Part of what brings together the characters in Tumbledown is their participation in a vocational rehabilitation programin this case, training in an assembly-line setup designed to teach them to work on an actual factory floor. As portrayed in the novel, this type of work not only offers patients (modest) financial compensation, it also prepares them for real life after rehab.
Vocational rehabilitation and/or training is part of the treatment program for many conditions; the state of Texas's Department of Assistive and Rehabilitative Services lists a wide variety of disabilitiesranging from mental illness to hearing impairmentfor which vocational rehabilitation might be appropriate. Part of the impetus for such programs is the stated goal of many patients to obtain employment and thereby gain entry into the "normal" economy and society and achieve a sense of self-fulfillment, independence, and self-reliance.
The type of training program depicted in Tumbledown is what's known as a "sheltered workshop," in which patients with disabilities work on a supervised production line in a segregated environment performing a variety of tasks, which can include assembly, packaging, or shipping. The workers are paidusually by the piecefor their work. Ideally, the goal is to eventually transition into an integrated workforce. The Encyclopedia of Mental Disorders argues that this type of segregated scenario is less preferable than a training program that is integrated from the start, listing "integrated setting" alongside "individual choice" and "person-centered planning" as best practices for professionals interested in providing vocational training to their clients. Integrated setting means the employment is provided in a more routine environment, while person-centered planning involves developing a plan of action involving the client in decisions.
Despite strong federal support and the fact that every state has an agency whose function it is to provide these types of services to those with mental illness and other disabilities, vocational training and rehabilitation programs have garnered a fair amount of criticism. According to some sources, more than 70 percent of people with disabilities are unemployed; those with mental disorders can experience unemployment rates approaching 90 percent. A 1997 report by the National Alliance on Mental Illness argued that federal and state programs have by and large failed those with mental disabilities, particularly severe mental illness, primarily by providing little support in the way of job placement services and ongoing support once a placement has been successfully obtained. The organization's several recommendations for strengthening the system argue for more oversight of and accountability by these vocational rehab programs, as well as education and legislation aimed at reducing workplace discrimination by the general population against those with mental illness.
This article was originally published in September 2013, and has been updated for the
September 2014 paperback release.
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