By Marvin Ross

In my anti-woke rant, I referred to having disabilities as a burden and one reader wrote that she did not find hers a burden. She also said that people with disabilities can work to some extent either in paid or volunteer positions. I was making a somewhat blanket statement when I used the word burden but having a disability does mean that you have limitations. The extent of that limitation will vary depending on what the disability is and how well we adjust to it.

I find my newly developed L5 stenosis a burden as I can no longer walk far but it does pale in comparison to other disabilities.

Dogs manage to show us how we should deal with infirmity as they quickly adapt to what has been thrown at them. My vet once told me that dogs have three legs and a spare. If you have seen a dog who lost a leg, you will notice that they manage quite well without (seemingly) depression. I have a neighbour dog with a wheelchair and she is as happy as can be. Her back end is paralyzed and she gets around with a couple of wheels on her back end.

Dogs can teach us a great deal about coping.

How much work someone with a mental disability can do varies but it is an important issue. Some people can work part-time but that becomes problematic when the condition is episodic and you never know when you are going to have a relapse. It takes a very understanding employer to cope with that. A few years ago, I met with an agency that trained and tried to place those with mental disabilities into paid jobs and they refused to deal with people with schizophrenia for that very reason.

On a psych ward with my son a number of years ago was a professor of medicine who was having a relapse of his bipolar disorder. It seems he went off his meds periodically and would end up in the hospital which was in the same building as the medical school. When he wasn’t locked in the isolation room, he would have the nurses go to his office to pick up his mail. A university employer can manage with an employee who is unreliable but most employers cannot.

I remember interviewing the late Dr Fred Frese a number of years ago and he made the comment that he kept going to school to collect degrees because no one would hire him or others with schizophrenia.

In Ontario, any work you do while on disability has to be reported and after a certain income, 50% is clawed back.

Volunteer work can be rewarding but my son’s experiences have been not that great as many positions have been very badly organized and often there is really nothing to do. In one position, he was ignored because the person who hired him did not tell anyone he was coming so they thought he was a client.

What is important and mostly totally overlooked is providing meaningful activity for people. That is something that is rarely done as the medical system medicates and stabilizes people and then says go away and fend for yourselves. How do they do that? They have no money and few resources so many turn to drugs to amuse themselves and gain some amount of pleasure from getting high. Now we have a bunch of people who are mentally ill and addicted.

Part of our advocacy must be to demand vocational rehabilitation or meaningful and rewarding activities for people as part of their treatment and ongoing support. A livable disability allowance or a a universal basic income (UBI) would be a step in the right direction. During the worst of covid, the Canadian Government provided a $2000 a month allowance to people who had lost their jobs. That was the minimum amount that they felt was needed to get by but we expect that the disabled can get by on around $1200 a month (once the added 5% is included for Ontario). That is barely existing.

It has long been recognized that the ability to work improves outcomes for the mentally ill, improves their self-esteem, alleviates psychiatric symptoms, and reduces dependency and relapse. In the days of asylums, patients worked on farms on the grounds of the hospital and in other meaningful jobs. “As asylums closed down, work experience played an important role in the preparation of patients for discharge. Patients who performed well on graded tasks within the hospital were gradually reintroduced to working in the community, often through special arrangements with local employers. As community care developed, these arrangements evolved into enterprises or workshops providing sheltered employment within a segregated work setting.”

Gradually, in most North American jurisdictions, these functions disappeared and degenerated into allowing discharged patients (and those who do not even get hospitalized care or any medical care), to fend for themselves with little community support or money.

Europe, and especially the Netherlands from what I can gather, does make an effort through individual placement support to help patients.

The cost of not paying attention to this aspect of care is likely far greater than the cost of helping people to have meaningful activity in their lives. What we have instead is the cost of arrests, incarceration, revolving doors in and out of emergency rooms and hospital stays and public nuisance – let alone the moral bankruptcy of our current policies.