Non-remunerative employment for those with head injuries; what are the options?
Over a lifetime there will be a number of different vocational placements for each client and by far the most successful take place outside the ‘four walls of home’.
My over-30-year journey as a case manager has made me appreciate the need for rehabilitation goals and how important it is to link them to mainstream activities. Employment is so strongly connected to self-esteem and self-worth that we have found it is a lifeline for many clients.
Over a lifetime there will be a number of different vocational placements for each client and by far the most successful take place outside the ‘four walls of home’. There is a huge psychological boost to going to work and the normality of it (pre-Covid-19). Of course the task has been much harder because of the pandemic and the moving goal posts, but it is still possible.
THE CLIENT’S INTERESTS
First identify the interests that a client has.
For example, for a young man interested in motorcycles it may be impossible for him to ride the machine, but he might be able to work on the engine and refurbish a motorcycle with help. This is something
that is relatively straightforward to organise. A simple workshop/garage needs to be identified and then a suitable assistant found, with some experience in mechanics, who will then need training in brain injury.
I recommend input from both a psychologist and an occupational therapist in the initial risk assessment before the idea is presented to the client. There could be a danger of raising the client’s expectations without support by professionals and before funding and equipment are identified. If they can set up a lock up/ garage, for example, it becomes a more sustainable activity that at least helps to pay for itself, although not generating income, and can be located near other similar ventures so that there are social advantages.
Other successful projects have included photographic studios, music studios, picture-framing, and upcycling furniture, and I also note that, if a workplace can be located at a farm enterprise or a commercial unit/ factory where there are other small businesses, it works well.
For the client it is all about having a focus and being part of a normal lifestyle, but at a slower pace than perhaps would be found in an urban centre. The recent pandemic has made this less feasible, but businesses have been allowed to continue, and if Covid procedures are followed, then there is no reason why people cannot continue to attend.
There are clients who cope with options such as Headway or Men in Sheds, centres of excellence for providing some vocational activities, but the majority of the younger people with head injury have time to fill from the age of 20 years to retirement age.
CHARITIES AND VOLUNTARY WORK
There are clients who cope with options such as Headway or Men in Sheds, centres of excellence for providing some vocational activities, but the majority of the younger people with head injury have time to fill from the age of 20 years to retirement age. They may need to move on from a rehabilitation centre, such as TRU at St Helens, to attending regular courses and then move on to a more long-term project.
There are clients who need something in the voluntary sector, so it is then possible to look at charity work with help from a support worker. It may be necessary to provide a disclaimer to state that any problem will be covered by the client and that insurance is in place.
FINDING THE RIGHT SUPPORT
One of the more interesting situations I have found myself in was when my client was one of the top ten commercial solicitors, but had been unable to continue as a partner and had been given a client liaison role. We engaged a speech therapist to video him before any meetings and to work on presentations and following up on the meetings. Unfortunately the solicitor was so damaged that he could not organise his affairs, and so we employed a personal assistant who had worked decluttering NHS executives’ desks
to help him organise his workspace. Although this was support at a much higher level than usual, it was evident that he needed help with his dysfunctional family and his general lifestyle in order to allow him to maintain any presence at work and help his self-esteem.
The support staff role is very specific to the vocational activity and they should be regarded more as mentors, and this approach is much more successful. Background assistance is not difficult to organise and the client needs to he helped to accept this.
As mentioned earlier, I consider that there should be support from a neuro-psychologist and a neuro-occupational therapist throughout the placement at different times, depending on whether the case manager’s ongoing assessment states that it is of value to the client. I consider that therapy support should be organised for a client’s lifestyle and not at a set level, but instead at different levels depending on what they are doing and what they are getting out of it.
There is no one answer, and clients may try various types of vocational support, but the main thing is to try and take it at the client’s pace and not risk failure because of the issues of timing with a personal injury claim, for example. However, there need
to be some goals, and some certainty that these goals are on track to being met in the different life that they are living now.
OVERCOMING CHALLENGES WITH A CASE MANAGER
One main issue is overcoming the possible concerns and fears of a case manager who does not see their role as being one of vocational consultant.
My experience is that every client needs the opportunity to have a review of their lifestyle annually, as many of us do around the New Year. Change may be needed to make the client feel comfortable with developing more activities, but as with so many of these, the biggest challenge is fear of failure. That is why, in my view, there are no shortcuts to any vocational activity. It has to be carefully planned and mapped out, as well as monitored.
We are still not very good at opening our doors to vocational opportunities for clients. I have spent hours in meetings with solicitors and experts all wanting to see their client do more, but extremely nervous of the idea of actually bringing in the client to their offices for a placement in case this might be seen to involve a conflict of interests. However, it is often possible to obtain a placement from a different organisation. Normally solicitors join the charitable activities to show their support, and I think it is time that we all opened our doors more to provide future placements for clients because they do need understanding employers for every step of their journey.