h i l e w o r t h w h i l e , t e n d t o p l a c e workers i n low-pay, l o w - s t a t u s j o b s . The fundamental i d e a b e h i n d e x p e r i m e n t s such as A-Way and A b e l E n t e r p r i s e s i s t h a t t h e w o r k p l a c e s h o u l d be made t o f i t t h e p s y c h i a t r i c a l l y l a b e l l e d i n d i v i d u a l , n ot t h e o t h e r way around. I n d i v i d u a l s i n v o l v e d i n such e n t e r p r i s e s g a i n d i g n i t y by v i r t u e o f t h e i r work b e i n g not j u s t a j o b , but a v e n t u r e i n w h i c h each i n d i v i d u a l s h a r e s r e s p o n s i b i l i t i e s and b e n e f i t s . The group d e c i d e d t h a t a worker c o - o p e r a t i v e model of o r g a n i z a t i o n would a l l o w workers t h e f l e x i b i l i t y t h e y needed. The group, l a c k i n g t h e t e c h n i c a l e x p e r t i s e needed f o r t h e i n i t i a t i o n o f a worker c o - o p e r a t i v e , approached a community o r g a n i z e r and a b u s i n e s s - c o n s u l t i n g f i r m . T h i s expanded group c o n t i n u e d t o meet f o r 18 months; i n t h e p r o c e s s , i t was d e c i d e d t h a t a l i g h t p a r c e l c o u r i e r s e r v i c e u s i n g the T o r o n t o t r a n s i t system would be a w o r k a b l e b u s i n e s s and would a l l o w workers t h e f l e x i b i l i t y t h e y needed. As Brown (1989) n o t e s : ...The d e c i s i o n t o d e v e l o p a worker c o - o p e r a t i v e r e s u l t e d from t h e i n a b i l i t y o f e x i s t i n g s e t t i n g s t o s a t i s f y t h e employment needs of t h i s p o p u l a t i o n . As members o f a c o - o p e r a t i v e , t h e p s y c h i a t r i c a l l y - d i s a b l e d would be a b l e t o d e v e l o p a l o n g - t e r m employment environment c h a r a c t e r i z e d by f l e x i b l e work hours, t o l e r a n c e o f i l l n e s s - r e l a t e d a b s e n t e e i s m , h i r e management who a r e a t t u n e d t o t h e i r s p e c i a l needs and d i s t r i b u t e p r o f i t amongst t h e m s e l v e s , (p. 31) The g o v e r n i n g s t r u c t u r e o f A-Way was f a s h i o n e d as f o l l o w s . A Community Development C o r p o r a t i o n was e s t a b l i s h e d . The n o n - p r o f i t s t a t u s o f t h e CDC a l l o w e d i t t o b e n e f i t from programs and f u n d i n g a g e n c i e s p r o h i b i t e d from d i r e c t l y s u p p o r t i n g b u s i n e s s v e n t u r e s . The CDC had a Board o f D i r e c t o r s , made up o f p e o p l e w i t h e x p e r i e n c e i n m e n t a l h e a l t h , b u s i n e s s , and community development. T h i s arrangement a l l o w e d A-Way t o b e n e f i t from t h e p r o f e s s i o n a l e x p e r t i s e o f t h e s e i n d i v i d u a l s . A-Way E x p r e s s C o u r i e r s was e s t a b l i s h e d as a worker c o - o p e r a t i v e . Funding was t o pass from t h e CDC t o A-Way. At i n c e p t i o n , A-Way E x p r e s s C o u r i e r s had i t s own Boar d o f D i r e c t o r s , c o m p l e t e l y made up o f w o r k e r s , and e l e c t e d by the g e n e r a l membership. A-Way was s t r u c t u r e d i n such a way t h a t d e c i s i o n - m a k i n g r e s p o n s i b i l i t y was t o r e s i d e i n i t i a l l y w i t h a g e n e r a l manager and th e B o a r d o f D i r e c t o r s o f t h e CDC. Over a f i v e y e a r p e r i o d , workers were t o be t r a i n e d i n c o - o p e r a t i v e p r i n c i p l e s , a t t h e end o f whi c h d e c i s i o n - m a k i n g r e s p o n s i b i l i t y was t o be under f u l l c o n t r o l o f t h e membership. A-Way E x p r e s s C o u r i e r s began o p e r a t i o n s i n 1987, w i t h $45,000 o b t a i n e d from p u b l i c a g e n c i e s f o r s t a r t - u p c a p i t a l f o r equipment and development. Funds came from t h e O n t a r i o M i n i s t r y o f H e a l t h , t h e O n t a r i o M i n i s t r y o f Housing, t h e C i t y o f T o r o n t o ' s community economic development fund and t h e H o l y T r i n i t y F o u n d a t i o n . T r a d i t i o n a l l e n d i n g a g e n c i e s had been u n i n t e r e s t e d i n f i n a n c i n g a b u s i n e s s owned and o p e r a t e d by e x - p s y c h i a t r i c p a t i e n t s . W i t h i n the f i r s t y e a r o f o p e r a t i o n s , A-Way needed a n o t h e r $44,000 f o r o p e r a t i n g c o s t s . O v e r l y o p t i m i s t i c revenue f o r e c a s t s and the d e c i s i o n t o buy, r a t h e r t h a n r e n t needed equipment. A t t h i s p o i n t , M i n i s t r y p e r s o n n e l r e f u s e d t o g r a n t the needed fu n d s , u n l e s s A-Way changed i t s o p e r a t i n g s t r u c t u r e from a worker c o - o p e r a t i v e t o a n o n - p r o f i t o r g a n i z a t i o n . A f t e r l e n g t h y d i s c u s s i o n , t h e Board o f the Community Development C o r p o r a t i o n d e c i d e d t o s a c r i f i c e t h e worker c o - o p e r a t i v e i n o r d e r t o save t h e b u s i n e s s . A-Way c u r r e n t l y runs under t h e d i r e c t i o n o f the Board o f t h e Community Development C o r p o r a t i o n ; worker r e p r e s e n t a t i o n on t h i s B o a r d has been i n c r e a s e d t o 50%. A l o n g w i t h t h e r e s t r u c t u r i n g o f A-Way from a worker co-o p e r a t i v e t o a n o n - p r o f i t o r g a n i z a t i o n , A-Way was a l s o c o m p e l l e d by th e M i n i s t r y t o change from b e i n g a c o m p e t i t i v e b u s i n e s s s e t t i n g t o a t h e r a p e u t i c s e t t i n g . A-Way p o l i c i e s were adapted t o adhere t o M i n i s t r y g u i d e l i n e s , as opposed t o c o m p e t i t i v e b u s i n e s s g u i d e l i n e s (Brown, 1989). Under n o n - p r o f i t management, A-Way has s u r v i v e d and grown. As of J a n u a r y 1993, A-Way employs 35 c o u r i e r s , 10 o f f i c e s t a f f , and has 800 customer a c c o u n t s . A-Way i s i n t h e p r o c e s s o f ex p a n d i n g i t s c o u r i e r s t a f f t o 50, and t o t h i s end i s c u r r e n t l y a t t e m p t i n g t o expand i t s c l i e n t base (CSDI, 1994). 3.1.3 F r e s h S t a r t C l e a n i n g and Maintenance I n o p e r a t i o n s i n c e 1989, F r e s h S t a r t C l e a n i n g and Maintenance i s a community b u s i n e s s t h a t p r o v i d e s c l e a n i n g s e r v i c e s t o a number of c l i e n t s i n t h e To r o n t o a r e a . F r e s h S t a r t has s e c u r e d 15 c l e a n i n g c o n t r a c t s , m o s t l y w i t h s o c i a l s e r v i c e a g e n c i e s , and p r e s e n t l y employs 40 c o n s u m e r / s u r v i v o r s o f t h e mental h e a l t h system. As w i t h o t h e r c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s , most s t a f f work p a r t - t i m e , b u t some employees have used t h e o p p o r t u n i t y t o work f u l l - t i m e and g e t o f f s o c i a l a s s i s t a n c e (CSDI, 1994). I n some c a s e s . F r e s h S t a r t has o b t a i n e d c o n t r a c t s w i t h s o c i a l s e r v i c e p r o v i d e r s by a g r e e i n g t o h i r e consumers of t h a t p a r t i c u l a r s e r v i c e . F r e s h S t a r t was d e v e l o p e d by c o n s u m e r / s u r v i v o r s and agency s t a f f as a way o f g e n e r a t i n g work o p p o r t u n i t i e s . At p r e s e n t . F r e s h S t a r t i s r u n as a n o n - p r o f i t c o r p o r a t i o n w i t h i t s own Board o f D i r e c t o r s . T h i s B o a r d c o n s i s t s o f 14 p e o p l e , 9 o f whom ar e c o n s u m e r / s u r v i v o r s . Of t h e 9 c o n s u m e r / s u r v i v o r s on t h e Board, 7 a r e s t a f f r e p r e s e n t a t i v e s ; the o t h e r two c o n s u m e r / s u r v i v o r r e p r e s e n t a t i v e s a r e r e c r u i t e d from t h e community. The r e s t o f t h e B o a r d i s made up of p e o p l e w i t h backgrounds i n law, b u s i n e s s , and s o c i a l s e r v i c e s . As a r e s u l t , s t a f f have a h i g h degree o f c o n t r o l , but a l s o have t h e b e n e f i t o f i n d i v i d u a l s w i t h p r o f e s s i o n a l e x p e r t i s e ( T r a i n o r & Tremblay, 1992). As o f 1992, F r e s h S t a r t has r e c e i v e d funds f o r i t s t h r e e management s t a f f (an e x e c u t i v e d i r e c t o r , o f f i c e a d m i n i s t r a t o r , and s i t e s u p e r v i s o r ) from CSDI (CSDI, i n t u r n , i s funded by t h e O n t a r i o M i n i s t r y o f H e a l t h ) ; s a l a r i e s f o r s t a f f and s u p p l i e s come from the p r o c e e d s o f t h e e n t e r p r i s e (CSDI, 1994). 3.1.4 U n i t y H o u s i n g U n i t y H o u s i n g began when a number of e x - p a t i e n t s l i v i n g t o g e t h e r i n s o c i a l h o u s i n g were e v i c t e d when one of t h e i r number s u f f e r e d a r e l a p s e . One o f t h o s e e v i c t e d , John H a t f u l l , d e c i d e d t o g e t a number o f p a t i e n t s t o g e t h e r t o l o o k a f t e r each o t h e r . They found a house. L i v i n g t o g e t h e r , and l o o k i n g a f t e r each o t h e r , H a t f u l l n o t i c e d t h a t p e o p l e were r e c o v e r i n g from t h e i r mental i l l n e s s e s ( R i c h , 1993). He began t o l o o k f o r o t h e r s who were i n t e r e s t e d . W i t h a $67,000 g r a n t from the B.C. M i n i s t r y o f H e a l t h , U n i t y Housing was formed as a s o c i e t y . U n i t y Housing now r e n t s 8 houses, o f f e r i n g a s a f e and n u r t u r i n g environment f o r a p p r o x i m a t e l y 50 e x - p a t i e n t s . B e s i d e s o f f e r i n g accommodation t o p e o p l e , an i n t e n s i v e s e l f -h e l p program has been i n i t i a t e d . Jobs p r e v i o u s l y done by p r o f e s s i o n a l s and p a i d c a r e - g i v e r s have been t a k e n o v e r by the consumers t h e m s e l v e s . A v o l u n t e e r i n c e n t i v e program has been e s t a b l i s h e d , p a y i n g v o l u n t e e r s a $100 - $200 honorarium, w h i c h a c t s as a 'top-up' t o t h e d i s a b i l i t y p e n s i o n t h a t members r e c e i v e . The f o l l o w i n g i s a l i s t o f the v o l u n t e e r p o s i t i o n s t h a t have been d e v e l o p e d . O f f i c e Management Program C o o r d i n a t o r Handyman/Driver O f f i c e Management V o l u n t e e r C o o r d i n a t o r Handyman/Painter Book K e e p i n g Handyman/Plumber R e c e p t i o n L i f e s k i l l s A s s i s t a n t s P u b l i c R e l a t i o n s I n d i v i d u a l O u t r e a c h Community E v e n t s C o o r d i n a t o r Community Group O u t r e a c h Bus D r i v e r C o u n s e l l i n g C a t e r i n g Advocacy J a n i t o r C a r p e t C l e a n e r U n i t y H o u s i n g i s committed t o v o l u n t e e r s e r v i c e d e l i v e r y , as a key a s p e c t o f i t s program. W h i l e what U n i t y does may not seem t o be l i k e o t h e r c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s . U n i t y Housing p r o v i d e s 'employment' f o r i t s v o l u n t e e r s by a l l o w i n g them t o d e v e l o p t a n g i b l e s k i l l s , by p a y i n g a $100 - $200 'top-up' on d i s a b i l i t y p e n s i o n s , and by g i v i n g p e o p l e some sense o f v o c a t i o n , o f p u rpose ( U n i t y Housing A s s o c i a t i o n , 1994) . 3.1.5 Consumer/Survivor A r t i s t C o - o p e r a t i v e The Consumer/Survivor A r t i s t C o - o p e r a t i v e was founded i n 1993 t o i d e n t i f y and s u p p o r t c o n s u m e r / s u r v i v o r a r t i s t s e n d e a v o u r i n g t o become f u l l - t i m e w o r k i n g a r t i s t s . O p e r a t i n g on a g r a n t from the B.C. M i n i s t r y o f H e a l t h ' s Consumer I n i t i a t i v e s Program, t h e co-o p e r a t i v e r e n t e d p a r t o f a b r i c k h e r i t a g e b u i l d i n g a t 1134 G r a n v i l l e S t . , i n Vancouver's west end. A f t e r 6 months spent r e f u r b i s h i n g and r e n o v a t i n g t h i s space, i t was opened i n J a n u a r y 1994 as t h e G a l l e r y Cachet (named a f t e r P a u l Cachet, the homeopathic d o c t o r who t r e a t e d V i n c e n t Van Gogh) ( W i l s o n , 1994). The G a l l e r y p r o v i d e s space f o r c o n s u m e r / s u r v i v o r s t o e x h i b i t t h e i r work. Members a r e a l s o p r o v i d e d w i t h a c c e s s t o computer and v i d e o equipment, l i b r a r y , workshops, and a c a r i n g atmosphere t o p u r s u e t h e i r a r t . I n the f u t u r e , the c o o p e r a t i v e hopes t o p r o v i d e s t u d i o space ( i n o t h e r b u i l d i n g s ) , l a u n c h a magazine, and have t r a v e l l i n g shows wh i c h o r i g i n a t e a t t h e G a l l e r y Cachet ( W i l s o n , 1994) . The C o o p e r a t i v e i n t e n d s t o r u n t h e Cachet as a commercial g a l l e r y , funded t h r o u g h t h e s a l e o f i t s a r t . The g a l l e r y i n t e n d s t o r u n 10 shows a y e a r . F u l l members of t h e C o o p e r a t i v e a r e t h o s e who f i t t h e c r i t e r i a o f b e i n g d e d i c a t e d a r t i s t s , who a r e consumers w i t h i n t h e mental h e a l t h system, o r a r e s u r v i v o r s o f c h i l d h o o d abuse. They must a l s o have d e v e l o p e d t h e i r a r t t o a l e v e l where i t can be e x h i b i t e d . F u l l members a r e t h e d e c i s i o n - m a k e r s i n t h e Co-op. A p p r e n t i c e members, t h o s e who meet t h e a d m i s s i o n c r i t e r i a but have not d e v e l o p e d t h e i r a r t t o p o i n t o f e x h i b i t i o n , have some a c c e s s t o Co-op r e s o u r c e s , b u t do not have v o t i n g p r i v i l e g e s . The Co-op had 30 members when t h e g a l l e r y opened, but i s growing as more c o n s u m e r / s u r v i v o r s hear about t h e p r o j e c t (Consumer/Survivor's A r t i s t Co-op, 1994). As mentioned, t h e Co-op runs on a $76,000 g r a n t from t h e B.C. M i n i s t r y o f H e a l t h ' s Consumer I n i t i a t i v e s Program, and i s sponsored by t h e West Coast M e n t a l H e a l t h Network, an o r g a n i z a t i o n t h a t r e p r e s e n t s and a c t s as an advocate f o r c o n s u m e r / s u r v i v o r s ( W i l s o n , 1994) . 3.2 A s p e c t s o f CSRB's 3.2.1 D e c i s i o n - m a k i n g / o r g a n i z a t i o n a l s t r u c t u r e o f CSRB's A key a s p e c t o f CSRB's i s t h a t t h e s e b u s i n e s s e s employ some form o f d e m o c r a t i c d e c i s i o n - m a k i n g p r o c e s s , a l l o w i n g members t o have a r o l e i n t h e development and management o f t h e b u s i n e s s . T h i s a s p e c t o f CSRB's i s p a r t i c u l a r l y i m p o r t a n t i n t h a t i t a d d r e s s e s the l a c k o f power t h a t c o n s u m e r / s u r v i v o r s come t o exp e c t i n t h e i r l i v e s . T r a i n o r and Tremblay (1992) recommend t h a t p r o j e c t s adopt o r g a n i z a t i o n a l models wh i c h p r o v i d e t h e o p p o r t u n i t y f o r maximum i n p u t by c o n s u m e r / s u r v i v o r s . The t h r e e p r i m a r y examples (A-Way E x p r e s s C o u r i e r s , A b e l E n t e r p r i s e s , and F r e s h S t a r t C l e a n i n g and Maintenance) show something o f t h e range o f d e c i s i o n - m a k i n g s t r u c t u r e s i n CSRB's. F r e s h S t a r t C l e a n i n g and Maintenance, d e v e l o p e d i n 1989, i s o r g a n i z e d as a n o n - p r o f i t o r g a n i z a t i o n w i t h i t s own Board o f D i r e c t o r s . The Board c o n s i s t s o f 14 p e o p l e , n i n e o f whom are c o n s u m e r / s u r v i v o r s . Of t h e s e n i n e , seven a r e e l e c t e d by non-management s t a f f ; two o t h e r consumers a r e r e c r u i t e d from the community. Ot h e r i n d i v i d u a l s , w i t h needed s k i l l s i n such a r e a s as law, b u s i n e s s , and s o c i a l s e r v i c e s have been r e c r u i t e d t o f i l l out th e b o a r d . T h i s arrangement p r o v i d e s employees w i t h a l a r g e degree o f c o n t r o l o v e r t h e b u s i n e s s , a t t h e same t i m e p r o v i d i n g t h e b u s i n e s s w i t h needed e x p e r t i s e i n c e r t a i n a r e a s (CSDI, 1994). Two o r g a n i z a t i o n s were i n c o r p o r a t e d when A-Way Ex p r e s s C o u r i e r s was d e v e l o p e d : Applause Community Development C o r p o r a t i o n , a n o n p r o f i t community c o r p o r a t i o n w h i c h has a mandate o f s u p p o r t i n g t h e development o f d e m o c r a t i c w o r k p l a c e s f o r consumers o f the men t a l h e a l t h system; and A-Way E x p r e s s C o u r i e r s L i m i t e d , a worker c o o p e r a t i v e i n c o r p o r a t e d as a f o r - p r o f i t s h a r e c a p i t a l c o r p o r a t i o n (Ward & Tremblay, 1988) . Each o r g a n i z a t i o n had i t s own Board o f D i r e c t o r s . A f t e r f i n a n c i a l d i f f i c u l t i e s and subsequent r e s t r u c t u r i n g , the worker c o o p e r a t i v e B o a r d o f D i r e c t o r s was d i s b a n d e d ; t h e b u s i n e s s t h e n became a n o n - p r o f i t e n t e r p r i s e . A b e l E n t e r p r i s e s i s a n o n - p r o f i t work c o o p e r a t i v e . W h i l e day-t o - d a y d e c i s i o n s a r e made by the Board o f D i r e c t o r s , major d e c i s i o n s a r e made a t t h e r e g u l a r membership meetings made e v e r y two weeks ( T r a i n o r & Tremblay, 1992). 3.2.2 C o m p o s i t i o n o f S t a f f T r a i n o r e t a l . (1992), i n r e f l e c t i n g on t h e e x p e r i e n c e s o f v a r i o u s CSRB's, make a number o f recommendations. P e r t a i n i n g t o s t a f f , t h e y recommend t h a t i t i s p r e f e r a b l e t h a t a l l employees be c o n s u m e r / s u r v i v o r s , but t h a t i t may be n e c e s s a r y f o r i n d i v i d u a l s w i t h e x p e r i e n c e i n t h e p a r t i c u l a r b u s i n e s s t o be employed d u r i n g an i n t e r i m s t a g e . A b e l E n t e r p r i s e s has employed s t a f f members ( i . e . non-consumers) . These p e o p l e t e n d t o have e x p e r t i s e i n a r e a s r e l a t e d t o th e b u s i n e s s ' s o p e r a t i o n ; t h o s e employed i n t h e p a s t have i n c l u d e d a c a b i n e t m a k e r , f i b r e g l a s s worker, and l a n d s c a p e d e s i g n e r . I t i s f e l t t h a t t h e s e p e o p l e would be l e s s l i k e l y t o r e i n f o r c e a ' p a t i e n t - c l i e n t ' r o l e w i t h t h e members o f t h e work group, t h a n i n d i v i d u a l s w i t h a s o c i a l s e r v i c e background. Schwartz (1992) has made t h e same p o i n t , o b s e r v i n g t h a t d i s a b l e d p e o p l e b e n e f i t from i n t e r a c t i o n i n what he c a l l s t he a s s o c i a t i o n a l w o r l d , where a p s y c h o l o g i c a l sense o f community e x i s t s , as opposed t o i n t e r a c t i o n i n t h e p r o f e s s i o n a l / b u r e a u c r a t i c w o r l d . A-Way E x p r e s s C o u r i e r s was i n i t i a l l y o r g a n i z e d as a worker co-o p e r a t i v e . Over a f i v e - y e a r p e r i o d , d e c i s i o n - m a k i n g r e s p o n s i b i l i t i e s were t o pass from t h e Board o f D i r e c t o r s o f the Community Development C o r p o r a t i o n t o t h e members o f t h e co-o p e r a t i v e . A t t h e b e g i n n i n g , s t a f f were d e s c r i b e d as ' b u s i n e s s managers' whose p r i m a r y r o l e was t o a s s i s t w i t h t h e b u s i n e s s ' s o p e r a t i o n s . A f t e r r e s t r u c t u r i n g , d e s c r i p t i o n s o f s t a f f p o s i t i o n s were changed t o 'Program C o o r d i n a t o r ' and 'Case Manager'; i m p l y i n g t h a t A-Way had become a t h e r a p e u t i c s e t t i n g , and t h a t m e n t a l h e a l t h p r o f e s s i o n a l s were needed t o m o n i t o r a c t i v i t i e s a t A-Way (Brown, 1989). F r e s h S t a r t employs about 40 p e o p l e , most o f whom work p a r t -t i m e . Three ' s t a f f a r e employed t o manage t h e agency; t h e s e a r e an e x e c u t i v e d i r e c t o r , an o f f i c e a d m i n i s t r a t o r , and a s i t e s u p e r v i s o r . 3.2.3 Source o f Funding Wismer and P e l l (1983) d e s c r i b e a number o f g u i d i n g p r i n c i p l e s w h i c h i n f o r m t h e s t r u c t u r e and o p e r a t i o n o f CED p r o j e c t s ; one o f t h e s e i s t h e a b i l i t y t o s e c u r e funds t o c o v e r o p e r a t i n g and program development c o s t s . A-Way E x p r e s s C o u r i e r s o b t a i n e d i t s i n i t i a l f u n d i n g from the O n t a r i o M i n i s t r y o f H e a l t h , t h e O n t a r i o M i n i s t r y o f Hou s i n g , the C i t y o f T o r o n t o ' s community economic development f u n d and t h e H o l y T r i n i t y F o u n d a t i o n . I t was p r o j e c t e d t h a t t h e v e n t u r e would break even by June 1990. I n A-Way's case , subsequent e v e n t s have made i t c l e a r t h a t o n g o i n g f u n d i n g was a n e c e s s i t y . As T r a i n o r and Tremblay (1992) note : CSRB's have shown t h e y can s u c c e s s f u l l y employ p e o p l e w i t h s e r i o u s m ental i l l n e s s . T h i s cannot be done i f t h e y a re e x p e c t e d t o have t h e same e f f i c i e n c y as o t h e r b u s i n e s s e s , (p. 70) A-Way now has ong o i n g f u n d i n g t h r o u g h t h e O n t a r i o M i n i s t r y of H e a l t h ' s C o n sumer/Survivor Development I n i t i a t i v e (CSDI). F r e s h S t a r t r e c e i v e s funds from t h e Consumer/Survivor Development I n i t i a t i v e ; t h e s e c o v e r t h e c o s t s o f i t s t h r e e a d m i n i s t r a t i v e s t a f f , and t h e r e n t o f i t s p r e m i s e s . Revenues from work p e r f o r m e d by F r e s h S t a r t c o v e r t h e pay f o r c l e a n i n g s t a f f and s u p p l i e s . 3.2.4 Market A b e l E n t e r p r i s e s ' main a c t i v i t y i s making f u r n i t u r e and s p e c i a l t y p r o d u c t s f o r p e o p l e w i t h p h y s i c a l d i s a b i l i t i e s ; t h r o u g h n e t w o r k i n g w i t h v a r i o u s a g e n c i e s , A b e l has d e v e l o p e d a market l o c a l l y i n t h e Simcoe a r e a , as w e l l as i n T o r o n t o . A b e l has s u p p l i e d f u r n i t u r e f o r a number o f h o s t e l s i n T o r o n t o . When A-Way E x p r e s s C o u r i e r s began o p e r a t i o n s i n 1987, most o f i t s c l i e n t base came from t h e p u b l i c and v o l u n t a r y s e c t o r , i n c l u d i n g s o c i a l a g e n c i e s , p r o v i n c i a l m i n i s t r i e s , s e v e r a l m u n i c i p a l l e v e l d epartments, s e v e r a l c o o p e r a t i v e b u s i n e s s e s , and some o f To r o n t o ' s major h e a l t h s e r v i c e s . From an i n i t i a l c l i e n t base o f 15, A-Way had 190 c l i e n t s w i t h i n a y e a r . A-Way members q u i c k l y r e a l i z e d however, t h a t i f t h e b u s i n e s s was t o t r y t o break even, t h e y would need t o expand i t s c l i e n t base. Towards t h i s end, A-Way has been a t t e m p t i n g t o move i n t o t he c o r p o r a t e market. As o f J a n u a r y 1993, A-Way had 8 00 customer a c c o u n t s , and i s making p l a n s t o h i r e more c o u r i e r s and f u r t h e r expand i t s c l i e n t base. The m a j o r i t y o f F r e s h S t a r t ' s c o n t r a c t s come from s o c i a l s e r v i c e p r o v i d e r s ; i n some c a s e s , F r e s h S t a r t has o b t a i n e d c l e a n i n g c o n t r a c t s f o r s o c i a l s e r v i c e a g e n c i e s by a g r e e i n g t o h i r e the consumers o f t h a t p a r t i c u l a r s e r v i c e t o work a t t h a t s i t e . These r e s u l t s show t h a t CSRB's s t a r t i n g o p e r a t i o n s s h o u l d t a r g e t s o c i a l s e r v i c e a g e n c i e s , p a r t i c u l a r l y t h o s e t h a t d e a l w i t h c o n s u m e r / s u r v i v o r s ; a t some p o i n t , however, e x p a n s i o n beyond t h e p u b l i c and v o l u n t a r y s e c t o r s may be n e c e s s a r y t o make t h e b u s i n e s s more f i n a n c i a l l y v i a b l e . Such e x p a n s i o n may a l s o p r o ve b e n e f i c i a l , as f a r as h e l p i n g t o c o u n t e r t h e s t i g m a a s s o c i a t e d w i t h c o n s u m e r / s u r v i v o r s i n the l a r g e r community. 4.0 Consumer/Survivor-Run B u s i n e s s e s : Lessons t o be L e a r n e d From t h e c o n t e x t c h a p t e r , from t h e e x p e r i e n c e s d e s c r i b e d i n t h e examples, and from o t h e r r e s e a r c h on c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s , i s s u e s o f r e l e v a n c e t o t h e s e i n i t i a t i v e s w i l l be d i s c u s s e d . These w i l l be d i v i d e d i n t o c o n s t r a i n t s and o p p o r t u n i t i e s f a c i n g CSRB's. 4.1 C o n s t r a i n t s f a c i n g CSRB's 4.1.1 B u r e a u c r a t i c R e s t r i c t i o n s A major c o n s t r a i n t f a c i n g c o n s u m e r / s u r v i v o r s i n t e r e s t e d i n g e t t i n g back i n t o t h e w o r k f o r c e , d e s c r i b e d i n a c c o u n t s o f the e x p e r i e n c e s o f b o t h A-Way Ex p r e s s C o u r i e r s and A b e l E n t e r p r i s e s , i s t h e b u r e a u c r a t i c r e s t r i c t i o n s p l a c e d upon them. These r e s t r i c t i o n s a f f e c t a number of a r e a s . P r i n c i p a l l y , l i m i t a t i o n s p l a c e d upon the amount o f money t h a t can be earned on t o p o f s o c i a l a s s i s t a n c e payments a c t as a d i s i n c e n t i v e t o employment f o r c o n s u m e r / s u r v i v o r s . A d d i t i o n a l l y , e l i g i b i l i t y f o r h o u s i n g and m e d i c a t i o n b e n e f i t s i s o f t e n t i e d t o r e c e i p t o f s o c i a l a s s i s t a n c e ; work can p l a c e an a c t u a l ( o r p s y c h o l o g i c a l ) t h r e a t t o such n e c e s s i t i e s f o r c o n s u m e r / s u r v i v o r s as m e d i c a t i o n and s h e l t e r . To a s s e s s t h e impact b u r e a u c r a t i c r e s t r i c t i o n s have on c o n s u m e r / s u r v i v o r s who w i s h t o work, i t i s n e c e s s a r y t o p r e s e n t a b r i e f o v e r v i e w o f Canada's income s e c u r i t y programs. These programs can be d i v i d e d i n t o t h r e e c a t e g o r i e s : 1. Programs d e s i g n e d t o h e l p t h e poor: - s o c i a l a s s i s t a n c e ( t h i s i n c l u d e s w e l f a r e and v a r i o u s d i s a b i l i t y a l l o w a n c e s ) - g u a r a n t e e d income supplements ( t h e s e v a r y from p r o v i n c e t o p r o v i n c e and a r e t a r g e t e d a t s e n i o r s and t h e d i s a b l e d ) - F e d e r a l C h i l d Tax B e n e f i t 2. Programs d e s i g n e d t o p r o v i d e income i n s u r a n c e : - Unemployment I n s u r a n c e - Canada and Quebec P e n s i o n P l a n s - spouse's a l l o w a n c e 3. U n i v e r s a l E n t i t l e m e n t s , not r e l a t e d t o economic need: - O l d Age S e c u r i t y (from CMHA News, S p r i n g 1993) P e o p l e w i t h a mental i l l n e s s t h a t a r e r e c e i v i n g s u p p o r t s u s u a l l y r e c e i v e s o c i a l a s s i s t a n c e , e i t h e r w e l f a r e o r a d i s a b i l i t y a l l o w a n c e . C u r r e n t l y , B r i t i s h Columbia's d i s a b i l i t y a l l o w a n c e p r o v i d e s a s i n g l e p e r s o n $771 a month. The p r o c e d u r e f o r d e t e r m i n i n g who i s e l i g i b l e f o r a d i s a b i l i t y a l l o w a n c e i s a cause o f much f r u s t r a t i o n f o r p e r s o n s w i t h a m ental i l l n e s s , o r w i t h o t h e r impediments. I n o r d e r t o be e l i g i b l e f o r a d i s a b i l i t y a l l o w a n c e , a p e r s o n must be d e f i n e d as e i t h e r d i s a b l e d o r p e r m a n e n t l y unemployable. I n t h e c a s e o f someone w i t h a mental i l l n e s s , t h e y may not f i t n e a t l y i n t o t h e s e c a t e g o r i e s . The n a t u r e o f many mental i l l n e s s e s i s t h a t t h e y a r e c y c l i c a l . A p e r s o n may be unemployable w h i l e t h e y a r e i l l , b u t c a p a b l e o f employment when t h e i r i l l n e s s i s i n r e m i s s i o n . The c o n c e p t o f a p e r s o n b e i n g 'permanently unemployable' does not work w e l l f o r someone w i t h a c y c l i c a l i l l n e s s (CMHA News, S p r i n g 1993). And two i n d i v i d u a l s w i t h t h e same i l l n e s s may have d i f f e r e n t l e v e l s o f d i s a b i l i t y as a r e s u l t o f t h a t i l l n e s s . As an example, we c o u l d c o n s i d e r two p e o p l e s u f f e r i n g from one o f t h e most common of m e n t a l i l l n e s s e s , manic d e p r e s s i o n . The f i r s t p e r s o n may do w e l l on m e d i c a t i o n , and have a network o f s u p p o r t s t h a t a l l o w s t h i s i n d i v i d u a l t o cope w i t h l i f e ' s s t r e s s e s . The second p e r s o n , a l s o d i a g n o s e d w i t h manic d e p r e s s i o n , may not d e a l w e l l w i t h m e d i c a t i o n , o r have an adequate network o f s u p p o r t s . T h i s second p e r s o n would be more d i s a b l e d by h e r i l l n e s s t h a n t h e f i r s t , and t h e l a b e l o f ' d i s a b l e d ' would be more a p p r o p r i a t e i n t h i s case (CMHA News, S p r i n g 1993). P e o p l e who r e c e i v e a d i s a b i l i t y a l l o w a n c e a r e c u r t a i l e d i n the amount of money t h e y can e a r n i n a d d i t i o n t o t h e i r b a s i c r a t e . I n B.C., t h e y can e a r n up t o $200 on t o p o f t h e i r b e n e f i t s w i t h o u t d e d u c t i o n ; above $200, any income i s t a x e d back a t 75% ( i . e . t h e y can keep 2 5 % ) . I n O n t a r i o , where most of Canada's e x p e r i m e n t s w i t h CSRB's e x i s t , a d i s a b i l i t y a l l o w a n c e pays $792 p e r month f o r a s i n g l e p e r s o n ; t h e y can e a r n $160 a month on t o p o f t h i s b a s i c amount; a f t e r t h i s , t h e y can keep 25% o f t h e i r e a r n i n g s . The s i t u a t i o n r e g a r d i n g b u r e a u c r a t i c r e s t r i c t i o n s has improved i n t h e p a s t few y e a r s . I n O n t a r i o , a t t h e t i m e o f Brown's 1989 a n a l y s i s , c o n s u m e r / s u r v i v o r s were o n l y a l l o w e d t o e a r n $100 on t o p of t h e i r d i s a b i l i t y p e n s i o n ; 50% o f t h e next $50 would be t a x e d back, and 100% o f a n y t h i n g earned above t h a t . C l e a r l y , t h e new r e g u l a t i o n s a r e an improvement. F o r t h o s e who want t o c o n t i n u e r e c e i v i n g d i s a b i l i t y a l l o w a n c e s , e a r n i n g a s m a l l top-up may be adequate, but i t doesn't p r o v i d e much i n c e n t i v e t o t h o s e who want t o work more and d e v e l o p a g r e a t e r l e v e l o f independence. Of g r e a t e r c o n c e r n t o t h o s e w o r k i n g i n CSRB's i s t h e p o s s i b i l i t y o f b e i n g c u t o f f from f i n a n c i a l a s s i s t a n c e a l t o g e t h e r i f t h e y work more ho u r s . Not o n l y does t h i s p l a c e t h e i n d i v i d u a l i n a d i f f i c u l t p o s i t i o n i f t h e y s u f f e r a r e l a p s e o f t h e i r i l l n e s s and need t o d i s c o n t i n u e w o r k i n g , i t a l s o p l a c e s o t h e r b e n e f i t s a t r i s k . S o c i a l h o u s i n g i s o f t e n dependent on r e c e i p t o f s o c i a l a s s i s t a n c e ; i f t h e i n d i v i d u a l i s c u t o f f , t h e y may be i n e l i g i b l e f o r such h o u s i n g . Inadequate h o u s i n g i s an i s s u e t h a t many p s y c h i a t r i c a l l y d i s a b l e d have t o d e a l w i t h ; f r e q u e n t l y , i n a d e q u a t e h o u s i n g can l e a d t o t h e r e l a p s e o f i l l n e s s . L i k e w i s e , m e d i c a t i o n b e n e f i t s a r e o f t e n t i e d t o s o c i a l a s s i s t a n c e ; w i t h o u t t h e s e b e n e f i t s , i n d i v i d u a l s may not be a b l e t o a f f o r d t h e i r o f t e n c o s t l y m e d i c a t i o n s . Without m e d i c a t i o n , t h e s e p e o p l e w i l l l i k e l y end up back i n h o s p i t a l (Brown, 1989). A d d r e s s i n g t h i s c o n s t r a i n t Brown n o t e s t h a t A-Way workers and s o c i a l s e r v i c e agency p e r s o n n e l e x p r e s s e d a d e s i r e t o see more f l e x i b l e e l i g i b i l i t y c r i t e r i a and a c c e s s t o extended b e n e f i t s f o r p s y c h i a t r i c a l l y d i s a b l e d i n d i v i d u a l s who a r e a t t e m p t i n g t o r e - e n t e r t h e w o r k f o r c e . F u r t h e r m o r e , p o l i c i e s t h a t g u a r a n t e e d s o c i a l h o u s i n g , m e d i c a t i o n b e n e f i t s , and immediate s o c i a l a s s i s t a n c e upon j o b l o s s would a c t t o s u p p o r t t h e p s y c h i a t r i c a l l y d i s a b l e d i n d i v i d u a l w h i l e t r y i n g t o i n c r e a s e t h e i r l e v e l o f independence. 4.1.2 A t t i t u d e s o f t h e G e n e r a l P u b l i c Towards Co n s u m e r / S u r v i v o r s An i s s u e i d e n t i f i e d i n t h e r e v i e w o f l i t e r a t u r e r e g a r d i n g v o c a t i o n a l r e h a b i l i t a t i o n i s the a t t i t u d e s t h a t t h e g e n e r a l p u b l i c has r e g a r d i n g c o n s u m e r / s u r v i v o r s (Cochrane e t a l . , 1992). The i m p o r t a n t p o i n t i s t h a t i t i s not o n l y t h e e f f e c t s o f p s y c h i a t r i c d i s a b i l i t i e s t h a t i m p a i r f u n c t i o n i n g i n s o c i e t y ; t h e s t i g m a a s s o c i a t e d w i t h such p s y c h i a t r i c c o n d i t i o n s a l s o i m p a i r s the f u n c t i o n i n g o f c o n s u m e r / s u r v i v o r s . Cochrane e t a l . p r e s e n t the f o l l o w i n g d e f i n i t i o n f o r s t i g m a : S t i g m a i s any a t t r i b u t e w h i c h d e e p l y d i s c r e d i t s and l o w e r s t h e s t a t u s o f an i n d i v i d u a l once he i s known t o p o s s e s s t h i s a t t r i b u t e . ( p.10 ) The l i t e r a t u r e r e v i e w e d s u g g e s t s t h a t w h i l e t h e l e v e l o f p u b l i c knowledge r e g a r d i n g m ental i l l n e s s has improved, a t t i t u d e s toward t h e s e p e o p l e remain ' r a t h e r r e j e c t i n g i n n a t u r e ' . Cochrane e t a l . (1992) s t a t e t h a t employers' r e a c t i o n toward t h i s p o p u l a t i o n t e n d t o r e f l e c t t h a t o f t h e g e n e r a l p u b l i c ; w h i l e employers may not e x p r e s s any r e l u c t a n c e t o h i r e p s y c h i a t r i c a l l y d i s a b l e d i n d i v i d u a l s when q u e s t i o n e d , i n r e a l i t y , i t would seem t h a t t h e y a r e r e l u c t a n t t o h i r e t h e s e i n d i v i d u a l s . Cochrane e t a l . summarize the problems t h a t f a c e p s y c h i a t r i c a l l y d i s a b l e d p e o p l e w i t h r e g a r d s t o s e e k i n g employment : 1. S o c i e t a l a t t i t u d e s toward the m e n t a l l y i l l , i n t e r n a l i z e d by p a t i e n t s , r e s u l t i n an e x p e c t a t i o n o f r e j e c t i o n , and l o w e r e d s e l f -image and s e l f - e s t e e m . Such f a c t o r s l e a d t o an u n w i l l i n g n e s s t o seek out s o c i a l c o n t a c t s ; 2. The b e h a v i o u r a l symptoms o f t h e d i s e a s e , w h i c h s e t t h e i n d i v i d u a l a p a r t , l e a d s t o e x p e c t a t i o n s by b o t h t h e employer and th e e x - p a t i e n t o f an i m p a i r e d a b i l i t y t o f u n c t i o n i n a c o m p e t i t i v e employment ; 3. D i s c r i m i n a t i o n by p o t e n t i a l employers and co-workers (Cochrane e t a l . , 1992) D e s p i t e t h e s e f i n d i n g s , t h e c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s d e s c r i b e d have g e n e r a l l y found a c c e p t a n c e i n t h e i r communities. A-Way E x p r e s s C o u r i e r s began by t a r g e t i n g s o c i a l s e r v i c e a g e n c i e s , p a r t i c u l a r l y t h o s e t h a t d e a l t w i t h c o n s u m e r / s u r v i v o r s . W h i l e some o f t h e s e a g e n c i e s d i d use A-Way's s e r v i c e , many d i d n o t . Brown (1989) a t t r i b u t e s t h i s t o c e r t a i n a g e n c i e s m a i n t a i n i n g a v i e w t h a t c o n s u m e r / s u r v i v o r s were not r e a l l y t o be t r u s t e d , t h a t the l e v e l o f r e s p o n s i b i l i t y i n v o l v e d i n t h e o p e r a t i o n o f t h i s b u s i n e s s was t o o much. When A-Way began t o expand and approached a c o r p o r a t e c l i e n t e l e , t h e y g e n e r a l l y found a c c e p t a n c e . Media r e s p o n s e t o the p r o j e c t has been f a v o u r a b l e , i n c l u d i n g a r t i c l e s i n t h e Globe and M a i l and The F i n a n c i a l P o s t , media o u t l e t s g e n e r a l l y thought t o be ' c o n s e r v a t i v e ' . One o f t h e a t t r a c t i o n s o f CED i n t e r v e n t i o n s t o many t h e o r i s t s i s t h a t i t seems t o b r i d g e the o l d debate o f ' l e f t ' v e r s u s ' r i g h t ' . W h i l e i t s a t t r a c t i o n t o tho s e who r e s o n a t e t o ' l e f t - l e a n i n g ' causes i s f a i r l y o b v i o u s -- i t s emphasis on s o c i a l j u s t i c e f o r m a r g i n a l i z e d groups i n s o c i e t y -- t h e r e i s much i n CED t h a t a l s o i s a t t r a c t i v e t o t h o s e o f the ' r i g h t ' ; t h e f a c t t h a t i t i s p r e s e n t e d as a non-governmental i n t e r v e n t i o n ; t h a t i t emphasizes p e r s o n a l i n i t i a t i v e and r e s p o n s i b i l i t y ; and t h a t i t v a l u e s m a r k e t - o r i e n t e d means o f c a p i t a l a c c u m u l a t i o n , a l b e i t f o r s o c i a l p u r p o s e s . As such, i t would seem t h a t CSRB's have t h e o p p o r t u n i t y t o g a i n mainstream s u p p o r t from t h e g e n e r a l p u b l i c , not o n l y from t h o s e of one i d e o l o g i c a l s t r i p e . F urthermore, t h e e x p e r i e n c e o f t h e CSRB's d e s c r i b e d would seem t o suggest t h a t t h e tendency t o s t i g m a t i z e c o n s u m e r / s u r v i v o r s i s overcome by t h e g e n e r a l p u b l i c ' s good w i l l t owards a l t e r n a t i v e p r o j e c t s . A b e l E n t e r p r i s e s o p e r a t e s i n a v e r y d i f f e r e n t s e t t i n g t h a n A-Way. Where A-Way e x i s t s i n M e t r o p o l i t a n T o r o n t o , A b e l e x i s t s i n a s m a l l e r community (Simcoe, O n t a r i o ) , i n a m a i n l y r u r a l a r e a . One may t h i n k t h a t s m a l l e r communities might p r e s e n t g r e a t e r b a r r i e r s t o t h e development o f CSRB's -- t h e p o p u l a t i o n o f c o n s u m e r / s u r v i v o r s i s s m a l l e r , and t h e p e r c e p t i o n t h a t s m a l l communities would be more l i k e l y t o s t i g m a t i z e a p o p u l a t i o n t h a t i s ' d i f f e r e n t ' . Y e t , i t would appear t h a t A b e l E n t e r p r i s e s has been a c c e p t e d i n t h i s community. Mary T a y l o r , A b e l ' s program d i r e c t o r , o v e r A b e l ' s 11-year h i s t o r y has made ong o i n g e f f o r t s t o f i n d l o c a l p e o p l e i n t e r e s t e d i n becoming i n v o l v e d i n A b e l E n t e r p r i s e s -- l o c a l b u s i n e s s p e r s o n s , c h u r c h g r o u p s , town o f f i c i a l s , s e r v i c e g r o u p s , and i n d i v i d u a l c i t i z e n s . When A b e l was f i r s t s t a r t i n g up, t h e l e a d e r s o f Simcoe's c h u r c h e s responded by announcing i t s s e r v i c e s from t h e i r p u l p i t s . When i n need o f space f o r a d r o p - i n c e n t r e , t h e l o c a l P r e s b y t e r i a n c h u r c h p r o v i d e d i t s basement. I n t e r a c t i o n between A b e l members and th e c h u r c h c o n g r e g a t i o n a l s o f o s t e r e d u n d e r s t a n d i n g o f c o n s u m e r / s u r v i v o r s and more c o n t a c t w i t h t h e community. A b e l E n t e r p r i s e s has a l s o e s t a b l i s h e d a r e l a t i o n s h i p w i t h Fanshawe C o l l e g e ; t h e c o l l e g e has, i n t h e p a s t , p r o v i d e d t h e c o o p e r a t i v e w i t h workshop space, and has p r o v i d e d c o o p e r a t i v e members w i t h a c c e s s t o c o l l e g e c o u r s e s . A b e l E n t e r p r i s e s has p r o v i d e d p r o d u c t s needed by t h e community. O v e r a l l , A b e l has had a v e r y p o s i t i v e r e l a t i o n s h i p w i t h t h e s u r r o u n d i n g community. I n ' C r o s s i n g t h e R i v e r ' , Schwartz comments on t h e b e n e f i t s t o t h e d i s a b l e d o f l i v i n g i n t h e community, and h a v i n g r e l a t i o n s h i p s i n t h e community which a r e not o f t h e c o n t r a c t u a l t y p e , as i n the p r o f e s s i o n a l o r b u r e a u c r a t i c w o r l d , but a r e o f t h e a s s o c i a t i o n a l v a r i e t y o f t h e everyday w o r l d . Such r e l a t i o n s h i p s w i l l have a b e n e f i c i a l impact not o n l y on the d i s a b l e d , but a l s o w i l l have a p o s i t i v e e f f e c t on t h e a t t i t u d e s towards t h e d i s a b l e d h e l d by the g e n e r a l p u b l i c . W h i l e t h e a t t i t u d e s o f t h e g e n e r a l p u b l i c may have an impact on t h e c o n s u m e r / s u r v i v o r who t r i e s t o e x i s t i n t h e community, p r o j e c t s s uch as CSRB's can a c t t o make l i f e i n t h e community e a s i e r ; t h e s e p r o j e c t s have the o p p o r t u n i t y t o p r o v i d e a p l a c e o f b e l o n g i n g , a r e a s o n t o t h i n k o f e x i s t e n c e as m e a n i n g f u l . I n t h i s way, we can see CSRB's t r u l y as a m e d i a t i n g s t r u c t u r e , an i n t e r m e d i a r y between t h e i m p e r s o n a l i t y o f l a r g e i n s t i t u t i o n s and the l i f e o f t h e i n d i v i d u a l . And i n a d d i t i o n , CSRB's a l s o w i l l be more l i k e l y t o g a i n t h e t r u s t o f t h o s e i n t h e community, t h a n t h e i n d i v i d u a l j u s t r e l e a s e d from t h e i n s t i t u t i o n , o r the i m p e r s o n a l government-run s o c i a l s e r v i c e agency. 4.1.3 A t t i t u d e s o f M e n t a l H e a l t h P r o f e s s i o n a l s ; The S e r v i c e Paradigm A number o f b a r r i e r s t o CSRB's a r i s e from t h e a t t i t u d e s o f m e n t a l h e a l t h p r o f e s s i o n a l s t h e m s e l v e s . As Cochrane e t a l . p o i n t o u t , not a l l me n t a l h e a l t h p r o f e s s i o n a l s agree t h a t work i s a n e c e s s a r y p a r t o f t h e r e h a b i l i t a t i v e p r o c e s s . Even where t h e r e i s agreement on the n e c e s s i t y o f work, t h e r e i s o f t e n disagreement on where i n t h e r e h a b i l i t a t i v e p r o c e s s i t s h o u l d t a k e p l a c e . Must t h e p a t i e n t o b t a i n work t o g e t w e l l ? Or must t h e p a t i e n t be w e l l b e f o r e she can work? T h i s i s s t i l l a c o n t e n t i o u s debate (Cochrane e t a l . , 1992). And, as d e s c r i b e d i n the s e c t i o n on mental h e a l t h p o l i c y , i n c r e a s i n g l y t h e r e i s debate upon t h e l i m i t a t i o n s o f f o r m a l s e r v i c e s and t h e p o t e n t i a l b e n e f i t s o f n o n - s e r v i c e approaches, and by e x t e n s i o n , the r o l e o f mental h e a l t h p r o f e s s i o n a l s . The e x c l u s i v e f o c u s on s e r v i c e i n mental h e a l t h p o l i c y has been termed t h e s e r v i c e paradigm. Brown s u g g e s t s t h a t A-Way E x p r e s s C o u r i e r s was c o m p e l l e d t o change t h e emphasis o f the p r o j e c t from t h a t o f a c o m p e t i t i v e b u s i n e s s t o a t h e r a p e u t i c s e t t i n g because o f p r e v a i l i n g a t t i t u d e s towards t h e p s y c h i a t r i c a l l y d i s a b l e d . I n i t s f i r s t y e a r o f o p e r a t i o n , A-Way h a v i n g r e c e i v e d an i n i t i a l g r a n t o f $45,000, had t o ask f o r an a d d i t i o n a l $44,000 from t h e M i n i s t r y o f H e a l t h t o c o n t i n u e o p e r a t i o n s i n i t s f i r s t y e a r . T h i s u n e x p e c t e d r e q u e s t was due t o an o v e r l y o p t i m i s t i c revenue f o r e c a s t , and s p e n d i n g money t o buy w a l k i e - t a l k i e ' s f o r c o u r i e r s ; had t h e w a l k i e - t a l k i e ' s been r e n t e d , t h e r e would not have been t h e s h o r t f a l l . W h i l e t h i s s h o r t f a l l was due t o management d e c i s i o n s . M i n i s t r y o f f i c i a l s demanded t h a t A-Way be c o n v e r t e d from a worker c o o p e r a t i v e t o a n o n - p r o f i t b u s i n e s s ; i n e f f e c t , making A-Way members pay f o r d e c i s i o n s made by t h e Board o f D i r e c t o r s . Brown (1989) argues t h a t t h e a c t i o n s o f t h e M i n i s t r y were r e f l e c t i v e o f a p r e v a i l i n g a t t i t u d e t h a t the p s y c h i a t r i c a l l y d i s a b l e d have a low c a p a b i l i t y . Brown s t a t e s t h a t t h e r e was l i t t l e a p p r e c i a t i o n o f t h e b e n e f i t s o f s e l f - h e l p , and M i n i s t r y o f H e a l t h s t a f f d i d not f u l l y u n d e r s t a n d t h e n a t u r e o f the p r o j e c t (Brown, 1989). I t s h o u l d be n o t e d t h a t t h e s e e v e n t s o c c u r r e d b e f o r e the C o n s u m e r / S u r v i v o r Development I n i t i a t i v e (CSDI) was implemented; t h e i m p l e m e n t a t i o n o f CSDI would i n d i c a t e a newfound r e s p e c t f o r s e l f - h e l p and mutual a i d i n i t i a t i v e s . CSDI was e n a c t e d by O n t a r i o ' s NDP government, e l e c t e d i n t h e f a l l o f 1990; A-Way's d i f f i c u l t i e s w i t h t h e M i n i s t r y o f H e a l t h o c c u r r e d d u r i n g t h e term of t h e p r e c e d i n g L i b e r a l government. Brown c i t e s Ogionwo (1981), who s t a t e s t h a t t h e p s y c h i a t r i c a l l y d i s a b l e d come t o v i e w themselves as t h e p e o p l e t h e y i n t e r a c t w i t h v i e w them; i n p a r t i c u l a r , m ental h e a l t h p r o f e s s i o n a l s . Viewed as dependent, d i s a b l e d , and i n f e r i o r by p r o f e s s i o n a l s , t h i s p o p u l a t i o n i n t e r n a l i z e s t h e s e v i e w s , and a r e l e s s l i k e l y t o t a k e r i s k s , o r b e l i e v e i n t h e m s e l v e s . The e x p e r i e n c e o f A b e l E n t e r p r i s e s has been somewhat d i f f e r e n t t h a n A-Way's ; A b e l has been a b l e t o d e v e l o p independence from p r o f e s s i o n a l i n t e r f e r e n c e . A t e l l i n g example o f t h i s r e g a r d s A b e l ' s d r o p - i n c e n t r e . The d r o p - i n c e n t r e a s s o c i a t e d w i t h A b e l E n t e r p r i s e s p l a y s an i m p o r t a n t r o l e i n m a i n t a i n i n g a sense of community a t t h e c o o p e r a t i v e . O r i g i n a l l y , t h e d r o p - i n c e n t r e was l o c a t e d i n t h e A d u l t M e n t a l H e a l t h S e r v i c e s C l i n i c o f Haldimand - N o r f o l k . T h i s i s t h e same agency t h a t p l a y e d a f o u n d i n g r o l e i n t h e development o f A b e l E n t e r p r i s e s , by a s s e s s i n g t h e needs of c o n s u m e r / s u r v i v o r s i n Haldimand and N o r f o l k c o u n t i e s , and by b r i n g i n g i n a community d e v e l o p e r t o h e l p s t a r t up t h e c o - o p e r a t i v e . But A b e l members u s i n g t h e d r o p - i n c e n t r e found t h e C l i n i c , w i t h i t s p r o f e s s i o n a l atmosphere, o p p r e s s i v e ; i t was not a p l a c e where members c o u l d f e e l c o m f o r t a b l e 'hanging o u t ' and t a l k i n g w i t h each o t h e r (CMHA, 1987). I t was d e c i d e d t o move the d r o p - i n c e n t r e ; d r a w i n g upon the c o n n e c t i o n s t h a t A b e l b u i l t w i t h t h e l o c a l community, the l o c a l P r e s b y t e r i a n c h u r c h agreed t o p r o v i d e i t s basement f o r use as a d r o p - i n c e n t r e . T h i s arrangement worked u n t i l A b e l was a b l e t o f i n d a l o c a t i o n f o r a d r o p - i n c e n t r e i n a f a v o u r a b l e l o c a t i o n i n downtown Simcoe; t h i s new l o c a t i o n has been p a i d f o r by revenues of t h e c o o p e r a t i v e . T h i s s i t u a t i o n i l l u s t r a t e s how A b e l , o r i g i n a l l y a p r o j e c t o f A d u l t M e n t a l H e a l t h S e r v i c e s o f H a l d i m a n d - N o r f o i k , has i n c r e a s e d i t s independence. A b e l ' s independence from a p r o f e s s i o n a l s o c i a l s e r v i c e a p p r o a c h i s f u r t h e r e x h i b i t e d by i t s a t t i t u d e t oward s t a f f i n g ; w h i l e t h e c o o p e r a t i v e does employ 'non-consumer' s t a f f , i t makes an e f f o r t towards h i r i n g p e o p l e who have s k i l l s r e l e v a n t t o A b e l ' s b u s i n e s s a c t i v i t i e s -- a d e s i g n e r - c a b i n e t m a k e r , f i b r e g l a s s d e s i g n e r , and a l a n d s c a p e d e s i g n e r have been h i r e d t o a s s i s t t h e c o o p e r a t i v e . 4.1.4 Problems I n h e r e n t i n Developincr New S e t t i n g s Brown c i t e s S a rason (1972), who d i s c u s s e s t h e problems i n h e r e n t i n t h e development of new s e t t i n g s . S a r a s o n s t a t e s t h a t agreement upon v a l u e s and e n t h u s i a s m a r e not enough f o r the s u c c e s s f u l development of a l t e r n a t i v e s e t t i n g s (Brown, 1989). He s u g g e s t s t h a t o t h e r f a c t o r s need t o be t a k e n i n t o c o n s i d e r a t i o n . These a r e : (a) D i f f e r e n c e s i n t h e s u b s t a n t i v e knowledge o f p a r t i c i p a n t s (b) I n t r a - and i n t e r p e r s o n a l f a c t o r s (c) H i s t o r i c a l f a c t o r s , p a r t i c u l a r l y t h e dynamics of t h e e x i s t i n g system F a i l u r e t o t a k e t h e s e f a c t o r s i n t o c o n s i d e r a t i o n , Sarason s u g g e s t s , w i l l l e a d t h e c r e a t o r s o f a l t e r n a t i v e s e t t i n g s t o u n d e r e s t i m a t e t h e impediments and d i f f i c u l t i e s t h a t i n e v i t a b l y w i l l be e n c o u n t e r e d . Brown (1989) , i n h e r a n a l y s i s o f A-Way Ex p r e s s C o u r i e r s , d e v e l o p s t h e s e p o i n t s w i t h r e g a r d t o A-Way's development. D i f f e r e n c e s i n t h e s u b s t a n t i v e knowledge o f p a r t i c i p a n t s As an exp e r i m e n t unique i n N o r t h A m e r i c a , t h o s e p a r t i c i p a t i n g i n A-Way's development d i d n ' t have an example t h a t t h e y c o u l d f o l l o w . Three groups o f a c t o r s were i n v o l v e d i n A-Way's development: m e n t a l - h e a l t h p r o f e s s i o n a l s , b u s i n e s s c o n s u l t a n t s , and th e c o n s u m e r / s u r v i v o r c l i e n t s t h e m s e l v e s . Brown n o t e s t h a t m e n t a l - h e a l t h p r o f e s s i o n a l s i n v o l v e d i n A-Way were accustomed t o a p r o f e s s i o n a l environment where c l i e n t s were a s s i g n e d t o s h e l t e r e d workshops. These p r o f e s s i o n a l s had l i t t l e e x p e r i e n c e i n im p l e m e n t i n g more c o m p e t i t i v e s e t t i n g s f o r t h e p s y c h i a t r i c a l l y d i s a b l e d . I n the terms used i n t h e c o n t e x t c h a p t e r o f t h i s t h e s i s , t h e s e p r o f e s s i o n a l s were g u i d e d by what McKnight would c a l l a t h e r a p e u t i c v i s i o n . The b u s i n e s s c o n s u l t a n t s , w h i l e h a v i n g had s u b s t a n t i a l e x p e r i e n c e i n d e v e l o p i n g c o - o p e r a t i v e b u s i n e s s e s , had l i t t l e e x p e r i e n c e w o r k i n g w i t h p s y c h i a t r i c p a t i e n t s . The c l i e n t s t h e m s e l v e s were engaged i n t r y i n g t o l e a r n about t h e o p e r a t i o n o f c o - o p e r a t i v e b u s i n e s s e s . A c c o r d i n g t o Brown, t h e y were making p r o g r e s s i n t h i s a r e a (Brown, 1989) . Members o f t h e Bo a r d o f t h e Community Development C o r p o r a t i o n , were l e s s i n c l i n e d t o l e a r n about c o - o p e r a t i v e e n t r e p r e n e u r s h i p ; t h e Board had become i n c r e a s i n g l y dominated by s o c i a l s e r v i c e p r o f e s s i o n a l s whose i n c l i n a t i o n s were a l s o toward a t h e r a p e u t i c v i s i o n . The c o n s u m e r / s u r v i v o r c l i e n t s t h emselves c o u l d be s a i d t o be o p e r a t i n g w i t h a community v i s i o n , where f i n d i n g a p l a c e where one b e l o n g s and i s c o n n e c t e d t o a community i s of g r e a t e r i m p o r t a n c e t o w e l l - b e i n g t h a n d e a l i n g w i t h t h e l i m i t a t i o n s imposed by t h e i r i l l n e s s and e x p e r i e n c e s . I n t r a - and I n t e r p e r s o n a l f a c t o r s Brown (1989) d i s c u s s e s how the d i f f e r i n g m o t i v e s of the v a r i o u s a c t o r s i n v o l v e d a f f e c t t h e development o f a l t e r n a t i v e s e t t i n g s . M e n t a l h e a l t h p r o f e s s i o n a l s , whose a r t i c u l a t e d motive would be h e l p i n g t h e i r c l i e n t s , l i k e l y a l s o have o t h e r m o t i v e s , namely c a r e e r advancement. B e h a v i o u r t h a t i s q u e s t i o n i n g o f the i n a d e q u a c i e s o f t h e e x i s t i n g mental h e a l t h system w i l l l i k e l y have p r o f e s s i o n a l r a m i f i c a t i o n s (Brown, 1989). Community d e v e l o p e r s i n v o l v e d i n development o f a l t e r n a t i v e s e t t i n g s have t h e i r own p e r s p e c t i v e s and i d e o l o g i e s . Concerned p r i m a r i l y w i t h s o c i a l change, t h e y may not be s e n s i t i v e t o the l i m i t a t i o n s p l a c e d on mental h e a l t h p r o f e s s i o n a l s , and may have u n r e a l i s t i c e x p e c t a t i o n s w i t h r e g a r d s t o what can be a c c o m p l i s h e d (Brown, 1989). C o n s u m e r / s u r v i v o r s may p e r c e i v e t h e m s e l v e s t o be p o w e r l e s s t o t a k e c o n t r o l o f t h e i r s i t u a t i o n . Accustomed t o s o c i a l a s s i s t a n c e , and dependent upon agency s t a f f , t h e development of a l t e r n a t i v e s e t t i n g s t h a t b e t t e r s u i t t h e i r needs may seem an u n r e a l i s t i c dream. Brown, i n h e r s t u d y o f A-Way E x p r e s s C o u r i e r s , a s s e r t s t h a t t h e f a i l u r e t o acknowledge the d i f f e r e n t p e r s p e c t i v e s o f t h o s e i n v o l v e d had an n e g a t i v e e f f e c t on t h e p r o j e c t ' s c o u r s e . H i s t o r i c a l f a c t o r s A n o t h e r problem i n h e r e n t t o the development o f a l t e r n a t i v e s e t t i n g s may be termed ' h i s t o r i c a l f a c t o r s ' (Sarason, 1972). Though d e v e l o p e d i n response t o t h e p e r c e i v e d i n a d e q u a c i e s of e x i s t i n g s e t t i n g s , t h e a l t e r n a t i v e s e t t i n g becomes a p a r t o f t h e e x i s t i n g system t h a t i t c r i t i q u e s . The a l t e r n a t i v e s e t t i n g w i l l o f t e n r e t a i n some o f t h e h i s t o r y , t r a d i t i o n , and p h i l o s o p h y o f more e s t a b l i s h e d s e t t i n g s . Brown n o t e s t h a t A-Way was c o n c e i v e d as a r a d i c a l a l t e r n a t i v e t o t h e e x i s t i n g v o c a t i o n a l r e h a b i l i t a t i o n system. A-Way was s t r u c t u r e d so as t o p r o v i d e t h e independence and f l e x i b i l i t y i n w o r k i n g h o u r s t h a t t h e c o n s u m e r / s u r v i v o r members f e l t t h e y needed. O r g a n i z e d as a worker c o - o p e r a t i v e , f u l l c o n t r o l o f t h e e n t e r p r i s e was t o pa s s t o t h e members o v e r a f i v e - y e a r p e r i o d . A-Way's e x i s t e n c e i n a mental h e a l t h system c h a r a c t e r i z e d by a b i a s o f c l i e n t incompetence had i m p l i c a t i o n s on i t s development. A l s o o f r e l e v a n c e was the f a c t t h a t A-Way was f o r c e d t o compete f o r funds w i t h more e s t a b l i s h e d programs. When f i n a n c i a l d i f f i c u l t i e s a r o s e , f u n d i n g a g e n c i e s assumed t h a t t h e cause was t h e slowness o f members, and t h e awkwardness o f t h e c o o p e r a t i v e s t r u c t u r e . Members of t h e b o a r d o f the Community Development C o r p o r a t i o n d e c i d e d t o j e t t i s o n t h e worker c o - o p e r a t i v e s t r u c t u r e i n f a v o u r o f a non-p r o f i t b u s i n e s s s t r u c t u r e . W h i l e members now make up h a l f t h e b o a r d membership, and a f l e x i b l e and s e n s i t i v e w o r k i n g environment has been m a i n t a i n e d , the o r i g i n a l worker c o o p e r a t i v e s t r u c t u r e has been abandoned. 4.1.5 D i f f i c u l t i e s I n h e r e n t i n the O p e r a t i o n o f C o o p e r a t i v e s T h i s c o n s t r a i n t r e l a t e s t o o b s t a c l e s t o t h e e f f e c t i v e f u n c t i o n i n g o f d e m o c r a t i c w o r k p l a c e s , and i n p a r t i c u l a r , o b s t a c l e s r e l a t i n g t o the i n v o l v e m e n t o f c o n s u m e r / s u r v i v o r s i n such w o r k p l a c e s . Gamson and L e v i n (1984) i d e n t i f y t h r e e common o r g a n i z a t i o n a l o b s t a c l e s t o t h e e f f e c t i v e f u n c t i o n i n g o f d e m o c r a t i c a l l y managed w o r k p l a c e s . These a r e ( i ) the l a c k o f a common c u l t u r e , o r s o c i a l c o n t r a c t , t h a t c r e a t e s a w i d e l y a c c e p t e d s e t o f v a l u e s w h i c h g u i d e b e h a v i o u r i n t h e e n t e r p r i s e ; ( i i ) an i n a p p r o p r i a t e m i x t u r e o f s k i l l s f o r t h e needs of the e n t e r p r i s e ; and ( i i i ) a l a c k o f d e m o c r a t i c norms f o r d e c i s i o n - m a k i n g . The f i r s t o b s t a c l e r e l a t e s t o the o b s e r v a t i o n t h a t most p e o p l e a r e a t t r a c t e d t o d e m o c r a t i c w o r k p l a c e s because of an a v e r s i o n t o t h e c u l t u r e o f the t r a d i t i o n a l w o r k p l a c e , w i t h i t s elements o f a u t h o r i t a r i a n i s m and c o n t r o l (Gamson & L e v i n , 1984). W h i l e t h e y may be i n agreement r e g a r d i n g what t h e s e w o r k p l a c e s a r e n o t , t h e y may have d i f f e r e n t i d e a s as t o what t h e y a r e . Gamson and L e v i n a s s e r t t h a t t h e s e w o r k p l a c e s need t o come t o a consensus r e g a r d i n g e x p l i c i t ways of d e a l i n g w i t h d e s t r u c t i v e members, and r e g a r d i n g t h e p o s i t i v e v a l u e s o f t h e e n t e r p r i s e . Gamson and L e v i n c a l l f o r two s t r a t e g i e s : a f o r m a l code of s o c i a l s t a t u t e s d e s c r i b i n g the r i g h t s and o b l i g a t i o n s o f w o r k e r s ; and second, a s p e c i a l emphasis on t h e t r a i n i n g o f w o r k e r s . The second o b s t a c l e , an i n a p p r o p r i a t e m i x t u r e o f s k i l l s f o r t h e needs o f t h e e n t e r p r i s e , w i l l l i k e l y be p a r t i c u l a r l y a p p l i c a b l e t o c o n s u m e r / s u r v i v o r s . Many c o n s u m e r / s u r v i v o r s have had t o drop out of t h e w o r k f o r c e because of i l l n e s s f a c t o r s . O b v i o u s l y , a p a r t i c u l a r emphasis w i l l have t o be p l a c e d on t r a i n i n g . Ward and Tremblay (1988) d e s c r i b e an i n t e n s i v e t r a i n i n g program f o r members o f A-Way E x p r e s s C o u r i e r s , when t h a t b u s i n e s s f i r s t opened. The t h i r d o b s t a c l e mentioned by Gamson and L e v i n i s t h e l a c k o f d e m o c r a t i c norms f o r d e c i s i o n - m a k i n g . They i d e n t i f y a r e a s o f c o n f l i c t r e g a r d i n g t h e e x e r c i s e o f a u t h o r i t y , o b t a i n i n g a c c o u n t a b i l i t y from members, the p r o d u c t i v e use o f c o n f l i c t , and t h e p r o d u c t i v e use o f meetings. W h i l e many p e o p l e show e n t h u s i a s m f o r t h e concept o f p a r t i c i p a t o r y s t r u c t u r e s , few i n our s o c i e t y have e x p e r i e n c e w i t h t h i s c o n c e p t . A t b e s t , we may be f a m i l i a r w i t h r e p r e s e n t a t i v e forms o f democracy. C o n s u m e r / s u r v i v o r s i n p a r t i c u l a r , may be accustomed t o h a v i n g d e c i s i o n s made f o r them by m e d i c a l o r s o c i a l s e r v i c e p e r s o n n e l . Y e t , from t h e CSRB's r e s e a r c h e d i n t h i s t h e s i s , i t appears t h a t w i t h some a s s i s t a n c e , c o n s u m e r / s u r v i v o r s have been a b l e t o f u n c t i o n i n a worker c o o p e r a t i v e . Brown (1989) i n t e r v i e w e d members o f A-Way t o t r y t o a s c e r t a i n how w e l l t h e y f u n c t i o n e d i n a worker c o o p e r a t i v e s e t t i n g . The members she i n t e r v i e w e d r e l a t e d t h e h i g h l e v e l o f worker p a r t i c i p a t i o n i n t h e c o o p e r a t i v e ' s development. She a l s o found t h a t member p a r t i c i p a t i o n and e d u c a t i o n was i m p o r t a n t t o t h o s e i n t e r v i e w e d . E a r l y i n A-Way's development, members e n l i s t e d t h e s e r v i c e s o f a b u s i n e s s - c o n s u l t i n g f i r m e x p e r i e n c e d i n d e v e l o p i n g w o r k e r c o o p e r a t i v e s . T h i s f i r m p r o v i d e d workers w i t h i n f o r m a t i o n about c o - o p e r a t i v e e n t r e p r e n e u r s h i p and o r g a n i z a t i o n a l p r o c e d u r e s (Brown, 1989). An i s s u e brought up by c r i t i c s o f worker c o o p e r a t i v e s i s t h a t t h e d e c i s i o n making p r o c e s s i s t o o l e n g t h y ; and so not c o n d u c i v e t o t h e need f o r q u i c k d e c i s i o n s made i n r e sponse t o c r i s e s o r o p p o r t u n i t i e s (Gamson & L e v i n , 1984). Gamson and L e v i n p o i n t out t h a t t h i s i s s u e r e f l e c t s a m i s u n d e r s t a n d i n g o f the scope of d e m o c r a t i c d e c i s i o n making: t y p i c a l l y t h e membership i s c o n s u l t e d on i s s u e s o f b r o a d p o l i c y , r a t h e r t h a n day-to-day management. 4.1.6 The D r i f t Towards P r o f e s s i o n a l i s m R e l a t e d t o t h e problems i n h e r e n t i n d e v e l o p i n g new s e t t i n g s d e s c r i b e d i n t h e p r e v i o u s s e c t i o n , i s what Schwartz c a l l s the d r i f t t owards p r o f e s s i o n a l i s m . The d i f f e r e n c e s i n s u b s t a n t i v e knowledge and i n m o t i v e s o f the v a r i o u s p a r t i c i p a n t s , and the i n s t i t u t i o n a l c o n t e x t t h e a l t e r n a t i v e s e t t i n g s l a n d i n t o , w i l l t e n d t o draw t h e new s e t t i n g towards e s t a b l i s h e d ways o f o p e r a t i n g . Our s o c i e t y ' s b i a s towards p r o f e s s i o n a l i s m i s l a r g e l y u n c o n s c i o u s , and p ervades our c o n c e p t i o n s about how we s h o u l d h e l p o t h e r s . Such a b i a s w i l l have an impact upon new s e t t i n g s , p a r t i c u l a r l y i f t h e y a r e e x p e r i e n c i n g t h e c o n f l i c t s d e s c r i b e d i n the p r e v i o u s s e c t i o n . W i t h o u t an awareness o f t h i s t r e n d , t h i s p e r v a s i v e b e l i e f system w i l l come t o d i s p l a c e a l t e r n a t i v e and community p r a c t i c e s (Schwartz, 1992) . When A-Way E x p r e s s C o u r i e r s r a n i n t o f i n a n c i a l d i f f i c u l t i e s i n i t s f i r s t y e a r of o p e r a t i o n , t h e response from Board members was t o suspend t h e p l a n t o d e v e l o p a worker c o - o p e r a t i v e ( a d m i t t e d l y a t government p r e s s u r e t o do s o ) , and d e v e l o p a somewhat more commonplace model, a n o n - p r o f i t community b u s i n e s s . W h i l e s t i l l a w o r t h w h i l e v e n t u r e , one t h a t p r o v i d e s employment and a l e v e l o f s t a b i l i t y t o i t s members t h a t t h e y would not o t h e r w i s e have had, t h e d r i f t towards p r o f e s s i o n a l i s m t h a t Schwartz d e s c r i b e s i s e v i d e n t . A b e l E n t e r p r i s e s e x p e r i e n c e has been d i f f e r e n t , l i k e l y f o r a number o f r e a s o n s -- i t s s m a l l s c a l e n a t u r e ( i t d i d n ' t g e t i n v o l v e d i n t h e l e v e l o f c a p i t a l o u t l a y t h a t A-Way d i d , and so d i d not get i n t o t r o u b l e f i n a n c i a l l y ) , and i t s s t r o n g c o n n e c t i o n s t o t h e l o c a l community. I n t h e f o l l o w i n g quote, Schwartz d e s c r i b e s t h e need f o r v i g i l a n c e r e g a r d i n g t h e tendency towards d r i f t . t h e t a s k o f p e o p l e t r y i n g t o do t h i s work, t h e n , i s not o n l y t o r e d i s c o v e r community, but t o f i n d ways t o c o u n t e r t h e t e n d e n c y t o d r i f t towards p r o f e s s i o n a l i z a t i o n . . . . t o do o t h e r w i s e i s t o l o s e one's way (Schwartz, 1992) S chwartz l i s t s a number o f ways t o d e a l w i t h t h e d r i f t towards p r o f e s s i o n a l i s m . He s u g g e s t s t h a t p r o j e c t s s h o u l d not t r y t o s u r v i v e i n i s o l a t i o n ; n e t w o r k i n g between p r o j e c t s i s a good way t o f o s t e r m u t ual s u p p o r t and a v o i d i n g d r i f t . N e t w o r k i n g may o c c u r on a f o r m a l o r i n f o r m a l l e v e l . Examples of f o r m a l s u p p o r t networks a r e the P r o v i n c i a l C o nsumer/Survivor B u s i n e s s C o u n c i l ( O n t a r i o ) and t h e T o r o n t o Community Economic Development Network. L e a d e r s h i p and e d u c a t i o n a l development programs t h a t p r o v i d e s k i l l s t o c o n s u m e r / s u r v i v o r s , a l l o w i n g them t o t a k e on g r e a t e r r e s p o n s i b i l i t i e s , w i l l a l s o c o u n t e r t h e tendency toward d r i f t . P r o j e c t r e v i e w mechanisms may a l s o p l a y a r o l e , p r o v i d e d t h a t t h e y do not f o c u s s o l e l y on whether o r not t h e p r o j e c t i s making money. As T r a i n o r and Tremblay p o i n t o u t , CSRB's cannot be e x p e c t e d t o have the same economic e f f i c i e n c y as o t h e r b u s i n e s s e s . A f u n d i n g s t r u c t u r e , such as O n t a r i o ' s C onsumer/Survivor Development I n i t i a t i v e , may a c t as an i n t e r m e d i a r y between CSRB's and t h e l a r g e b u r e a u c r a c i e s o f government; Schwartz a s s e r t s t h a t s u ch s t r u c t u r e s might be n e c e s s a r y t o c u t down t h e amount of paperwork and b u r e a u c r a t i c p r o c e d u r e s t h a t s m a l l , i n f o r m a l s e t t i n g s have t o d e a l w i t h (Schwartz, 1992) . Schwartz a l s o p r o p o s e s t h a t f u n d i n g approaches be s t r u c t u r e d i n such a way t h a t t h e f u n d i n g body cannot e x e r t p r e s s u r e on t h e a l t e r n a t i v e s e t t i n g s uch t h a t a ' d r i f t towards p r o f e s s i o n a l i s m ' o c c u r s . Such p r e s s u r e was seen i n t h e example o f A-Way E x p r e s s C o u r i e r s . F i n a l l y , i f a p r o j e c t has d r i f t e d so f a r from i t s o r i g i n a l p u r p ose t h a t i t cannot be t u r n e d around, d e - f u n d i n g may be n e c e s s a r y (Schwartz, 1992). O n t a r i o ' s Consumer/Survivor Development I n i t i a t i v e (CSDI) i s an example o f a f u n d i n g approach t h a t m i n i m i z e s p r e s s u r e f o r p r o f e s s i o n a l i z a t i o n . CSDI i s an i n i t i a t i v e t h a t has a mandate f o r f u n d i n g c o n s u m e r / s u r v i v o r - d r i v e n p r o j e c t s , and r e q u i r e s t h a t p r o j e c t s , i n o r d e r t h a t t h e y be e l i g i b l e f o r f u n d i n g , have a d e m o c r a t i c , membership-driven p r o c e s s i n p l a c e . 4.2 O p p o r t u n i t i e s f o r CSRB's - Why have t h e examples s t u d i e d succeeded? D e s p i t e t h e c o n s t r a i n t s d i s c u s s e d , our p r i m a r y examples (A-Way, A b e l E n t e r p r i s e s , and F r e s h S t a r t ) have s u r v i v e d o v e r a l e n g t h of t i m e . The r e s e a r c h s u g g e s t s t h e f o l l o w i n g c h a r a c t e r i s t i c s o f t h e s e p r o j e c t s (some i n h e r e n t t o t h e model i t s e l f ) have c o n t r i b u t e d t o t h e i r s u r v i v a l . 4.2.1 Human F a c t o r s Because CSRB's have demonstrated t h e f o l l o w i n g b e n e f i t s , c o n s u m e r / s u r v i v o r s a r e m o t i v a t e d t o d e v e l o p , p a r t i c i p a t e i n , and s u p p o r t CSRB's. 1. F l e x i b l e work s c h e d u l e s : T o l e r a n c e o f m e d i c a l l y - r e l a t e d absences, p a r t - t i m e work s c h e d u l e s ( g e n e r a l l y p r e f e r r e d by c o n s u m e r / s u r v i v o r s ) , and a guarantee t h a t employment w i l l be a v a i l a b l e s h o u l d a worker's i l l n e s s f o r c e him o r h e r t o r e t u r n t o h o s p i t a l f o r a p e r i o d o f ti m e , a r e i m p o r t a n t c h a r a c t e r i s t i c s o f CSRB's. 2. S u p p o r t i v e management s t r a t e g i e s can a s s i s t c o n s u m e r / s u r v i v o r s t h r o u g h an u n d e r s t a n d i n g t h e n a t u r e o f t h e i r i l l n e s s e s , and o f f e r i n g non-judgemental s u p p o r t . 3. P a r t - t i m e work o f f e r s t h e o p p o r t u n i t y t o supplement s o c i a l a s s i s t a n c e payments. 3. Involvement w i t h a CSRB, e s p e c i a l l y g i v e n t h e s h a r i n g o f c o n t r o l o v e r d e c i s i o n s , w i l l i n c r e a s e s o c i a l i n t e r a c t i o n between c o n s u m e r / s u r v i v o r s . 4. O f t e n p o s s e s s i n g c h e c k e r e d h i s t o r i e s i n t h e w o r k f o r c e , i n t e r s p e r s e d w i t h p e r i o d s o f unemployment and h o s p i t a l i z a t i o n . CSRB's o f f e r c o n s u m e r / s u r v i v o r s t h e o p p o r t u n i t y t o c r e a t e a work h i s t o r y f o r t h e m s e l v e s . 5. Involvement w i t h CSRB's can p r o v i d e c o n s u m e r / s u r v i v o r s w i t h s k i l l s t h a t w i l l a s s i s t i n subsequent employment, s h o u l d the i n d i v i d u a l w i s h t o move on t o a g r e a t e r l e v e l o f r e s p o n s i b i l i t y . 6. Involvement w i t h a CSRB w i l l a s s i s t c o n s u m e r / s u r v i v o r s t o s t r u c t u r e t h e i r t i m e . The enjoyment o f l e i s u r e t ime i s o f t e n dependent on a sense o f accomplishment i n o t h e r a r e a s o f l i f e (Cochrane e t a l . , 1990). 7. The p r e v i o u s b e n e f i t s mentioned w i l l l i k e l y r e s u l t i n an i n c r e a s e i n s e l f - e s t e e m w h i c h w i l l be b e n e f i c i a l f o r t h e i n d i v i d u a l s ' l i f e i n g e n e r a l . (from Brown, 198 9) Support f o r t h e a s s e r t i o n t h a t i n v o l v e m e n t w i t h CSRB's w i l l have a p o s i t i v e impact on c o n s u m e r / s u r v i v o r s i s g i v e n by a s t u d y on r e c i d i v i s m ( T r a i n o r & Tremblay, 1992). The s t u d y s u r v e y e d c o n s u m e r / s u r v i v o r s i n v o l v e d i n f i v e CSRB's. These i n d i v i d u a l s were as k e d t o f i l l out a q u e s t i o n n a i r e , e l i c i t i n g i n f o r m a t i o n r e g a r d i n g f i v e a r e a s o f s e r v i c e use: ( i ) number o f days spent i n h o s p i t a l , ( i i ) number o f a d m i s s i o n s t o h o s p i t a l , ( i i i ) v i s i t s t o o u t - p a t i e n t s e r v i c e s , ( i v ) c o n t a c t s t o c r i s i s s e r v i c e s , and (v) v i s i t s t o p r i v a t e p h y s i c i a n s . Those s u r v e y e d were asked t o p r o v i d e t h i s i n f o r m a t i o n f o r e q u a l p e r i o d s , b e f o r e i n v o l v e m e n t , and a f t e r j o i n i n g t h e CSRB. I t s h o u l d be n o t e d t h a t r e c a l l b i a s i s i m p l i c i t i n t h i s method. The h y p o t h e s i s was t h a t CSRB i n v o l v e m e n t would have a p o s i t i v e e f f e c t on t h e t h r e e a r e a s of s e r v i c e use w h i c h would r e p r e s e n t t h e most s e r i o u s problems i n a p e r s o n ' s l i f e . The f i n d i n g s o f t h e s u r v e y s u p p o r t e d t h e h y p o t h e s i s : f o r number o f days i n h o s p i t a l , number o f a d m i s s i o n s t o h o s p i t a l , and c r i s i s c o n t a c t s , t h e r e was a s t a t i s t i c a l l y s i g n i f i c a n t d e c r e a s e . P r i v a t e d o c t o r v i s i t s and h o s p i t a l o u t - p a t i e n t s e r v i c e s , b o t h i n d i c a t i v e o f maintenance s u p p o r t , a l s o d e c r e a s e d , though not enough t o be s t a t i s t i c a l l y s i g n i f i c a n t ( T r a i n o r & Tremblay, 1992). These f i n d i n g s s t r e n g t h e n t h e n o t i o n t h a t c o n s u m e r / s u r v i v o r s w i l l be m o t i v a t e d t o p a r t i c i p a t e i n CSRB's. As w e l l , CSRB's a r e l i k e l y t o g a i n s u p p o r t from t h e g e n e r a l community; p e o p l e i n t e r e s t e d i n making a c o n t r i b u t i o n t o t h e i r community w i l l l i k e l y see CSRB's as w o r t h w h i l e . Such community s u p p o r t has been p a r t i c u l a r l y b e n e f i c i a l i n the example o f A b e l E n t e r p r i s e s , which has g a i n e d b u s i n e s s o p p o r t u n i t i e s , and v a r i o u s forms o f a s s i s t a n c e from i t s community, t h a t has c o n t r i b u t e d g r e a t l y t o i t s s u c c e s s . 4.2.2 Economic F a c t o r s The r e c i d i v i s m s t u d y quoted i n t h e p r e v i o u s s e c t i o n s u g g e s t s t h a t CSRB's w i l l a l s o have a p o s i t i v e impact e c o n o m i c a l l y , i f c o n s u m e r / s u r v i v o r s i n v o l v e d w i t h CSRB's make l e s s use o f t r a d i t i o n a l m e d i c a l and s o c i a l s e r v i c e s . A l s o , t h e s e s t r u c t u r e s o p e r a t e w i t h fewer p r o f e s s i o n a l s t a f f t h a n o t h e r v o c a t i o n a l programs, and so a r e l e s s c o s t l y i n t h i s r e g a r d . Because CSRB's a r e e f f i c i e n t from a community w e l f a r e p o i n t o f vi e w , t h e y a r e a t t r a c t i v e t o government program f u n d e r s , and a t t r a c t i v e t o i n v e s t o r s i n t e r e s t e d i n w o r t h w h i l e community p r o j e c t s . 4.2.3 Br o a d Community Support To v a r y i n g d e g r e e s , t h e examples s t u d i e d have g e n e r a t e d b r o a d community s u p p o r t , beyond the s e r v i c e p r o v i d e r s who n o r m a l l y are t h e o n l y s u p p o r t a v a i l a b l e f o r c o n s u m e r / s u r v i v o r s . A-Way's attemp t s t o move beyond i t s s o c i a l s e r v i c e c l i e n t e l e and i n t o T oronto's c o r p o r a t e w o r l d i s an example o f a CSRB b r o a d e n i n g i t s base of s u p p o r t . A b e l E n t e r p r i s e s ' e f f o r t s -- t a r g e t i n g l o c a l b u s i n e s s e s , c h u r c h c o n g r e g a t i o n s , t h e l o c a l community c o l l e g e -- g e n e r a t e d awareness i n t h e community, p r o v i d e d the e n t e r p r i s e w i t h v a r i o u s s u p p o r t s i n i t s development, and g e n e r a t e d economic o p p o r t u n i t i e s f o r t h e e n t e r p r i s e . A b e l ' s e f f o r t s would seem t o e x e m p l i f y S c h w a r t z ' s approach, w h i c h aims t o re-awaken a community's c a p a c i t y t o " c a r e , c o n s o l e , c o r r e c t , and c o u n s e l " , f u n c t i o n s t h a t have been t a k e n o v e r by s o c i e t y ' s i n s t i t u t i o n s (CBC Radioworks, 1994) . CSRB's have demonstrated t h e a b i l i t y t o g e n e r a t e b r o a d community s u p p o r t ; t h i s has c o n t r i b u t e d t o t h e s u c c e s s o f the examples s t u d i e d . T h i s a b i l i t y t o g e n e r a t e b r o a d community s u p p o r t a l s o c o n t r i b u t e s t o t h e v i a b i l i t y o f CSRB's. P r o j e c t s c a p a b l e of g e n e r a t i n g b r o a d community s u p p o r t w i l l have a much b e t t e r chance t o succeed, and once a g a i n w i l l be more a t t r a c t i v e t o program f u n d e r s and i n v e s t o r s . 4.2.4 M e a n i n q f u l n e s s One o f t h e most i m p o r t a n t c h a r a c t e r i s t i c s t h a t make CSRB's w o r t h w h i l e i s t h a t t h e y p r o v i d e an o p p o r t u n i t y f o r more m e a n i n g f u l l i v e s f o r c o n s u m e r / s u r v i v o r s . T h i s i s a c c o m p l i s h e d i n a number of ways. CSRB's o f f e r t h e c o n s u m e r / s u r v i v o r t h e o p p o r t u n i t y t o engage i n m e a n i n g f u l and p r o d u c t i v e work; m e a n i n g f u l , t h r o u g h h a v i n g some l e v e l o f c o n t r o l o v e r t h e e n t e r p r i s e ; and p r o d u c t i v e , as t h e CSRB p r o v i d e s a good o r s e r v i c e needed by t h e community. Through h a v i n g a r o l e i n t h e management o f t h e e n t e r p r i s e , e i t h e r t h r o u g h s h a r e d ownership o r t h r o u g h some form o f d e m o c r a t i c c o n t r o l o v e r d e c i s i o n s made, c o n s u m e r / s u r v i v o r s can a s s i s t i n the c r e a t i o n o f a work environment t h a t s u i t s t h e i r needs. CSRB's, i n t h a t t h e y address not o n l y e f f i c i e n c y and t h e r a p e u t i c b e n e f i t s , but a l s o meaning and d i g n i t y , a r e l i k e l y t o a t t r a c t s u p p o r t from c o n s u m e r / s u r v i v o r s . 4.3 L a r g e - S c a l e P o l i t i c a l and Economic F a c t o r s A n o t h e r a s p e c t w h i c h c o n t r i b u t e s t o t h e v i a b i l i t y o f CSRB's i s t h e p a r t i c u l a r p o l i t i c a l and economic c l i m a t e o f t h e s e t i m e s . A t r o u b l e d economy, where unemployment f o r a l l workers i s h i g h , w i l l make i t e s p e c i a l l y d i f f i c u l t f o r t h e p s y c h i a t r i c a l l y d i s a b l e d worker t o f i n d c o m p e t i t i v e employment. One s t u d y from B r i t a i n , c o n d u c t e d by a r e g i o n a l p s y c h i a t r i c h o s p i t a l , showed t h a t r i s i n g unemployment r a t e s had t h e e f f e c t o f d e c r e a s i n g t h e numbers of m e n t a l l y i l l f i n d i n g c o m p e t i t i v e employment. T h i s s t u d y a s s e r t e d t h a t an unemployment r a t e o f g r e a t e r t h a n 6% made the placement o f p s y c h i a t r i c a l l y d i s a b l e d workers n e a r l y i m p o s s i b l e (Morgan and Cheadle, 1975). F u r t h e r m o r e , economic downturns w i l l t e n d t o have an e f f e c t on v o c a t i o n a l programs t h a t p r o v i d e employment f o r p s y c h i a t r i c a l l y d i s a b l e d i n d i v i d u a l s (Church and P a k u l a , 1984; O l s h a n s k y , 1968). Concerns r e g a r d i n g p u b l i c debt w i l l l i k e l y cause p r e s s u r e s on f u n d i n g f o r such programs. T h i s s i t u a t i o n , w h i c h i n c l u d e s c o n c e r n about p u b l i c f u n d i n g o f programs and a t i g h t l a b o u r market, might make a l t e r n a t i v e s e t t i n g s such as CSRB's more a t t r a c t i v e . 4.4 R a t i o n a l e f o r a Funding S t r u c t u r e As d i s c u s s e d p r e v i o u s l y , CSRB's p r o v i d e b e n e f i t s t o c o n s u m e r / s u r v i v o r s . Furthermore, p o l i t i c a l and economic f a c t o r s f a v o u r t h e e s t a b l i s h m e n t o f a l t e r n a t i v e s e t t i n g s . And, as we have found from t h e a n a l y s i s o f examples, CSRB's a r e l i k e l y t o need o n g o i n g f u n d i n g and s u p p o r t . More e x p e r i m e n t s w i t h CSRB's w i l l p r o v i d e more knowledge r e g a r d i n g o p p o r t u n i t i e s and c o n s t r a i n t s t o t h e i r development. S c h w a r t z , i n d e s c r i b i n g t h e needs o f a l t e r n a t i v e s e t t i n g s , c a l l s f o r an i n t e r m e d i a r y s t r u c t u r e m e d i a t i n g between s m a l l , i n f o r m a l s e t t i n g s , and l a r g e government b u r e a u c r a c i e s ; i n t h i s way, the s m a l l e r s e t t i n g i s not overwhelmed w i t h p r o c e d u r e s and paperwork n e c e s s a r y t o s a t i s f y i t s f u n d i n g agency (Schwartz, 1992). I n d e v e l o p i n g CSRB's, c o n s u m e r / s u r v i v o r s w i l l l i k e l y have t o d e a l not o n l y w i t h a l a c k o f c a p i t a l , but a l s o w i t h some o f t h e o t h e r c o n s t r a i n t s mentioned, such as b u r e a u c r a t i c r e s t r i c t i o n s and a h i s t o r y o f dependency upon p r o f e s s i o n a l i z e d s e r v i c e s . A s u p p o r t i v e s t r u c t u r e may be t h e most a p p r o p r i a t e way o f s u p p o r t i n g t h e development and maintenance o f CSRB's ( T r a i n o r & Tremblay, 1992). What would such a s t r u c t u r e f o r CSRB's l o o k l i k e ? T h i s q u e s t i o n w i l l be d i s c u s s e d i n Chapter 5. 5.0 S u p p o r t i n g CSRB's C o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s , as an a l t e r n a t i v e t o e x i s t i n g v o c a t i o n a l r e h a b i l i t a t i o n programs f o r t h e m e n t a l l y i l l , d e s e r v e t o be g i v e n more a t t e n t i o n ; t o d e v e l o p more e x p e r i m e n t s o f t h i s n a t u r e , some s u p p o r t s w i l l be needed. T h i s c o u l d be a c h i e v e d t h r o u g h a p r o v i n c i a l s t r a t e g y , t h a t makes the development o f CSRB's an e x p l i c i t i n t e n t i o n o f p o l i c y ( T r a i n o r & Tremblay, 1992). C o n s u m e r / S u r v i v o r Development I n i t i a t i v e O n t a r i o i s l e a d i n g the way, i n the r e g a r d o f making CSRB's an e x p l i c i t i n t e n t i o n o f p o l i c y . O n t a r i o ' s Consumer/Survivor Development I n i t i a t i v e (CSDI) has r e s u l t e d i n t h e development o f 34 c o n s u m e r / s u r v i v o r i n i t i a t i v e s . The Consumer/Survivor Development I n i t i a t i v e (CSDI) i s funded by t h e Community M e n t a l H e a l t h Branch o f t h e O n t a r i o M i n i s t r y o f H e a l t h . I t was e n a c t e d i n 1991 t o p r o v i d e d i r e c t f u n d i n g t o c o n s u m e r / s u r v i v o r - r u n i n i t i a t i v e s . An i n i t i a l g r a n t o f $3.1 M i l l i o n was p r o v i d e d f o r CSDI; th e Community M e n t a l H e a l t h B r a n c h t h e n i s s u e d a c a l l f o r p r o p o s a l s from v a r i o u s c o n s u m e r / s u r v i v o r groups. D i s t r i c t H e a l t h C o u n c i l s , and community mental h e a l t h a g e n c i e s . From 266 p r o p o s a l s r e c e i v e d , 42 were s e l e c t e d f o r f u n d i n g . A t t h e b e g i n n i n g , about h a l f o f t h e s e l e c t e d p r o j e c t s were a l i g n e d w i t h community mental h e a l t h a g e n c i e s . However, CSDI came t o t h e p o i n t o f v i e w t h a t i n o r d e r f o r c o n s u m e r / s u r v i v o r o r g a n i z a t i o n s t o break away from t h e p r o f e s s i o n a l s e r v i c e model (the ' s e r v i c e p a r a d i g m ' ) , i t would be b e s t f o r p r o j e c t s t o be independent o f t r a d i t i o n a l s e r v i c e a g e n c i e s . Most p r o j e c t s i n i t i a l l y s p o n s o r e d by community mental h e a l t h a g e n c i e s a r e now f r e e - s t a n d i n g , and a r e b e i n g i n c o r p o r a t e d as n o n - p r o f i t o r g a n i z a t i o n s . I n i t i a t i v e s i n f o u r a r e a s have been promoted: mutual s u p p o r t , advocacy, knowledge p r o d u c t i o n and s k i l l s t r a i n i n g , and economic development. Of t h e t o t a l o f 34 i n i t i a t i v e s , seven have an economic development f o c u s . These i n c l u d e s e v e r a l i n o p e r a t i o n o r i n the p l a n n i n g s t a g e s b e f o r e CSDI was en a c t e d , but w h i c h a r e now a s s i s t e d by CSDI f u n d i n g . CSDI i s a response t o t h e l i m i t a t i o n s o f t h e t r a d i t i o n a l m e n t a l h e a l t h s e r v i c e system (CSDI, 1994). C o n s u m e r / s u r v i v o r s had found t h a t t h e t r a d i t i o n a l s e r v i c e system had not been an answer t o f i n d i n g s e l f - r e a l i z a t i o n ; w h i l e funds were b e i n g g i v e n t o s e r v i c e a g e n c i e s and t o e x p e n s i v e p r o f e s s i o n a l s e r v i c e s , consumers o f t e n f o u n d t h e m s e l v e s c o n f i n e d t o l i v e s o f p o v e r t y and a l i e n a t i o n . The f o l l o w i n g quote, from CSDI's l i t e r a t u r e , d e s c r i b e s something o f CSDI's r a t i o n a l e and p h i l o s o p h y : CSDI i s unique i n t h a t i t has made i t p o s s i b l e t o p l a c e r e a l , s u b s t a n t i a l f u n d i n g i n t h e hands o f c o n s u m e r / s u r v i v o r g r o u p s . W h i l e t h e r e has been much r h e t o r i c about t h e im p o r t a n c e o f s e l f - h e l p and o f c o n s u m e r / s u r v i v o r i n v o l v e m e n t i n t h e men t a l h e a l t h system, t h r o u g h CSDI t h e government o f O n t a r i o has made a v a i l a b l e t h e f u n d i n g and r e s o u r c e s t o a c t u a l l y demonstrate t h e i m p o r t a n c e . . ( CSDI, 1994, p . l ) I n 1992, CSDI r e c e i v e d a t h r e e - y e a r g r a n t from T r e a s u r y Board o f $3.5 m i l l i o n a y e a r ; t h o s e funds c u r r e n t l y s u p p o r t t h e 34 c o n s u m e r / s u r v i v o r i n i t i a t i v e s . The CSDI i s one example o f a s u p p o r t s t r a t e g y f o r CSRB's. Based on t h e l i t e r a t u r e r e v i e w e d i n t h i s t h e s i s , and t h e examples o f CSRB's d e s c r i b e d , what elements s h o u l d a p r o v i n c i a l s t r a t e g y encompass? 5.1 Elements o f a p r o v i n c i a l s t r a t e g y s u p p o r t i n g CSRB's 5.1.1 F u n d i n g f o r CSRB's S h o u l d CED v e n t u r e s o b t a i n funds from government? Wismer and P e l l (1983), i n d e s c r i b i n g a s p e c t s o f community-based economic development, advocate t h a t CED p r o j e c t s be a b l e t o r a i s e t h e funds n e c e s s a r y f o r t h e i r o p e r a t i o n . P a r t o f t h e a l l u r e o f a l t e r n a t i v e s e t t i n g s f o r t h e d i s a b l e d i s t h a t t h e y p r o v i d e an a l t e r n a t i v e form o f s e r v i c e t o t h e d i s a b l e d t h a t i n v o l v e s l e s s p u b l i c f u n d i n g t h a n t r a d i t i o n a l s e r v i c e s . A t a p r a c t i c a l l e v e l , however, f u n d i n g from government a g e n c i e s has been needed by a l l the examples o f CSRB's d i s c u s s e d i n o r d e r t o s u r v i v e . CSRB's have shown t h a t t h e y can s u c c e s s f u l l y employ p e o p l e w i t h a h i s t o r y o f s e r i o u s m ental i l l n e s s . As such, t h e y c a n ' t be e x p e c t e d t o have the same e f f i c i e n c y as o t h e r b u s i n e s s e s . Ongoing s u b s i d i e s w i l l l i k e l y be n e c e s s a r y ( T r a i n o r & Tremblay, 1992) . There i s , however, an example o f an a l t e r n a t i v e v o c a t i o n a l s e t t i n g t h a t has s u r v i v e d w i t h o u t government f u n d i n g . A l l - W i n Workshops i n Richmond has o p e r a t e d s i n c e 1991; i t was founded by Dr. C y r i l Brown and h i s w i f e , J a n . Brown, a r e t i r e d d o c t o r and p a r a p l e g i c , wanted t o p r o v i d e a s e t t i n g where d i s a b l e d p e o p l e c o u l d p e r f o r m m e a n i n g f u l work. A l l - W i n p r e s e n t l y i s i n t h e b u s i n e s s o f r e c y c l i n g u s e d p r i n t e r c a r t r i d g e s , by r e - i n k i n g and r e l o a d i n g them. I t s c o r p o r a t e c l i e n t s i n c l u d e V a n C i t y S a v i n g s C r e d i t U n i o n and Burnaby G e n e r a l H o s p i t a l . Run as a n o n - p r o f i t s o c i e t y and r e g i s t e r e d c h a r i t y . A l l - W i n p r o v i d e s employment t o p e o p l e w i t h a range o f d i s a b i l i t i e s - from m u l t i p l e s c l e r o s i s t o s c h i z o p h r e n i a . Brown wants A l l - W i n t o be a w o r k i n g model f o r o t h e r groups i n t e r e s t e d i n independent, s e l f - s u p p o r t i n g workshops r u n by and f o r p e o p l e w i t h d i s a b i l i t i e s . 5.1.2 A s p e c t s o f CSRB's t o be encouracred W h i l e c o n t r o l o f t h e i r development s h o u l d be i n t h e hands of c o n s u m e r / s u r v i v o r s t h e m s e l v e s , T r a i n o r and Tremblay (1992) recommend t h a t c e r t a i n key a s p e c t s a r e v i t a l t o t h e impact t h a t CSRB's can have on t h i s p o p u l a t i o n . 5.1.2.1 F l e x i b i l i t y i n w o r k i n g hours F l e x i b i l i t y i n w o r k i n g hours, a l l o w i n g w o r kers t o work p a r t -t i m e , t a k e t i m e o f f f o r m e d i c a l r e a s o n s , o r appointments i s a key a s p e c t o f t h e examples o f CSRB's d e s c r i b e d . 5.1.2.2 The a d o p t i o n o f o r g a n i z a t i o n a l models w h i c h guarantee c o n t r o l t o c o n s u m e r / s u r v i v o r s T r a i n o r and Tremblay recommend t h a t a l l employees be c o n s u m e r / s u r v i v o r s ; f o r an i n t e r i m phase, however, i t may be n e c e s s a r y t o employ i n d i v i d u a l s w i t h e x p e r t i s e i n t h e p a r t i c u l a r b u s i n e s s . 5.1.2.3 Ensure t h a t p r o j e c t s adopt o r g a n i z a t i o n a l models which emphasize t h e i n v o l v e m e n t o f employees i n d e c i s i o n making P r o j e c t s funded t h r o u g h CSDI must have a d e m o c r a t i c , m e m b e r s h i p - d r i v e n p r o c e s s i n p l a c e . P r o j e c t s must have a Board o f D i r e c t o r s , s t e e r i n g committee o r some o t h e r g o v e r n i n g s t r u c t u r e w h i c h i s e l e c t e d by, and r e f l e c t s t h e membership. 5.1.2.4 Supp o r t o f Ne t w o r k i n g Between CSRB's P r o v i d i n g t e c h n i c a l a s s i s t a n c e t o c o n s u m e r / s u r v i v o r s c o u l d a l s o p r o v i d e a s e t t i n g f o r n e t w o r k i n g between i n d i v i d u a l s and groups i n t e n d i n g t o d e v e l o p t h e i r own b u s i n e s s e s . I n O n t a r i o , t h e P r o v i n c i a l Consumer/Survivor B u s i n e s s C o u n c i l , s u p p o r t s n e t w o r k i n g between CSRB's; the Tor o n t o Community Economic Development Network, and the Women's Community Economic Development Network b r i n g t o g e t h e r CED e f f o r t s . These a s p e c t s -- f l e x i b i l i t y i n w o r k i n g h o u r s , a d o p t i o n o f o r g a n i z a t i o n a l models g u a r a n t e e i n g c o n t r o l t o c o n s u m e r / s u r v i v o r s , emphasis on employee-involvement, and n e t w o r k i n g -- may be m a i n t a i n e d i n CSRB's by the s u p p o r t i v e s t r u c t u r e by o n l y f u n d i n g t h o s e p r o j e c t s w h i c h adhere t o t h e s e a s p e c t s . 5.1.3 T e c h n i c a l Support A n o t h e r o f T r a i n o r and Tremblay's recommendations i s t h a t CSRB's be o f f e r e d t e c h n i c a l s u p p o r t . A model f o r t h i s may come from Vancouver's Downtown E a s t s i d e Economic Development S o c i e t y (DEEDS), w h i c h c l o s e d i t s doors i n 1993 due t o d i s c o n t i n u a t i o n o f f e d e r a l f u n d i n g . DEEDS was c l o s e d d e s p i t e i t s s u c c e s s i n a c t i n g as an b u s i n e s s i n c u b a t o r , employing an e s t i m a t e d 250 p e o p l e (Globe and M a i l , A p r . 9, 1991) . DEEDS had 11 spaces a t i t s l o c a t i o n where f l e d g l i n g b u s i n e s s e s c o u l d get s t a r t e d . I t a l s o p r o v i d e d b u s i n e s s c o u n s e l l i n g , p h o t o c o p i e r and f a x machine, and a s m a l l l i b r a r y o f s e l f - h e l p b u s i n e s s books. The b u s i n e s s c o u n s e l l o r a s s i s t e d c l i e n t s by h e l p i n g them s e t out a b u s i n e s s p l a n , i d e n t i f y m a rkets, and f i n d f u n d i n g s o u r c e s and o t h e r r e s o u r c e s . DEEDS a l s o p r o v i d e d i t s s e r v i c e s t o b u s i n e s s e s i n t h e community f o r a $15 annual membership. DEEDS a l s o had s t a r t e d a PAL ( p e e r - a s s i s t e d loan) program. W i t h t h i s approach, based on T h i r d - W o r l d l e n d i n g c i r c l e s , a s m a l l group o f DEEDS members meet r e g u l a r l y t o o f f e r mutual s u p p o r t , g u i d a n c e , and m o n i t o r i n g o f s m a l l l o a n s i n t h e $500 - $1000 range. L i k e o t h e r PAL programs, t h i s program i s d e s i g n e d t o p r o v i d e c a p i t a l t o poor p e o p l e who l a c k c o l l a t e r a l and e q u i t y , and don't q u a l i f y f o r l o a n s from e s t a b l i s h e d f i n a n c i a l i n s t i t u t i o n s . A s u p p o r t s t r u c t u r e f o r CSRB's, as w e l l as p r o v i d i n g f u n d i n g , might a l s o p r o v i d e such t e c h n i c a l s e r v i c e s t o a s s i s t c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s . B u s i n e s s c o u n s e l l i n g , and the p r o v i s i o n o f computer, f a x , and p h o t o c o p i e r s e r v i c e c o u l d a s s i s t s uch b u s i n e s s e s i n g e t t i n g o f f the ground. Such a s e r v i c e c o u l d a l s o s u p p o r t n e t w o r k i n g between CSRB's. 5.1.4 Economic d i s i n c e n t i v e s t o employment A p r o v i n c i a l s t r a t e g y t o s u p p o r t CSRB's would a l s o have t o a d d r e s s t h e i s s u e o f economic d i s i n c e n t i v e t o employment. C u r r e n t l y , p e o p l e can o n l y e a r n $250 on t o p o f t h e i r a s s i s t a n c e ; any amount e a r n e d above t h a t i s t a x e d back. Making t h e s e a l l o w a n c e s more generous would h e l p ; as would g u a r a n t e e s f o r d i s a b l e d p e o p l e t h a t t h e i r a c c e s s t o s o c i a l h o u s i n g and m e d i c a t i o n b e n e f i t s would not be j e o p a r d i z e d by i n c r e a s i n g t h e i r i n v o l v e m e n t i n employment. 5.1.4.1 A n a l y s i s o f E x p e n d i t u r e s A t a p o l i c y l e v e l , t h e r e has been much d i s c u s s i o n o f a l l o c a t i o n o f funds away from i n s t i t u t i o n a l s e t t i n g s , and towards community s e r v i c e s e t t i n g s ; l i k e w i s e , p o l i c y documents put out by p r o v i n c i a l governments d i s c u s s the need f o r s e l f - h e l p , mutual a i d and advocacy i n i t i a t i v e s . An a n a l y s i s o f e x p e n d i t u r e s r e v e a l s a l a c k o f commitment t o community s e r v i c e s , i n c o m p a r i s o n t o the f u n d s s t i l l p r o v i d e d t o i n s t i t u t i o n a l s e t t i n g s . An a n a l y s i s o f O n t a r i o ' s p r o v i n c i a l mental h e a l t h e x p e n d i t u r e s , c o n d u c t e d f o r the 1989 - 1990 f i s c a l y e a r , shows t h a t o n l y 16.5% o f p r o v i n c i a l mental h e a l t h f u n d i n g went t o community mental h e a l t h s e r v i c e s . And as f o r f u n d s a l l o c a t e d t o s e l f - h e l p i n i t i a t i v e s , t h e s e a r e t i n y i n c o m p a r i s o n t o b o t h i n s t i t u t i o n a l and community s e t t i n g s ( L u r i e & T r a i n o r , 1992). I n O n t a r i o , $3.2 m i l l i o n was spent on t h e non-s e r v i c e s e c t o r , r e p r e s e n t i n g about 0.2% o f t o t a l m e n t a l h e a l t h e x p e n d i t u r e s . An i s s u e brought up by mental h e a l t h workers i s c o m p e t i t i o n f o r funds - w i l l f u n d i n g o f more s e l f - h e l p p r o j e c t s , p a r t i c u l a r l y CED p r o j e c t s , r e s u l t i n fewer funds f o r e s t a b l i s h e d programs, e s p e c i a l l y t h o s e i n t h e v o c a t i o n a l r e h a b i l i t a t i o n f i e l d ? M u t u a l a i d and s e l f - h e l p r e p r e s e n t a t i n y p e r c e n t a g e of t h e t o t a l amount spent on mental h e a l t h . The s m a l l - s c a l e n a t u r e of p r o j e c t s i n t h i s s e c t o r means t h a t t h e y would not t e n d t o be a t h r e a t t o l a r g e r , t r a d i t i o n a l programs. And g i v e n t h e i r p o t e n t i a l f o r g r e a t e r c o s t - e f f e c t i v e n e s s , funds d i r e c t e d t o t h i s s e c t o r c o u l d be a w i s e r i n v e s t m e n t . 6•0 C o n c l u s i o n The l i t e r a t u r e r e v i e w e d makes c l e a r t h a t w h i l e e x i s t i n g forms o f v o c a t i o n a l r e h a b i l i t a t i o n a r e a p p r o p r i a t e i n many c a s e s , t h e y a l s o have l i m i t a t i o n s . These l i m i t a t i o n s i n c l u d e dependency on p r o f e s s i o n a l s and t h e f a c t t h a t work i s o f t e n o f a m e n i a l n a t u r e . Community economic development i s an economic model p a r t i c u l a r l y a p p l i c a b l e t o t h e most m a r g i n a l i z e d groups i n s o c i e t y . S e l f - h e l p i s a movement i n mental h e a l t h t h a t emphasizes t h e i m p o r t a n c e o f mutual a i d , p a r t i c u l a r l y as an a l t e r n a t i v e t o p r o f e s s i o n a l i z e d s e r v i c e s t h a t r e i n f o r c e p a t t e r n s o f dependency. T a k i n g elements from b o t h community economic development and s e l f -h e l p , c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s , p r o v i d e m e a n i n g f u l work t o c o n s u m e r / s u r v i v o r s by v i r t u e o f t h e i r h a v i n g a r o l e i n t h e development and management of t h e e n t e r p r i s e . Based on a r e v i e w o f r e l e v a n t l i t e r a t u r e , and a r e v i e w o f f i v e examples o f c o n s u m e r / s u r v i v o r - r u n b u s i n e s s e s , t h e f o l l o w i n g c o n s t r a i n t s f a c i n g t h e s e p r o j e c t s can be d e t e r m i n e d : ( i ) b u r e a u c r a t i c r e s t r i c t i o n s , w i t h r e s p e c t t o how much c o n s u m e r / s u r v i v o r s can e a r n above t h e i r d i s a b i l i t y p e n s i o n s ; ( i i ) a t t i t u d e s o f t h e g e n e r a l p u b l i c towards c o n s u m e r / s u r v i v o r s , s p e c i f i c a l l y t h e s t i g m a a t t a c h e d t o mental i l l n e s s ; ( i i i ) t he a t t i t u d e s o f mental h e a l t h p r o f e s s i o n a l s , s p e c i f i c a l l y what has been d e s c r i b e d as t h e s e r v i c e paradigm; ( i v ) problems i n h e r e n t t o t h e development of a l t e r n a t i v e s e t t i n g s , and (v) t h e d r i f t towards p r o f e s s i o n a l i s m t h a t many a l t e r n a t i v e s e t t i n g s e x p e r i e n c e . From th e r e v i e w of l i t e r a t u r e and t h e examples o f CSRB's, the f o l l o w i n g o p p o r t u n i t i e s were ap p a r e n t : ( i ) the b e n e f i t s t h a t CSRB's p r e s e n t t o c o n s u m e r / s u r v i v o r s ; ( i i ) economic f a c t o r s t h a t c a l l i n t o q u e s t i o n t h e v i a b i l i t y o f e x i s t i n g forms o f v o c a t i o n a l r e h a b i l i t a t i o n , and make the development o f a l t e r n a t i v e s an o p t i o n ; ( i i i ) a s u p p o r t s t r u c t u r e , w h i c h t h r o u g h f u n d i n g , and t e c h n i c a l a s s i s t a n c e , w i l l a c t as a c a t a l y s t f o r t h e development o f CSRB's. An o u t l i n e o f such a s u p p o r t s t r u c t u r e i s d e v e l o p e d , i n c l u d i n g t h e f o l l o w i n g a s p e c t s : ( i ) ongoing f u n d i n g f o r CSRB's; ( i i ) the encouragement of f l e x i b i l i t y i n w o r k i n g h o u r s , d e m o c r a t i c d e c i s i o n -making, c o n s u m e r / s u r v i v o r c o n t r o l , and n e t w o r k i n g ; ( i i i ) t e c h n i c a l s u p p o r t , and ( i v ) a d d r e s s i n g t h e i s s u e o f economic d i s i n c e n t i v e s t o work. A f u r t h e r a s p e c t t h a t c o u l d be a d d r e s s e d by such a s u p p o r t i v e s t r u c t u r e would be an a n a l y s i s o f government e x p e n d i t u r e s on mental h e a l t h , d e t e r m i n i n g what the l e v e l s o f f u n d i n g a r e f o r the i n s t i t u t i o n a l , community, and mutual a i d / s e l f - h e l p s e c t o r s , and whether t h e mutual a i d / s e l f - h e l p s e c t o r i s a d e q u a t e l y funded. A p h i l o s o p h i c a l background f o r t h e development o f CSRB's i s p r e s e n t e d : i n mental h e a l t h , we can see a t r a n s i t i o n from a t h e r a p e u t i c v i s i o n , t o an advocacy v i s i o n , and now t o a community v i s i o n . Such a community v i s i o n f o r mental h e a l t h s h o u l d not be r o m a n t i c i z e d ; a l t e r n a t i v e s e t t i n g s w i l l have t h e i r drawbacks. But, as Schwartz (1992) p o i n t s o u t , i t i s i n such s e t t i n g s t h a t p e o p l e w i l l f i n d independence and a c c e p t a n c e . Gandhi's a d m o n i t i o n t h a t we s h o u l d 'beware of t h i n k i n g o f systems so p e r f e c t t h a t nobody w i l l have t o be good', seems t o be r e l e v a n t i n t h i s c a s e ; i n CSRB's, c o n s u m e r / s u r v i v o r s a r e not c r e a t i n g s e t t i n g s t h a t a r e p e r f e c t , but s e t t i n g s t h a t w i l l a l l o w t h e i n h e r e n t good i n p e o p l e and i n communities t o show i t s e l f . 7.0 B i b l i o g r a p h y Anthony, W.A., H o w e l l , J . & Danley, K.S. The C h r o n i c a l l y M e n t a l l y 111: R e s e a r c h and S e r v i c e s . SP M e d i c a l and S c i e n t i f i c Books, J a m a i c a , N.Y., 1983. Bond, G. Su p p o r t e d work as a m o d i f i c a t i o n o f t h e t r a n s i t i o n a l employment model f o r p a t i e n t s w i t h p s y c h i a t r i c d i s a b i l i t i e s . P s y c h o s o c i a l R e h a b i l i t a t i o n J o u r n a l . V o l . 11, No. 2, 1987. Brown, J u d i t h . 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