H O T E L
As shown by the results of the analysis of the work of schizophrenia-diagnosed people which was conducted byK. Mauser (2001), the percentage of the professionally active in this group of patients on the free labour market in the countries of Western Europe and North America, amounts to 10-20. Over 80% of the chronically ill, who receive community support in various forms, remain permanently unemployed (Ezzy, 1993). It must be stressed that those kinds of social and professional rehabilitation that are available in Poland embrace circa 9,000-11,000 of the mentally ill, which is fewer than 10% of the 120,000 of people suffering from schizophrenia and other psychotic disorders. These people should be embraced, in accordance with their individual needs, by regional programmes of work and rehabilitation.There is no single answer to the question how work influences the symptoms of mental illness. But it is not to be doubted that this influence on the obtained treatment outcome may be extremely spectacular, which was observed in all those programmes of psychiatric care where work was incorporated into a broader system of treatment and rehabilitation (Dörner, 1998; Cechnicki & Kaszyński, 2000).The community system of treatment, psychotherapy and rehabilitation of people suffering from schizophrenia has been run for many years now by the Chair of Psychiatry of the Medical College of the Jagiellonian University as well as by the Adult Psychiatry Clinic in Kraków, which collaborate with the National Fund for the Rehabilitation of the Disabled, non-governmental organisations of professionals, patients and their families. A part of this system is to solve the problem of unemployment among the mentally ill. The programme of social and professional rehabilitation is based on the conviction that the efficiency of therapy depends on the degree to which the instruction on the basic social skills and classic forms of occupational therapy are integrated with the capabilities of the mentally ill who acquire, at different stages of their rehabilitation, particular skills that are necessary in their actual employment. The above described system of treatment, psychotherapy and rehabilitation of people suffering from schizophrenia includes also the Outpatient Therapy and Rehabilitation of Psychoses, the Outpatient Ward, the Counselling Service for the Families, the Patients’ Hostel, and Occupational Therapy Workshops.Within the system, economic ventures are undertaken so as to employ the mentally ill. This is connected with the fact that the members of the therapeutic team often establish non-governmental organisations that aim to help those who underwent mental crises to return to their community and professional environment. The first organisation of the kind was the Kraków Foundation Hamlet (established by us in 1992), which provided sheltered workplaces in the so-called social firm, which is a café named Miodowa 9. The café employs a few mental patients and another few people can also receive here their professional training.The next venture was necessitated by the need to co-ordinate all our activities aimed at professional rehabilitation and, in a broad sense, the education of the general public (e.g. during the nationwide programme Schizophrenia: Open the Doors, which fights social stigma and exclusion of the mentally ill). Thus originated the Association for the Development of Community Psychiatry and Care at the Adult Psychiatry Clinic in Kraków. It co-operates with the Clinic in the task of rehabilitation and social re-integration of the mentally ill. Together with the Families’ Association Mental Health, it offered new sheltered workplaces in the so-called professional activity enterprise, a hotel named Pensjonat U Pana Cogito. Its employees are fifteen disabled people suffering from chronic schizophrenia. The rehabilitation programme at the hotel is dovetailed with the occupational therapy workshop and the general municipal system of psychiatric care. As a sideline, the hotel is expected to work out a model of a Polish social firm and to initiate a nationwide support organisation Social Firms: Poland, which is to promote social and economic initiatives targeted at employing the mentally ill.The main reason why new economic entities in Poland originate as social firms is that sheltered workplaces are liquidated in consequence of the worsening economic conditions. At the same time an increase in the unemployment rate is observed (20%, and among the youth 40%), while the social distance towards the mentally ill is growing and the existent forms of social and professional rehabilitation are criticised. The free labour market offers practically no employment for the mentally ill. So in 2003 new legal regulations were adopted re “public benefit activities.”
We think that various forms of community support should be organised and “public benefit activities” should be conducted at the local government level, in close co-operation with psychiatric care professionals, employment agencies and the patients’ communities. We demand a national-scale initiative to create regional programmes for the protection of mental health, which programmes should embrace people who underwent mental crises so that they can participate in the life of society, and especially in its important aspect, namely work.
The idea to establish a social firm in Kraków was conceived thanks to the co-operation between Kraków and its twin partner, Edinburgh. The representatives of NGOs, local government and the Kraków university-level schools visited Edinburgh and its several enterprises of the social-firm type. Such firms have been functioning for many years in Great Britain, Germany, Italy and Holland. Edinburgh for over ten years has had its boarding house Six Marys’ Place, whose employees are people with mental disorders and others who had come across problems on the labour market. As there is an immense need to create sheltered workplaces in Kraków, while adapting to the requirements of the market, there appeared an idea to establish a hotel which would function as a social firm. The aim of the project was to provide sheltered employment to those who are disabled due to their mental illness and to give them rehabilitation, an opportunity to re-enter social life and to find a model solution of how to re-integrate those who were marginalised back into their social and professional activities. An important aspect here is also a change of the public image of a mentally ill person. As a result, it is expected in the long run that social attitudes towards the mentally ill will be changed and the decades-old, harmful stereotypes will disappear. An Edinburgh-based NGO, Community Enterprise Limited, together with the Families’ Association Mental Health from Kraków and the Society of the Friends of the Disabled from Łódź, applied jointly for the grant of the British National Lottery Charities Board so as to raise funds to support the idea of establishing social firms in Poland and to invest in particular projects. The Scottish NGOs shared with us their experience, and they backed and supervised the execution of the project.
The principle ruling the establishment of such a social enterprise is the collaboration between NGOs, business organisations, local and national authorities. The project was executed along three main lines, instrumental in the achievement of the goal. The first was to build a support network for the established social firm, namely to find contacts and contractors at the local level, to co-operate with people and institutions that would offer their support and advice at the subsequent stages of the project (market research, marketing strategies, drafting business plan, legal counselling). This reinforcement of the identity of the firm and the Association was a crucial factor, especially that the previous activity of the Association had consisted in emergency volunteer work of its members: providing support to and strengthening the bonds between the families and the patients. So to enter the market of tourist services and to compete on it was an entirely novel, unfamiliar experience.
The second field of operation was to raise funds to carry out the project in the situation when the grant offered for the years 2000-2002 covered the administrative costs and only 20% of the investment costs. Of utmost importance here were the co-operation and the involvement of the municipality of Kraków: it offered a real estate and a building plot in a locality that is propitious to the tourist business. Funds were gathered from very many sources: from sponsors, grants and government funds. Important contributors were also the Association for the Development of Community Psychiatry and Care and its members, professionals in psychiatric care.
The third kind of activity was to draft and carry out a rehabilitation programme so as to prepare the future employees of the hotel for their work and to embrace more and more people after mental crises in the execution of the project. The core of this programme was to provide knowledge and skills indispensable on the tourist market. The training involved cooking skills, restaurant service, on-the-job training and traineeships in the Kraków hotels and cafés, computer skills, marketing and gardening. All the courses were run together by the Kraków hotels Holiday Inn and Regent, café Miodowa 9, the Occupational Therapy Workshops and the Association for the Development of Community Psychiatry and Care. The participants were forty people who had suffered from mental illnesses, and sixteen of them were later employed in the hotel. The remaining participants had a chance to improve their qualifications, to acquire new skills and to work on their day schedule and various minor tasks. We had an opportunity to see how the perspective of actual employment influenced the involvement and the potential for development among those who participated in the rehabilitation after their psychic crises. They became reliable, self-sufficient employees, who after some time could be able to find a job outside sheltered employment. The rehabilitation group was a flexible one, and each participant could individually schedule the training so as to suit their capabilities, interests and needs.
Our project constitutes a model of co-operation between NGOs, local government and national government. The co-operating institutions were the Municipal Welfare Centre, the National Fund for the Rehabilitation of the Disabled, the Polish-German Society of Mental Health, the municipalities of Kraków and Edinburgh, German partners such as Initiative und Leistung, Nassauische Sparkasse, Aktion der Ev. Kirchen Hoffnung für Osteuropa, Rheinische Hilfsgemeinschaft, and other sponsors and organisations which, besides funds, provided their organisational, logistic and counselling expertise.
An important contributor to the establishment and operations of the social firm was the appointed Social Supervisory Board, which consisted of representatives of business circles, specialist organisations, mass media and government. The members of the Board offered their support and experience to find solutions to the arising problems and to make strategic decisions. We assume that those who were engaged in the activities of the Board will continue for many years to assist the hotel in its operations as it has both to fulfil its social mission and to compete with other tourist market businesses, maintaining a solid reputation. When the firm achieves such skills and a strong position, it will be able to function independently and to offer adequate compensation to the mentally ill, who are the most marginalised and the poorest social group.
As conditioned by the legal regulations that are in force in Poland, we decided that the hotel would function as a so-called “professional activity enterprise,” which resembles a social firm and receives subsidies while being obliged to employ seriously disabled people as 75% of its staff. Consequently, the employer faces additional obligations and restrictions. However, we decided upon such a status of the hotel having analysed the market demand and our competitiveness potential. According to the definition, a social firm is to employ the disabled as 30-40% of its staff, that is twice as few as a professional activity enterprise, as stipulated by the legislation. The fact that the proportion is lower is a basic legislative challenge: the enterprise has to be competitive while receiving small subsidies from the government.
The research on the quality of life among the mentally ill, conducted by the Chair of Psychiatry of the Medical College, Jagiellonian University, clearly demonstrates that those patients who are employed and whose daily schedule is tightly structured are less frequently readmitted during the relapses and, even if so, for a shorter time; also their self-assessment is higher, they are more self-sufficient and independent. Therefore the costs of treatment and disability benefits may be obviously balanced by the advantages of the above described form of employment, financially supported by the state.Agnieszka Lewonowska-Banach
Manager of the Project
Director of the Professional Activity Enterprise„U Pana Cogito”
Association for the Development of Community Psychiatry and Care
Adress: ul. Michała Bałuckiego 6 30-318 Kraków e-mail : firstname.lastname@example.org