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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 I L L N E S S  by  DAVID GEORGE KERR B.Sc,  Simon F r a s e r U n i v e r s i t y ,  1990  A T H E S I S SUBMITTED I N PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE FACULTY OF GRADUATE STUDIES S c h o o l o f Community a n d R e g i o n a l P l a n n i n g We a c c e p t t h i s t h e s i s a s c o n f o r m i n g to the re^^liired standard  THE UNIVERSITY OF B R I T I S H COLUMBIA O c t o b e r 1994 i'^c?"!  D a v i d G e o r g e K e r r , 1994  In  presenting this  degree at the  of  department  this or  publication of  in  University of  freely available for copying  thesis  this  fulfilment  of  his  or  the  requirements  British Columbia, I agree that the  reference and study. I further  thesis for by  partial  representatives.  an advanced  Library shall make it  agree that permission for extensive  scholarly purposes may be her  for  It  thesis for financial gain shall not  is  granted  by the  understood  head of  that  copying  1 The University of British Columbia Vancouver, Canada  Date  DE-6 (2/88)  _ /V, 1993  or  be allowed without my written  permission.  De^j^mefrT of  my  La.  - i ^ " ' - '  Abstract Consumer/survivor-run which  people  with  a  businesses  history  of  (CSRB's) a r e b u s i n e s s e s i n  mental  illness  play  a  role  in  d e v e l o p i n g a n d m a n a g i n g 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 o f activity  include  flexibility  i n working  hours,  and  some f o r m  of  democratic c o n t r o l over the business. Consumer/survivor-run community  economic  h i s t o r y of mental These  development  predominant  and  employ  aspects  self-help  of  f o r people  both  with  a  illness.  businesses  rehabilitation  businesses  act  as  f o r people  forms  an  alternative  with a history  form  of  of mental  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 ,  vocational  illness.  s u c h as  The  sheltered  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 supported  employment  are  often  beneficial,  but  are  not  without  l i m i t a t i o n s . D e p e n d e n c y 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 entry-level  jobs,  and  a  lack  l i m i t a t i o n s d e s c r i b e d i n the  of  independence  are  some  of  the  literature.  F i v e c a s e s o f CSRB's f r o m a c r o s s Canada a r e a n a l y z e d . From t h e l i t e r a t u r e r e v i e w e d and t h e 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 faced  by  CSRB's and  opportunities  presented  f o r support  to  them  (i) bureaucratic r e s t r i c t i o n s  that  through p u b l i c p o l i c y are discussed. The  constraints  included  l i m i t what c o n s u m e r / s u r v i v o r s may pensions;  (ii)  hold to  development  a of  disability  a t t i t u d e s of the g e n e r a l p u b l i c , namely the  of mental i l l n e s s ; who  e a r n on t o p o f t h e i r  (iii)  stigma  a t t i t u d e s of mental h e a l t h p r o f e s s i o n a l s ,  ' s e r v i c e paradigm'; alternative  (iv) problems  settings,  and  (v)  inherent i n the  the  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  drift  settings.  towards  Opportunities the  benefits  (flexibility and  p r e s e n t e d f o r t h e d e v e l o p m e n t o f CSRB's i n c l u d e :  that  CSRB's  hold  for  consumer/survivors  i n h o u r s , s t a b l e employment, a s e n s e o f s e l f - r e l i a n c e  independence);  the economic c l i m a t e  (high  unemployment,  p u b l i c d e b t , e t c . ) w h i c h w i l l make t r a d i t i o n a l f o r m s o f rehabilitation provision could  of  less ongoing  viable.  Government  f u n d i n g and  support,  technical  vocational  including  support  high  the  f o r CSRB's,  a i d i n t h e development of t h i s type of a l t e r n a t i v e s e t t i n g .  TABLE OF CONTENTS Abstract T a b l e o f Contents L i s t of F i g u r e s  i i iv vi  Chapter One Introduction 1.1 Methodology  1 4  Chapter Two  7  Context f o r CSRB's  2.1 Mental 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 of the M e n t a l l y 111 2.1.2 The 20th Century 2.1.3 The Canadian Context 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 2.1.5 Challenges to Community Care 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 Clubs 2.1.7 Canadian Mental H e a l t h P o l i c y The Emergent P i c t u r e 2.1.8 The Sector-Based Model 2.1.9 Summary  11 13 16  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 2.2.1 Employment P r e p a r a t i o n Programs 2.2.2 S h e l t e r e d Work 2.2.3 T r a n s i t i o n a l Employment 2.2.4 Supported Employment 2.2.5 Summary  17 18 19 20 22 24  2.3 Community Economic Development 2.3.1 The Concept of 'Community' i n Community Economic Development 2.3.2 Dimensions of Community Economic D eve1opment  24  2.4  7 7 8 8 9 10 10  25 27  Mental H e a l t h , P e r s p e c t i v e s on the D i s a b l e d , and P l a n n i n g  Chapter Three Consvimer/Survivor-Run Businesses 3.1 Examples of CSRB's 3.1.1 Abel E n t e r p r i s e s 3.1.2 A-Way Express C o u r i e r s 3.1.3 F r e s h S t a r t C l e a n i n g and Maintenance 3.1.4 U n i t y Housing 3.1.5 Consumer/Survivors' A r t i s t s Cooperative 3.2 Aspects of CSRB's 3.2.1 Decision-making/ O r g a n i z a t i o n a l S t r u c t u r e of CSRB's 3.2.2 Composition of S t a f f  32 39 41 41 44 47 48 50 52 52 53  3.2.3 Source o f Funding 3.2.4 Market Chapter Four  Consumer/Survivor-Run B u s i n e s s e s : Lessons to be Learned  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 4.1.2 A t t i t u d e s o f the General P u b l i c Towards Consumer/Survivors  54 55  57 57 57 60  4.1.3 A t t i t u d e s of Mental 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 4.1.4 Problems Inherent i n Developing New Settings 4.1.5 D i f f i c u l t i e s Inherent i n the O p e r a t i o n of Cooperatives 4.1.5 The D r i f t Towards P r o f e s s i o n a l i s m  71 73  4.2 O p p o r t u n i t i e s f o r CSRB's - Why have the examples s t u d i e d succeeded? 4.2.1 Human F a c t o r s 4.2.2 Economic F a c t o r s 4.2.3 Broad Community Support 4.2.4 Meaningfulness  76 76 78 78 79  64 67  4.3 L a r g e - s c a l e P o l i t i c a l and Economic Factors 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 Supporting Consumer/Survivor-Run Businesses 5.1 Elements o f a P r o v i n c i a l S t r a t e g y Supporting CSRB's 5.1.1 Funding f o r CSRB's 5.1.2 Aspects o f CSRB's to be Encouraged 5.1.2.1 F l e x i b i l i t y i n Working Hours 5.1.2.2 The Adoption o f O r g a n i z a t i o n a l Models which Guarantee C o n t r o l to Consumer/Survivors 5.1.2.3 E n s u r i n g that 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 the Involvement o f Employees i n Decision-Making 5.1.2.4 Support o f Networking Between CSRB's 5.1.3 T e c h n i c a l Support 5.1.4 Economic D i s i n c e n t i v e s t o Employment 5.1.5 A n a l y s i s o f Expenditures  80 81  Chapter F i v e  Chapter S i x Bibliography  Conclusion  82 84 84 85 85 85  85 86 86 87 87 89 91  L I S T OF Figure  1  Figure 2  FIGURES  The Community R e s o u r c e Bank  15  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  39  1.0 My  Introduction  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  community history  economic of  development  mental  illness:  and  field,  self-help for  bridging  people  consumer/survivor-run  with  a  businesses  (CSRB's) . F r o m a r e v i e w o f t h e r e l e v a n t l i t e r a t u r e , and o f C a n a d i a n CSRB p r o j e c t s , their  c h a r a c t e r i s t i c s of  development,  potential  and  this  activity,  opportunities  p r o v i n c i a l strategy  will  for supporting  constraints  to  identified.  A  be  CSRB's w i l l  then  be  outlined. F i r s t , some t e r m i n o l o g y . someone who, health such  due  'Consumer' i n t h i s c o n t e x t ,  t o m e n t a l i l l n e s s , has  system. This  experiences,  t e r m has  over  sought help from the  come t o be  s u c h t e r m s as  p r e f e r r e d by  'patient'  t e r m ' c o n s u m e r ' g i v e s t o t h e i n d i v i d u a l who services proper  the  notion  of  someone who  describes  has  or  mental  people  'client';  consumes m e n t a l rights  with  to  the  health  fairness  and  treatment.  'Survivor'  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  t h e m s e l v e s i n t h e c a r e o f t h e m e n t a l h e a l t h s y s t e m due  to  found  traumatic  events i n t h e i r l i v e s , r a t h e r than a mental i l l n e s s . Such people  do  not  of  consider  t h e m s e l v e s as m e n t a l l y  a m e n t a l h e a l t h s y s t e m t h e y see Consumer/Survivor-run people guiding (i)  with role.  CSRB's  a  personal Two  as  ill  se, but  of  are  enterprises  the  mental  to  make  the  workplace  f i t the workplace. 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 members may  replace  each other  on  the  basis  which play  a  are:  more  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 t h e  in  health  i m p o r t a n t a s p e c t s of t h i s model  attempt  as v i c t i m s  oppressive.  businesses  experience  per  suitable  for  consumer/survivor  i n t o the e n t e r p r i s e ; of  health  factors.  Where p e o p l e may n o t be a b l e t o w o r k f u l l - t i m e , t h e y may be a b l e t o work  part-time,  social (ii)  o r work  a schedule that  service- related CSRB's,  to  a  allows  f o r medical-  and  absences.  varying  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 a n d m a n a g i n g the  enterprise. What  i s the r a t i o n a l e  f o r CSRB's?  Following  the onset  of  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 , a n d a r e u n a b l e t o work. L a c k i n g  a r o l e i n t h e c o m m u n i t y , t h e s e p e o p l e may  p r o g r e s s i v e l y more w i t h d r a w n a n d i s o l a t e d . To combat s u c h and d e v e l o p v o c a t i o n a l  and l i f e  skills,  become  isolation  vocational rehabilitation  programs have been d e v e l o p e d . The  sheltered  workshop  has  been  the  most  common  form  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 skill  level;  Criticism  payment  i s a t o k e n sum,  of sheltered  of low  u s u a l l y b e l o w minimum wage.  workshops has  f o c u s e d on  'institutional  d e p e n d e n c y ' , 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  normal.  With  independence,  little  people  opportunity  remain  to develop  a t a low l e v e l  s e l f - r e l i a n c e and  of functioning.  This  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 rehabilitation,  such  as  supported  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 support. vocational  Transitional  with access t o ongoing  employment  t r a i n i n g i s followed  refers  to  a  by j o b placement  model and  counselling in  which  substantial  support f o r a t r a n s i t i o n a l period. While representing  an improvement o v e r t h e s h e l t e r e d workshop  environment, the models are placed  also  s u p p o r t e d employment and now  facing criticism.  i n t e n d t o be e n t r y - l e v e l and  be a p r o b l e m . D e s p i t e full-time  f o r people  been e s t i m a t e d  models  r e l i a n c e are  (1989)  Couriers,  opportunities  who  are  t o be  o n l y 20%  (Canadian  while  e x i s t i n g forms  some who for  a  have a m e n t a l greater  level  of  illness, of  self-  worker  its  to  co-operative  applicability  Based  concluded  rehabilitation.  function  in a  on  that  f o r s e l f - r e l i a n c e and  especially appropriate Recently,  and  disabled.  she  vocational able  the  model  to  of  vocational  t h e d e v e l o p m e n t o f employment o p p o r t u n i t i e s  psychiatrically  forms of  that  provide  analyzed  organization,  r e h a b i l i t a t i o n and  Express  is  serve  which  have been h o s p i t a l i z e d  needed.  Brown  the  are  1984).  CSRB's  rehabilitation  alternative  business  for  who  And  clients  the  rate  low p a y i n g .  that  these 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,  I n s t i t u t e of C u l t u r a l A f f a i r s ,  vocational  jobs  may  employment  rationale  The  employment  dependency  w i t h a m e n t a l i l l n e s s has  The  transitional  a  this  case  study  model  business  those  A-Way  provided  self-determination For  of  for  than  more other  consumer/survivors  s e t t i n g , CSRB's  are  an  option.  a s u r v e y was  completed i n Ontario  measure the  i m p a c t o f CSRB i n v o l v e m e n t on t h e u s e  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  that attempted to of mental  survey found that  health  involvement  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 d a y s 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 contacts  ( T r a i n e r & Tremblay,  p r o g r a m s , and  crisis  1992).  CSRB's a t t e m p t t o r e d e f i n e t h e w o r k e r ' 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 . such,  CSRB's  are  a  form  of  community  economic  As  development  initiative. Recently,  policy  makers and  p l a n n e r s have caught  up  to  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 Recent  mental  governments British  health  policy  put  out  by  lives.  provincial  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 .  Columbia,  Funding program.  funds One  a r e g r a n t e d v i a t h e Consumer  of  t h e B.C.  Coast M e n t a l H e a l t h Network, of  statements  the  organizations  funded,  In  Initiative t h e West  i s i n t e r e s t e d i n CSRB's, a n d a c o u p l e  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  the  way  with  government  consumer  set  up  (CSDI) . S i n c e  the  1991,  34  initiatives.  In  Consumer/Survivor self-help  1991,  the  provincial  Development  Initiative  projects  have  been  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 , and a c t i v i t y  groups, t o economic  initiatives.  s e t up  by  advocacy,  Five of the p r o j e c t s  f u n d e d b y CSDI a r e CSRB's. It  would  seem  t o be  beneficial  CSRB's be d e v e l o p e d . W i t h more e x a m p l e s o n how  1.1  that  more  experiments  with  w i l l come more i n f o r m a t i o n  t h i s model can work.  Methodology F i v e examples  o f CSRB's w e r e a n a l y z e d i n t h i s  thesis.  T h r e e 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 , a n d F r e s h Start  Cleaning  and  Maintenance,  a l l located  in  Ontario,  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 e x a m p l e s o f CSRB's. The s e l e c t i o n o f t h r e e e x a m p l e s w h i c h h a v e b e e n 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 h a n d , l o o k i n g a t  s u c c e s s f u l e x a m p l e s a l l o w s t h e a n a l y s i s o f why t h e s e e x a m p l e s h a v e survived  -- why h a v e t h e s e p a r t i c u l a r p r o j e c t s b e e n s u c c e s s f u l ?  Other  e x a m p l e s i n O n t a r i o were n o t u s e d ,  less established, on  a s t h e y were newer,  a n d t h e r e was n o t a s much i n f o r m a t i o n a v a i l a b l e  these. The  Less  o t h e r two examples s e l e c t e d a r e from t h e V a n c o u v e r a r e a .  i n f o r m a t i o n was a v a i l a b l e o n t h e s e a s t h e y a r e a l s o v e r y new  (Unity  Housing  having  Consumer/Survivor were  chosen  been  Artists'  t o give  i n operation  for a  year,  the  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  an i d e a o f t h e d i v e r s e nature  of  activity  occurring. Information thesis  was  on t h e f i v e  extracted  from  (i) existing  examples; and ( i i ) brochures projects  e x a m p l e s o f CSRB's s t u d i e d i n t h i s literature  on  these  and i n f o r m a t i o n sheets i s s u e d by t h e  themselves.  Personal  i n t e r v i e w s w i t h people  examples w o u l d have been d i f f i c u l t ,  involved with  given the fact  l o c a t e d i n O n t a r i o . And, as mentioned,  the primary  that they are  t h e 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 w e r e d r a w n u p o n 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 ; these ranged (Trainor  &  Tremblay,  Consumer/Survivor newspaper  1987;  used  1992;  Ward  &  journal  articles  Tremblay,  1988),  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  articles.  Similarly, were  f r o m Brown's 1989 t h e s i s ,  t o analyze Abel Enterprises,  (Canadian  Institute  of Cultural  a number o f s o u r c e s Affairs,  1 9 8 4 ; CMHA,  CSDI, 1 9 9 4 ; T r a i n o r & T r e m b l a y , 1 9 9 2 ) . O n l y t w o s o u r c e s w e r e  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).  Information (relating  to  for  the  the  areas  discussion  of  the  context  for  of  health  policy,  vocational  mental  CSRB's  r e h a b i l i t a t i o n , c o m m u n i t y e c o n o m i c d e v e l o p m e n t , and p e r s p e c t i v e s the  disabled)  was  from agencies Some obtained  gathered  p r i m a r i l y from  library  research,  on and  i n v o l v e d w i t h mental h e a l t h .  insight  into  issues  affecting  consumer/survivors  was  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 C o a s t  Mental  Health  Network,  consumer/survivors,  and  an  volunteer  organization work w i t h  representing  the  Canadian  Mental  Health Association. This benefits (1989),  t h e s i s does not of  CSRB's,  or  attempt  ask  i n her research,  to  whether  looked  s y s t e m a t i c a l l y analyze this  at these  model  can  questions  work.  and  found  CSRB's w e r e v i a b l e , a n d w e r e 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 . thesis  attempts  Constraints  to  to the  have worked, a r e the  lessons  proposed.  bring  a  planning  development  analyzed  learned,  a  CSRB's, a n d  to  that This area. they  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  strategy  for  reasons  this  Brown  that  broad  of  perspective  the  supporting  CSRB's  is  2.0 C o n t e x t 2.1  Mental  Health  f o r Consumer/Survivor-run  Businesses  Policy  In order t o analyze Consumer/Survivor-Run Businesses a supportive provincial  strategy could look l i k e ,  i ti s necessary  to review mental h e a l t h p o l i c y , i n c l u d i n g the h i s t o r i c a l of the mentally i l l ,  a n d what  treatment  Canada's a p p r o a c h t o m e n t a l h e a l t h , and r e c e n t  trends i n mental 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 T r e a t m e n t o f t h e M e n t a l l y 111 A  review  of treatment  of the mentally  y i e l d s many e x a m p l e s o f h o r r i f i c thinking  symptoms  possession,  of  burned  mental  treatment. illness  ill  through  E a r l y New  were  and t o r t u r e d m e n t a l l y  signs  ill  history  Englanders, of  people.  demonic In  later  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 t h r o w n in  poor houses.  However,  i n many c a s e s  c a r e d f o r a t home b y t h e i r f a m i l i e s With  ill  insane.  Public  initiated.  that  were d i s t i n g u i s h e d from provision  Philippe  f o r care  Pinel,  a French  f o r b e t t e r treatment people  sympathetic to  (Brown,  ill  people  were  1990).  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 century, the  mentally  worked  mentally  could  be  treatment,  h i s methods  the retarded, of  the mentally  doctor  of mentally  rehabilitated,  elderly,  and s o c i a l  ill  people;  through  treatment'.  reformer,  respectful  H i s asylums  was  he b e l i e v e d  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  as 'moral  ill  and  and  referred  reported  good  rates of cure. As a r e s u l t o f p o s i t i v e d e v e l o p m e n t s s u c h a s t h i s , a s y l u m s f o r the  mentally  ill  became  more  widespread  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  i n the 19th century.  of 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 resulted  in  institutions  increasingly  impersonal  provided  a  curative  efficacy.  Public  c u t s i n government more c r o w d e d  2.1.2  The In  becoming and  more  crowded;  bureaucratized.  environment,  Having  institutions  opinion turned against  care  now  became formerly  lost  institutions,  their  leading  to  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 a n d  (Brown,  1989).  20th Century the  20th  century,  a  number  of  developments  l e d to  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 theory  caused  a  change  i n how  t h e n a t u r e and  causes  of  mental  i l l n e s s w e r e r e g a r d e d ; e n v i r o n m e n t a l a n d e m o t i o n a l f a c t o r s came t o be  seen  as  important i n the  treatment of  mentally  ill  people.  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 1 9 5 0 ' s , d e c r e a s e d some o f t h e symptoms o f m e n t a l i l l n e s s . The human r i g h t s movement o f t h e I 9 6 0 ' s led  to  an  developments  appreciation  of  patients'  civil  rights.  These  l e d t o a movement t o w a r d s d e i n s t i t u t i o n a l i z a t i o n  of  patients. Governments, calls  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  for deinstitutionalization.  But  there  was  a  failure  to  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 of support would  2.1.3  The  have.  Canadian Context  C a n a d i a n m e n t a l 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  shifts  i n r e c e n t d e c a d e s . From 1950 t o 1960, t h e i n s t i t u t i o n a l s y s t e m expanded  was  a n d i m p r o v e d . T h e r e w e r e l a r g e i n c r e a s e s i n t h e number o f  professional,  a d m i n i s t r a t i v e , and n u r s i n g  18,000 new b e d s w e r e p r o v i d e d  staff during  this  i n p s y c h i a t r i c and g e n e r a l  time;  hospitals  ( T r a i n o r e t a l . , 1992). The  Canadian  patients  was  movement  spurred  towards  deinstitutionalization  by the release,  of  i n 1963, o f t h e C a n a d i a n  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 M i n d ( G r i f f i n e t a l . , 1963) the  . S u b s e q u e n t l y , f r o m a t o t a l o f 69,359 b e d s a v a i l a b l e i n 1 9 6 3 , number o f b e d s w e r e c u t t o 22,551 b y 1977 ( S t a t i s t i c s  1977)  .  In  addition.  More  f o r the Mind  called  p s y c h i a t r i c s e r v i c e s which would enable t h e m e n t a l l y the  Canada,  f o r community ill  to live i n  community.  2.1.4 P r o b l e m s w i t h The  move t o w a r d s c o m m u n i t y 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  provision  was made  community, been  Deinstitutionalization  f o r medical  and t h e r a p e u t i c  no p r o v i s i o n was made f o r o t h e r  provided  for i n institutional  services  i n the  n e c e s s i t i e s t h a t had  settings,  such  as  housing,  v o c a t i o n a l programs, and income. By 1980,  l a r g e numbers o f f o r m e r p a t i e n t s w e r e 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 . ended  up  returning  psychiatric  to hospital.  h o s p i t a l s was s h o r t e r ,  chronically  mentally  While  the length  of  Many  stay  at  t h e number o f r e a d m i s s i o n s o f  i l lindividuals  had  increased.  Clearly,  d e i n s t i t u t i o n a l i z a t i o n was n o t w o r k i n g . Brown failure  (1989) c o n v i n c i n g l y  was  systematic  says t h a t  due t o t h e f a i l u r e  plan of coordinated  deinstitutionalization's  of professionals  community c a r e  t o provide  programs t h a t  a  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 c o m m u n i t y .  More  supports  for  patients  returning  to  the  community  were  required. In response to t h i s centres,  and  agencies to help  s u c h a s h o u s i n g and  2.1.5  situation,  more c o m m u n i t y m e n t a l  consumer/survivors with  vocational rehabilitation,  health  necessities  have been  created.  C h a l l e n g e s t o Community C a r e Despite  the  advances,  i n c r e a s i n g l y being paradigm'  existing  challenged.  The  forms of  challenges  ( T r a i n o r e t a l . , 1992) . The  community care identify a  underlying  are  'service  assumption of  the  s e r v i c e p a r a d i g m 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  ill,  treatment geared  and  that  f o r those  towards  the  service  individuals;  improving  the  system  planning  level  of  is  there  in this  service  to  area  provide i s to  available  to  be the  afflicted. Those  who  challenge  the  service  paradigm  suggest  that  a very  large  improvements i n the h e a l t h c a r e system have not p l a y e d role  i n the  improvement of  public  b a s i c p u b l i c h e a l t h m e a s u r e s and Organization point  study of  o f t h o s e who  health;  lifestyle  schizophrenia  criticize  the  they point  instead  changes. A World  to  Health  dramatically underscores  the  s e r v i c e paradigm:  This study c l e a r l y demonstrated that the s o p h i s t i c a t e d t r e a t m e n t a p p r o a c h e s o f w e s t e r n n a t i o n s a r e no m a t c h f o r the dramatically marginalized positions to which these n a t i o n s r e l e g a t e the person w i t h s c h i z o p h r e n i a . A l l the 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 o u r t r e a t m e n t m e t h o d s h a v e b e e n u n a b l e t o p r o d u c e o u t c o m e s w h i c h a r e as g o o d 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  Self-Help  Clubs  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 available  to  consumer/survivors,  p a t i e n t s developed psychosocial Fountain for  House and H o r i z o n  many  non-professionals  s e l f - h e l p c l u b s . The f i r s t  House, p r o v i d e d  skills,  friendships,  housing  and  employment.  members  can support  and a s s i s t a n c e  The  philosophy  themselves  2.1.7 C a n a d i a n M e n t a l H e a l t h  of  t o develop  i n the l o c a t i o n of such  clubs  i n t h e community w i t h  degree o f support, without extensive  clubs.  mutual support networks  e x - p a t i e n t s , p r o v i d i n g members w i t h t h e o p p o r t u n i t y  social  and  i s that a limited  professionalized services.  P o l i c y - The E m e r g e n t  Picture  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 o n some o f t h e n e e d s b e c o m i n g 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  mental health 2.  f o r establishing clear priorities  system should  The n e e d  a s t o whom t h e  support;  f o r r e a l l o c a t i o n of resources  (both  fiscal  and  human); 3. 4.  The n e e d f o r c o o r d i n a t i o n o f t h e m e n t a l h e a l t h Regionalization/Decentralization  of  system;  administration  and  service delivery; 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 6.  consumer  and f a m i l y  and s e r v i c e d e l i v e r y ;  p a r t i c i p a t i o n i n the mental  health  system; 7. t h e n e e d t o p r o v i d e aid  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  ( M a c n a u g h t o n , 1992, p. 7-10) .  The  first  priority  described  by Macnaughton,  establishing  clear  priorities,  g r o u p s who  refers to  the  need t o  most n e e d t h e money. The  a l l o c a t e funds to  those  most n o t i c e a b l e a s p e c t o f  this  t r e n d i s t h a t of i n c r e a s i n g the s u p p o r t f o r community s e r v i c e s , therefore decreasing  t h e i n f l u e n c e , and  support f o r ,  and  institutional  settings. The  second t r e n d , the need f o r r e a l l o c a t i o n of r e s o u r c e s ,  also  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 , provincial  p o l i c y documents  are  clearly  in  favour  of  recent  community  support s e r v i c e s . The  l a s t two  relevance  l i s t e d by Macnaughton have d i r e c t  t o the development of c o n s u m e r / s u r v i v o r - r u n  Macnaughton  describes  participation experiences, in  p o l i c y trends  the  trend  mental  c o n s u m e r s and  political  s y s t e m . New  in  a  involvement  toward health  aimed  c o n s u m e r p a r t i c i p a t i o n on p l a n n i n g  at  changing  Through  their  the  concerns  c o n s u m e r s and  their  consumer  the  mental  health for  boards. Through w r i t t e n p o l i c y  p r a c t i s e , p r o v i n c i a l governments are  including  consumer  Saskatchewan have a l l o w e d  and  processes  system.  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  B r u n s w i c k , A l b e r t a , and  of  family  businesses.  and  now  trying to  families,  with  family  recognize  consultation  representatives  ( M a c n a u g h t o n , 19 9 2 ) . Most r e c e n t m e n t a l 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 strengthening  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 trend away from...the " s e r v i c e mentality", i . e . the i m p l i c i t belief 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 w h a t e v e r p r o g r a m s a r e p r e s c r i b e d f o r them ( M a c n a u g h t o n ,  1992,  New  p.9).  B r u n s w i c k ' s M e n t a l H e a l t h C o m m i s s i o n f u n d s more t h a n  30  s e l f - h e l p g r o u p s 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 m o d e l .  In  Quebec,  funding  for  self-help  initiatives  i s provided  through  " R e g r o u p e m e n t d e s R e s s o u r c e s A l t e r n a t i v e s e n Santé M e n t a l e " . I n B r i t i s h C o l u m b i a , a number o f s e l f - h e l p i n i t i a t i v e s The B.C. These  exist.  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 F u n d i n g ' .  funds,  Vancouver  Million  Mental  committees present,  $5  Health Society  make d e c i s i o n s there  Advocacy,  are  the  Constituency  f o r the past year,  four  about  (GVMHS). M e n t a l how  projects:  and  the  to the health  t h e money w i l l Unity  Vancouver-Richmond project,  goes  be  Housing,  Mental  Greater advisory  spent. The  At  Kettle  Health  Consumer  Consumer/Survivor  Artists'  Cooperative.  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 b r o u g h t 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 C a n a d i a n  Mental  H e a l t h A s s o c i a t i o n , o f the Mental H e a l t h S e r v i c e s Committee,  which  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  could  b e s t be position  s u p p o r t e d i n t h e c o m m u n i t y . T h i s was f o r people w i t h s e r i o u s mental  Support  f o r People  Church,  1984)  was  with  Severe  h a v e g u i d e d t h e CMHA's o n g o i n g p r o j e c t  to lead to a  Disabilities a  (Trainor  set of p r i n c i p l e s  ' r i c h and f u l f i l l i n g l i v e s  &  that  " 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 illness live  policy  i l l n e s s . A Framework f o r  Mental  published, outlining  people  i n t h e community'  mental (Trainor  e t a l . , 1 9 9 2 ) . 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 e n t a l h e a l t h p r o b l e m s be empowered  t o c o n t r o l t h e i r own l i v e s a n d t o make c h o i c e s a b o u t 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 c o m m u n i t y be m o b i l i z e d t o u s e a l l i t s c a p a c i t y t o support people 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 f r o m i n s t i t u t i o n a l i z e d  community  services  constituted  community,  s u p p o r t e d by v a r i o u s  than  sheltered  being  from  c a r e t o an emphasis  a paradigm  shift;  programs,  was s e e n  t h e community  living t o be  on  i n the better  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 s y s t e m s a r e p e r f e c t i b l e - that  what was n e e d e d was b e t t e r ways o f p r o v i d i n g  services to  p e o p l e . However, t h e r e i s a g r o w i n g 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 n o t 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 c o m m u n i t y s e r v i c e s may s t i l l f o s t e r d e p e n d e n c y a n d separate  people  from  becoming  apparent.  t h e community,  a second  paradigm  shift i s  There i s a dawning awareness t h a t n o n - s e r v i c e approaches,  such  a s s e l f - h e l p a n d m u t u a l 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 that  s e r v i c e approaches  do n o t .  B o t h a s c a t e g o r i e s o f human a c t i o n a n d i n t h e way i n w h i c h 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 r e n o t s e r v i c e s . T h e y 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 s e e 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 a n d 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 . T h e y 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 b y many p e o p l e w i t h m e n t a l i l l n e s s (Trainor  e t a l . , 1992,  p.  26).  T h r o u g h t h e CMHA's Framework f o r S u p p o r t and r e a l i z a t i o n i s evident consumers  now  play  a  other reports,  t h a t p o l i c y needs t o r e f l e c t central  role  in  their  the  own  a  fact  that  support  and  community s u r v i v a l ( T r a i n o r et a l . , 1992). As a  an  a l t e r n a t i v e to the  Community  Process  s e r v i c e paradigm, T r a i n o r  Paradicrm,  which  instead  of  describes  focusing  on  the  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 t h e c o m m u n i t y ' s o v e r a l l s u p p o r t . In t h i s paradigm, the (ii)  consumers  groups are  themselves,  included along  h e a l t h s y s t e m . The is  r e f e r r e d t o as  al.,  r o l e of  ( i ) f a m i l i e s and  ( i i i )generic  w i t h the  r o l e of  informal  community (iv) the  networks,  agencies formal  and  mental  model - t h a t encompasses t h e s e f o u r components the  Community R e s o u r c e B a s e M o d e l  (Trainor  et  1992) .  Figure  1.  The  Community R e s o u r c e Bank  Consumer Self-Help  F a m i l i e s and Informal Networks  Person  G e n e r i c Community A g e n c i e s and G r o u p s  The  The F o r m a l Mental H e a l t h System  r o l e of 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  as c r u c i a l , b u t becomes r e c o g n i z e d  as o n l y one  of f o u r s e c t o r s  seen that  are  put i n t o p l a y i n the support of the i n d i v i d u a l .  model,  i n practise,  would  direct  three  The  fundamental  Framework changes  in  policy.  1. C o n s u m e r s a n d f a m i l i e s w o u l d h a v e a r o l e a s f a r a s d e v e l o p i n g s e l f - h e l p and m u t u a l a i d i n i t i a t i v e s , advocacy. Support f o r such i n i t i a t i v e s  w o u l d be  and needed.  2. C o n s u m e r s and f a m i l i e s w o u l d h a v e a r o l e i n t h e development  of p o l i c y ;  i n planning, developing,  and  m o n i t o r i n g s e r v i c e s ; generic s o c i a l agencies would have a r o l e , 3. The  appropriate.  r o l e o f government  sectors; the  2.1.9  as  also  becomes one  of supporting a l l the  i n s t e a d of t h e i r former r o l e of  s e r v i c e system  administering  ( T r a i n o r e t a l . , 1992, p. 2 7 ) .  Summary The  limitations  of  deinstitutionalization More r e c e n t l y , most  recent  and  institutionalized the p r o v i s i o n  of  care  led  community  services.  t h e community c a r e system has been c r i t i c i z e d .  trend  has  been  towards  self-help  and  to  mutual  The aid  approaches. Consumer/survivor-run businesses are part of t h i s trend towards n o n - s e r v i c e approaches i n the mental h e a l t h f i e l d . policy service  documents  have  approaches.  encourages  encouraged  The  CMHA  the  development  of  report  'Framework  for  a Community R e s o u r c e Bank, e m p h a s i z i n g t h a t  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 , health p o l i c y should r e f l e c t  this.  Recent  such  non-  Support' consumers  and t h a t  mental  2.2  Vocational  R e h a b i l i t a t i o n f o r the 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 s u c h as  Trainor  &  vocational  Tremblay  rehabilitation  dimensions,  and  would  like,  look  vocational  (1992)  what  a  as  an  programs.  alternative  To  discuss  provincial strategy  i t is  necessary  to  this  that  review  to  existing  field,  supported  its them  e x i s t i n g forms  of  rehabilitation.  Vocational  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 S e c o n d W o r l d War,  i n r e s p o n s e t o the needs of  disabled  to  veterans.  Programs  designed  meet  the  needs  p h y s i c a l l y d i s a b l e d w e r e u s e d t o meet t h e n e e d s o f o t h e r including  individuals  deinstitutionalization, increased The  with the  a  mental  demands  of  disabled,  illness.  placed  on  the  these  With services  dramatically. d i f f e r e n c e s b e t w e e n t h e E u r o p e a n and  to vocational  r e h a b i l i t a t i o n n e e d t o be  American approaches  clarified  at  this  point.  The  E u r o p e a n 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 t e n d e d t o  be  based  on  a  philosophy  c i t i z e n s ; t h i s has psychiatrically  that  employment  is  a  right  i n c l u d e d a commitment t o f u l l employment f o r t h e  disabled,  government p r o v i d e  and  has  led  to  an  work f o r t h i s p o p u l a t i o n .  b e e n a c c o m p l i s h e d i n two  ways:  expectation  This  provision  in of  most  European  sheltered  work,  s u b s t i t u t e p e r m a n e n t employment In  the  United  that  commitment  has  (i) through a system of quotas  for  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 t h e p r i v a t e and p u b l i c legislated  for ' a l l  countries; which  in  and  sectors,  ( i i ) through  Europe  is  viewed  the as  (Brown, 198 9) .  States,  where  the  process  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  to rehabilitation  problem-oriented  than  in  h a v e b e e n much more p e r s o n - a n d  Europe.  Professionals  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 e r s have a l a r g e r r o l e i n t h e American 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 p l a c e m e n t t e n d t o be made o n t h e b a s i s o f e v a l u a t i v e a n d d i a g n o s t i c assessments.  Rehabilitation consists  beginning  in  the  different  forms  institution,  of  and  o f work. R e c e n t l y ,  a  series  gradually  there  of  steps,  progressing  has been a  to  realization  t h a t more f l e x i b i l i t y i s n e e d e d i n v o c a t i o n a l p r o g r a m m i n g . T h i s i s based path;  on t h e o b s e r v a t i o n some  may  rehabilitation  that  relapse,  schedule.  not a l l p a t i e n t s  and  need  European  to  follow  approaches,  work, have been r e c e i v i n g i n c r e a s e d emphasis in  recent  f o l l o w t h e same  such  a  different  as supported  i n the United  States  years.  Vocational  programs  may  be d e s c r i b e d  as f a l l i n g  into  four  from  adjustment  broad categories : 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 Employment  preparation  Programs programs  vary  work  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  Work  adjustment  (Cochrane e t a l . , 1990).  programs  are  oriented  towards  assisting  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 e n v i r o n m e n t . T h i s  i s done  by  skills.  assisting  patients  i n t h e development  of job-related  S u c h p r o g r a m s may d e a l w i t h s u c h i s s u e s a s p u n c t u a l i t y , t o work, communication s k i l l s , and a p p r o p r i a t e Most  often,  these  Increasingly, where t h e r e  programs  are offered  motivation  dress and behaviour.  i n sheltered  settings.  t h e s e p r o g r a m s may be o f f e r e d i n c o m m u n i t y s e t t i n g s , i s a focus on t h e a c q u i s i t i o n o f j o b - r e l a t e d  through d a i l y  living.  Occupational acquisition  skills  of  skills  training  job-specific  programs  skills,  and  deal  usually  c o m p l e t i o n o f work a d j u s t m e n t programs and c a r e e r  with occur  the after  counselling.  C a r e e r placement t r a i n i n g programs a i m 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 search and marketing  Elements o f career adjustment  counselling,  training,  techniques.  pre-employment c o u n s e l l i n g ,  marketing  and m o t i v a t i o n a l  work  training are  employed i n such programs. For Mental  example, Health  employment offers  t h e Vancouver-Burnaby  Association  preparation.  vocational  has  two  The CMHA's  and p r e - v o c a t i o n a l  Branch  programs  Vocational  o f t h e Canadian that  deal  Services  and  skills,  ( i n c l u d i n g work a d j u s t m e n t a s w e l l a s s k i l l t r a i n i n g ) ,  computer s k i l l s .  which  program  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 work s k i l l s  with  offers  CMHA a l s o h a s a n Employment S e r v i c e s  a range  of services  including  vocational  program testing,  career c o u n s e l l i n g , job search techniques, job coaching, placement, and  2.2.2  follow-up  Sheltered Sheltered  support.  Work w o r k , u n t i l v e r y r e c e n t l y , h a s b e e n t h e most common  f o r m 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 w o r k  has  been the  e m o t i o n a l and  engaging i n productive traditionally carried  out  by  by  structured  activities.  soliciting  patients.  environment,  intended to provide and  h o s p i t a l to At  work  The  patients  These f a c i l i t i e s from  a  regimented  routine  of  a  then  heavily  vocational  r e c r e a t i o n . W o r k s h o p s s u c h as t h e s e  social  skills,  are  and  assist with  the  t r a n s i t i o n from  community.  these  settings,  the  work  the  done  by  patients  institution,  tends  to  be  or only a token  same t i m e , h o s p i t a l s came t o d e p e n d  s o u r c e of cheap l a b o u r .  of the  is  an e n v i r o n m e n t w h e r e p a t i e n t s c a n d e v e l o p t h e i r  f o r t h e i r work. At  this  from  have o p e r a t e d  i n d u s t r i e s , which  menial i n nature. Patients often received nothing, sum  derive  workshops u s u a l l y p r o v i d e  with  t r a i n i n g , c o u n s e l l i n g , and  vocational  physical benefit  Work t e n d e d t o be  b a s e d on  the  r a t h e r t h a n the needs of the p a t i e n t  on  needs  (Cochrane  e t a l . , 1990) . Most r e c e n t of  s t u d i e s suggest that the h i g h l y s t r u c t u r e d  t h e s e workshops does not  provide  an e n v i r o n m e n t w h e r e  nature  patients  c a n 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 d e p e n d e n t on  the  sheltered  s e t t i n g (Trainor  Brown n o t e s surrounding the the  disability  that  acquired  disability itself.  are  & Tremblay,  social  and  1992).  psychological  a c t u a l l y more o f  Brown s t a t e s  an  factors  obstacle  than  further:  . . . s t a f f who h a v e n o t r e f l e c t e d c r i t i c a l l y u p o n 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 the 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 Increasing  workshops  led  disillusionment to  a  search  for  with  traditional  alternative  forms  of  sheltered vocational  r e h a b i l i t a t i o n . One s u c h a l t e r n a t i v e  came t o be c a l l e d  transitional  e m p l o y m e n t . T h e s e p r o g r a m s 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 to  one  year)  Usually  work  these placements  s h a r e one  work  are h a l f - t i m e ,  competitive  so t h a t  two  settings.  clients  employment p r o g r a m s t y p i c a l l y b e n e f i t  have v o c a t i o n a l  require  i n regular,  a situation  adjustment  individuals  s k i l l s , and  a r e as  such employable,  where t h e i r  social  functioning  can  be  improved.  In  this  and  way,  that  t h e r e i s more e m p h a s i s  on c l i e n t s '  but  who  level  of  transitional  e m p l o y m e n t p r o g r a m s c a n be s e e n t o d i f f e r f r o m s h e l t e r e d in  can  j ob.  Transitional who  placements  abilities  workshops  rather  than  disabilities. The clients  job placements t y p i c a l l y are e n t r y - l e v e l upon c o m p l e t i o n o f t h e i r  placement,  positions.  are h i r e d  Some  on by  the  company. A l t h o u g h the placements are temporary, the p o s i t i o n s are not; u p o n c o m p l e t i o n o f t h e p l a c e m e n t , a new  c l i e n t w i l l take over the  position. The  major  incentive  for  employment programs i s t h a t  companies  to  use  transitional the  client  f o r t h e j o b ; and e n s u r e 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  misses  a  shift,  a  treatment  backup  staff  An Vancouver  example  be  provided.  Clients  a t a l l t i m e s . Work p e r f o r m a n c e  higher f o r clients r e g u l a r employees  will  sponsoring agencies t r a i n  from t r a n s i t i o n a l  have  access  i s often  to  actually  employment p r o g r a m s t h a n f o r  (Cochrane e t a l . , 1990). of  a  transitional  employment  a r e a i s the Coast T r a n s i t i o n a l  C o a s t F o u n d a t i o n was  founded  i n 1974  program  from  the  Employment P r o g r a m .  The  to provide quality  housing.  job  readiness  people  training,  challenged  social  a n d employment  by p s y c h i a t r i c i l l n e s s .  opportunities f o r  One  o f t h e programs  o f f e r e d b y C o a s t i s a Work R e a d i n e s s p r o g r a m t h a t p r e p a r e s members for  r e - e n t r y i n t o t h e j o b m a r k e t . The m a j o r c o m p o n e n t s o f t h e work  readiness  p r o g r a m a r e t h e 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 o n a d a i l y b a s i s . Members d e v e l o p w o r k a d j u s t m e n t s k i l l s , self-esteem,  and c o n f i d e n c e  (Coast  Foundation,  1993).  C O A S T ' S T r a n s i t i o n a l Employment P r o g r a m (TEP) p j r o v i d e s members who  have  developed  workforce.  As  their  with  job s k i l l s  other  a means o f r e - e n t e r i n g t h e  transitional  employment  programs,  TEP  placements 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 rates.  Initially,  a COAST employment  client  t o l e a r n the job,  employer's standards. miss a s h i f t ,  and ensure t h a t  COAST e n s u r e s t h a t  a backup w i l l  support are a l s o provided. for  counsellor  be p r o v i d e d ;  works  i t i s being should  with the  done t o t h e  a client  need t o  on-going monitoring  and  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  6 m o n t h s a n d t h e n move o n 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  client  t o gain experience  Employers industries,  Realty  u s e t h e TEP p r o g r a m  ranging  corporations; Centre,  who  United (Coast  i n d i f f e r e n t work e n v i r o n m e n t s .  from  employers Services  come  small  family-based  include  S t . John  C r e d i t Union,  Foundation,  from  a v a r i e t y of  businesses the Divine  t o major Day  Care  Canadian T i r e and G o o d r i c h  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 w o r k s h o p t h a t h a s become common  i s supported  employment  model,  employment.  training  occurs  Whereas before  i n the job  transitional  placement,  in  supported  employment,  placement  occurs  first.  The  client  is  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 t h e 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 appropriate provides  and j o b s p e c i f i c .  temporary  And where  placements  for  transitional  clients,  employment  with  supported  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;  likewise,  support i s ongoing. Clients suit  are involved  their interests,  are u s u a l l y  i n i d e n t i f y i n g what t y p e o f w o r k  abilities,  i n entry-level  would  and a s p i r a t i o n s ; work p l a c e m e n t s  positions,  though  sometimes  non-entry  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 . Supported  employment  i s thought  b y some  researchers  t o be  a p p r o p r i a t e f o r t h o s e who n e e d 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 , b u t 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 . , have  noted  that  unemployable'  some  individuals  i n o t h e r programs,  1990). Other r e s e a r c h e r s labelled  are able  'permanently  t o cope  well  in a  c o m p e t i t i v e b u s i n e s s e n v i r o n m e n t , 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 w o r k s e t t i n g i s t h o u g h t t o be more e f f i c i e n t a n d h a s a better  chance  of leading t o success than t r a i n i n g  in a  sheltered  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 is  seen t o maximize  the f i t  between  the client,  t h e employer, and  t h e j o b . S u p p o r t e d employment i s s e e n t o p r o v i d e f o r g r e a t e r 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'  researchers  feel  transitional  employment  Bond  (1987) ,  such  found  programs create.  that  only  as  sheltered  that  some  workshops  and  A study from Maryland, 5%  of  clients  client  in  cited i n  transitional  e m p l o y m e n t went on t o c o m p e t i t i v e e m p l o y m e n t ; t h e s t u d y t h a t s t a f f i n t r a n s i t i o n a l p r o g r a m s may b e t t e r workers to the c o m p e t i t i v e Despite  the  successes  and  be r e l u c t a n t t o l o s e t h e i r  workforce. positive  aspects  of  employment, not a l l d i s a b l e d w o r k e r s f i n d i t the b e s t Chronic  psychiatrically  difficult  to  maintain  private sectors  suggested  disabled  workers  competitive  may  employment  (Brown, 1 9 8 9 ) , due  t o such  in  supported  alternative.  still  find  i t  the  public  or  i s s u e s as  absenteeism,  n e g a t i v e s t e r e o t y p e s , and p o o r w o r k r e c o r d s . T h e s e i s s u e s h a v e b e e n u s e d as a r a t i o n a l e f o r t h e development o f a v a r i a t i o n o f  supported  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 North America g e n e r a l l y takes the  form of (c)  (a) employment p r e p a r a t i o n p r o g r a m s ,  transitional  employment,  and  (d)  (b)  s h e l t e r e d work,  supported  employment.  range of o p t i o n s doesn't provide f o r a l l m e n t a l l y i l l new  a l t e r n a t i v e s are The  worker  supported and will  be  the  co-operative  business  described  individuals;  needed. model  differs  employment i n t h a t i t e n a b l e s  operate  This  i n which they  f u r t h e r i n Chapter  from  other  forms  p a t i e n t s to develop, are 3,  employed. T h i s  of own,  model  "Consumer/Survivor-Run  Businesses".  2.3  Community E c o n o m i c D e v e l o p m e n t Consumer/Survivor-run  businesses  offer  promise  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 . this  stage  t o put  this  model  i n context,  as  as  I t i s important a  specific  tool  an at of  community economic development. A d i s c u s s i o n of community economic  d e v e l o p m e n t 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 , a n d what i s s u e s r e g a r d i n g  CED  are r e l e v a n t . C o m m u n i t y e c o n o m i c d e v e l o p m e n t h a s b e e n d e f i n e d i n a number o f d i f f e r e n t w a y s . 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 process whereby people i n a community organize 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 the available 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 e c o n o m i c p r o b l e m s ( C a t h o l i c New T i m e s , Dec. 20, 1992, p. 13) . Community  economic  communities,  in  that  unrecognized  strengths  development i t  has  the  of  marginal  is  ideal  capacity  f o r marginalized to  communities  a v a i l a b l e l a b o u r a n d o t h e r u n u s e d r e s o u r c e s . CED particular  People very  -  high  of  particularly  strategies  place  who  resources.  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  r a t e o f unemployment.  The  available  resources  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 Community  use  e m p h a s i s 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 ,  which f i n d uses f o r a v a i l a b l e  a  make  economic  development  projects  could  have this  talents.  provide  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 time.  2.3.1 The c o n c e p t o f 'community' i n c o m m u n i t y e c o n o m i c d e v e l o p m e n t 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 c o m m u n i t y e c o n o m i c d e v e l o p m e n t . F o n t a n (1993) makes a typology of these d i f f e r e n t  conceptions.  1. A G e o g r a p h i c B a s e , where community i s attempted i n a s p e c i f i c particularly  geographical  geared toward a s p e c i f i c  area;  economic development i s  s o c i a l group,  m a r g i n a l i z e d groups i n s o c i e t y  development  area,  a marginalized urban o r r u r a l  2. A S o c i a l B a s e , w h e r e community  the  economic  particularly  (the unemployed,  women,  young, t h e d i s a b l e d , . . . ) ;  3. A Community B a s e , where c o m m u n i t y developed i n a location, shared i n t e r e s t ;  economic development i s  where r e s i d e n t s s h a r e a s t r o n g  o r a common h i s t o r y a n d s e n s e o f  belonging.  In community  t h e case  of consumer/survivor-run businesses  economic  development  i s attempted w i t h  w i t h a g r o u p o f p e o p l e i n s o c i e t y who h a v e b e e n P e r r y (1987) a n d M a c L e o d development  must be b a s e d  (CSRB's),  a social  marginalized.  (1986) a s s e r t t h a t c o m m u n i t y  i n a specific  base,  economic  geographic 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 t h e p o p u l a t i o n a s a w h o l e , t o w h i c h p o w e r c a n be t r a n s f e r r e d  back.  Power o v e r t h e l i v e s o f c o n s u m e r / s u r v i v o r s h a s t r a d i t i o n a l l y resided  with  system  --  representatives institutions,  professionals.  Self-help  consumer/survivor-run  of the t r a d i t i o n a l community  and mutual  businesses  service  a r e an  (1988)  CSRB i n T o r o n t o , p r o v i d e s development w i t h  state  health  agencies,  aid initiatives, example,  c o n s u m e r / s u r v i v o r s t o take back c o n t r o l o v e r t h e i r Ward & T r e m b l a y  mental  and  of which  may  assist  lives.  t h a t A-Way E x p r e s s C o u r i e r s ,  a useful  model  f o r community  'non-geographic' communities.  a  economic  2.3.2  Dimensions  o f Community E c o n o m i c D e v e l o p m e n t  The a s p e c t s o f c o m m u n i t y l i f e t o w a r d w h i c h c o m m u n i t y development next  two  account  may  be d i r e c t e d c a n be d i v i d e d i n t o f o u r a r e a s . I n t h e  sections, of  CED's  o p e r a t i o n a l i z e CED; we  economic  i t i s not dimensions,  my  intention  and  the  to  tools  give  that  a  detailed  are  used  to  r a t h e r , t h i s a s k e t c h of the t e r r a i n , such that  c a n s e e w h e r e CSRB's f i t  i n t o the l a r g e r  picture.  1. L a n d Use P l a n n i n g : Community i n i t i a t i v e s use,  or  to  improve  oriented  towards  the p h y s i c a l  or  gaining  control  socioeconomic  over  land  infrastructure  through: (i)  housing  ( i i ) z o n i n g , i n w h i c h 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 given area (iii)  collective  residential,  land  ownership,  commercial, or i n d u s t r i a l  affecting  environmental,  purposes.  2. E m p l o y m e n t : Initiatives  directed  toward  the  development  of  of  employability;  the  community's  human r e s o u r c e s , t h r o u g h : (i)  the  development  development  of job s k i l l s  promoting  the  through p r e - e m p l o y a b i l i t y or v o c a t i o n a l  training. (ii)  job training; providing a given clientele t r a i n i n g  a community  with  enterprise.  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 : Initiatives  geared  community t h r o u g h :  toward  assisting  b u s i n e s s development  i n the  (i) through  private such  or  c o l l e c t i v e business  measures  as  technical  i n d i v i d u a l s o r g r o u p s t o s e t up (ii)  the  (iii) business (iv) closing, 4.  resource  assistance;  groups,  training  businesses;  development of community  business incubators;  development  enterprises;  t o o l s used i n c o n j u n c t i o n  with  new  development; e a r l y warning systems; i d e n t i f y i n g p l a n t s and  intervening  t o k e e p them i n  i n danger  of  operation;  P r i v a t e or C o l l e c t i v e Investment:  Initiatives  to  mobilize  financial  resources  for  community  development. (i) operative  private  banks, w h i c h have a  social orientation,  or  co-  banks;  ( i i ) community l o a n funds, a s s i s t i n g the community i n managing of  loans of venture c a p i t a l f o r s o c i a l  Fontan describes activists into  two  to  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  operationalize  categories.  those i n t e r v e n t i o n  initiatives.  As  CED  (Fontan,  explained  1 9 9 3 ) . T h e s e he  below,  the  t o o l s which take a p l u r a l ,  t o w a r d s c o m m u n i t y e c o n o m i c d e v e l o p m e n t . The  first or  Intervention  The community  primary  of  the  with  business  is  approach  other category i s for approach.  Tools  example  development  organization,  category  global  those t o o l s which take a singular, or s p e c i a l i z e d ,  Global  divides  of  a  global  corporation  intervention  (CDC).  A  CDC  is  a board of d i r e c t o r s i n c l u d i n g and  social  service  sectors,  tool a  is  the  non-profit  representatives and  direct  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 t h e community. C o m m u n i t y D e v e l o p m e n t 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 c o operatives.  Both  are structures  s e t up  with  the i n t e n t i o n of  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 . Y e t CDC s u s u a l l y carry  out diverse  governing  not f i t t i n g  under  the present  laws  co-operatives.  Corporations capital  functions  a r e s e t up  than a small business  risk-taking: shielded  while  from  conceivably corporation's  larger  end  An up  amounts  could. Limited l i a b i l i t y  a c o r p o r a t i o n may go b a n k r u p t ,  liability.  still  t o accumulate  employee  of  financially  a  of  encourages  employees a r e  corporation  well-off,  could  despite  a  demise.  Such methods as d i v i s i o n o f l a b o u r ,  coordination,  systematic  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 u s e d b y 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 f r o m t h e way i n w h i c h a small business aspects  would operate.  W h i l e most c o r p o r a t i o n s u s e t h e s e  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 these  methods f o r t h e b r o a d e r good o f t h e community As  (MacLeod, 1986) .  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 u n d e r t h e c o n t r o l o f  shareholders The  through the board of d i r e c t o r s ,  not the s t a f f .  other 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 the  t e c h n i c a l r e s o u r c e g r o u p f o r CED. The t e c h n i c a l r e s o u r c e described  by  Fontan,  i s designed  to  support  group, as  the creation  of  i n s t i t u t i o n s t h a t a d v o c a t e a g l o b a l a p p r o a c h . Towards t h i s end, t h e t e c h n i c a l resource  g r o u p may engage i n s u c h a c t i v i t i e s a s r e s e a r c h  and  the t r a i n i n g  development,  of  interveners  consulting  f o r i n t e r v e n t i o n groups  or public  publishing  and  encouraging  documentation,  and  and  volunteers,  administrations, networking  and  c o n s u l t a t i o n b e t w e e n 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 specific projects project  g r o u p 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  (as o p p o s e d t o i n s t i t u t i o n s ) . A c t i v i t i e s s u c h a s  development,  management  and  administrative  financial  s t r u c t u r i n g , and t h e development  practices  may  assist  specific projects  Specialized  Intervention  Fontan's listed, will  be u n d e r t a k e n  list  of  though only  be d e s c r i b e d  o f sound  by t h e t e c h n i c a l  (Fontan,  resource  support, accounting group t o  1993).  Tools specialized  those  intervention  tools of specific  tools  relevance  will  be  t o CSRB's  here.  1. c o m m u n i t y l a n d t r u s t s 2. c o m m u n i t y l o a n f u n d 3. m i c r o - e n t e r p r i s e lending  associations  projects  (including peer-assisted  schemes)  4. c o m m u n i t y l a n d u s e  corporations  5. n e i g h b o u r h o o d b o a r d s 6. human r e s o u r c e  development  7. s c h o o l - b u s i n e s s  compacts  8. c o m m u n i t y b u s i n e s s  incubators  9. e a r l y w a r n i n g s y s t e m s * 10. a l t e r n a t i v e b u s i n e s s e s : defined its  initiatives  (with reference  to plant  closures)  An a l t e r n a t i v e b u s i n e s s i s  by F o n t a n 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  into  s t r u c t u r e some f o r m o f d e m o c r a t i c c o n t r o l b y i t s  w o r k e r s . T h i s may t a k e t h e f o r m o f management; a w o r k e r c o o p e r a t i v e  co-operative  i s a l e g a l business  s t r u c t u r e , p r o v i d i n g e a c h worker-member w i t h one s h a r e .  one  vote,  and an e q u a l v o i c e  alternative  i n company m a t t e r s . O r a n  b u s i n e s s may h a v e c o m m u n i t y 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 ultimately responsible may be p r o v i d e d  f o r the corporation,  with direct representation  * 11. t r a i n i n g b u s i n e s s e s :  b u t employees on t h e board.  A t r a i n i n g business i s a  non-profit  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 with  the operation  o f a b u s i n e s s t h a t p r o d u c e s goods and  s e r v i c e s t o t h e community. Such p r o j e c t s u s u a l l y individuals  i n unstable  income, e x - o f f e n d e r s , are,  s i t u a t i o n s -- t h o s e  s t r e e t youth, o r other  o r a r e becoming, m a r g i n a l i z e d .  of such a p r o j e c t provides  i s the Picasso  target  lacking people  who  A Vancouver example  Cafe, a business which  on-the-job t r a i n i n g f o r youth with  unstable  backgrounds.  Fontan 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 related to profitability, so the 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 literature 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 a n d e c o n o m i c 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 , b u t 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 n o t t o r e p r o d u c e a m o d e l o r i m p o s e f r o m o n 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 o u t ( F o n t a n , 1993, p. 3 7 ) .  2.4 M e n t a l H e a l t h , In  this  Perspectives  section,  the r e l a t i o n s h i p  s t r a t e g i e s and p e r s p e c t i v e s well,  developments  disabled w i l l discussion  on t h e D i s a b l e d ,  between  on t h e d i s a b l e d w i l l  i n mental  health  will  present  t h a t have p a r a l l e l e d  how  the  discussed  health  be d i s c u s s e d .  and p e r s p e c t i v e s  thinking  on  As  on t h e  theory.  mental  This health  and t h e changes i n o t h e r  fields  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  c o n c e p t o f a 'community v i s i o n '  i n mental  health.  i n t h e c h a p t e r on mental h e a l t h p o l i c y ,  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 place  mental  be r e l a t e d t o d e v e l o p m e n t s i n p l a n n i n g  s t r a t e g i e s has changed over time,  As  and P l a n n i n g  f o r many  i l l p e o p l e was t o  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 ,  lack  of funding  caused  institutions  l i t t l e more t h a n w a r e h o u s e s f o r t h e m e n t a l l y  ill,  t o become  providing  social  c o n t r o l o v e r a p o p u l a t i o n s e e n a s d e v i a n t . The i n s t i t u t i o n a l s y s t e m has  also  taken  away  power  committed t o h o s p i t a l ,  from  those  who  made t o u n d e r g o  enter  i t . They a r e  treatment,  then  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 p r o g r a m s ; t h u s t h e y become c o n s u m e r s of  social  services,  and  dependent  on  professionals.  professionals,  w h e t h e r t h e y be s o c i a l  psychiatrists,  s e t t h e agenda f o r r e h a b i l i t a t i o n  These  workers, p s y c h o l o g i s t s ,  or  of the patient.  John McKnight describes three p e r s p e c t i v e s governing a t t i t u d e s towards t h e d i s a b l e d : vision,  (i) the therapeutic v i s i o n ,  and ( i i i ) t h e community  The  therapeutic  prescribed  vision  by p r o f e s s i o n a l s t o meet  ( i i ) t h e advocacy  vision.  d e f i n e s p e o p l e i n terms o f needs ), which i t i s t h e r e s p o n s i b i l i t y  expert  systems  (CBC R a d i o w o r k s ,  1994) . The  vision  has supported t h e i n s t i t u t i o n a l approach t o mental  ( as of  therapeutic health.  Within  the f i e l d of planning,  t h e dominant  planning  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 approach,  the planner i s responsible  this  f o r (i) s e t t i n g goals, ( 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 e n d s , a n d (iv) for and  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 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 solutions,  implementation  i n the evaluation of decisions.  towards c e n t r a l i z a t i o n ,  o f a l t e r n a t i v e s , and  I n terms  o f i t s methods  t h i s model o f p l a n n i n g  about  i n c r e a s i n g awareness of  governments  the q u a l i t y  of  care  of patients' c i v i l  t o save  money  spent  and  bias  h a s 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 Concerns  i n the  health.  i n institutions,  rights,  an  and t h e eagerness  on i n s t i t u t i o n s  l e d to the  movement t o w a r d s d e i n s t i t u t i o n a l i z a t i o n o f m e n t a l p a t i e n t s . A f t e r a  period  i n which  inadequate, population shelter,  services  community the things  to  services that  those  were  released  s e t up  were  t o provide  the i n s t i t u t i o n  once  grossly to  d i d , such  this as  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 t o w a r d s c o m m u n i t y c a r e i n m e n t a l h e a l t h was b a s e d on  a realization  different vision,  of patients'  perspectives  civil  rights.  on t h e d i s a b l e d ,  McKnight,  describes  outlining  t h e advocacy  which views 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 which  need t o be d e f e n d e d . The a d v o c a c y 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 h a s p a r a l l e l s w i t h t h e development theory.  Rooted  o f advocacy p l a n n i n g  i n the realm of planning  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 a d v o c a c y p l a n n i n g movement d e v e l o p e d i n t h e I 9 6 0 ' s . Advocacy  planning  has g e n e r a l l y  been  applied  to defending the  i n t e r e s t s of community groups, e n v i r o n m e n t a l c a u s e s , the poor,  and  the d i s e n f r a n c h i s e d  and  government  the e s t a b l i s h e d powers of b u s i n e s s  (Hudson, 1 9 7 9 ) .  responsible  for  disabilities.  great  The  professionals  and  But  advocacy  improvements of  recently,  for  releasing  this  vision  w a l l of h e l p e r s ' ,  place.  community f o r the  her  from  has  who  community  service  a new  the  larger  community  criticized,  (CBC  referred disabled  community.  care i n  s e t t i n g has  and  as  Clients  a h o s t i l e , rather  institutional  nearly  from  the been  l e g a l safeguards  inflexible  as  the  R a d i o w o r k s , 1994) .  Community V i s i o n  domain,  administrative  norms  together  for  s o c i e t y as governed and  their  the  own  c o n s i s t i n g o f two by  legal,  community domain,  purposes.  had  domains:  contractual,  McKnight  e x t e n s i v e l y on what he v i e w s as t h e n e g a t i v e i m p a c t  have  concerned  people  been  c o m m u n i t y as  systems  they replaced  institutional  has  with  i n p r o t e c t i n g the  complete w i t h a w a l l of r e g u l a t i o n s  McKnight describes  come  people  and  Second, i n t r y i n g t o p r o v i d e  disabled,  i n s t i t u t i o n s that  The  of  been  p o i n t s . F i r s t , what J o h n M c K n i g h t h a s  disconnect  hospitable  making  lives  parents,  u l t i m a t e l y come t o c o n c e i v e o f t h e  created,  the  has  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  t o as a ' d e f e n s i v e  than  in  vision  friends,  responsible  p a r t i c u l a r l y on two  individual,  The  advocacy  was  institutions, services.  against  where has  the and  people written  professionalism  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 a d v a n c e , c o m m u n i t i e s  lost  Radioworks,  their  capacities  to  care,  counsel,  and  console  (CBC  criticize  the  1994).  McKnight's ideas  parallel  those of  o t h e r s who  'service  paradigm'  c r i t i c s point  on  which  social  services  a r e based.  These  o u t t h a t s o c i a l s e r v i c e h a s 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  discussed  previously,  there  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  that  place  emphasis  independence. McKnight d e s c r i b e s vision  of care  on  greater  self-reliance  a community v i s i o n ,  f o r the disabled  that  emphasizes  and  describing a  belonging,  and  c o n n e c t e d n e s s t o community. In  the  transactive  field  of  planning,  planning which  theory,  calls  Friedmann's  for a  theory  decentralization  of of  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 a n d c l i e n t , h a s some p a r a l l e l s  with McKnight's  community  vision. Friedmann personal  contact  felt  that  planning  should  occur  as a  result of  between people a f f e c t e d by d e c i s i o n s ;  through a  p r o c e s s o f ' s o c i a l l e a r n i n g ' b e t w e e n p l a n n e r a n d c l i e n t w o u l d come the  relevant  Friedmann  issues  saw t h a t  development  t o be d e a l t w i t h . A t a n i n s t i t u t i o n a l transactive planning  of decentralized  planning  also  should  institutions  level,  include the that  assist  people t o take 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 their the  lives  (Hudson, 1 9 7 8 ) . T r a n s a c t i v e  planning  human d i m e n s i o n s o l a c k i n g i n s y n o p t i c  was t o e m p h a s i z e  planning:  . . . a t t e n t i o n t o t h e 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 instrumental objectives - f o r example, psycho-spiritual d e v e l o p m e n t , enhancement o f d i g n i t y , a n d c a p a c i t y f o r s e l f h e l p (Hudson, 1978) .  Radical planning movements  in  tradition,  mental  Gunton  tradition  which  i s another planning health  have  describes  spurred  policy analysts  parallels.  the  to which  In  criticisms  alternative  a t t r i b u t e d t o s u c h a u t h o r s as  theory  Ilich,  models.  current  discussing of  the  These  Grabow, and  this  synoptic  criticisms,  Heskin,  identify  as:  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 i m p o s e t h e i r v a l u e s on s o c i e t y b y d e f i n i n g p r o b l e m s i n s u c h a way that broad p a r t i c i p a t i o n i s discouraged. Professionals cultivate d e p e n d e n c y i n o r d e r t o m a i n t a i n p o w e r and p r e s t i g e ( G u n t o n , 1981).  Planners lies  i n the  radical tradition  believe  that  a  solution  i n ' s o c i a l l e a r n i n g ' , which merely perpetuates the p r i v i l e g e d  p o s i t i o n of p l a n n e r s ; role  don't  of  government  concentration referees  of  nor  do  they believe i t l i e s  without  power,  i n an u n e q u a l  tackling  nor  the  i n reducing  problems  relegating planners  to  of  the  private  the  role  of  world.  ...planners must become social reformers committed to f u n d a m e n t a l 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 complexity that gives technocrats p o w e r b a s e d on their s u p e r i o r k n o w l e d g e . P l a n n e r s e n g a g e d 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 social u n i t s b a s e d on w o r k e r o w n e r s h i p and c o m m u n i t y cooperatives and communes w h e r e p r o f e s s i o n a l p l a n n e r s a r e ultimately e l i m i n a t e d (Gunton, 1981).  In  the  mental  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 s e e n t o  reflect  aspects of the run  businesses,  reflect  an  health  field,  transactive planning structures  awareness of  more r e f l e c t i v e o f t h e  the  b a s e d on  the  recent  approach.  Consumer/survivor-  worker ownership,  l i m i t a t i o n s of  r a d i c a l approach to  and  professionalism, planning.  which are  The  f o l l o w i n g diagram  between mental  (Figure  health, planning  2)  theory,  summarizes and  the  parallels  perspectives  on  the  disabled discussed i n this section.  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 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  Mental H e a l t h Theory  P e r s p e c t i v e on the D i s a b l e d (McKnight)  Planning Theory Rational Comprehens i v e Planning  Institutional Care  Therapeutic Vision  Community Care  Advocacy Planning  Advocacy Vision  Self-help/ Mutual A i d  Radical/ Transactive Planning  Community Vision  Mediating Of concept  Structures i n Society relevance of  to  consumer/survivor-run  mediating  Mediating  businesses  structures. Sociologist  l u t h e r a n p a s t o r R i c h a r d Neuhaus w r o t e To of  Theory  Structures  in  Public  Peter  is  the  Berger  and  Empower P e o p l e : The  Policy,  in  1977.  Berger  Role and  N e u h a u s ' 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 n p r e c e d e n t e d ' s p l i t b e t w e e n 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  d o m i n a t e d by  large institutions,  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 1994). S o c i e t y ' s 'mediating friends,  churches,  associations  s t r u c t u r e s ' -- t h e f a m i l y ,  clubs,  local  businesses  -- a c t as a b u f f e r b e t w e e n a v a s t and  and  and  the  Radioworks, neighbours, voluntary  bureaucratized  state,  and  the  individual,  whose  life  is  usually  of  private  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 structures life.  Yet  public  t h a t p r o v i d e m e a n i n g and these  policy.  mediating Berger's  relevance to the  structures  analysis  have not  i s that  been s u p p o r t e d  the  decline  settings w i l l ultimately lead to t o t a l i t a r i a n i s m --an state  acting  support  d i r e c t l y on  f o r such  necessary,  the  mediating  structures  and w o u l d reduce  Berger applicable  and  i n d i v i d u a l . To  through  concept  of  by  advocate  channelling  government.  then  In  the  field  of  and  Neuhaus, policy  t h e i r own  have  the  mediating  structure  services,  opportunity  to  social services.  Neuhaus'  choose  among  or they could  competing then set  structures. businesses could  i n that  they  support  study of mediating  by p u b l i c for  development businesses.  a of,  p o l i c y of such  policy and  they  Clients  provide  be an  seen  as a form  alternative  p r o v i s i o n o f s e r v i c e s by g o v e r n m e n t a n d o t h e r i n s t i t u t i o n s .  support  is  funds d i r e c t l y t o c l i e n t s of s o c i a l s e r v i c e s ,  Consumer/Survivor-run  and  is  meaning. structures  social  i n s t i t u t i o n s where t o spend t h e i r voucher,  mediating  these  all-powerful  public  mediating  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  up  of  by  t o the p r o v i s i o n of s o c i a l s e r v i c e s , c u r r e n t l y provided  largely  would  Berger  a l i e n a t i o n and c o n s e r v e  Neuhaus'  individual's  that  ongoing  structures structures,  explicitly support  and  the  lends  addresses  for,  to  of the  Berger  necessity  of  philosophical fostering  the  Consumer/Survivor-run  3.0 C o n s u m e r / S u r v i v o r - R u n In  t h e 1960's,  challenged;  institutional  later,  the  Businesses  care f o r the mentally i l l  community  service  system  was  was  also  c h a l l e n g e d . Community s e r v i c e h a s i n common w i t h t h e i n s t i t u t i o n a l system  the idea  that  i t i s possible  to create  a  'system  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 h a s b e e n s e e n a s t h e o n l y use  of mental  health  budgets.  Recently, people  involved  f i e l d o f m e n t a l h e a l t h h a v e come t o q u e s t i o n w h e t h e r 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  that valid  i n the  i t i s i n fact  (CBC R a d i o w o r k s ,  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  1994).  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 h a n d i c a p p e d . One o f these  changes  initiatives; direct  has these  action.  been  the  trend  initiatives  Such d i r e c t  that  initiatives.  people with  becoming  more  consumer/survivor  are not services,  but a form o f  a c t i o n may t a k e t h e f o r m o f a d v o c a c y ,  peer counselling, or s e l f - h e l p . economic  towards  I n some c a s e s i t t a k e s t h e f o r m o f  The i d e a o f b u s i n e s s e s , s e t up i n s u c h a way  a psychiatric widespread.  history  Support  control  the business, i s  f o r consumer/survivor-run  b u s i n e s s e s comes o n 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 esteem  s e l f - r e l i a n c e , which i n turn helps the i n d i v i d u a l s '  and mental  self-  health.  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 a l s o comes o n 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 p r o m o t e a n individuals' Ontario's  rehabilitation. provincial  A  study  psychiatric  c o m p e t i t i v e s e t t i n g s worked  of  programs  hospitals  offered  concluded  1992).  that  b e t t e r than 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 of people w i t h a h i s t o r y of mental i l l n e s s T r a i n o r & Tremblay,  at  (cited i n  In  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  consumer/survivors,  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 , b u t e m p l o y e e s and e m p l o y e r s . focus  i s on  create  these  individuals  meaningful  professional  work;  using their  there  is  talents  little  or  and  no  skills input  to from  staff.  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 of the to  The  individual  t h e e m p l o y m e n t s e t t i n g ; work becomes m e a n i n g f u l b y v i r t u e o f t h e  i n d i v i d u a l ' s stake i n the e n t e r p r i s e (Trainor et a l . ,  1992).  Such  b u s i n e s s e s h a v e come t o be c a l l e d 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 , or  CSRB's  ( T r a i n o r & Tremblay,  1992).  CSRB's a r e an a t t e m p t b y p e o p l e who h a v e u s e d t h e m e n t a l h e a l t h s y s t e m t o e s t a b l i s h an e c o n o m i c p r e s e n c e w h i c h t h e y c a n c o n t r o l . By d o i n g t h i s , t h e y h a v e b e e n 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 liability and d i r e c t l y c o n f r o n t a m a j o r 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 : the 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 h a n d , 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 the o t h e r . ( T r a i n o r e t a l . , 1992, p. 70)  F i v e e x a m p l e s o f CSRB's a r e r e v i e w e d b e l o w t o f i n d a n s w e r s t o the f o l l o w i n g questions:  1.  What  are  activity? vocational  the  i.e  distinguishing  what  characteristics  distinguishes  rehabilitation,  and  CSRB's  from  from  other  of  this  other  types  of  sort  of  types  of  business  organization? 2. What a r e t h e o p p o r t u n i t i e s f o r t h e d e v e l o p m e n t 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 are t o addressed (i)  by r e s e a r c h i n g :  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 e x a m p l e s o f CSRB's;  (il)  information  promotional  For  provided  by  CSRB's t h e m s e l v e s ,  i.e.  brochures,  material.  the purposes of 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  sufficient  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 opportunities  The  and  constraints to t h e i r  f i v e e x a m p l e s o f CSRB's t o be 1. A b e l  analyzed  Fresh Start Cleaning  4.  Unity  5.  Consumer/Survivor A r t i s t s  and  Maintenance  Housing  Examples of Abel  are:  Couriers  3.  3.1.1  development.  Enterprises  2. A-Way E x p r e s s  3.1  Co-operative  CSRB's  Enterprises  Abel Enterprises i s a consumer/survivor-run business i n Simcoe, O n t a r i o .  I t has a l s o b e e n known as t h e  W o r k i n g G r o u p , a f t e r H a l d i m a n d and N o r f o l k which  i t operates.  The  oldest  of  t h e s i s , A b e l E n t e r p r i s e s began i n The  e n t e r p r i s e b e g a n as  the  Haldimand-Norfoik Mental Health people with  a  serious  mental  illness  lack  financial  employment,  need.  effect that psychotropic  Also  CSRB's  Services,  issues  of  Haldimand-Norfoik  counties,  r e s u l t of  C a n a d a Works f u n d i n g ,  were  the  operating  the region  described  in  in  this  1983.  s u p p o r t e d by  desperate  the  a study, i n t o the  i n the  found poor  found  m e d i c a t i o n s had  that  be  issues  region.  living  to  conducted  of  the  facing  This  most  by  study, pressing  conditions,  and  concern  the  on t h e m e n t a l l y  was ill.  From  t h e s e i s s u e s came t h e 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 . E m p h a s i s was to  be p l a c e d o n g r o u p p a r t i c i p a t i o n  and  direction  themselves  i n decision-making;  o f t h e c o o p e r a t i v e was  (CMHA,  t o come  from  control,  t h e members  1987).  S t a r t i n g w i t h a number o f men who w e r e c o n s u m e r s o f H a l d i m a n d Norfolk  Mental  Health  S e r v i c e s , and w i t h  community development worker, start,  the assistance of a  A b e l E n t e r p r i s e s was b o r n .  t h e c o o p e r a t i v e has been committed  to taking  From t h e  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 b y t h e c o m m u n i t y ; s o m e t i m e s opportunities  have  been  small  i n scale,  sometimes  these  large  (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 16-foot  c a n o e , w h i c h w o u l d 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 co-operative project  resulted  project. that  and p u b l i c i t y i n $700  The g r o u p  from  the surrounding  f o r t h e group,  l e a r n e d , from  t h e r e was a n e e d l o c a l l y  community.  and awareness  the V i c t o r i a n  f o r specialty  Order  items  of  This  f o r the Nurses,  f o r physically  h a n d i c a p p e d p e o p l e , s u c h a s b a t h b o a r d s , p o r t a b l e w h e e l c h a i r ramps, walkers,  a n d amputee b o a r d s .  wood-working s k i l l s , for  them.  approached  The  A s s e v e r a l members o f t h e g r o u p h a d  producing these  local  community  i t e m s was a n a t u r a l  college,  Fanshawe  project  College,  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 to  college  c o u r s e s . Through t h i s  a r r a n g e m e n t , members h a v e  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 , furniture pesticides repair,  was  refinishing,  horticulture,  and f u n g i c i d e s ,  commercial  cooking f o rthe public,  access taken  f i r s t a i d , work s a f e t y ,  commercial fruit  and m a r k e t i n g  application  trees, (CMHA,  small 1987).  of  engine  O t h e r w o r k p r o j e c t s were e m b a r k e d u p o n . A f o o d c o n c e s s i o n , r u n for  four  consecutive  summers,  provided  employment  and  developed  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 o n o t h e r activities. weeding  The  group a l s o o b t a i n e d  a woodlot  f o r the l o c a l  a contract  f o r p l a n t i n g and  Forestry Station. This  was  one  p r o j e c t t h a t d i d n ' t w o r k f o r members. The w o r k was s t r e n u o u s ,  and  t h e r e was n o w h e r e t o r e l a x a n d t a k e a b r e a k ; a s a r e s u l t , actually reached, the  went  on  strike  against  A  compromise  was  w h e r e b y t h e members a g r e e d t o f i n i s h o f f t h e c o n t r a c t , o n  condition  situation actually  that  shows have  no  one some  work  The c o - o p e r a t i v e months  shovelling  control  this  over  type  be  o f CSRB's  their  work  has s t r u g g l e d t o f i n d  after  undertaken. --  that  This  workers  environment  and  (CMHA, 1 9 8 7 ) .  t o keep busy.  walks  of  of the strengths  d e c i s i o n s t h a t e f f e c t them  winter  management.  members  enough work o v e r  Members h a v e o f t e n  snowfalls.  I n an  found  attempt  to  the  themselves find  other  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 sculptures, Christmas  t o be s o l d t o l o c a l  businesses  a n d homes d u r i n g t h e  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 t h e regular workforce. skills  necessary  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 f o r success  b r i d g e t o r e g u l a r employment Overall,  operating  i n the workplace,  and t h e s o c i a l  A b e l may  a c t as a  f o r members.  in a  relatively  small  community,  Abel  E n t e r p r i s e s h a s b e e n a s u c c e s s . One i s s u e f a c e d b y members h a s b e e n t h e amount t h e y c a n e a r n o n 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 , it  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 people  of t h e i r d i s a b i l i t y allowance;  before  may e a r n $160 on t o p  a b o v e t h i s mark, e a r n i n g s a r e t a x e d  M b a c k a t 75%. previous the do  While t h i s p o l i c y provides  regulations  which taxed  l i m i t a t i o n s placed provide  issue  s e t t i n g aside enterprise.  up,  o n t h e amount o f i n c o m e t h a t c a n be e a r n e d  faced  by Abel  At present,  Abel  has been  e m p l o y s many p e o p l e  expansion  of the enterprise,  A-Way E x p r e s s  part-time  could  be b u i l t  competitive enterprise,  employment,  and worker  Couriers  transit to  full  (CMHA, 1 9 8 7 ) .  i s p e r h a p s t h e b e s t known e x a m p l e i n  Canada o f a b u s i n e s s r u n w i t h Toronto  that of  on a  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  A-Way E x p r e s s C o u r i e r s  the  Enterprises  a p o r t i o n o f p r o f i t s t o be u s e d f o r e x p a n s i o n o f t h e  b e n e f i t s c o u l d be d e v e l o p e d  3.1.2  b a c k e a r n i n g s more s t r i n g e n t l y ,  a d i s i n c e n t i v e t o w a r d s w o r k i n g more.  Another  basis;  more i n c e n t i v e t o w o r k t h a n  other  system,  input  by consumer/survivors.  couriers  courier  deliver parcels  companies.  A-Way,  a  at  Using rates  non-profit  i s r u n b y a Community D e v e l o p m e n t C o r p o r a t i o n  Board of  Directors. A-Way came i n t o b e i n g  p a r t l y a s a r e s u l t o f a 1982 M a y o r ' 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 the e f f e c t s o f medication, The look  task  housing, and f i n a n c i a l  support.  f o r c e was p r e s s e d b y some 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 o  at  the  issue  of  increasing  job  opportunities  for  consumer/survivors. In  1985, t h e program  coordinator  of Progress  Place,  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 with  had been i n v o l v e d  i n the creation of Abel Enterprises  some o f t h e p e o p l e  who w e r e  clients  t o meet  a t t h e day treatment  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 h a d s c h i z o p h r e n i a , d i s e a s e t h a t c a u s e s 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 and  difficult  to place i n traditional  vocational  were c o n s i d e r e d p e r m a n e n t l y unemployable  'high-risk'  programs.  by mental  a  health  Most staff.  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 , p o o r work r e c o r d s , and  h a v e many h e a l t h a n d  social  assistance related  appointments,  c a u s i n g them t o n e e d f l e x i b l e w o r k 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 n o t  w i l l i n g t o accommodate t h e n e e d s o f t h e s e w o r k e r s . Schemes s u c h 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 w o r k e r s i n low-pay,  l o w - s t a t u s j o b s . The  fundamental i d e a behind experiments  s u c h a s A-Way a n d 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 o t t h e o t h e r way by  around. virtue  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  of  their  work b e i n g not  which each i n d i v i d u a l The  group  just  a job, but  s h a r e s r e s p o n s i b i l i t i e s and  decided  that  a  worker  dignity  a venture i n  benefits.  c o - o p e r a t i v e model  o r g a n i z a t i o n would a l l o w workers the f l e x i b i l i t y  of  t h e y needed.  The  group, l a c k i n g the 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 of a  worker  co-operative,  approached  a  community  organizer  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 e x p a n d e d g r o u p c o n t i n u e d t o meet f o r 18  months;  courier workable needed.  i n the  service  p r o c e s s , i t was  using  b u s i n e s s and As B r o w n  the  Toronto  would  allow  decided that transit workers  a  system the  light would  flexibility  parcel be  a  they  (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 w o r k e r c o - o p e r a t i v e r e s u l t e d from the i n a b i l i t y of 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 the e m p l o y m e n t n e e d s o f 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 w o u l d be a b l e  t o d e v e l o p a l o n g - t e r m employment e n v i r o n m e n t c h a r a c t e r i z e d by f l e x i b l e work h o u r s , 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 n e e d s a n d 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 a s f o l l o w s . A  C o m m u n i t y D e v e l o p m e n t 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 f r o m p r o g r a m s a n d f u n d i n g agencies  prohibited  from  directly  supporting business  ventures.  The CDC h a d a B o a r d 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 in  mental  health,  arrangement expertise  business,  allowed of  A-Way  these  and  to  community  benefit  individuals.  development.  from  A-Way  the  Express  This  professional Couriers  was  e s t a b l i s h e d a s a w o r k e r c o - o p e r a t i v e . F u n d i n g was t o p a s s f r o m t h e CDC t o A-Way. A t i n c e p t i o n , Board o f D i r e c t o r s ,  A-Way E x p r e s s  C o u r i e r s h a d i t s own  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  t h e g e n e r a l membership. A-Way  was  structured  i n such  a  way  that  decision-making  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 a n d t h e B o a r d o f D i r e c t o r s o f t h e CDC. O v e r 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 w h i 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 u n d e r 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 b e g a n o p e r a t i o n s i n 1987, obtained and  from p u b l i c  development.  agencies f o r start-up  development  Traditional  f o r equipment  F u n d s came f r o m t h e O n t a r i o M i n i s t r y  the O n t a r i o M i n i s t r y o f Housing, economic  capital  w i t h $45,000  fund  and  of Health,  the C i t y of Toronto's the Holy  Trinity  community  Foundation.  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 a n d o p e r a t e d b y 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 t h e first  year  operating  of  operations,  costs.  d e c i s i o n t o buy,  Overly  needed  optimistic  another  revenue  $44,000 f o r  forecasts  and t h e  r a t h e r than 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 personnel changed  A-Way  r e f u s e d t o g r a n t t h e n e e d e d f u n d s , u n l e s s A-Way  i t s operating  s t r u c t u r e from a worker  co-operative  to 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 lengthy d i s c u s s i o n , the Board o f t h e Community Development C o r p o r a t i o n d e c i d e d co-operative under  i n order  the direction  t o s a c r i f i c e t h e worker  t o save t h e b u s i n e s s . o f t h e Board  A-Way c u r r e n t l y r u n s  o f t h e Community  Development  C o r p o r a t i o n ; w o r k e r 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 to  50%. A l o n g  with  t h e r e s t r u c t u r i n g o f A-Way f r o m a w o r k e r 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-Way was a l s o c o m p e l l e d b y t h 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  therapeutic  setting.  A-Way p o l i c i e s  were a d a p t e d  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).  U n d e r n o n - p r o f i t management, A-Way h a s s u r v i v e d a n d g r o w n . A s of January has  1993,  A-Way e m p l o y s 35 c o u r i e r s , 10 o f f i c e  800 c u s t o m e r 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 e x p a n d i n g i t s  courier  staff  t o 50, and t o t h i s  expand i t s c l i e n t base  3.1.3  s t a f f , and  (CSDI,  end i s c u r r e n t l y a t t e m p t i n g t o  1994).  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,  Fresh S t a r t Cleaning and Maintenance  i s a c o m m u n i t y 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 o f c l i e n t s i n t h e T o r o n t o a r e a . F r e s h S t a r t h a s s e c u r e d 15 c l e a n i n g contracts,  mostly  with  social  service  agencies,  and p r e s e n t l y  e m p l o y s 40 c o n s u m e r / s u r v i v o r s o f t h e m e n t a l h e a l t h s y s t e m . As  with  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 w o r k p a r t - t i m e , b u t some e m p l o y e e s h a v e u s e d t h e o p p o r t u n i t y t o w o r k f u l l - t i m e get o f f s o c i a l assistance  (CSDI,  and  1994).  I n some c a s e s . F r e s h S t a r t h a s o b t a i n e d c o n t r a c t s w i t h 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 o f t h a t  social  particular  service. Fresh  Start  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 a s a way o f g e n e r a t i n g w o r k o p p o r t u n i t i e s . A t p r e s e n t . F r e s h Start  i s run  as  a non-profit  corporation  with  i t s own  Board  of  Directors. This  Board  consists  of  14  people,  9  of  whom  are  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 B o a r d , 7 a r e staff  representatives;  the  other  two  consumer/survivor  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 f r o m t h e c o m m u n i t y . The B o a r d i s made up o f p e o p l e w i t h b a c k g r o u n d s  r e s t of the  i n l a w , 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 h a v e a h i g h d e g r e e o f c o n t r o l , but  also  expertise As  have  the  benefit  of  ( T r a i n o r & Tremblay,  of  1992,  management s t a f f  Fresh Start  individuals  with  professional  1992). has  received  funds  f o r i t s three  (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 ) f r o m CSDI (CSDI, i n t u r n , i s f u n d e d b y 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 f r o m t h e proceeds of the e n t e r p r i s e  3.1.4  Unity Unity  (CSDI,  1994).  Housing Housing  together i n social  began  when  a  number  of  ex-patients  h o u s i n g w e r e e v i c t e d when one  of t h e i r  living number  s u f f e r e d a r e l a p s e . One get  of those e v i c t e d , John H a t f u l l , decided  a number o f p a t i e n t s t o g e t h e r  found  a  Hatfull  house. noticed  illnesses He  L i v i n g together,  (Rich,  began  $67,000  that  and  were  looking  recovering  look  for  f r o m t h e B.C.  others  who  help  other,  from  mental  were  consumers  their  i n t e r e s t e d . With  rents  has and  been paid  themselves.  initiated.  care-givers A  volunteer  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  Jobs  was  50  ex-patients.  intensive  previously  have been incentive  taken  self-  done  over  program  by  by  has  the been  - $200 h o n o r a r i u m , w h i c h a c t s  ' t o p - u p ' 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 .  following  is  a  list  of  the  a  8 houses, o f f e r i n g a  o f f e r i n g a c c o m m o d a t i o n t o p e o p l e , an  program  professionals  as a  a f t e r each  n u r t u r i n g environment f o r approximately  Besides  They  M i n i s t r y of Health, U n i t y Housing  f o r m e d as a s o c i e t y . U n i t y H o u s i n g now s a f e and  a f t e r each other.  1993).  to  grant  people  to look  to  volunteer  positions  that  have  The been  developed.  O f f i c e Management P r o g r a m 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  Handyman/Painter  Coordinator  Book K e e p i n g  Handyman/Plumber  Reception  Lifeskills  Public Relations  I n d i v i d u a l Outreach  Community E v e n t s C o o r d i n a t o r  Community G r o u p O u t r e a c h  Bus  Counselling  Driver  Catering  Advocacy  Janitor  Carpet  Assistants  Cleaner  U n i t y Housing 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 , a k e y a s p e c t o f i t s p r o g r a m . W h i l e what U n i t y d o e s may be  like  other  provides develop  n o t seem t o  consumer/survivor-run businesses. Unity  'employment' tangible  f o r i t s volunteers  skills,  by  paying a  by  $100  allowing  -  as  $200  Housing them  to  'top-up'  on  d i s a b i l i t y p e n s i o n s , and b y g i v i n g p e o p l e some s e n s e o f v o c a t i o n , of purpose  3.1.5  (Unity Housing A s s o c i a t i o n ,  1994) .  Consumer/Survivor A r t i s t Co-operative The C o n s u m e r / S u r v i v o r A r t i s t C o - o p e r a t i v e was  f o u n d e d 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  endeavouring to  become f u l l - t i m e B.C.  Ministry  working a r t i s t s .  o f H e a l t h ' s Consumer  operative  rented  Granville  St.,  refurbishing 1994  as  homeopathic  part  of  a  brick  i n Vancouver's  west  and r e n o v a t i n g t h i s  the  O p e r a t i n g on  Gallery  d o c t o r who  Cachet  Initiatives heritage end.  After  after  the  Program,  co-  building  s p a c e , i t was (named  a g r a n t from  6  t r e a t e d V i n c e n t Van Gogh)  at  months  opened Paul  the  1134 spent  i n January  Cachet,  (Wilson,  the  1994).  The G a l l e r y p r o v i d e s s p a c e 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 w o r k . 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 c o m p u t e r video  equipment,  library,  workshops,  and  a caring  atmosphere  and to  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 studio  space  travelling  (in other buildings),  shows w h i c h  originate  launch a  magazine,  at the G a l l e r y  and  Cachet  have  (Wilson,  1994) . The  Cooperative intends  to run  the Cachet  as  a  commercial  g a l l e r y , f u n d e d 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 o f 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 of  being dedicated a r t i s t s ,  who  a r e consumers w i t h i n  the  mental  h e a l t h s y s t e m , 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 a b u s e . T h e y must  also  h a v e 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 w h e r e i t c a n be e x h i b i t e d .  Full  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 b u t h a v e n o t d e v e l o p e d art  to p o i n t of e x h i b i t i o n ,  h a v e some a c c e s s t o Co-op r e s o u r c e s ,  b u t do n o t h a v e v o t i n g p r i v i l e g e s .  The Co-op  h a d 30 members when  t h e g a l l e r y o p e n e d , b u t i s g r o w i n g a s more c o n s u m e r / s u r v i v o r s about t h e p r o j e c t As mentioned,  their  (Consumer/Survivor's  Artist  Co-op,  hear  1994).  t h e Co-op r u n s o n a $76,000 g r a n t f r o m 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 P r o g r a m , a n d i s s p o n s o r e d by  t h e West  Coast  Mental  H e a l t h Network,  an  organization  that  r e p r e s e n t s and a c t s as an a d v o c a t e 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 aspect form  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 e m p l o y  of democratic  decision-making  process,  allowing  some  members t o  h a v e a r o l e i n t h e d e v e l o p m e n t a n d 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 t h e lack  o f power  lives.  that  consumer/survivors  T r a i n o r and Tremblay  organizational  models which  come  t o expect  i n their  (1992) recommend t h a t p r o j e c t s  adopt  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  input by consumer/survivors. The  three  Enterprises, something  primary  and  Fresh  o f t h e range  Fresh Start organized  as a  Directors.  Express  Cleaning  staff;  Couriers,  Abel  and Maintenance)  show  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. developed  non-profit organization with  consumer/survivors.  community. O t h e r  Start  (A-Way  C l e a n i n g and Maintenance,  The B o a r d  management  examples  consists Of  two o t h e r  i t s own B o a r d  o f 14 p e o p l e ,  these  nine,  seven  consumers  nine  i s of  o f whom a r e  are elected  are recruited  i n d i v i d u a l s , w i t h needed s k i l l s  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  i n 1989,  by nonfrom t h e  i n such areas as  been r e c r u i t e d t o f i l l out  the board. 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 of  control  business Two  over  with  the business,  needed  a t t h e same  expertise i n certain  organizations  were  incorporated  time areas when  providing the (CSDI, A-Way  1994). Express  C o u r i e r s was d e v e l o p e d : A p p l a u s e Community D e v e l o p m e n t 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 h a s a mandate o f s u p p o r t i n g the  development  of democratic  mental h e a l t h system;  workplaces  f o r consumers  of the  a n d 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 w o r k e r  cooperative  incorporated  (Ward & T r e m b l a y , Directors.  1988) . E a c h o r g a n i z a t i o n  After  restructuring,  as a f o r - p r o f i t share c a p i t a l  financial  the worker  h a d i t s own B o a r d o f  difficulties  cooperative  corporation  and  Board  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  of  subsequent  Directors  enterprise.  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 . to-day  decisions  a r e made  by  the Board  of  was  W h i l e day-  Directors,  major  decisions  a r e made a t t h e r e g u l a r m e m b e r s h i p m e e t i n g s made e v e r y  two  ( T r a i n o r & Tremblay,  weeks  3.2.2  1992).  Composition of S t a f f Trainor  various staff,  et a l .  (1992),  i n reflecting  on t h e e x p e r i e n c e s o f  CSRB's, make a number o f r e c o m m e n d a t i o n s . t h e y recommend t h a t i t i s p r e f e r a b l e  consumer/survivors,  but that  Pertaining to  t h a t a l l e m p l o y e e s be  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 interim  stage.  Abel  Enterprises  has  employed  staff  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 the business's a  operation;  cabinetmaker,  felt  that  these  'patient-client'  t h o s e employed i n t h e p a s t have  included  f i b r e g l a s s worker, and landscape d e s i g n e r . people  would  role with  individuals with a social  be  less  likely  to reinforce  t h e members o f t h e w o r k  group,  s e r v i c e background. Schwartz  made t h e same p o i n t ,  observing  that  interaction  he c a l l s  the a s s o c i a t i o n a l world,  i n what  It i s a  than  (1992) h a s  disabled people benefit  from  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 in the professional/bureaucratic  world.  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 a s a w o r k e r c o operative.  Over  responsibilities Community  five-year  Corporation  A t the beginning, whose p r i m a r y  operations.  period,  decision-making  were t o p a s s from t h e B o a r d o f D i r e c t o r s o f t h e  Development  operative. managers'  a  t o t h e members  staff  were  described  r o l e was t o a s s i s t  the co-  as  'business  the  business's  After restructuring, descriptions of staff  positions  were changed t o 'Program C o o r d i n a t o r '  with  of  a n d 'Case M a n a g e r ' ;  implying  t h a t A-Way h a d become a t h e r a p e u t i c s e t t i n g , a n d 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). Fresh  S t a r t e m p l o y s a b o u t 40 p e o p l e , most o f whom w o r k p a r t -  time. Three ' s t a f f  a r e e m p l o y e d t o manage t h e a g e n c y ; t h e s e a r e a n  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  3.2.3  supervisor.  Source o f Funding Wismer and P e l l  which inform  (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  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  these i s t h e a b i l i t y t o secure funds t o cover o p e r a t i n g and program development  costs.  A-Way E x p r e s s C o u r i e r s Ontario  M i n i s t r y of Health,  obtained  its initial  the Ontario  funding  from t h e  M i n i s t r y o f Housing, the  C i t y o f T o r o n t o ' s community economic development f u n d a n d t h e H o l y T r i n i t y Foundation.  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 w o u l d b r e a k  even b y June 1990. I n A-Way's c a s e , ongoing note :  funding  subsequent  was a n e c e s s i t y .  e v e n t s h a v e made i t c l e a r As T r a i n o r  and Tremblay  that  (1992)  CSRB's h a v e shown t h e y c a n s u c c e s s f u l l y e m p l o y p e o p l e w i t h s e r i o u s m e n t a l i l l n e s s . T h i s c a n n o t be done i f t h e y a r e e x p e c t e d t o h a v e t h e same e f f i c i e n c y a s o t h e r b u s i n e s s e s , (p. 70) A-Way now h a s o n g o i n g Health's  funding  through  the Ontario  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  Fresh  Start  Development  receives  Initiative;  administrative staff,  funds  these  from  cover  the  M i n i s t r y of  (CSDI).  Consumer/Survivor  the costs  and t h e rent o f i t s premises.  of  i t s three  Revenues from  work p e r f o r m e d b y F r e s h S t a r t c o v e r t h e p a y f o r c l e a n i n g s t a f f and supplies.  3.2.4  Market Abel  Enterprises'  s p e c i a l t y products networking locally  with  f o r people  various  i n t h e Simcoe  supplied furniture  client  base  activity  furniture  with physical d i s a b i l i t i e s ;  agencies, area,  i s making  Abel  as w e l l  has developed as i n Toronto.  and  through a  market  Abel  has  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 its  main  came  C o u r i e r s b e g a n o p e r a t i o n s i n 1987, from  the public  and v o l u n t a r y  most o f sector,  i n c l u d i n g s o c i a l agencies, p r o v i n c i a l m i n i s t r i e s , several municipal level  departments,  Toronto's  several cooperative  businesses,  a n d some o f  m a j o r h e a l t h s e r v i c e s . From a n i n i t i a l c l i e n t b a s e o f 15,  A-Way h a d 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  realized  h o w e v e r , 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 b r e a k e v e n , t h e y w o u l d need t o expand i t s c l i e n t base. Towards t h i s attempting  e n d , A-Way h a s b e e n  t o move i n t o t h e c o r p o r a t e m a r k e t . A s o f J a n u a r y 1 9 9 3 ,  A-Way h a d 8 00 c u s t o m e r a c c o u n t s ,  a n d i s m a k i n g 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  majority  of Fresh  Start's  s e r v i c e p r o v i d e r s ; i n some c a s e s , contracts  f o r social  service  contracts  come  Fresh S t a r t has obtained  agencies  by agreeing  c o n s u m e r s 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 These  r e s u l t s show t h a t  target social  s e r v i c e agencies,  consumer/survivors;  from  CSRB's s t a r t i n g  social cleaning  t o h i r e the site.  operations  p a r t i c u l a r l y those that deal  a t some p o i n t ,  however,  should with  expansion beyond t h e  p u b l i c a n d 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 . S u c h e x p a n s i o n may a l s o p r o v e b e n e f i c i a l , as  f a r as  helping  to  counter  the  stigma  c o n s u m e r / s u r v i v o r s i n t h e l a r g e r community.  associated  with  4.0  Consumer/Survivor-Run Businesses: Lessons  From t h e the  context chapter,  examples,  businesses,  and  from  issues  other  of  from  Learned  the experiences d e s c r i b e d i n  research  relevance  t o be  to  on  these  consumer/survivor-run initiatives  will  be  d i s c u s s e d . T h e s e 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 facing  4.1  CSRB's.  Constraints facing  4.1.1  CSRB's  Bureaucratic Restrictions A  major  getting  back  constraint into  the  facing  consumer/survivors  workforce,  interested  d e s c r i b e d i n accounts  in  of  the  e x p e r i e n c e s o f b o t h A-Way E x p r e s s C o u r i e r s a n d 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 u p o n them. T h e s e a f f e c t a number o f a r e a s . P r i n c i p a l l y , amount o f  money t h a t c a n  payments  act  as  consumer/survivors.  be  a  earned  l i m i t a t i o n s p l a c e d upon the on  top  disincentive  Additionally,  restrictions  of  social assistance  to  eligibility  employment  for  for  and  housing  medication b e n e f i t s i s o f t e n t i e d to r e c e i p t of s o c i a l a s s i s t a n c e ; work  can  place  necessities To  an  actual  ( or  psychological )  f o r consumer/survivors  assess  the  consumer/survivors  who  impact  threat  as m e d i c a t i o n and  bureaucratic  to  such  shelter.  restrictions  have  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  on 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 c a n 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. P r o g r a m s 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 disability - guaranteed  allowances) income supplements  (these v a r y from p r o v i n c e  to  province  and  a r e t a r g e t e d a t s e n i o r s and  the  disabled) - F e d e r a l C h i l d Tax 2.  Programs designed - Unemployment - C a n a d a and - spouse's  Benefit  to provide  Quebec P e n s i o n  Plans  allowance  1993)  People w i t h a mental i l l n e s s social  allowance. provides  single  determining of  who  person  r e c e i v i n g supports  either  British  is eligible  much f r u s t r a t i o n  other  that are  assistance,  Currently, a  r e l a t e d t o economic need:  Security  ( f r o m CMHA News, S p r i n g  receive  insurance:  Insurance  3. U n i v e r s a l E n t i t l e m e n t s , n o t - O l d Age  income  welfare  Columbia's  $771  a  month.  or  a  with  a  mental  allowance  procedure  f o r a d i s a b i l i t y allowance  f o r persons  disability  disability The  usually  for  i s a cause  illness,  or  with  impediments. In order  t o be  eligible  f o r a d i s a b i l i t y allowance,  a person  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 u n e m p l o y a b l e . t h e c a s e o f someone w i t h a m e n t a l i l l n e s s , t h e y may i n t o these  c a t e g o r i e s . The  nature  t h e y a r e c y c l i c a l . A p e r s o n may but  capable  be u n e m p l o y a b l e w h i l e t h e y a r e  two  ill,  i s i n remission.  'permanently unemployable' does not  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 And  f i t neatly  o f many m e n t a l i l l n e s s e s i s t h a t  o f employment when t h e i r i l l n e s s  concept of a person being  not  In  (CMHA News, S p r i n g  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  The work  1993).  different  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 e x a m p l e ,  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 f r o m one o f t h e most common o f m e n t a l i l l n e s s e s , m a n i c d e p r e s s i o n . The f i r s t p e r s o n may medication,  and  individual  have  a  network  t o cope w i t h l i f e ' s  of  stresses.  d i a g n o s e d w i t h m a n i c d e p r e s s i o n , may or  have an adequate  network  Spring  would  be  more  The  allows  this  second  person,  also  not d e a l w e l l w i t h medication,  than the f i r s t ,  and  appropriate i n this  would  the l a b e l  case  of  (CMHA News,  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 allowance are c u r t a i l e d i n the  amount o f money t h e y c a n 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 . B.C.,  on  that  of supports. T h i s second person  be more d i s a b l e d b y h e r i l l n e s s 'disabled'  supports  do w e l l  they can  e a r n up  t o $200 on  top of t h e i r  benefits  d e d u c t i o n ; a b o v e $200, any i n c o m e i s t a x e d b a c k a t 7 5 %  In  without  ( i . e . they  c a n k e e p 2 5 % ) . I n O n t a r i o , where most o f C a n a d a ' s e x p e r i m e n t s w i t h CSRB's e x i s t , single  a  person;  disability they  can  amount; a f t e r t h i s ,  allowance  earn  $160  pays  $792 p e r  a m o n t h on  top of  month  for a  this  basic  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 h a s in  the past  few  years.  In Ontario, at the  time  of  improved  Brown's  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 w e r e o n l y a l l o w e d t o e a r n $100 of  their  back,  and  disability 100%  of  r e g u l a t i o n s a r e an For  those  pension;  50%  of the next  anything earned  above  want  to  continue  a l l o w a n c e s , e a r n i n g a s m a l l t o p - u p may 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  Of  greater  that.  would  on t o p  be  Clearly,  taxed  the  new  improvement.  who  a g r e a t e r l e v e l of  $50  1989  receiving  be a d e q u a t e ,  disability  but i t doesn't  want t o w o r k more a n d  develop  independence. concern  to  those  working  in  CSRB's  is  the  p o s s i b i l i t y of being  c u t o f f from f i n a n c i a l  assistance  altogether  i f t h e y w o r k more h o u r s . N o t o n l y d o e s 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 working, 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 if  the i n d i v i d u a l i s cut o f f ,  housing.  they  may  be  assistance;  ineligible  f o r such  I n a d e q u a t e h o u s i n g i s a n 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 c a n l e a d to the relapse of i l l n e s s . Likewise,  medication benefits are often  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  able  medication, (Brown,  to afford these  their  people  often  will  c o s t l y medications.  likely  e n d up  back  Without  i n hospital  1989).  Addressing this  constraint  B r o w n n o t e s t h a t A-Way w o r k e r s a n d s o c i a l s e r v i c e a g e n c y p e r s o n n e l expressed a desire access  to  individuals  t o s e e more f l e x i b l e  extended  benefits  who  attempting  are  Furthermore, p o l i c i e s benefits,  that  for  eligibility  c r i t e r i a and  psychiatrically  to  re-enter  guaranteed s o c i a l  and immediate s o c i a l a s s i s t a n c e  disabled  the  workforce.  housing,  medication  upon j o b l o s s would a c t  to support the p s y c h i a t r i c a l l y disabled i n d i v i d u a l while t r y i n g t o increase  t h e i r l e v e l of 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 T o w a r d s C o n s u m e r / S u r v i v o r s An  issue  identified  i n the review  of l i t e r a t u r e  regarding  vocational 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 that the general has  regarding  consumer/survivors  (Cochrane  et  public  a l . , 1992).  The  important  point  disabilities associated functioning  i s that i t i s not only the e f f e c t s of p s y c h i a t r i c  that with  impair such  functioning  psychiatric  of consumer/survivors.  in  society;  conditions Cochrane  also  the  stigma  impairs  the  et a l . present  the  f o l l o w i n g d e f i n i t i o n f o r stigma:  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 a n i n d i v i d u a l o n c e 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  reviewed  knowledge r e g a r d i n g  suggests  that  while  the l e v e l  of public  mental i l l n e s s has improved, a t t i t u d e s toward  these people remain 'rather r e j e c t i n g i n nature'.  Cochrane e t a l .  (1992) s t a t e t h a t e m p l o y e r s ' r e a c t i o n t o w a r d t h i s p o p u l a t i o n to  reflect  that  of the general  public; while  tend  e m p l o y e r s may n o t  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 reality,  i t w o u l d seem t h a t t h e y a r e r e l u c t a n t  to h i r e these i n d i v i d u a l s . Cochrane  et  a l .  summarize  the  problems  that  face  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 mentally  ill,  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 image and s e l f - e s t e e m . seek out s o c i a l 2.  The  t o an u n w i l l i n g n e s s  to  contacts;  behavioural  individual  Such f a c t o r s l e a d  self-  apart,  symptoms  leads  of  the  to expectations  t h e e x - p a t i e n t o f an i m p a i r e d  disease,  which  set the  by b o t h t h e employer and  a b i l i t y to function i n a  competitive  employment ; 3. D i s c r i m i n a t i o n b y p o t e n t i a l e m p l o y e r s a n d c o - w o r k e r s  (Cochrane  et  al.,  1992)  Despite these findings,  the consumer/survivor-run businesses  d e s c r i b e d have g e n e r a l l y found acceptance A-Way agencies,  Express  C o u r i e r s began  particularly  those  that  by  i n their  communities.  targeting  dealt  social  service  with consumer/survivors.  W h i l e some o f t h e s e a g e n c i e s d i d u s e A-Way's s e r v i c e , many d i d n o t . B r o w n (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 that  consumer/survivors  were n o t r e a l l y  t o be t r u s t e d ,  that the  l e v e l of r e s p o n s i b i l i t y involved i n the operation of t h i s business was t o o much. When A-Way b e g a n t o e x p a n d a n d a p p r o a c h e d clientele, project  t h e y g e n e r a l l y found acceptance. Media  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  a corporate  response  t o the  i n t h e Globe  and  M a i l a n d The F i n a n c i a l P o s t , m e d i a o u t l e t s g e n e r a l l y t h o u g h t t o be 'conservative'. 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 t h e o l d d e b a t e o f ' l e f t ' v e r s u s  'right'.  W h i l e i t s a t t r a c t i o n t o t h o s e who r e s o n a t e t o ' l e f t - l e a n i n g ' is  fairly  obvious  --  i t s emphasis  on  social  causes  justice  for  m a r g i n a l i z e d g r o u p s 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 those of the ' r i g h t ' ; as  a non-governmental  initiative  the fact that i t i s presented  intervention;  and r e s p o n s i b i l i t y ;  that  i t emphasizes  personal  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 . A s s u c h , it  would  support  seem t h a t CSRB's h a v e t h e o p p o r t u n i t y t o g a i n from  ideological  the general stripe.  d e s c r i b e d would  public,  Furthermore,  seem t o s u g g e s t  not  only  from  the experience that  the tendency  mainstream  those of  the  of  one  CSRB's  to stigmatize  consumer/survivors  i s overcome b y t h e g e n e r a l  p u b l i c ' s good  will  towards 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 AWay. 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 smaller  community  (Simcoe, O n t a r i o ) ,  i n a mainly  rural  may t h i n k t h a t s m a l l e r c o m m u n i t i e s m i g h t p r e s e n t to  the  development  consumer/survivors  of  CSRB's  i s smaller,  --  exists i na area.  One  greater barriers  the  population  and t h e p e r c e p t i o n  that  of small  c o m m u n i t i e s w o u l d 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 'different'.  Y e t , i t would appear that Abel  accepted i n t h i s Mary  E n t e r p r i s e s has been  community.  Taylor,  Abel's  program  d i r e c t o r , over  Abel's  11-year  h i s t o r y h a s made o n g 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 church  involved  groups,  i n Abel  town  Enterprises  officials,  -- l o c a l  service  businesspersons,  groups,  and  individual  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 u p , t h e l e a d e r s o f S i m c o e ' s churches responded by announcing i t s s e r v i c e s from t h e i r When i n n e e d o f s p a c e f o r a d r o p - i n c e n t r e , t h e l o c a l church provided the  church  Fanshawe  congregation  Enterprises College;  cooperative  Presbyterian  i t s b a s e m e n t . I n t e r a c t i o n b e t w e e n A b e l members a n d also  fostered  c o n s u m e r / s u r v i v o r s a n d more c o n t a c t Abel  pulpits.  with  has a l s o  the college workshop  access  of  w i t h t h e community.  established  a  relationship with  has, i n the past,  space,  to college  understanding  and has p r o v i d e d courses.  Abel  provided  the  cooperative  members  with  provided  p r o d u c t s needed b y t h e community. O v e r a l l , A b e l has h a d a  very p o s i t i v e r e l a t i o n s h i p with the surrounding  Enterprises  has  community.  I n ' C r o s s i n g t h e R i v e r ' , S c h w a r t z comments o n t h e b e n e f i t s t o  the in  disabled  of 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  t h e community w h i c h a r e n o t o f t h e c o n t r a c t u a l  professional variety  or bureaucratic  of the everyday  beneficial  world, but are of the a s s o c i a t i o n a l  world.  impact not only  type, as i n the  Such  relationships  on t h e d i s a b l e d ,  will  but also w i l l  have  a  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 t h e general  public.  While the a t t i t u d e s of the general on  the consumer/survivor  projects easier;  such  to exist  c a n a c t t o make  we  a reason t o think of existence can  intermediary the  tries  t h e s e p r o j e c t s have t h e o p p o r t u n i t y  belonging, way,  a s CSRB's  who  p u b l i c may h a v e a n i m p a c t  life  see  CSRB's  truly  as  a  i n the  life  i n the  t o provide  community a place of  as m e a n i n g f u l .  mediating  between t h e i m p e r s o n a l i t y  community,  of large  structure,  an  i n s t i t u t i o n s and  of the individual.  A n d 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 from  In this  the i n s t i t u t i o n ,  or the impersonal  government-run  released social  s e r v i c e agency.  4.1.3  Attitudes  of  Mental  Health  Professionals;  The  Service  Paradigm A number o f b a r r i e r s t o CSRB's a r i s e mental h e a l t h p r o f e s s i o n a l s As  Cochrane  professionals rehabilitative necessity  et  agree  process.  o f work,  themselves.  a l . point that  there  from t h e a t t i t u d e s o f  work  Even  out, is  where  i s often  a  not  a l l mental  necessary  there  part  i s agreement  disagreement  on where  health of  the  on t h e i n the  rehabilitative  process  i t should  take  place.  Must  the patient  o b t a i n w o r k t o g e t w e l l ? O r must t h e p a t i e n t b e w e l l b e f o r e s h e c a n work? T h i s And,  i ss t i l l  a contentious  as described  increasingly  there  debate  i n the section  i s debate  upon  (Cochrane e t a l . , 1992). on mental  health  the l i m i t a t i o n s  policy,  of  formal  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  extension,  the role  of  mental  health  professionals.  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 the  service  paradigm.  B r o w n 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 change  t h e emphasis  of the project  business t o a therapeutic towards  A-Way h a v i n g r e c e i v e d  buy  of a  competitive  In  i t sfirst  year  to  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  t o a n o v e r l y o p t i m i s t i c r e v e n u e f o r e c a s t , a n d s p e n d i n g money t o walkie-talkie's  rented,  there  shortfall  would  f o r couriers; n o t have  non-profit  A-Way b e c o n v e r t e d  business;  had t h e w a l k i e - t a l k i e ' s  been  was due t o management  demanded t h a t  i n effect,  the s h o r t f a l l .  decisions.  While  Ministry  from a worker c o o p e r a t i v e making  A-Way  actions  of the Ministry  attitude that  were  reflective  members  of a  been this  officials to a  pay f o r  d e c i s i o n s made b y t h e B o a r d o f D i r e c t o r s . B r o w n (1989) a r g u e s the  of  a n i n i t i a l g r a n t o f $45,000, h a d  a s k f o r a n a d d i t i o n a l $44,000 f r o m t h e M i n i s t r y o f H e a l t h  continue operations due  that  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  the p s y c h i a t r i c a l l y disabled.  operation, to  from  was c o m p e l l e d t o  that  prevailing  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 have a l o w c a p a b i l i t y .  B r o w n 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 self-help, the  and M i n i s t r y o f Health  nature of the project  (Brown,  staff 1989).  d i d not f u l l y  understand  It  should  be  noted  that  C o n s u m e r / S u r v i v o r Development the  implementation  these  events  Initiative  occurred  (CSDI) was  government, e l e c t e d i n the f a l l  with  the  M i n i s t r y of  preceding  Liberal  Brown  Health  o f 1990;  e n a c t e d by A-Way's  occurred  during  (1981),  who  the  Ontario's  difficulties term  of  Ogionwo  states  that  view  them; as  in  particular,  professionals.  Viewed  professionals,  this population internalizes  less l i k e l y  the  the  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 t h e m s e l v e s a s t h e p e o p l e with  for  government.  cites  interact  the  implemented;  o f CSDI w o u l d i n d i c a t e a n e w f o u n d r e s p e c t  s e l f - h e l p a n d m u t u a l a i d i n i t i a t i v e s . CSDI was NDP  before  t o take r i s k s ,  dependent,  disabled,  or believe i n  mental and  these  they  health  inferior  views,  and  by are  themselves.  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 b e e n somewhat d i f f e r e n t than  A-Way's ; A b e l  has  been  able  to  develop  independence  from  professional interference. 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  drop-in centre.  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 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 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 Health  Services  agency  that  played  Enterprises, Haldimand developer the  Clinic  by  and  a  of Haldimand founding  assessing  Norfolk  role  the  counties,  i n the  needs and  important  cooperative.  l o c a t e d i n the Adult  - Norfolk.  of by  The  This  Mental  i s the  development  of  consumer/survivors  bringing i n a  same Abel in  community  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 . B u t A b e l members u s i n g  drop-in  centre  found  the  a t m o s p h e r e , o p p r e s s i v e ; i t was comfortable  Clinic,  with  i t s professional  n o t a p l a c e w h e r e members c o u l d  ' h a n g i n g o u t ' and t a l k i n g w i t h e a c h o t h e r  feel  (CMHA, 1 9 8 7 ) .  It  was  decided  connections  t o move t h e  that Abel  Presbyterian  church  built  drop-in  with  the  centre;  local  agreed to provide  d r a w i n g upon  community,  i t s basement  the  the  local  f o r use  as  d r o p - i n c e n t r e . T h i s a r r a n g e m e n t w o r k e d u n t i l A b e l was  able to  a  location  location  for  a  drop-in  downtown S i m c o e ; t h i s new  centre  in  a  favourable  a  find in  l o c a t i o n has b e e n p a i d f o r b y r e v e n u e s o f  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 p r o j e c t of Adult Mental Health  Abel, o r i g i n a l l y  S e r v i c e s of Haldimand-Norfoik,  a  has  i n c r e a s e d i t s independence. Abel's approach  independence  is  from  a  f u r t h e r e x h i b i t e d by  professional  social  i t s a t t i t u d e toward  service staffing;  w h i l e t h e c o o p e r a t i v e d o e s e m p l o y 'non-consumer' s t a f f , i t makes an effort  towards h i r i n g  business  activities  designer,  and  p e o p l e who --  a  have  skills  relevant  designer-cabinetmaker,  a landscape designer  to  Abel's  fibreglass  have been h i r e d t o a s s i s t  the  cooperative.  4.1.4  Problems Inherent Brown  inherent  cites  i n the  agreement successful  upon  i n Developincr  Sarason  (1972),  d e v e l o p m e n t o f new values  and  development of  suggests that other  New  who  Settings discusses  the  problems  s e t t i n g s . Sarason s t a t e s  enthusiasm  are  not  alternative settings  f a c t o r s n e e d t o be  taken  enough (Brown,  into  that  for 1989).  the He  consideration.  These are : (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 k n o w l e d g e o f p a r t i c i p a n t s (b)  Intra-  and  (c) H i s t o r i c a l system  interpersonal factors f a c t o r s , p a r t i c u l a r l y the dynamics of the  existing  Failure suggests,  t o take  will  these  lead  factors  the creators  into of  consideration,  alternative  Sarason  settings  to  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  encountered.  Brown  (1989) , i n h e r a n a l y s i s  o f A-Way  Express  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 d e v e l o p m e n t .  Differences  i n the substantive  knowledge o f p a r t i c i p a n t s  As a n e x p e r i m e n t u n i q u e 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 in  A-Way's  follow.  development  Three  didn't  groups  of  development: mental-health the  have  actors  an example were  that  involved  they in  could  A-Way's  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  consumer/survivor c l i e n t s  themselves.  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  w e r e a c c u s t o m e d t o a p r o f e s s i o n a l e n v i r o n m e n t where c l i e n t s assigned  to sheltered  experience  workshops.  i n implementing  These p r o f e s s i o n a l s  more  competitive  had  settings  this  t h e s i s , t h e s e p r o f e s s i o n a l s w e r e g u i d e d b y what  would c a l l The  a therapeutic business  experience  little  for  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 t h e terms used i n t h e context of  were  the  chapter McKnight  vision.  consultants,  i n developing  while  co-operative  having  had  businesses,  substantial had  little  experience working with p s y c h i a t r i c patients. The  c l i e n t s t h e m s e l v e s were e n g a g e d i n t r y i n g t o l e a r n a b o u t  the o p e r a t i o n  of co-operative  were making p r o g r e s s  i n this  businesses. area  According  (Brown,  1989) . Members o f t h e  B o a r d o f t h e Community D e v e l o p m e n t C o r p o r a t i o n , t o l e a r n about c o - o p e r a t i v e increasingly  dominated  by  entrepreneurship; social  service  t o Brown, t h e y  were l e s s  inclined  t h e B o a r d h a d become professionals  whose  i n c l i n a t i o n s were a l s o t o w a r d a t h e r a p e u t i c The  vision.  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 c o u l d be  s a i d to  o p e r a t i n g w i t h a c o m m u n i t y v i s i o n , where f i n d i n g a p l a c e where  be 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  well-being  than  illness  Intra-  and  and  w o u l d be namely  the  l i m i t a t i o n s imposed  by  their  experiences.  (1989)  actors  settings.  with  Interpersonal  Brown various  dealing  discusses  involved  Mental  their  how  affect  health  helping  career  factors the the  differing development  professionals, clients,  advancement.  motives  likely  Behaviour  whose also  that  of  of  the  alternative  a r t i c u l a t e d motive have o t h e r  motives,  i s questioning  of  inadequacies of the 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 professional ramifications Community d e v e l o p e r s settings  have  primarily  with  limitations  their  own  social  placed  on  i n development of a l t e r n a t i v e  perspectives  mental  they  and  may  health  not  ideologies. be  professionals,  and  be  may  the have  accomplished  1989). perceive  t h e m s e l v e s t o be p o w e r l e s s t o  take c o n t r o l of t h e i r s i t u a t i o n . Accustomed t o s o c i a l dependent  settings  Concerned  sensitive to  w i t h r e g a r d s t o what c a n  C o n s u m e r / s u r v i v o r s may  and  have  1989).  involved  change,  u n r e a l i s t i c expectations (Brown,  (Brown,  the  that  upon agency s t a f f ,  the  better  needs  suit  their  development may  seem  assistance,  of  alternative  an  unrealistic  dream. Brown, i n h e r the  failure  to  s t u d y o f A-Way E x p r e s s C o u r i e r s ,  acknowledge  the  asserts  different perspectives  of  that those  involved  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  Historical  factors  Another settings Though  course.  problem  inherent  t o t h e development  may be t e r m e d ' h i s t o r i c a l f a c t o r s ' developed  i n response  existing  settings,  existing  system  that  alternative  (Sarason,  to the perceived  the alternative  of  1972).  inadequacies of  s e t t i n g becomes a p a r t o f t h e  i tcritiques.  The a l t e r n a t i v e  setting  will  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 , a n d p h i l o s o p h y o f more established  settings.  B r o w n n o t e s t h a t A-Way was c o n c e i v e d a s a r a d i c a l to  the existing  structured  vocational  so as t o provide  working hours that  rehabilitation  system.  t h e independence  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 o p a s s t o t h e members o v e r a f i v e - y e a r A-Way's e x i s t e n c e i n a m e n t a l h e a l t h  a bias  of the enterprise  period.  t o compete f o r  p r o g r a m s . When f i n a n c i a l  difficulties  t h e c a u s e was t h e s l o w n e s s o f  members, a n d t h e a w k w a r d n e s s 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 . of  by  on i t s development.  A l s o o f r e l e v a n c e was t h e f a c t t h a t A-Way was f o r c e d  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  was  t h e y needed.  system c h a r a c t e r i z e d  o f c l i e n t incompetence had i m p l i c a t i o n s  f u n d s w i t h more e s t a b l i s h e d  A-Way  and f l e x i b i l i t y i n  Organized as a worker co-operative, f u l l c o n t r o l was  alternative  Members  t h e b o a r d o f t h e Community D e v e l o p m e n t C o r p o r a t i o n d e c i d e d t o  jettison  t h e worker  co-operative  p r o f i t business structure.  structure  i n favour  o f a non-  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  working 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 abandoned.  has been  4.1.5  Difficulties This  Inherent i n the Operation of  constraint  relates  to  obstacles  Cooperatives to  the  effective  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 relating  to  the  involvement  of  consumer/survivors  in  such  workplaces. 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 obstacles  t o the e f f e c t i v e  workplaces.  These are  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  ( i ) t h e l a c k o f a common c u l t u r e ,  or  social  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 accepted set of values which behaviour skills  in  for  the  the  enterprise;  needs  of  ( i i ) an  the  guide  inappropriate mixture  enterprise;  and  (iii)  a  lack  of of  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 t h e o b s e r v a t i o n t h a t most p e o p l e are a t t r a c t e d the  culture  to democratic  of  the  traditional  a u t h o r i t a r i a n i s m and c o n t r o l be  workplaces  b e c a u s e o f an  workplace,  i t s elements  of  (Gamson & L e v i n , 1 9 8 4 ) . W h i l e t h e y  may  i n a g r e e m e n t 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  have d i f f e r e n t that  these  explicit  workplaces  may  consensus  regarding  ways o f d e a l i n g w i t h d e s t r u c t i v e members, a n d  regarding  strategies:  need  to  come  a  f o r m a l code o f  to  on t h e t r a i n i n g o f second  and  a  Gamson and  social  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 ;  The  are not, they  i d e a s a s t o what t h e y a r e . Gamson a n d L e v i n a s s e r t  the p o s i t i v e values of the e n t e r p r i s e . two  with  aversion to  statutes  second,  Levin call  for  describing  the  a special  emphasis  workers.  o b s t a c l e , an  i n a p p r o p r i a t e mixture of s k i l l s  t h e n e e d s 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  for  applicable  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 h a v e h a d t o d r o p o u t of  the  workforce  because  of  illness  factors.  Obviously,  a  p a r t i c u l a r emphasis w i l l Ward  intensive  training  p r o g r a m 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  business  first  Tremblay  (1988)  describe  an  opened. The  of  and  h a v e t o be p l a c e d o n t r a i n i n g .  t h i r d o b s t a c l e m e n t i o n e d b y Gamson a n d L e v i n i s t h e l a c k  democratic  conflict  norms f o r d e c i s i o n - m a k i n g .  regarding  the  exercise  They i d e n t i f y  areas of  authority,  obtaining  of  accountability  f r o m members, t h e p r o d u c t i v e  the productive  use of meetings.  While  many  people  show  enthusiasm  use o f c o n f l i c t ,  f o r the  and  concept  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 o u r s o c i e t y have e x p e r i e n c e  of with  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 f o r m s o f d e m o c r a c y . 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 a c c u s t o m e d to  having  decisions  made f o r them b y m e d i c a l  or social  service  personnel.  that  Yet,  from  t h e CSRB's r e s e a r c h e d  with  some a s s i s t a n c e ,  f u n c t i o n i n a worker  i n this  consumer/survivors  thesis,  i t appears  have been a b l e t o  cooperative.  B r o w n (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  well  members  they she  functioned interviewed  i n a worker related  cooperative  the  high  setting.  level  of  The  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 d e v e l o p m e n t . She a l s o f o u n d t h a t member  participation  interviewed. services  Early  education  i n A-Way's  about c o - o p e r a t i v e 1989).  This  was  development,  of a business-consulting  worker cooperatives.  (Brown,  and  members  firm experienced  firm provided  entrepreneurship  important  to  those  e n l i s t e d the i n developing  workers w i t h  information  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  An  i s s u e b r o u g h t up b y c r i t i c s  of worker c o o p e r a t i v e s  i s that  t h e d e c i s i o n m a k i n g p r o c e s s i s t o o l e n g t h y ; and s o n o t c o n d u c i v e t o the  need  for  opportunities that  this  quick  decisions  (Gamson & L e v i n ,  issue  reflects  made  in  response  1 9 8 4 ) . Gamson and  a  misunderstanding  to  crises  Levin point  of  the  on  out  scope  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 the membership i s  or  of  consulted  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 d a y - t o - d a y management.  4.1.6  The  Drift  Related  Towards P r o f e s s i o n a l i s m  to the  problems inherent  d e s c r i b e d i n the previous  i n developing  new  settings  s e c t i o n , i s what S c h w a r t z c a l l s t h e  drift  towards 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 k n o w l e d g e 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 t h e 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 settings  land  established  into, ways  professionalism conceptions  of is  a b o u t how  an i m p a c t u p o n new the  will  conflicts  tend  to  operating. largely we  draw  the  Our  society's  unconscious,  should help others.  new  setting  and  bias  in  the  previous  awareness of t h i s t r e n d , t h i s p e r v a s i v e d i s p l a c e a l t e r n a t i v e and  towards  pervades  our  Such a b i a s w i l l  have  s e t t i n g s , p a r t i c u l a r l y i f they are  described  experiencing  section.  Without  b e l i e f system w i l l  community p r a c t i c e s  towards  (Schwartz,  an  come t o  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  in  i t s f i r s t y e a r o f o p e r a t i o n , t h e r e s p o n s e f r o m B o a r d members was  to  suspend the  at  government  plan  to develop a worker co-operative  pressure  to  do  so),  and  develop  a  commonplace m o d e l , a n o n - p r o f i t c o m m u n i t y b u s i n e s s . worthwhile  venture,  one  that  provides  employment  (admittedly somewhat  more  While s t i l l and  a  level  a of  stability the  to  drift  i t s members t h a t  towards  they would not  professionalism  that  otherwise  Schwartz  have  had,  describes  is  evident. Abel  Enterprises experience  has  been d i f f e r e n t ,  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 n the  ( i t d i d n ' t get  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  into trouble financially),  and  likely  for a  involved  so d i d not  i t s strong connections  to the  get  local  community. In  the  following  v i g i l a n c e regarding  the  quote,  Schwartz  describes  tendency towards  the  need  for  drift.  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 w o r k , t h e n , i s n o t o n l y t o r e d i s c o v e r c o m m u n i t y , b u t t o f i n d ways t o c o u n t e r the tendency to 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 . . . . to do o t h e r w i s e i s t o l o s e o n e ' s way ( S c h w a r t z , 1992) Schwartz  lists  a  number o f  ways t o  deal  with  the  drift  towards  professionalism. He  suggests  isolation;  that  networking  projects  should  between p r o j e c t s  not  try  is a  to  survive  g o o d way  to  in  foster  m u t u a l 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  or  networks  are  the  (Ontario)  and  the  informal  Provincial  level.  Examples  of  Consumer/Survivor  formal  Business  support Council  formal  T o r o n t o Community E c o n o m i c D e v e l o p m e n t N e t w o r k . Leadership skills  to  and  consumer/survivors,  responsibilities,  not  focus  development programs t h a t allowing  w i l l a l s o counter  Project review t h e y do  educational  m e c h a n i s m s may s o l e l y on  them  to  take  on  the tendency toward  provide greater  drift.  also play a role, provided  whether o r not  the p r o j e c t  money. As T r a i n o r and T r e m b l a y p o i n t o u t , CSRB's c a n n o t be  that  i s making expected  t o have the A  same e c o n o m i c e f f i c i e n c y as o t h e r  funding  structure,  Development I n i t i a t i v e , and  the  such  such  may  a c t as  large bureaucracies  structures  might  as  of  be  businesses.  Ontario's  an  Consumer/Survivor  intermediary  b e t w e e n CSRB's  government; Schwartz a s s e r t s  necessary  to  cut  down  the  that  amount  of  p a p e r w o r k 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  deal  with  (Schwartz,  funding  a p p r o a c h e s be  structured  body cannot e x e r t p r e s s u r e 'drift the  on  the  towards p r o f e s s i o n a l i s m '  e x a m p l e o f A-Way E x p r e s s Finally,  purpose  that  necessary  i f a project i t  cannot  (Schwartz,  Ontario's an  1992) . S c h w a r t z  example  of  projects,  that  the  a  funding  Such p r e s s u r e  was  a  seen i n  Couriers. has  be  drifted  turned  so  f a r from  around,  i t s original  de-funding  may  be  1992).  funding  order  that  a l t e r n a t i v e s e t t i n g such that  occurs.  approach  CSDI i s an  that  they  that  minimizes  initiative  consumer/survivor-driven in  i n s u c h a way  proposes  Consumer/Survivor Development I n i t i a t i v e  professionalization. funding  also  t h a t has  projects, be  eligible  and for  democratic, membership-driven process i n place.  (CSDI) i s  pressure  for  a mandate f o r requires  funding,  that  have  a  4.2  O p p o r t u n i t i e s f o r CSRB's  -  Why  have  the  examples  studied  succeeded? Despite  the constraints  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 , a n d F r e s h S t a r t ) h a v e s u r v i v e d o v e r a l e n g t h of  time.  The  r e s e a r c h suggests  these p r o j e c t s to  their  4.2.1  characteristics  of  (some i n h e r e n t t o t h e m o d e l i t s e l f ) h a v e c o n t r i b u t e d  survival.  Human F a c t o r s Because  CSRB's  consumer/survivors support 1.  the f o l l o w i n g  have  demonstrated  are motivated  the  following  t o develop,  benefits,  participate  i n , and  CSRB's.  Flexible  absences,  work  schedules :  part-time  consumer/survivors) ,  work and  hospital  schedules a  a v a i l a b l e should a worker's  Tolerance  guarantee  of  medically-related  (generally that  preferred  employment  will  by be  i l l n e s s f o r c e him o r her t o r e t u r n t o  f o r a p e r i o d of time,  are important  characteristics  of  CSRB's. 2. S u p p o r t i v e management s t r a t e g i e s c a n a s s i s t through  an  understanding  o f f e r i n g non-judgemental 3.  Part-time  work  the  nature  of  consumer/survivors  their  illnesses,  and  support.  offers  the opportunity to  supplement  social  a s s i s t a n c e payments. 3. I n v o l v e m e n t over  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  decisions,  will  increase  social  interaction  between  consumer/survivors. 4.  Often  possessing  interspersed  with  checkered  periods  of  histories  unemployment  in and  the  workforce,  hospitalization.  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 themselves. 5.  Involvement  skills  that  with  will  CSRB's  assist  can provide  consumer/survivors  i n subsequent  employment,  with  should  the  i n d i v i d u a l w i s h t o move o n 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  with  structure  their  dependent  on  (Cochrane  et a l . ,  7.  The  a  time. sense  previous  increase  in  individuals'  a  CSRB The  assist  consumer/survivors  enjoyment o f  o f accomplishment  leisure  time  i n other  to  i s often  areas  of  life  1990). benefits  self-esteem life  will  mentioned which  will  will  likely  be  result  beneficial  i n an  f o r the  i n general.  ( f r o m B r o w n , 198 9)  Support  f o r the assertion  that  involvement  w i t h CSRB's  will  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 recidivism  (Trainor  &  Tremblay,  1992).  The  study  surveyed  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. T h e s e i n d i v i d u a l s w e r e asked 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  information regarding  five  a r e a s o f s e r v i c e u s e : ( i ) number o f d a y s s p e n t  (ii)  number o f a d m i s s i o n s t o h o s p i t a l ,  services, private  (iv) contacts to c r i s i s  physicians.  information  Those  f o r equal  surveyed  (iii) visits  services, were  periods, before  and  asked  i n hospital,  toout-patient (v) v i s i t s  to provide  involvement,  and  to this  after  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 m e t h o d . 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 w o u l d h a v e a positive represent  effect  on t h e t h r e e a r e a s o f s e r v i c e u s e w h i c h  t h e most  serious  problems  in a  person's  life.  would 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 d a y s 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 , a n d c r i s i s c o n t a c t s , there  was  visits  a  statistically  significant  and  hospital  out-patient  maintenance  support,  also  statistically  significant  decrease.  services,  decreased,  both  though  ( T r a i n o r & Tremblay,  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 will  be m o t i v a t e d  likely  to  gain  to participate support  from  Private  not  indicative  of  enough  be  general  to  1992). consumer/survivors  i n CSRB's. A s w e l l , the  doctor  CSRB's a r e  community;  people  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 see  CSRB's  as  worthwhile.  particularly beneficial  Such  community  support  likely  has  i n t h e example o f A b e l E n t e r p r i s e s ,  been 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 E c o n o m i c F a c t o r s The r e c i d i v i s m s t u d y q u o t e d that  CSRB's  will  also  have  a  consumer/survivors  involved  traditional  and s o c i a l  operate  medical  with  fewer  i n the previous section positive  with  impact  CSRB's  services.  professional  staff  programs, and so a r e l e s s c o s t l y i n t h i s  suggests  economically, i f  make  less  use  of  A l s o , these  structures  than  vocational  other  regard.  B e c a u s e CSRB's a r e e f f i c i e n t f r o m a c o m m u n i t y w e l f a r e p o i n t o f view,  they  attractive  are attractive to  investors  t o government interested  in  program  funders,  worthwhile  and  community  projects. 4.2.3 B r o a d  Community S u p p o r t  To  degrees,  varying  t h e examples  s t u d i e d have  generated  broad  community  s u p p o r t , b e y o n d t h e s e r v i c e p r o v i d e r s who  normally 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 a t t e m p t s to  move b e y o n d  corporate  i t s social  world  service  and  into  i s a n e x a m p l e o f a CSRB b r o a d e n i n g  support. Abel Enterprises' e f f o r t s church  clientele  congregations,  the l o c a l  i t s base of  -- t a r g e t i n g l o c a l community  Toronto's  college  businesses, --  generated  awareness i n t h e community, p r o v i d e d t h e 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 d e v e l o p m e n t , and g e n e r a t e d economic o p p o r t u n i t i e s for  the  enterprise.  Abel's  efforts  would  seem  to  exemplify  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 taken over by s o c i e t y ' s i n s t i t u t i o n s CSRB's community  have  demonstrated this  has  ability  to  1994) .  generate  contributed to the  broad  success  of 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  support  also  support;  the  (CBC R a d i o w o r k s ,  contributes to the v i a b i l i t y  o f CSRB's. P r o j e c t s  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 to  succeed,  f u n d e r s and  4.2.4  and  once  again  will  be  capable of  h a v e a much b e t t e r c h a n c e  more  attractive  t o program  investors.  Meaninqfulness One  o f t h e most  important  characteristics  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 a n 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 lives  f o r consumer/survivors.  This i s accomplished  i n a number o f  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 a n d p r o d u c t i v e w o r k ; 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 ; a n d p r o d u c t i v e , a s 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 Through having a r o l e  community.  i n t h e management o f  e i t h e r through shared ownership  the  enterprise,  o r t h r o u g h some f o r m o f  democratic  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  c r e a t i o n o f a work environment  needs.  CSRB's,  in  that  that suits their  they  address  not  only  efficiency  t h e r a p e u t i c b e n e f i t s , b u t a l s o m e a n i n g and d i g n i t y , attract  4.3  support  from  i n the  and  are l i k e l y  to  consumer/survivors.  Large-Scale P o l i t i c a l  and E c o n o m i c 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 the p a r t i c u l a r p o l i t i c a l A high,  and e c o n o m i c c l i m a t e o f t h e s e  t r o u b l e d economy, will  where  make i t e s p e c i a l l y to  find  unemployment difficult  times.  f o r a l l workers  f o r the  c o m p e t i t i v e employment.  is  psychiatrically  disabled  worker  One  Britain,  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 ,  study  from  showed t h a t  r i s i n g u n e m p l o y m e n t r a t e s h a d 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 a n u n e m p l o y m e n t r a t e o f g r e a t e r t h a n 6% made t h e p l a c e m e n t psychiatrically Cheadle,  disabled  workers  nearly  impossible  (Morgan  of and  1975).  Furthermore, vocational  economic downturns w i l l t e n d t o have an e f f e c t  programs  that provide  disabled  individuals  (Church  Concerns  regarding public  and  debt  employment Pakula, will  for  1984;  likely  on  psychiatrically  Olshansky, cause  1968).  pressures  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 , which i n c l u d e s concern about p u b l i c f u n d i n g of p r o g r a m s a n d a t i g h t l a b o u r m a r k e t , m i g h t make a l t e r n a t i v e  settings  s u c h a s CSRB's more  attractive.  4.4 R a t i o n a l e f o r a F u n d i n g As  discussed  consumer/survivors. favour found  ongoing provide their  previously,  CSRB's  Furthermore,  political  the establishment from  Structure benefits  and economic  and s u p p o r t .  CSRB's  are l i k e l y  More e x p e r i m e n t s  with  t o need  CSRB's  will  development.  calls  i n d e s c r i b i n g t h e needs  f o r an  intermediary  structure  of a l t e r n a t i v e settings, mediating  between  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 ; smaller  setting  paperwork necessary In developing deal  factors  more k n o w l e d g e r e g a r d i n g o p p o r t u n i t i e s a n d c o n s t r a i n t s t o  Schwartz,  the  to  o f a l t e r n a t i v e s e t t i n g s . A n d , a s we h a v e  t h e a n a l y s i s o f examples,  funding  provide  i s not  overwhelmed  with  small,  i n t h i s way,  procedures  t o s a t i s f y i t s f u n d i n g agency (Schwartz, CSRB's, c o n s u m e r / s u r v i v o r s  not only with a lack of c a p i t a l ,  will  likely  but also with  and  1992). have t o  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 the  development  1992).  and maintenance  What w o u l d  question w i l l  such  a  be d i s c u s s e d  o f CSRB's  structure  (Trainor  f o r CSRB's  i n C h a p t e r 5.  look  &  Tremblay, like?  This  5.0  S u p p o r t i n g CSRB's  Consumer/survivor-run  businesses,  as  an  alternative  to  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 the 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 n e e d e d .  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 t h e d e v e l o p m e n t an e x p l i c i t  i n t e n t i o n of p o l i c y  C o n s u m e r / S u r v i v o r Development  ( T r a i n o r & Tremblay,  intention  of  Development I n i t i a t i v e consumer/survivor  1992).  Initiative  O n t a r i o i s l e a d i n g t h e way, explicit  o f CSRB's  i n t h e r e g a r d o f m a k i n g CSRB's an  policy.  Ontario's  Consumer/Survivor  (CSDI) h a s r e s u l t e d i n t h e d e v e l o p m e n t  o f 34  initiatives.  The C o n s u m e r / S u r v i v o r D e v e l o p m e n t I n i t i a t i v e  (CSDI) i s f u n d e d  b y t h e Community M e n t a l H e a l t h B r a n c h o f t h e O n t a r i o M i n i s t r y  of  Health.  to  It  was  enacted  in  1991  to  provide  direct  funding  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 was  p r o v i d e d f o r CSDI;  issued a c a l l District  the  Community M e n t a l  Million  H e a l t h Branch  then  f o r p r o p o s a l s from v a r i o u s consumer/survivor groups.  Health Councils,  and  community m e n t a l  health  agencies.  From 266 p r o p o s a l s r e c e i v e d , 42 w e r e s e l e c t e d f o r f u n d i n g . At  the b e g i n n i n g , about  half  of the s e l e c t e d  projects  were  a l i g n e d w i t h c o m m u n i t y m e n t a l h e a l t h a g e n c i e s . H o w e v e r , CSDI came to  the  point  organizations (the  'service  independent initially  of  view  t o break  that  away f r o m  paradigm'), of  order  for  consumer/survivor  the p r o f e s s i o n a l  i t would  traditional  sponsored by  in  be  service  community m e n t a l  best  service  for projects  agencies. health  Most  model to  be  projects  agencies are  now  free-standing,  and  are  being  incorporated  as  non-profit  organizations. 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: advocacy,  knowledge p r o d u c t i o n and s k i l l s  development. development  mutual support,  training,  and  economic  Of t h e t o t a l o f 34 i n i t i a t i v e s , s e v e n h a v e a n e c o n o m i c f o c u s . These i n c l u d e  several  i n operation or 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 e n a c t e d , b u t w h i c h a r e now a s s i s t e d b y CSDI f u n d i n g . CSDI  i s a  response  to the limitations  mental h e a l t h s e r v i c e system  (CSDI,  of the traditional  1994). Consumer/survivors 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 n o t 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 f u n d s were b e i n g g i v e n t o s e r v i c e agencies and t o expensive p r o f e s s i o n a l  services,  consumers  often  found themselves 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 q u o t e , f r o m C S D I ' s l i t e r a t u r e , d e s c r i b e s s o m e t h i n g 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 u n i q u e i n t h a t i t h a s 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 groups. While t h e r e h a s b e e n much r h e t o r i c about t h e importance 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 involvement i n t h e m e n t a l h e a l t h s y s t e m , t h r o u g h CSDI t h e g o v e r n m e n t o f O n t a r i o h a s made a v a i l a b l e t h e f u n d i n g a n d r e s o u r c e s t o a c t u a l l y d e m o n s t r a t e t h e i m p o r t a n c e . . ( CSDI, 1 9 9 4 , p . l ) I n 1 9 9 2 , CSDI r e c e i v e d a t h r e e - y e a r g r a n t f r o m T r e a s u r y B o a r d o f $3.5  million  a  consumer/survivor The Based of  CSDI  year;  those  funds  support  t h e 34  initiatives.  i s one e x a m p l e  on t h e l i t e r a t u r e  o f a support  strategy  reviewed i n t h i s t h e s i s ,  CSRB's d e s c r i b e d , what e l e m e n t s  encompass?  currently  f o r CSRB's.  and t h e examples  should a p r o v i n c i a l  strategy  5.1 E l e m e n t s 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 5.1.1  CSRB's  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 f u n d s f r o m g o v e r n m e n t ? W i s m e r a n d  Pell  (1983),  i n describing  aspects  of  community-based  economic  d e v e l o p m e n t , a d v o c a t e 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 f u n d s necessary f o r t h e i r  operation.  Part  of the a l l u r e  s e t t i n g s f o r the disabled i s that they provide of s e r v i c e t o the d i s a b l e d that i n v o l v e s traditional At  of a l t e r n a t i v e  an a l t e r n a t i v e f o r m  less p u b l i c funding  than  services.  a  practical  level,  however,  funding  from  government  a g e n c i e s h a s b e e n n e e d e d b y a l l t h e e x a m p l e s o f CSRB's d i s c u s s e d i n order  to survive.  employ p e o p l e w i t h they  can't  be  businesses.  CSRB's h a v e  shown t h a t  a h i s t o r y of serious  expected  to  have  the  Ongoing s u b s i d i e s w i l l  they  mental same  can  successfully  illness.  As  such,  e f f i c i e n c y as  other  l i k e l y be n e c e s s a r y  (Trainor  &  T r e m b l a y , 1992) . There setting  i s , however,  that  has  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  survived  without  government  Workshops  i n Richmond has o p e r a t e d s i n c e  Dr.  Brown and h i s w i f e ,  Cyril  funding.  1 9 9 1 ; i t was  J a n . Brown,  a retired  All-Win  founded doctor  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 p e r f o r m m e a n i n g f u l work. A l l - W i n  presently  could  i s i n the business of  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 Its  corporate  Burnaby  clients  General  registered  include  Hospital.  charity. All-Win  VanCity  Run  as  provides  a  Savings  Credit  non-profit  employment  - from m u l t i p l e s c l e r o s i s t o  Brown  to  All-Win  be  a  working  model  them.  Union  society  and and  t o people with  range of d i s a b i l i t i e s wants  by  a  schizophrenia.  f o r other  groups  i n t e r e s t e d i n independent, people with  s e l f - s u p p o r t i n g workshops r u n by and f o r  disabilities.  5.1.2 A s p e c t s o f CSRB's t o be encouracred While  c o n t r o l o f t h e i r d e v e l o p m e n t s h o u l d be i n t h e h a n d s o f  consumer/survivors recommend t h a t  themselves,  Trainor  and  c e r t a i n key aspects are v i t a l  CSRB's c a n h a v e o n t h i s  5.1.2.1 F l e x i b i l i t y Flexibility  Tremblay  (1992)  t o t h e impact  population.  i n working  hours  i n working hours,  a l l o w i n g workers  t o work p a r t -  time, take time o f f f o r medical reasons, o r appointments a s p e c t o f t h e e x a m p l e s o f CSRB's  5.1.2.2  The  adoption  that  of  i s a key  described.  organizational  models  which  guarantee  c o n t r o l t o consumer/survivors Trainor  and  Tremblay  consumer/survivors ; necessary  f o r an  recommend interim  that  phase,  t o employ i n d i v i d u a l s w i t h  a l l employees however,  expertise  i t may  be be  i n the p a r t i c u l a r  business.  5.1.2.3  Ensure  emphasize  that  the  Projects  involvement funded  membership-driven Directors, which  projects  adopt of  through  employees CSDI  process i n place.  steering  committee  organizational  must  in  models  decision  have  a  which making  democratic,  P r o j e c t s must h a v e a B o a r d o f  o r some o t h e r  governing  i s e l e c t e d by, and r e f l e c t s t h e membership.  structure  5.1.2.4 S u p p o r t Providing also  provide  o f Networking technical  a  setting  B e t w e e n CSRB's  assistance t o consumer/survivors f o r networking  between  could  individuals  and  g r o u p s 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 . In O n t a r i o , t h e P r o v i n c i a l Consumer/Survivor  Business Council,  s u p p o r t s n e t w o r k i n g b e t w e e n CSRB's; t h e T o r o n t o Community E c o n o m i c D e v e l o p m e n t N e t w o r k , a n d t h e Women's Community E c o n o m i c D e v e l o p m e n t N e t w o r k b r i n g t o g e t h e r CED e f f o r t s . These  aspects  -- f l e x i b i l i t y  i n working  hours,  adoption of  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  maintained  employee-involvement,  networking  --  may  i n CSRB's b y t h e s u p p o r t i v e s t r u c t u r e b y o n l y  those p r o j e c t s which  5.1.3  and  Technical Another  be  funding  adhere t o these a s p e c t s .  Support  o f T r a i n o r and Tremblay's  recommendations  i s that  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 m o d e l f o r t h i s may come f r o m V a n c o u v e r ' s Downtown E a s t s i d e E c o n o m i c D e v e l o p m e n t S o c i e t y (DEEDS), which  c l o s e d i t s doors  funding.  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  DEEDS was c l o s e d d e s p i t e  business i n c u b a t o r , employing Mail,  i t s success  a n e s t i m a t e d 250 p e o p l e  A p r . 9, 1991) . DEEDS h a d 11 s p a c e s  f l e d g l i n g businesses could get started. counselling,  i n acting  (Globe and  at i t s location  I t also provided business  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  by h e l p i n g them s e t o u t a b u s i n e s s p l a n , i d e n t i f y m a r k e t s ,  services  sources to  where  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.  funding  as an  and o t h e r  businesses  resources.  i n the  DEEDS  community  also for a  clients and f i n d  provided i t s $15  annual  membership. DEEDS a l s o  had  With t h i s approach, group  of  PAL  (peer-assisted  on T h i r d - W o r l d l e n d i n g regularly  to  loan)  program.  circles,  PAL  t o poor  programs,  this  people  lack collateral  who  program  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  o f f e r mutual  also  provide  consumer/survivor-run p r o v i s i o n of such  small  support,  is  designed and  financial  to  equity,  such  technical  businesses.  c o m p u t e r , f a x , and  businesses  i n getting  don't  institutions.  services  Business  provide  and  A s u p p o r t s t r u c t u r e f o r CSRB's, a s w e l l a s p r o v i d i n g might  a  a n d 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 r a n g e .  other  capital  based  a  DEEDS members meet  guidance, Like  started  funding,  to  counselling,  photocopier service  o f f the ground.  Such a  assist and  could  the  assist  service  could  a l s o s u p p o r t n e t w o r k i n g b e t w e e n CSRB's.  5.1.4  E c o n o m i c d i s i n c e n t i v e s t o employment A  address  p r o v i n c i a l strategy the  Currently,  issue  people  of  to support  economic  can o n l y  CSRB's w o u l d  disincentive  e a r n $250 on  also  to  top of t h e i r  a n y amount e a r n e d a b o v e t h a t i s t a x e d b a c k . M a k i n g t h e s e more g e n e r o u s w o u l d h e l p ; that  as w o u l d g u a r a n t e e s  have  employment. assistance; allowances  for disabled  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  n o t be j e o p a r d i z e d  5.1.4.1 A n a l y s i s At  a  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  of  policy  to  people would  i n employment.  Expenditures level,  there  has  been  a l l o c a t i o n o f f u n d s away f r o m i n s t i t u t i o n a l  much  discussion  s e t t i n g s , and  of  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 and  advocacy  lack  of  funds  commitment  still  Ontario's 1989  initiatives. to  provided  An  the need f o r s e l f - h e l p , mutual a i d analysis  community to  of  expenditures  services,  institutional  i n comparison  s e t t i n g s . An  p r o v i n c i a l mental h e a l t h expenditures,  - 1990  f i s c a l year,  reveals  shows t h a t o n l y 16.5%  to  allocated  to  self-help  Trainor, service  1992).  In  sector,  Ontario,  $3.2  representing  and  conducted f o r the  about  these  are  0.2%  was of  spent total  as f o r  tiny  community s e t t i n g s  million  of  of p r o v i n c i a l mental  initiatives,  comparison to both i n s t i t u t i o n a l  the  analysis  h e a l t h f u n d i n g went t o c o m m u n i t y m e n t a l h e a l t h s e r v i c e s . And funds  a  in  (Lurie  on  the  mental  &  nonhealth  expenditures. An  issue  b r o u g h t up  f o r funds - w i l l CED  projects,  funding  result  in  by  mental h e a l t h workers  is  o f more s e l f - h e l p p r o j e c t s , fewer  funds  for  total  amount  projects  spent  in this  s e l f - h e l p represent on  mental  sector  health.  means t h a t  particularly  established  e s p e c i a l l y those i n the v o c a t i o n a l r e h a b i l i t a t i o n M u t u a l a i d and  competition  programs,  field?  a t i n y percentage of The  small-scale  t h e y would not  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 p r o g r a m s . And  given  nature  tend  to  a wiser  investment.  be  of a  their potential  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 be  the  could  6•0 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  of v o c a t i o n a l also  Conclusion  have  rehabilitation  limitations.  forms  a r e a p p r o p r i a t e i n many c a s e s ,  These  limitations  they  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  is  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 g r o u p s i n s o c i e t y . Self-help  is  importance  a  of  movement mutual  professionalized Taking elements  i n mental  aid,  services  health  particularly  that  as  an  emphasizes  the  alternative  to  that r e i n f o r c e p a t t e r n s of  dependency.  from b o t h community economic development and  self-  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 consumer/survivors  by  virtue  of  in  the  B a s e d 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  five  d e v e l o p m e n t a n d management o f t h e  examples  of  constraints  restrictions,  consumer/survivors attitudes  of  a  role  businesses,  projects  can  with  be  respect  the  following  determined: to  how  (i) much  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 )  the  general  specifically  the  attitudes  mental  of  these  having  enterprise.  consumer/survivor-run facing  bureaucratic  their  stigma  public  attached  towards to  mental  health professionals,  been d e s c r i b e d as t h e s e r v i c e paradigm;  consumer/survivors, illness;  (iii)  specifically  what  the has  (iv) problems inherent to  t h e d e v e l o p 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  (v) t h e d r i f t  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  towards  experience.  From t h e r e v i e w o f l i t e r a t u r e a n d t h e e x a m p l e s o f CSRB's, t h e f o l l o w i n g o p p o r t u n i t i e s were a p p a r e n t :  ( i ) t h e 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  into  question  the  viability  of  existing  forms  of  vocational  r e h a b i l i t a t i o n , a n d make t h e d e v e l o p m e n t o f a l t e r n a t i v e s a n (iii)  a  support  assistance,  structure,  will  which  through  f u n d i n g , and  technical  a c t a s a c a t a l y s t f o r t h e d e v e l o p m e n t o f CSRB's.  An o u t l i n e o f s u c h 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 , the  following  option;  aspects:  (i) ongoing  including  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 hours, 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 ; s u p p o r t , and  ( i i i ) technical  ( i v ) a d d r e s s i n g the i s s u e of economic d i s i n c e n t i v e s t o  w o r k . 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 b y s u c h a  supportive  s t r u c t u r e w o u l d be an a n a l y s i s o f g o v e r n m e n t e x p e n d i t u r e s on m e n t a l health,  determining  institutional,  what  community,  whether the mutual  in  therapeutic  vision,  vision.  as Schwartz  background  mental  health,  funding  we  aid/self-help  can  for  the  sectors,  and  i s adequately  see  vision,  funded.  a  transition  a n d now health  from  (1992) p o i n t s  s h o u l d not  out, i t i s i n such s e t t i n g s that  and a c c e p t a n c e . G a n d h i ' s  good',  seems t o be  relevant  in this  But, people  that case;  nobody  that  communities  will  t o show  allow itself.  the  inherent  good  in  we  will  i n CSRB's,  c o n s u m e r / s u r v i v o r s are not c r e a t i n g s e t t i n g s t h a t are p e r f e c t , settings  be  admonition that  so p e r f e c t  a  t o a community  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.  'beware o f t h i n k i n g o f s y s t e m s  h a v e t o be  are  f o r t h e d e v e l o p m e n t o f CSRB's i s  t o an a d v o c a c y  f i n d independence  should  mutual  of  Such a community v i s i o n f o r m e n t a l  romanticized;  will  and  levels  aid/self-help sector  A philosophical presented:  the  people  and  but in  7.0  Bibliography  A n t h o n y , W.A., H o w e l l , J . & D a n l e y , 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 a n d S e r v i c e s . SP M e d i c a l a n d S c i e n t i f i c B o o k s , J a m a i c a , N.Y., 1 9 8 3 .  Bond,  G. S u p p o r t e d w o r k a s 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 . 1 1 , No. 2, 1 9 8 7 .  Brown, J u d i t h . A P s y c h o s o c i a l A n a l y s i s o f an I n n o v a t i v e Model o f S u p p o r t e d 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 . M.A. thesis. Department o f E d u c a t i o n , U n i v e r s i t y o f Toronto. 1989 .  CBC  R a d i o w o r k s . B e y o n d I n s t i t u t i o n s (CBC I d e a s t r a n s c r i p t ) . The C a n a d i a n B r o a d c a s t i n g C o r p o r a t i o n , T o r o n t o , O n t a r i o , 1994.  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 . 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