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An ambivalent atmosphere: Employment training programs and mental health recovery
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Health and Place journal homepage: http://www.elsevier.com/locate/healthplace
An ambivalent atmosphere: Employment training programs and mental health recovery Monica Perski a, Robert Wilton a, *, Josh Evans b a b
School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, Alberta, Canada
A R T I C L E I N F O
A B S T R A C T
Keywords: Mental health recovery Employment Workplaces Assemblage
This article critically examines the role of employment training programs in the personal recovery of adults living with mental illness in community settings. Using Cameron Duff’s (2014) notion of ‘assemblages of recovery,’ we explore how, and to what extent, employment training programs provide the supportive resources linked to personal recovery. Using an ethnographic case study, we describe the ambivalent atmospheres associated with one program. This ambivalence expresses the fundamental tension between the genuine aspirations of personal recovery and the realities of the capitalist labor process.
1. Introduction Brian is in his mid-fifties and lives with Schizophrenia.1 He has been coming to New Day, a packaging and assembly business that provides ‘employment training’ for people with mental ill health, for just over a year. On its website, New Day identifies engagement in ‘productive work’ as a key factor in promoting positive mental health. Brian works three days a week at New Day, and is paid a training allowance rather than an hourly wage. During a conversation, Brian said he liked participating at the worksite because it gave him the opportunity to leave his house several times per week. He had been without work for ten years prior to New Day, and commented that coming to the worksite was ‘better than sitting at home smoking cigarettes all day’. Yet later on, Brian equated his work with ‘slave labour’ because of the very low pay associated with the packing and assembly tasks. In this sense, Brian was deeply ambivalent about his relationship with the training program. On the one hand, the program was integral to his weekly routine, and provided an important reason to leave his house and interact with other people. At the same time, the feeling that he was engaged in ‘slave la bour’ impacted his self-esteem, while the pay (as little as $16 for three days of work) did little to improve his material circumstances. How do we critically assess the significance of New Day as a place in the context of Brian’s life, or the many other employment-training
programs populated by those living with, and recovering from, mental ill health?2 In this paper we seek to answer this question, drawing from Cameron Duff’s (2014, 2016) work on ‘assemblages of recovery’ that examines how the characteristics of different places constitute experi ences of mental health recovery. Emphasizing the ways social, material and affective resources enable or frustrate recovery, this approach provides a novel way for thinking about employment training programs as atmospheres and the multiplicity of impacts that these atmospheres have on their participants. We first summarize recent work on assemblages of recovery that provides the conceptual framing for our analysis. We then outline our methodology, which centers on a detailed examination of one training program in Southern Ontario using a combination of observer partici pation and interviews/focus groups. The subsequent analysis is orga nized around the atmospheres of New Day drawing particular attention to the effects they have upon program participants. These effects can be manifold, contradictory and felt in different ways by different partici pants. We conclude by arguing that this ambivalence provides the basis for an important critique of the assumed links between employment training and mental health recovery. It also provides an illustration of the ways in which places might be experienced as simultaneously enabling and disabling.
* Corresponding author. E-mail addresses: [email protected] (M. Perski), [email protected] (R. Wilton), [email protected] (J. Evans). 1 Names reported here (of both individuals and the organization) have been changed to ensure confidentiality. This research was supported by a grant from the Social Science and Humanities Research Council of Canada (# 410–876682). 2 At New Day alone, more than 120 people participated in employment training over the course of a year. https://doi.org/10.1016/j.healthplace.2019.102266 Received 25 July 2019; Received in revised form 14 November 2019; Accepted 2 December 2019 1353-8292/© 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Monica Perski, Health & Place, https://doi.org/10.1016/j.healthplace.2019.102266
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1.1. Mental health recovery and paid employment
a stigmatized social identity. More generally, we need to think critically about the diverse ‘spaces and cultures of work … as well as the terms and conditions of employment’ (Strauss, 2018, p, 5) that characterize the varied sites of work and vocational training occupied by people with mental ill health. Third, the narrow focus on paid work as central to successful re covery obscures the myriad other ways in which people might engage in meaningful and productive activity. In one sense, this speaks to the importance of recognizing the unpaid and volunteer work that many disabled people perform (Hall and Wilton, 2015), as well as the more informal work of self-care and care for others that characterize people’s everyday lives. More broadly, it suggests a need to challenge what Gibson-Graham (2006) label a pervasive ‘capitalocentrism’ in which diverse forms of productive activity are always deemed less valuable than the hegemonic norm of wage labour in the capitalist economy.
In recent decades, recovery has become a key paradigm within mental health care, emerging in part from first-person accounts of the lived experience of mental ill health (Deegan, 1988; Jacobson and Greenley, 2001; Davidson et al., 2010). In a key statement, Anthony (1993, p, 527) emphasized that within the recovery movement becoming well could not be understood narrowly in relation to the illness itself: Recovery from mental illness involves much more than recovery from the illness itself. People with mental illness may have to recover from the stigma they have incorporated into their very being; from the iatrogenic effects of treatment settings; from lack of recent opportunities for self-determination; from the negative side effects of unemployment; and from crushed dreams. Recovery is often a complex, time-consuming process. Recovery is understood as an ongoing individual journey, premised on a notion of what it means to live a fulfilling life in the presence of mental ill health. Within academic scholarship, places of work and employment training are understood as central to journeys of recovery and community integration (Dunn et al., 2008; Kirsh et al., 2010; Villotti et al., 2017). Work in rehabilitation science and allied fields emphasizes the recovery-promoting potential of employment. In a well-cited paper, Dunn et al. (2008, p, 61) note: Work is a source of pride, self-esteem and empowerment, and a facilitator of coping … Study participants also found the structure and routines of work to be recovery-promoting and experienced intangible benefits that were unavailable elsewhere. More recently, Villotti et al. (2018, p, 3113) argue that: ‘work is a leading factor in promoting recovery, particularly in facilitating social integration and citizenship’. Studies report that many people with mental illness – including those with significant and enduring conditions like Schizophrenia and bipolar disorder – want to engage in paid work (Nicholson et al., 2018). In pursuit of this goal, psychiatric rehabilitation has established a range of interventions aimed at increasing work inte gration (Visier, 1998; Battin et al., 2016) often using the social enter prise model to create supportive workplaces and employment opportunities (Williams et al., 2012; Evans and Wilton, 2016). Yet while there are benefits associated with paid work, Laws (2011) has cautioned that a commonsense understanding of the healthful ef fects of employment within the recovery movement has become increasingly hegemonic in a workfarist context in which ‘everyday de sires, routines and habits are subordinated to work’ (Maija and Katri, 2019, p,230). Moreover, the pervasiveness of this healthful employment discourse has tended to drown out more critical interpretations of the experience of work activities for people living with mental ill health. Three issues deserve mention in this regard. First, there is evidence that people struggle in practice to find and keep paid work, particularly in mainstream workplaces. This struggle is driven by multiple factors, including a lack of workplace accommoda tions and the enduring stigma surrounding mental illness (e.g., Wilton, 2006; Villotti et al., 2018). In practice, stable work opportunities in integrated employment settings – and their associated benefits – may be elusive. In turn, these challenges mean that significant numbers of people may be stuck on the margins of the mainstream labour market, in a mix of training programs, sheltered work sites, and ‘bad jobs’ (Kalle berg, 2011). Second, the literature on the healthful effects of work activity often has little to say about the specific nature of the work people are tasked with performing and the associated working conditions and employ ment relations. This is surprising given that such factors are relevant to the assessment of the health effects of different forms of employment for people’s recovery. As one exception, Holmqvist (2009) analysis of the Samhall employment training program in Sweden suggests that the ‘dirty work’ characteristic of the program was detrimental to people’s self-esteem and was integral to the construction of ‘disabled workers’ as
1.2. Placing recovery: assemblages, resources and atmospheres Recent scholarship on mental health recovery has emphasized the ways in which community participation and social inclusion are integral to recovery (e.g., Leamy et al., 2011). This scholarship can be located within a larger tradition exploring recovery-promoting interactions within particular spaces and places (Gesler and Kearns, 2005; Con radson, 2005). Cameron Duff (2011, 2012, 2014, 2016) has made a notable contribution to this scholarship by elucidating the role of ‘enabling places’ in processes of community-based recovery. While recognizing the contribution of existing studies (particularly the thera peutic landscape tradition), Duff contends that the focus of this schol arship has often been on people’s experiences of, and preferences for, specific settings, with insufficient attention given to the specific ‘con ditions of real experience’ (Duff, 2014, p, 100) that enable social participation and hence are involved in the process of recovery. For Duff, ‘what is needed is a relational logic that starts with the interaction of person and place in determining how particular places promote or enable health and wellbeing’ (2011, p, 151). Engaging specifically with mental health, Duff’s (2016) more recent work artic ulates a relational conception of place as an ‘assemblage’ of human and nonhuman bodies, forces, affects and relations. In Duff’s (2011, 2014, 2016) work, keywords such as encounter, event and becoming express the processual nature of assemblages that are in constant states of gen eration, re-composition and transformation. It is in detailing the ‘enmeshing of bodies, spaces and forces within specific forms of envel opment’ that ‘conditions of real experience’ can be understood (Duff, 2016, p, 63). The connection between assemblage and recovery can be found in the ways that different assemblages engender the resources that support one’s ‘becoming well’ by expanding one’s capacity to be empowered, connect to others, and feel hope (Duff, 2014). With respect to those resources that enable recovery, Duff identifies three classes: material, social, and affective. Material resources reflect the way in which as semblages bring objects into stabilized relationships forming ‘the ma terial properties of place itself’ that can be leveraged towards greater autonomy (Duff, 2011, p, 153). Social resources reflect the extent to which a given assemblage ‘facilitate[s] the creation of novel associa tions’, among human and non-human actors, that reduce isolation (2011, p, 153). Finally, affective resources reflect the ways in which assemblages engender certain feeling states (hope, joys, anger, sadness) that produce a positive orientation towards the future. These resources, in their presence or absence, can expand or shrink the ‘action-potential’ of the recovering subject. From this perspective, recovery is a ‘qualita tive transformation in the assemblages that express the recovering body’ (Duff, 2014, p, 102). Recovery, therefore, is a function of the entire assemblage, ‘remove one element and the assemblage morphs again, transforming the experience of recovery’ (Duff, 2014, p, 115). This application of assemblage theory to place and recovery is pro vocative, not least because it questions assumptions about the innate 2
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qualities of particular places as recovery inducing. A relational approach encourages us to think about how recovery is realized through assem blages – sometimes sustained, sometimes only fleeting in nature – that produce the resources needed for recovery (Evans et al., 2015; Gorman and Cacciatore, 2017). The focus on assembly invites us to rethink the recovery paradigm’s emphasis on people as ‘agents in their own recov ery’ (Parr and Davidson, 2010, p, 264). Indeed, Duff’s (2016) explora tion of mental health recovery relocates agency from the individual to the expressive characteristics of assemblages. Working with the notion of ‘atmosphere’ (Bille et al., 2015; Smith, 2019) offers one way to approach these expressive characteristics. At mospheres contribute to ‘gradual increases in a body’s power of acting and commensurate increases in that body’s “scope of activity”’ (Duff, 2016, p, 66). In this way, atmosphere provides geographers with an evocative way of linking assemblages and recovery. Understandings of atmosphere resonate with understandings of assemblages themselves: like an assemblage, an atmosphere is a constellation of people and things that blurs the boundaries between the material and immaterial, the human and non-human. Simultaneously, the notion of atmosphere res onates with recovery by signaling some kind of shift in sensory experi ence that unfolds on a tacit level yet registers as an emotional response (Anderson, 2009). This understanding of atmosphere is particularly prescient in recovery-focused activities, such as job training programs, that intentionally seek to shape the experience of, and emotional response to, employment by ‘staging’ particular atmospheres (Bille et al., 2015), particularly those with therapeutic ends (see Smith, 2019). As expressions of material, social and affective assemblages, these at mospheres are one way of conceiving the specific ‘conditions of real experience’ (Duff, 2014) linked to recovery. This atmospheric approach allows for more nuanced analyses of the ways in which places can impact recovery in different ways and to varying degrees; in this sense ‘places may have different effects, some times enabling, sometimes indifferent and sometimes detrimental or harmful’ (Duff, 2011, p, 155). These effects may shift over time, and they may be experienced in distinct ways by different individuals. Here, we are particularly interested in the ways that disparate effects may be felt simultaneously, mediated through entwined social, affective and material resources. This requires us to be attentive to a range of complex effects – those that are both enabling and disabling – that may inform assessments of place in relation to personal recovery. As Duff suggests, thinking through and applying the concept of ‘assemblages of recovery’ does not entail a search for ideal types but instead requires an exami nation of the shifting mix of resources generated in place, and the ways in which corresponding atmospheres both enable and frustrate recovery.
approached by the New Day manager with an offer of a paid summer studentship at the organization. The first author then asked if it would be possible combine the studentship with participant observation focused on the daily operations and participant experiences of the training program. Since a key part of the studentship consisted of administering a job satisfaction survey to program participants, organization staff saw no problem with also permitting the first author’s own data collection. In accordance with ethics requirements, posters were displayed in the worksite identifying the first author and explaining her dual roles. She also introduced herself to all worksite participants, and explained the confidential nature of the project. The studentship role meant that the first author spent 10 weeks on the shop floor of the packaging business, interacting with program participants and supervisors. She was able to attend the staff meetings of non-disabled supervisors and managers and performed some of the jobs assigned to worksite participants when contract deadlines meant addi tional assistance was required. In this regard, fieldwork could be char acterized as a type of observer participation, a form of immersion in the everyday ‘flow’ of the shop (Andrews et al., 2014) that permitted access to both discursive interactions and the “ineffable, tacit, affective, and haptic elements of the space” (Smith, 2019, p, 6). With regard to the latter, close attention was paid to the embodied dispositions of workers and their interactions with the environment. Detailed field notes were taken throughout the 10-week period, and transcribed in full for analysis. Towards the end of the participant observation, the first author conducted an interview with the worksite manager to clarify and probe issues that were observed during partici pant observation. Finally, the manager provided access to quantitative data on the number and characteristics of program participants that were analyzed to provide a sense of organizational context. Field notes, interview and the focus group were transcribed in full. A thematic coding approach was employed for this project overall but for this paper we have narrowed the focus to consider the ways in which the data illustrate the program’s atmospheres and their effects on participants. 2.1. New Day: the nature of the organization New Day operates out of a large warehouse-style worksite where participants package and assemble various products. At the time of data collection, there were 68 participants at the training program. Although New Day’s mandate is to serve a broad population of people living with mental ill health, in practice the training program is targeted at people with ‘serious’ mental health issues. The program’s manager explains that the purpose of the program is ‘to give people something to do, let them make a little bit of money, get their confidence up so hopefully they’ll go into [competitive employment]’. Similarly the executive di rector, added that the program ‘[is a] rehabilitation worksite where clients develop work skills in a structured environment, from there they can go into competitive employment’. Once hired, participants are required to work a minimum of ten to 12 hours per week, with the expectation that weekly hours will increase over time. Asked about the nature of the work at New Day, the executive director characterized it as labour intensive ‘hand-work’ that meant the organization could provide work opportunities for as many participants as possible: We don’t have very sophisticated machinery, like the only machin ery we have is the shrink-wrap machine that puts the plastic film around that product. Everything we do is hand-work and that’s labour intensive but that’s what we are in the business to do. Accommodations are made for participants, recognizing that mental and physical health problems may mean they need to work at a slower pace, require additional training and support, and/or need time away
2. Methodology and data collection This paper is based on an in-depth case study of New Day, an employment-training program for people living with mental ill health in Southern Ontario. New Day was one of a number of programs included in a larger research project on employment and the social economy for people living with mental ill health. As part of the larger project, the first and second authors conducted interviews with the program’s executive director and two non-disabled supervisory staff members, and a focus group with ten worksite participants. The interview with the executive director focused on the daily operations of the training program, the types of work available at the program, and its suitability for people living with mental health issues. Interviews with supervisory staff focused on the daily operations of the program, the assignment of work tasks, and the social environment at work. The focus group covered is sues such as participants’ daily experiences at work, their feelings about the program, social relationships with staff and other clients, their wages, and past experiences in mainstream workplaces. It was con ducted in a private space away from other clients and staff members and lasted approximately 80 min. During the initial stage of data collection, the first author was 3
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from work for health reasons. Participants are paid a training allowance that reflects the amount of work accomplished in a shift (effectively piece-work) and the rates assigned to different tasks in the worksite.3 The provincial ministry of health is the principal funder of the training program and staff salaries, while participants’ training allowances are paid from business revenues. The program has a customer base of about 40 companies; most of these are local businesses but several large corporations also have con tracts with the program. The director and program manager both emphasized that the biggest challenge facing New Day was the lack of consistent business. The lack of stable contracts had a number of impacts on the atmosphere at New Day. The most obvious was the consequent uncertainty of how much work there was to offer worksite participants from week to week. At the same time, the specific work tasks available to participants varied significantly. Finally, the pressure to ensure work meant that New Day’s manager regularly bid for contracts at prices below the competitive market rate. While underbidding other quotes helped win contracts, the strategy had a direct, negative impact on business revenues and the piece rates paid to worksite participants. There were sixty-eight clients in the program at the time of the research, of whom forty-three were male. The average age of partici pants was forty-five. Data provided for the financial year prior to the research indicated that more than half of participants were living with Schizophrenia and other psychotic disorders, while another quarter re ported anxiety disorders.4 Three quarters of participants were on pro vincial disability income support, while others relied on welfare payments, family support and state pensions. One third lived alone, while another third lived in shared accommodation with non-relatives, and the remainder reported living with parents or other family members. Although the worksite is advertised as a transitional program, the average time participants worked at New Day was five and a half years and some had worked there for more than fifteen years. While some people did leave, data collected by New Day indicated a cyclical pattern of program withdrawal and re-entry that was driven by changes in mental health and by difficulties transitioning into ‘mainstream’ employment. For many people this meant that New Day was, in practice, a long-term workplace.
but also about ensuring the timely fulfillment of contracts. In practice, these competing priorities could produce tensions in the worksite. As one of the VSWs explained: Some will come in and they’ll just shoot to one job, you know, like [corporate contract]. We’ll try and rotate it a little bit because we do have other jobs that are not as well paying. So we just try and stagger them, right. People get upset but it’s just making sure you treat every body the same (Jeff). Dealing with the tensions around work tasks proved a source of frustration for some supervisory staff. During a conversation, Grace characterized the worksite participants as ‘spoiled’, arguing that they had too much choice and didn’t respect the authority of the worksite staff. Notwithstanding these tensions, worksite participants talked in mostly positive terms about the material character of the work they performed. Here, the repetitive doing of packaging work offered tem porary respite from daily pressures and problems. Several other people noted the benefit of being able to lose oneself in the work. People also talked about the physicality of the work as being healthful. Working with one’s hands was seen as a positive both in terms of exercise and creativity. Nancy was in her early fifties and had worked at New Day for three and half years. Commenting on her experience, she said: I love the work. I love it so much. [Int: What do you love about it?] You’re working with your hands and um I’m artistic so it fulfills that side of me. Beyond the work itself, the material properties of the worksite were also important to some participants. Asked about what he liked about New Day, Roy talked about the nature of the work but he also identified the health and safety signs in the workplace as material resources that enabled him to cope with stress. Working on jobs that you enjoy and just leaving the stress some where … Some days when I’m really stressed out I look at that [sign]. I just read it every day or I read the safety signs over there and I just look at some of these pictures. That’s one of the parts that I like about it. This offers an interesting example of the way that places may be enabling “to the extent that they contain objects and materials vital to the practice of recovery and the ongoing process of staying well” (Duff, 2012, p, 1392), and the heterogeneity of things that might be enrolled in individual’s efforts to stay well. Yet not all reactions to the work tasks were positive. This was particularly true for one of the ‘dirtiest’ jobs at New Day – repairing clothes hangers. Many people complained about this task. Shannon, for example, was in her early forties and had multiple diagnoses including body dysmorphia, which is characterized by persistently negative thoughts about her body image. While working on the clothes hangers one afternoon, Shannon shouted, “I hate this! I hate this!” When the first author went over to ask if she was okay, Shannon explained that the hangers were dirty and that she did not like her hands getting dirty. Several other participants characterized this work as undignified and demeaning. As we noted earlier, New Day struggled to find stable con tracts, and the clothes hangers were one of the most reliable sources of work for participants and a stable source of revenue for the organization. In this sense, the shifting contractual relations – as material properties of the worksite – had an important impact on New Day’s ability to sustain an atmosphere conducive to recovery. When there were few other active contracts, several worksite participants told the VSWs that they did not want to come in if they had to work on the clothes hangers. In response, the worksite manager announced at a monthly meeting that people scheduled to work on a particular day had to show up and perform the tasks assigned to them. Several days later the following interaction occurred: Harry was sitting at one of the worktables with his arm crossed, not doing anything. The VSW asked Harry why he wasn’t working and he noted that he did not want to work on that particular job. The VSW told Harry he either needed to work on this task or he’d be sent home. Since he still refused to work, she sent Harry home (field note excerpt).
2.2. New Day: an assemblage of recovery? 2.2.1. Atmospheres of productivity and alienation In this first section of the analysis, we consider the material char acteristics of New Day and its associated atmospheres. While the financial benefits associated with work activity are certainly significant, we direct attention to the material properties of the workplace and the work itself, and the multiple effects of these properties on worksite participants. On a typical day, there were five to six different packaging and assembly jobs on the go at New Day. Common tasks included cleaning and repairing wire clothes hangers for a dry cleaning company, assembling liquid medicine bottles, assembling packets of anti-bacterial hand wipes, filling and sealing bags of candy, and assembling travel toothbrushes. These work tasks involved varying degrees of skill and complexity and had differences in the piece rate associated with their completion. For example, the piece rate for travel toothbrushes was 7.5 cents per brush whereas for clothes hangers it was $1.59 per rack. Responsibility for assigning people to different jobs fell to the three vocational support workers (VSW) at New Day. Assignments were based on VSW’s assessment of people’s capacities and preferences for work; this assessment was partly about achieving a healthy fit for participants 3 As an employment training program, New Day is currently exempted from minimum wage laws although this exemption is scheduled to end in 2019. 4 These data were based on the 127 people who had been participants at New Day over the course of that year.
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enjoyed was being with others. Participants frequently sat quietly together at the lunch table in the worksite kitchen or at the picnic tables outside during breaks. These field note excerpts exemplify these observations: At the [kitchen] table, I noticed [Ann] and [Lucy] sitting quietly across from each other. They were each eating a snack but did not converse with each other. They sat there for the entire break period and when the bell went, they went back to work without talking (field note excerpt). I saw Lindsay, Jackson, Kim, and Rodney sitting at picnic tables, but no one was talking. They were quietly smoking or eating their lunch[es]. Once they were done, most of them went back inside or just sat outside enjoying the sunny day. (field note excerpt). In this sense, physical co-presence appeared to be an integral part of New Day’s social atmosphere. As Jacob noted, “part of why it’s good to come here is to be with other people”. People were more ambivalent about relationships with paid staff members. In part, this was because these interactions embodied a ten sion between a therapeutic imperative to provide support to worksite participants and a managerial imperative to fulfill worksite contracts (see Evans and Wilton, 2019). Efforts to reduce conversation during work time certainly contributed to this ambivalence. While participants felt staff members were mostly supportive in their interactions, some supervisors were seen as more approachable than others as is clear in the following exchange during the focus group: Roy: Some of them are understanding, I think. Some of them don’t give a crap, okay. So it depends on the people I think and who are willing to talk to. Brian: You just gotta pick and choose [laughs] who you go to, you know. This sense of unevenness with respect to the social connections at New Day is important for thinking about the relational nature of place and the ways in which different associations within the same site might produce distinct outcomes – sometimes enabling but at other times not.
In addition to relational and affective tensions around dirty work, many participants were concerned with the training allowances. As we saw at the outset of the paper, Brian characterized the work as ‘slave labour’. After pay cheques were distributed one afternoon, Ann looked at her cheque and commented that her earnings were “a joke”. During fieldwork it became clear that some people’s daily earnings were effectively zero if they worked on a job with a low piece rate and had to pay for public transportation to get to and from New Day, as the following exchange illustrates: Shannon told Gail she had completed 3 [clothes hanger] racks so far, to which Gail responded that Shannon would only need to finish one more [rack] in order to pay her bus fare for the day, which is seven dollars (field note excerpt). Participants were also frustrated by a lack of transparency about piece rates for different jobs. As Jordan said: ‘they [the VSWs] don’t even tell you, they don’t tell us how much we’re making. You just kinda learn as you go’. While staff members said that they did not actively withhold piece rates from participants, in practice VSWs were reluctant to share the information. This was likely a strategy to reduce resistance when people were assigned to lower-paying contracts, a fact that was not lost on Brad who said: “I think they don’t tell people because everybody would flock to one job, you know what I mean?” Finally, fieldwork revealed that a person’s training allowance could be further reduced at the discretion of the staff. Andrea, one of the VSWs, explained that if a participant was seen walking around the worksite or talking with other people staff might dock their pay by up two dollars. I asked Andrea if clients complain about getting money deducted from their pay in these circumstances. She said it happens once [in a while], but most of the time the clients don’t know how much they are being paid anyways, so they have nothing to complain about … For the clients who do complain, staff tells them that they were not working hard enough and that is why the pay was deducted (field note excerpt). Low rates of pay, a lack of transparency about piece rates and the arbitrary power of staff to deduct pay – often without participants’ knowledge – raise concerns about the precarity of worksite participants (Strauss, 2017) and the material effects associated with this place.
2.2.3. Atmospheres of belonging and impermanence The previous sections have directed attention to the material prop erties and social connections that constitute the New Day worksite as place. Yet it is clear that these properties and connections are closely linked to the affective resources associated with New Day. As Duff (2012) notes, there are complex linkages among social, material and affective resources that work to shape dynamic and emergent experi ences of place, which in turn facilitate (or constrain) mental health re covery. This was most clear in the feeling states engendered by participation in work activity, a connection made by all participants. For example:
2.2.2. Atmospheres of solidarity and difference Notwithstanding their concerns about ‘dirty’ work and pay, most participants had very positive reactions to the social atmosphere constituted by the worksite. Many people talked about New Day as a place of connection, directly countering physical isolation and their own tendency to withdraw from others. For example: Natalie: It rehabilitates you. I can see that I’ve benefitted from coming to work because I was getting very withdrawn and it sort of brought me out of my shell and helped me to get back into life again and interacting with people. Brad: I tend to, I’ve isolated and I still do. So like I said it just gets you out of the, out of your apartment, gets you socializing, you know. You feel good about yourself. From an assemblage perspective, “action is … an expression of the specific associations an actor is capable of sustaining” (Duff, 2011, p, 152). In this sense, associations made possible through participation at New Day are productive of social action; as Brad suggests, presence in the worksite ‘gets you socializing’. Interestingly, one of the findings during fieldwork was that people working at New Day did not actually talk very much to one another. Observations over the three-month period suggested that only a handful of people conversed with other participants. The absence of conversation during work shifts is perhaps not surprising; indeed one of the VSWs explained that supervisors had recently cracked down on talking to ensure contracts were being ful filled on time. But even during breaks there was relatively little con versation at New Day. Despite this, many people considered their time at the organization to be social in nature. Ann explained that she liked the worksite because it was her only opportunity for “social time” each week. Part of the explanation may lie in the fact that what people
It’s good for your self-esteem … You feel like you’re productive, you know, so you feel better about yourself, you know (Brad) [The work] makes me feel good about myself that I’ve accomplished something at the end of the day” (Jacob). These sentiments are important in the sense that they link, at least in part, the ‘healthful effects’ of employment to the affective states engendered by work activity in a social context that imbues such activity with significant moral value (Frayne, 2015). Yet this was not always the case at New Day; forms of dirty and demeaning work engendered negative feeling states among some participants. Concurrently, very low rates of pay impacted some people’s sense of self-worth. Asked about the training allowance, Roy commented: It’s like a self-esteem thing, that’s how I feel. If you got $10.50 an hour, at least you feel part of it more, like you’re more a part of the system, of the province, instead of just saying, you know, we’re going to pay you x less than that. These data provide a useful illustration of the manifold effects engendered through such programs – ‘sometimes enabling, sometimes 5
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indifferent and sometimes detrimental or harmful’ (Duff, 2011, p, 155) – and the ways in which actors are moved by these disparate effects in a given place. A final theme that had both social and affective resonance concerned feelings of comfort at the worksite. Many people talked about the importance of New Day as a workplace where there was a shared un derstanding of mental ill health and a lack of pressure to either conceal or disclose mental illness to others. For example: What I like is that this [site] is specifically tailored for people with mental illness and I feel comfortable in this environment because of that (Keith). It’s like a family here and they understand that you have a mental illness and sometimes you’ll feel better than other times. That makes life so much easier. It makes life worth living and it gives you hope (Nancy). As these statements suggest, an atmosphere of shared understanding and acceptance of mental ill health represented an important affective resource for many at New Day, engendering feelings of comfort, ease and hopefulness. While supervisory staff recognized this they expressed more critical sentiments about the ‘comfort’ engendered at the worksite. People will usually come in and get comfortable here so it’s kinda like talking to them, ‘hey, you guys are capable of a lot more’. ‘But I’m comfortable here’ and I’m like, ‘you’re comfortable because you got a nice chair to sit on and you can chat (Jared). For some people it’s transitional. For a lot of people it’s a place just to come and stay and I don’t see them anyways moving on [Int: Is that a good thing?] I just think they get a little too comfortable here (Jeff). These sentiments reflect the stated objective of New Day to transition people to competitive employment. For supervisors, the affective affordances of the program need to be managed to ensure this goal can be realized. Too much comfort works against a normative vision of re covery that links improving mental wellness with increasing capacity for ‘mainstream’ employment. This reflects an enduring tension in thera peutic work initiatives “between economically viable employment and specifically therapeutic occupations; between the competing re quirements of protectionism and reality” (Laws, 2011 p, 78). This enduring tension is a fundamental ‘horizon of experience’ with regard to recovery itself, a tension that can be found in the very definition of personal recovery understood not as a goal but rather “a complex, time-consuming process” (Anthony, 1993, p, 527).
worker control, hierarchies of authority and limited comfort – and in so doing produced atmospheres of alienation, difference and impermanence. As such, New Day may be assessed as an assemblage of recovery, but one with a somewhat ambivalent atmosphere. This employment training program combined an array of affects, forces, signs, movements, ex pressions and events that seemed to advance recovery by increasing workers’ capacity to feel productive, connected and important but also, in other respects, induced a retreat in recovery by restricting partici pants’ autonomy, interactions and attachment to the program. In ways, the resultant ambivalence speaks to the broader placement of the pro gramming, and the workers, in relation to a much larger constellation of economic, social and political assemblages. What we find in settings such as New Day is a stalemate between the inclusive relations required for participation in mainstream employment and the alienating relations constituting the labour process under capitalism (Davidson et al., 2010). At the same time, we are mindful that social economy organizations like New Day are themselves precarious, struggling to balance the ten sions inherent in the therapeutic employment endeavor (Laws, 2011), while at the same time negotiating the market logics of the mainstream economy through relationships with suppliers, customers, landlords and other actors (Gibson-Graham, 2006). The ambivalent atmosphere that we have documented at New Day, and the relational processes that underlie it, raise broader questions about the extent to which employ ment training and the transition to competitive employment should be positioned as central to the recovery journey. Alternative spaces of re covery have been highlighted in this regard (see Parr and Davidson, 2010) and a future agenda for the geographies of mental health should prioritize unpacking these assemblages of recovery. Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi. org/10.1016/j.healthplace.2019.102266. References Anderson, B., 2009. Affective atmospheres. Emotion. Space Soc. 2, 77–81. Andrews, G., Chen, S., Myers, S., 2014. The “taking place” of health and wellbeing: towards non-representational theory. Soc. Sci. Med. 108, 210–222. Anthony, W., 1993. Recovery from mental illness. Psychosoc Rehabil. J. 16, 521–538. Battin, C., Bouvet, C., Hatala, C., 2016. A systematic review of the effectiveness of the clubhouse model. Psychiatr. Rehabil. J. 39, 305–312. Bille, M., Bjerregaard, P., Sørensen, T., 2015. Staging atmospheres: materiality, culture, and the texture of the in-between. Emotion Space Soc. 15, 31–38. Conradson, D., 2005. Landscape, care and the relational self: therapeutic encounters in rural England. Health Place 4, 337–348. Davidson, L., Rakfeldt, J., Strauss, J., 2010. The Roots of the Recovery Movement in Psychiatry. John Wiley & Sons, West Sussex, UK. Deegan, P., 1988. Recovery: the lived experience of rehabilitation. Psychosoc Rehabil. J. 11, 11–19. Duff, D., 2011. Networks, resources and agencies: on the character and production of enabling places. Health Place 17, 149–156. Duff, C., 2012. Exploring the role of ‘enabling places’ in promoting recovery from mental illness. Health Place 18, 1388–1395. Duff, C., 2014. Assemblages of Health: Deleuze’s Empiricism and the Ethology of Life. Springer, New York. Duff, C., 2016. Atmospheres of recovery: assemblages of health. Environ. Plan. 48, 58–74. Dunn, E., Wewiorski, N., Rogers, S., 2008. The meaning and importance of employment to people in recovery from serious mental illness: results from a qualitative study. Psychiatr. Rehabil. J. 32, 59–62. Evans, J., Wilton, R., 2019. Well enough to work? Social enterprise employment and the geographies of mental health recovery. Ann. Assoc. Am. Geogr. 109, 87–103. Evans, J., Wilton, R., 2016. Supportive workplaces, mental illness, and recovery. In: Giesbrecht, M., Crooks, V. (Eds.), Place, Health & Diversity: A Canadian Perspective. Ashgate, Burlington, VT, pp. 76–95. Evans, J., Semogas, D., Smallwood, J., Lohfeld, L., 2015. ‘This place gives me a reason to care’: understanding managed alcohol programs as enabling places. Health Place 33, 118–124. Frayne, D., 2015. The Refusal of Work. The Theory and Practice of Resistance to Work. Zed Books, London. Gesler, W., Kearns, R., 2005. Culture/Place/Health. Routledge, London. Gibson-Graham, J.K., 2006. A Postcapitalist Politics. University of Minnesota Press, Minneapolis.
3. Conclusion Increasingly, recovery is being defined as an individual, life-long journey completed in the presence, rather than the absence, of mental ill health (Dunn et al., 2008). Recent scholarship by health geographers has sought to place these journeys by chronicling the enabling role of specific spaces (Parr and Davidson, 2010). Towards this end, we have approached these spaces – and New Day specifically – as assemblages and in doing so conceived personal recovery as the ‘transformation of the myriad assemblages by which the “recovering subject” is expressed’ including assemblages such as the home, family, citizenship and, in the case of our analysis, employment (Duff, 2014, p, 118). Duff elaborates: Each such assemblage must be transformed in the course of the body’s becoming well, in a combinatorial reterritorialization of the af fects, percepts, gestures, forces, signs, utterances, expressions and events by which subjectivity is expressed (2014, p, 118). The preceding account provides a rich description of a range of complex reterritorializations, some that are enabling and some that are disabling. The account invites a more ambivalent assessment of employment training programs and their role in expanding people’s capacity to be empowered, connect to others, and feel hope. In many respects, employment training programs reterritorialize by imposing a structure of routinized activity contributing to an atmosphere of pro ductivity, solidarity and belonging. These atmospheres were conducive to recovery by inducing the feeling of ‘becoming well.’ However, New Day also imposed the structure of the ‘sheltered workshop’ – limited 6
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Health and Place xxx (xxxx) xxx Parr, H., Davidson, J., 2010. Mental and emotional health. In: Brown, T., McLafferty, S., Moon, G. (Eds.), A Companion to Health and Medical Geography. Wiley-Blackwell, Malden, MA, pp. 258–277. Smith, T., 2019. Therapeutic Taskscapes and Craft Geography: Cultivating Well-Being and Atmospheres of Recovery in the Workshop. Social & Cultural Geography. https://doi.org/10.1080/14649365.2018.1562088. Visier, L., 1998. Sheltered employment for persons with disabilities. Int. Labour Rev. 137, 347–365. Strauss, K., 2018. Labour geography 1: Towards a geography of precarity. Prog. Hum. Geogr. 42 (4), 622–630. Villotti, P., Corbiere, M., Dewa, C., Fraccaroli, F., Lecomte, T., 2018. The role of selfstigma and job tenure self-efficacy in people with severe mental disorders. Disabil. Rehabil. 40 (26), 3113–3119. Villotti, P., Corbi�ere, M., Fossey, E., Fraccaroli, F., Lecomte, T., Harvey, C., 2017. Work accommodations and natural supports for employees with severe mental illness in social businesses. Community Ment. Health J. 53, 864–870. Williams, A., Fossey, E., Harvey, C., 2012. Social firms: sustainable employment for people with mental illness. Work 43, 530–562. Wilton, R., 2006. Disability disclosure in the workplace. Just Labour 8, 24–39.
Gorman, R., Cacciatore, J., 2017. Cultivating our humanity: a systematic review of care farming & traumatic grief. Health Place 47, 12–21. Hall, E., Wilton, R., 2015. Thinking differently about work and social inclusion for disabled people. In: Grover, C., Piggott, L. (Eds.), Disabled People, Work and Welfare. Policy Press, Bristol, pp. 128–143. Holmqvist, M., 2009. Disabled people and dirty work. Disabil. Soc. 24, 869–882. Jacobson, N., Greenley, D., 2001. What is recovery? A conceptual model and explication. Psychiatr. Serv. 52, 482–485. Kalleberg, A., 2011. Good Jobs, Bad Jobs: the Rise of Polarized and Precarious Employment Systems in the United States, 1970s-2000s. Russell Sage Foundation, Washington DC. Kirsh, B., Krupa, T., Cockburn, L., Gewurtz, R., 2010. A Canadian model of work integration for persons with mental illnesses. Disabil. Rehabil. 32, 1833–1846. Laws, J., 2011. Crackpots and basket-cases: a history of therapeutic work and occupation. Hist. Hum. Sci. 24, 65–81. Leamy, M., Bird, V., Le Boutillier, C., 2011. Conceptual framework for personal recovery in mental health. Br. J. Psychiatry 199, 445–452. Maija, K., Katri, K., 2019. The moral orders of work and health: a case of sick leave due to burnout. Sociol. Health Illn. 41, 219–233. Nicholson, J., Wright, S., Carlisle, A., 2018. Pre-post, mixed-methods feasibility study of the WorkingWell mobile support tool for individuals with serious mental illness. BMJ Open 8, e019936.
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Contents lists available at ScienceDirect
Health and Place journal homepage: http://www.elsevier.com/locate/healthplace
An ambivalent atmosphere: Employment training programs and mental health recovery Monica Perski a, Robert Wilton a, *, Josh Evans b a b
School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, Alberta, Canada
A R T I C L E I N F O
A B S T R A C T
Keywords: Mental health recovery Employment Workplaces Assemblage
This article critically examines the role of employment training programs in the personal recovery of adults living with mental illness in community settings. Using Cameron Duff’s (2014) notion of ‘assemblages of recovery,’ we explore how, and to what extent, employment training programs provide the supportive resources linked to personal recovery. Using an ethnographic case study, we describe the ambivalent atmospheres associated with one program. This ambivalence expresses the fundamental tension between the genuine aspirations of personal recovery and the realities of the capitalist labor process.
1. Introduction Brian is in his mid-fifties and lives with Schizophrenia.1 He has been coming to New Day, a packaging and assembly business that provides ‘employment training’ for people with mental ill health, for just over a year. On its website, New Day identifies engagement in ‘productive work’ as a key factor in promoting positive mental health. Brian works three days a week at New Day, and is paid a training allowance rather than an hourly wage. During a conversation, Brian said he liked participating at the worksite because it gave him the opportunity to leave his house several times per week. He had been without work for ten years prior to New Day, and commented that coming to the worksite was ‘better than sitting at home smoking cigarettes all day’. Yet later on, Brian equated his work with ‘slave labour’ because of the very low pay associated with the packing and assembly tasks. In this sense, Brian was deeply ambivalent about his relationship with the training program. On the one hand, the program was integral to his weekly routine, and provided an important reason to leave his house and interact with other people. At the same time, the feeling that he was engaged in ‘slave la bour’ impacted his self-esteem, while the pay (as little as $16 for three days of work) did little to improve his material circumstances. How do we critically assess the significance of New Day as a place in the context of Brian’s life, or the many other employment-training
programs populated by those living with, and recovering from, mental ill health?2 In this paper we seek to answer this question, drawing from Cameron Duff’s (2014, 2016) work on ‘assemblages of recovery’ that examines how the characteristics of different places constitute experi ences of mental health recovery. Emphasizing the ways social, material and affective resources enable or frustrate recovery, this approach provides a novel way for thinking about employment training programs as atmospheres and the multiplicity of impacts that these atmospheres have on their participants. We first summarize recent work on assemblages of recovery that provides the conceptual framing for our analysis. We then outline our methodology, which centers on a detailed examination of one training program in Southern Ontario using a combination of observer partici pation and interviews/focus groups. The subsequent analysis is orga nized around the atmospheres of New Day drawing particular attention to the effects they have upon program participants. These effects can be manifold, contradictory and felt in different ways by different partici pants. We conclude by arguing that this ambivalence provides the basis for an important critique of the assumed links between employment training and mental health recovery. It also provides an illustration of the ways in which places might be experienced as simultaneously enabling and disabling.
* Corresponding author. E-mail addresses: [email protected] (M. Perski), [email protected] (R. Wilton), [email protected] (J. Evans). 1 Names reported here (of both individuals and the organization) have been changed to ensure confidentiality. This research was supported by a grant from the Social Science and Humanities Research Council of Canada (# 410–876682). 2 At New Day alone, more than 120 people participated in employment training over the course of a year. https://doi.org/10.1016/j.healthplace.2019.102266 Received 25 July 2019; Received in revised form 14 November 2019; Accepted 2 December 2019 1353-8292/© 2019 Elsevier Ltd. All rights reserved.
Please cite this article as: Monica Perski, Health & Place, https://doi.org/10.1016/j.healthplace.2019.102266
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1.1. Mental health recovery and paid employment
a stigmatized social identity. More generally, we need to think critically about the diverse ‘spaces and cultures of work … as well as the terms and conditions of employment’ (Strauss, 2018, p, 5) that characterize the varied sites of work and vocational training occupied by people with mental ill health. Third, the narrow focus on paid work as central to successful re covery obscures the myriad other ways in which people might engage in meaningful and productive activity. In one sense, this speaks to the importance of recognizing the unpaid and volunteer work that many disabled people perform (Hall and Wilton, 2015), as well as the more informal work of self-care and care for others that characterize people’s everyday lives. More broadly, it suggests a need to challenge what Gibson-Graham (2006) label a pervasive ‘capitalocentrism’ in which diverse forms of productive activity are always deemed less valuable than the hegemonic norm of wage labour in the capitalist economy.
In recent decades, recovery has become a key paradigm within mental health care, emerging in part from first-person accounts of the lived experience of mental ill health (Deegan, 1988; Jacobson and Greenley, 2001; Davidson et al., 2010). In a key statement, Anthony (1993, p, 527) emphasized that within the recovery movement becoming well could not be understood narrowly in relation to the illness itself: Recovery from mental illness involves much more than recovery from the illness itself. People with mental illness may have to recover from the stigma they have incorporated into their very being; from the iatrogenic effects of treatment settings; from lack of recent opportunities for self-determination; from the negative side effects of unemployment; and from crushed dreams. Recovery is often a complex, time-consuming process. Recovery is understood as an ongoing individual journey, premised on a notion of what it means to live a fulfilling life in the presence of mental ill health. Within academic scholarship, places of work and employment training are understood as central to journeys of recovery and community integration (Dunn et al., 2008; Kirsh et al., 2010; Villotti et al., 2017). Work in rehabilitation science and allied fields emphasizes the recovery-promoting potential of employment. In a well-cited paper, Dunn et al. (2008, p, 61) note: Work is a source of pride, self-esteem and empowerment, and a facilitator of coping … Study participants also found the structure and routines of work to be recovery-promoting and experienced intangible benefits that were unavailable elsewhere. More recently, Villotti et al. (2018, p, 3113) argue that: ‘work is a leading factor in promoting recovery, particularly in facilitating social integration and citizenship’. Studies report that many people with mental illness – including those with significant and enduring conditions like Schizophrenia and bipolar disorder – want to engage in paid work (Nicholson et al., 2018). In pursuit of this goal, psychiatric rehabilitation has established a range of interventions aimed at increasing work inte gration (Visier, 1998; Battin et al., 2016) often using the social enter prise model to create supportive workplaces and employment opportunities (Williams et al., 2012; Evans and Wilton, 2016). Yet while there are benefits associated with paid work, Laws (2011) has cautioned that a commonsense understanding of the healthful ef fects of employment within the recovery movement has become increasingly hegemonic in a workfarist context in which ‘everyday de sires, routines and habits are subordinated to work’ (Maija and Katri, 2019, p,230). Moreover, the pervasiveness of this healthful employment discourse has tended to drown out more critical interpretations of the experience of work activities for people living with mental ill health. Three issues deserve mention in this regard. First, there is evidence that people struggle in practice to find and keep paid work, particularly in mainstream workplaces. This struggle is driven by multiple factors, including a lack of workplace accommoda tions and the enduring stigma surrounding mental illness (e.g., Wilton, 2006; Villotti et al., 2018). In practice, stable work opportunities in integrated employment settings – and their associated benefits – may be elusive. In turn, these challenges mean that significant numbers of people may be stuck on the margins of the mainstream labour market, in a mix of training programs, sheltered work sites, and ‘bad jobs’ (Kalle berg, 2011). Second, the literature on the healthful effects of work activity often has little to say about the specific nature of the work people are tasked with performing and the associated working conditions and employ ment relations. This is surprising given that such factors are relevant to the assessment of the health effects of different forms of employment for people’s recovery. As one exception, Holmqvist (2009) analysis of the Samhall employment training program in Sweden suggests that the ‘dirty work’ characteristic of the program was detrimental to people’s self-esteem and was integral to the construction of ‘disabled workers’ as
1.2. Placing recovery: assemblages, resources and atmospheres Recent scholarship on mental health recovery has emphasized the ways in which community participation and social inclusion are integral to recovery (e.g., Leamy et al., 2011). This scholarship can be located within a larger tradition exploring recovery-promoting interactions within particular spaces and places (Gesler and Kearns, 2005; Con radson, 2005). Cameron Duff (2011, 2012, 2014, 2016) has made a notable contribution to this scholarship by elucidating the role of ‘enabling places’ in processes of community-based recovery. While recognizing the contribution of existing studies (particularly the thera peutic landscape tradition), Duff contends that the focus of this schol arship has often been on people’s experiences of, and preferences for, specific settings, with insufficient attention given to the specific ‘con ditions of real experience’ (Duff, 2014, p, 100) that enable social participation and hence are involved in the process of recovery. For Duff, ‘what is needed is a relational logic that starts with the interaction of person and place in determining how particular places promote or enable health and wellbeing’ (2011, p, 151). Engaging specifically with mental health, Duff’s (2016) more recent work artic ulates a relational conception of place as an ‘assemblage’ of human and nonhuman bodies, forces, affects and relations. In Duff’s (2011, 2014, 2016) work, keywords such as encounter, event and becoming express the processual nature of assemblages that are in constant states of gen eration, re-composition and transformation. It is in detailing the ‘enmeshing of bodies, spaces and forces within specific forms of envel opment’ that ‘conditions of real experience’ can be understood (Duff, 2016, p, 63). The connection between assemblage and recovery can be found in the ways that different assemblages engender the resources that support one’s ‘becoming well’ by expanding one’s capacity to be empowered, connect to others, and feel hope (Duff, 2014). With respect to those resources that enable recovery, Duff identifies three classes: material, social, and affective. Material resources reflect the way in which as semblages bring objects into stabilized relationships forming ‘the ma terial properties of place itself’ that can be leveraged towards greater autonomy (Duff, 2011, p, 153). Social resources reflect the extent to which a given assemblage ‘facilitate[s] the creation of novel associa tions’, among human and non-human actors, that reduce isolation (2011, p, 153). Finally, affective resources reflect the ways in which assemblages engender certain feeling states (hope, joys, anger, sadness) that produce a positive orientation towards the future. These resources, in their presence or absence, can expand or shrink the ‘action-potential’ of the recovering subject. From this perspective, recovery is a ‘qualita tive transformation in the assemblages that express the recovering body’ (Duff, 2014, p, 102). Recovery, therefore, is a function of the entire assemblage, ‘remove one element and the assemblage morphs again, transforming the experience of recovery’ (Duff, 2014, p, 115). This application of assemblage theory to place and recovery is pro vocative, not least because it questions assumptions about the innate 2
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qualities of particular places as recovery inducing. A relational approach encourages us to think about how recovery is realized through assem blages – sometimes sustained, sometimes only fleeting in nature – that produce the resources needed for recovery (Evans et al., 2015; Gorman and Cacciatore, 2017). The focus on assembly invites us to rethink the recovery paradigm’s emphasis on people as ‘agents in their own recov ery’ (Parr and Davidson, 2010, p, 264). Indeed, Duff’s (2016) explora tion of mental health recovery relocates agency from the individual to the expressive characteristics of assemblages. Working with the notion of ‘atmosphere’ (Bille et al., 2015; Smith, 2019) offers one way to approach these expressive characteristics. At mospheres contribute to ‘gradual increases in a body’s power of acting and commensurate increases in that body’s “scope of activity”’ (Duff, 2016, p, 66). In this way, atmosphere provides geographers with an evocative way of linking assemblages and recovery. Understandings of atmosphere resonate with understandings of assemblages themselves: like an assemblage, an atmosphere is a constellation of people and things that blurs the boundaries between the material and immaterial, the human and non-human. Simultaneously, the notion of atmosphere res onates with recovery by signaling some kind of shift in sensory experi ence that unfolds on a tacit level yet registers as an emotional response (Anderson, 2009). This understanding of atmosphere is particularly prescient in recovery-focused activities, such as job training programs, that intentionally seek to shape the experience of, and emotional response to, employment by ‘staging’ particular atmospheres (Bille et al., 2015), particularly those with therapeutic ends (see Smith, 2019). As expressions of material, social and affective assemblages, these at mospheres are one way of conceiving the specific ‘conditions of real experience’ (Duff, 2014) linked to recovery. This atmospheric approach allows for more nuanced analyses of the ways in which places can impact recovery in different ways and to varying degrees; in this sense ‘places may have different effects, some times enabling, sometimes indifferent and sometimes detrimental or harmful’ (Duff, 2011, p, 155). These effects may shift over time, and they may be experienced in distinct ways by different individuals. Here, we are particularly interested in the ways that disparate effects may be felt simultaneously, mediated through entwined social, affective and material resources. This requires us to be attentive to a range of complex effects – those that are both enabling and disabling – that may inform assessments of place in relation to personal recovery. As Duff suggests, thinking through and applying the concept of ‘assemblages of recovery’ does not entail a search for ideal types but instead requires an exami nation of the shifting mix of resources generated in place, and the ways in which corresponding atmospheres both enable and frustrate recovery.
approached by the New Day manager with an offer of a paid summer studentship at the organization. The first author then asked if it would be possible combine the studentship with participant observation focused on the daily operations and participant experiences of the training program. Since a key part of the studentship consisted of administering a job satisfaction survey to program participants, organization staff saw no problem with also permitting the first author’s own data collection. In accordance with ethics requirements, posters were displayed in the worksite identifying the first author and explaining her dual roles. She also introduced herself to all worksite participants, and explained the confidential nature of the project. The studentship role meant that the first author spent 10 weeks on the shop floor of the packaging business, interacting with program participants and supervisors. She was able to attend the staff meetings of non-disabled supervisors and managers and performed some of the jobs assigned to worksite participants when contract deadlines meant addi tional assistance was required. In this regard, fieldwork could be char acterized as a type of observer participation, a form of immersion in the everyday ‘flow’ of the shop (Andrews et al., 2014) that permitted access to both discursive interactions and the “ineffable, tacit, affective, and haptic elements of the space” (Smith, 2019, p, 6). With regard to the latter, close attention was paid to the embodied dispositions of workers and their interactions with the environment. Detailed field notes were taken throughout the 10-week period, and transcribed in full for analysis. Towards the end of the participant observation, the first author conducted an interview with the worksite manager to clarify and probe issues that were observed during partici pant observation. Finally, the manager provided access to quantitative data on the number and characteristics of program participants that were analyzed to provide a sense of organizational context. Field notes, interview and the focus group were transcribed in full. A thematic coding approach was employed for this project overall but for this paper we have narrowed the focus to consider the ways in which the data illustrate the program’s atmospheres and their effects on participants. 2.1. New Day: the nature of the organization New Day operates out of a large warehouse-style worksite where participants package and assemble various products. At the time of data collection, there were 68 participants at the training program. Although New Day’s mandate is to serve a broad population of people living with mental ill health, in practice the training program is targeted at people with ‘serious’ mental health issues. The program’s manager explains that the purpose of the program is ‘to give people something to do, let them make a little bit of money, get their confidence up so hopefully they’ll go into [competitive employment]’. Similarly the executive di rector, added that the program ‘[is a] rehabilitation worksite where clients develop work skills in a structured environment, from there they can go into competitive employment’. Once hired, participants are required to work a minimum of ten to 12 hours per week, with the expectation that weekly hours will increase over time. Asked about the nature of the work at New Day, the executive director characterized it as labour intensive ‘hand-work’ that meant the organization could provide work opportunities for as many participants as possible: We don’t have very sophisticated machinery, like the only machin ery we have is the shrink-wrap machine that puts the plastic film around that product. Everything we do is hand-work and that’s labour intensive but that’s what we are in the business to do. Accommodations are made for participants, recognizing that mental and physical health problems may mean they need to work at a slower pace, require additional training and support, and/or need time away
2. Methodology and data collection This paper is based on an in-depth case study of New Day, an employment-training program for people living with mental ill health in Southern Ontario. New Day was one of a number of programs included in a larger research project on employment and the social economy for people living with mental ill health. As part of the larger project, the first and second authors conducted interviews with the program’s executive director and two non-disabled supervisory staff members, and a focus group with ten worksite participants. The interview with the executive director focused on the daily operations of the training program, the types of work available at the program, and its suitability for people living with mental health issues. Interviews with supervisory staff focused on the daily operations of the program, the assignment of work tasks, and the social environment at work. The focus group covered is sues such as participants’ daily experiences at work, their feelings about the program, social relationships with staff and other clients, their wages, and past experiences in mainstream workplaces. It was con ducted in a private space away from other clients and staff members and lasted approximately 80 min. During the initial stage of data collection, the first author was 3
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from work for health reasons. Participants are paid a training allowance that reflects the amount of work accomplished in a shift (effectively piece-work) and the rates assigned to different tasks in the worksite.3 The provincial ministry of health is the principal funder of the training program and staff salaries, while participants’ training allowances are paid from business revenues. The program has a customer base of about 40 companies; most of these are local businesses but several large corporations also have con tracts with the program. The director and program manager both emphasized that the biggest challenge facing New Day was the lack of consistent business. The lack of stable contracts had a number of impacts on the atmosphere at New Day. The most obvious was the consequent uncertainty of how much work there was to offer worksite participants from week to week. At the same time, the specific work tasks available to participants varied significantly. Finally, the pressure to ensure work meant that New Day’s manager regularly bid for contracts at prices below the competitive market rate. While underbidding other quotes helped win contracts, the strategy had a direct, negative impact on business revenues and the piece rates paid to worksite participants. There were sixty-eight clients in the program at the time of the research, of whom forty-three were male. The average age of partici pants was forty-five. Data provided for the financial year prior to the research indicated that more than half of participants were living with Schizophrenia and other psychotic disorders, while another quarter re ported anxiety disorders.4 Three quarters of participants were on pro vincial disability income support, while others relied on welfare payments, family support and state pensions. One third lived alone, while another third lived in shared accommodation with non-relatives, and the remainder reported living with parents or other family members. Although the worksite is advertised as a transitional program, the average time participants worked at New Day was five and a half years and some had worked there for more than fifteen years. While some people did leave, data collected by New Day indicated a cyclical pattern of program withdrawal and re-entry that was driven by changes in mental health and by difficulties transitioning into ‘mainstream’ employment. For many people this meant that New Day was, in practice, a long-term workplace.
but also about ensuring the timely fulfillment of contracts. In practice, these competing priorities could produce tensions in the worksite. As one of the VSWs explained: Some will come in and they’ll just shoot to one job, you know, like [corporate contract]. We’ll try and rotate it a little bit because we do have other jobs that are not as well paying. So we just try and stagger them, right. People get upset but it’s just making sure you treat every body the same (Jeff). Dealing with the tensions around work tasks proved a source of frustration for some supervisory staff. During a conversation, Grace characterized the worksite participants as ‘spoiled’, arguing that they had too much choice and didn’t respect the authority of the worksite staff. Notwithstanding these tensions, worksite participants talked in mostly positive terms about the material character of the work they performed. Here, the repetitive doing of packaging work offered tem porary respite from daily pressures and problems. Several other people noted the benefit of being able to lose oneself in the work. People also talked about the physicality of the work as being healthful. Working with one’s hands was seen as a positive both in terms of exercise and creativity. Nancy was in her early fifties and had worked at New Day for three and half years. Commenting on her experience, she said: I love the work. I love it so much. [Int: What do you love about it?] You’re working with your hands and um I’m artistic so it fulfills that side of me. Beyond the work itself, the material properties of the worksite were also important to some participants. Asked about what he liked about New Day, Roy talked about the nature of the work but he also identified the health and safety signs in the workplace as material resources that enabled him to cope with stress. Working on jobs that you enjoy and just leaving the stress some where … Some days when I’m really stressed out I look at that [sign]. I just read it every day or I read the safety signs over there and I just look at some of these pictures. That’s one of the parts that I like about it. This offers an interesting example of the way that places may be enabling “to the extent that they contain objects and materials vital to the practice of recovery and the ongoing process of staying well” (Duff, 2012, p, 1392), and the heterogeneity of things that might be enrolled in individual’s efforts to stay well. Yet not all reactions to the work tasks were positive. This was particularly true for one of the ‘dirtiest’ jobs at New Day – repairing clothes hangers. Many people complained about this task. Shannon, for example, was in her early forties and had multiple diagnoses including body dysmorphia, which is characterized by persistently negative thoughts about her body image. While working on the clothes hangers one afternoon, Shannon shouted, “I hate this! I hate this!” When the first author went over to ask if she was okay, Shannon explained that the hangers were dirty and that she did not like her hands getting dirty. Several other participants characterized this work as undignified and demeaning. As we noted earlier, New Day struggled to find stable con tracts, and the clothes hangers were one of the most reliable sources of work for participants and a stable source of revenue for the organization. In this sense, the shifting contractual relations – as material properties of the worksite – had an important impact on New Day’s ability to sustain an atmosphere conducive to recovery. When there were few other active contracts, several worksite participants told the VSWs that they did not want to come in if they had to work on the clothes hangers. In response, the worksite manager announced at a monthly meeting that people scheduled to work on a particular day had to show up and perform the tasks assigned to them. Several days later the following interaction occurred: Harry was sitting at one of the worktables with his arm crossed, not doing anything. The VSW asked Harry why he wasn’t working and he noted that he did not want to work on that particular job. The VSW told Harry he either needed to work on this task or he’d be sent home. Since he still refused to work, she sent Harry home (field note excerpt).
2.2. New Day: an assemblage of recovery? 2.2.1. Atmospheres of productivity and alienation In this first section of the analysis, we consider the material char acteristics of New Day and its associated atmospheres. While the financial benefits associated with work activity are certainly significant, we direct attention to the material properties of the workplace and the work itself, and the multiple effects of these properties on worksite participants. On a typical day, there were five to six different packaging and assembly jobs on the go at New Day. Common tasks included cleaning and repairing wire clothes hangers for a dry cleaning company, assembling liquid medicine bottles, assembling packets of anti-bacterial hand wipes, filling and sealing bags of candy, and assembling travel toothbrushes. These work tasks involved varying degrees of skill and complexity and had differences in the piece rate associated with their completion. For example, the piece rate for travel toothbrushes was 7.5 cents per brush whereas for clothes hangers it was $1.59 per rack. Responsibility for assigning people to different jobs fell to the three vocational support workers (VSW) at New Day. Assignments were based on VSW’s assessment of people’s capacities and preferences for work; this assessment was partly about achieving a healthy fit for participants 3 As an employment training program, New Day is currently exempted from minimum wage laws although this exemption is scheduled to end in 2019. 4 These data were based on the 127 people who had been participants at New Day over the course of that year.
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enjoyed was being with others. Participants frequently sat quietly together at the lunch table in the worksite kitchen or at the picnic tables outside during breaks. These field note excerpts exemplify these observations: At the [kitchen] table, I noticed [Ann] and [Lucy] sitting quietly across from each other. They were each eating a snack but did not converse with each other. They sat there for the entire break period and when the bell went, they went back to work without talking (field note excerpt). I saw Lindsay, Jackson, Kim, and Rodney sitting at picnic tables, but no one was talking. They were quietly smoking or eating their lunch[es]. Once they were done, most of them went back inside or just sat outside enjoying the sunny day. (field note excerpt). In this sense, physical co-presence appeared to be an integral part of New Day’s social atmosphere. As Jacob noted, “part of why it’s good to come here is to be with other people”. People were more ambivalent about relationships with paid staff members. In part, this was because these interactions embodied a ten sion between a therapeutic imperative to provide support to worksite participants and a managerial imperative to fulfill worksite contracts (see Evans and Wilton, 2019). Efforts to reduce conversation during work time certainly contributed to this ambivalence. While participants felt staff members were mostly supportive in their interactions, some supervisors were seen as more approachable than others as is clear in the following exchange during the focus group: Roy: Some of them are understanding, I think. Some of them don’t give a crap, okay. So it depends on the people I think and who are willing to talk to. Brian: You just gotta pick and choose [laughs] who you go to, you know. This sense of unevenness with respect to the social connections at New Day is important for thinking about the relational nature of place and the ways in which different associations within the same site might produce distinct outcomes – sometimes enabling but at other times not.
In addition to relational and affective tensions around dirty work, many participants were concerned with the training allowances. As we saw at the outset of the paper, Brian characterized the work as ‘slave labour’. After pay cheques were distributed one afternoon, Ann looked at her cheque and commented that her earnings were “a joke”. During fieldwork it became clear that some people’s daily earnings were effectively zero if they worked on a job with a low piece rate and had to pay for public transportation to get to and from New Day, as the following exchange illustrates: Shannon told Gail she had completed 3 [clothes hanger] racks so far, to which Gail responded that Shannon would only need to finish one more [rack] in order to pay her bus fare for the day, which is seven dollars (field note excerpt). Participants were also frustrated by a lack of transparency about piece rates for different jobs. As Jordan said: ‘they [the VSWs] don’t even tell you, they don’t tell us how much we’re making. You just kinda learn as you go’. While staff members said that they did not actively withhold piece rates from participants, in practice VSWs were reluctant to share the information. This was likely a strategy to reduce resistance when people were assigned to lower-paying contracts, a fact that was not lost on Brad who said: “I think they don’t tell people because everybody would flock to one job, you know what I mean?” Finally, fieldwork revealed that a person’s training allowance could be further reduced at the discretion of the staff. Andrea, one of the VSWs, explained that if a participant was seen walking around the worksite or talking with other people staff might dock their pay by up two dollars. I asked Andrea if clients complain about getting money deducted from their pay in these circumstances. She said it happens once [in a while], but most of the time the clients don’t know how much they are being paid anyways, so they have nothing to complain about … For the clients who do complain, staff tells them that they were not working hard enough and that is why the pay was deducted (field note excerpt). Low rates of pay, a lack of transparency about piece rates and the arbitrary power of staff to deduct pay – often without participants’ knowledge – raise concerns about the precarity of worksite participants (Strauss, 2017) and the material effects associated with this place.
2.2.3. Atmospheres of belonging and impermanence The previous sections have directed attention to the material prop erties and social connections that constitute the New Day worksite as place. Yet it is clear that these properties and connections are closely linked to the affective resources associated with New Day. As Duff (2012) notes, there are complex linkages among social, material and affective resources that work to shape dynamic and emergent experi ences of place, which in turn facilitate (or constrain) mental health re covery. This was most clear in the feeling states engendered by participation in work activity, a connection made by all participants. For example:
2.2.2. Atmospheres of solidarity and difference Notwithstanding their concerns about ‘dirty’ work and pay, most participants had very positive reactions to the social atmosphere constituted by the worksite. Many people talked about New Day as a place of connection, directly countering physical isolation and their own tendency to withdraw from others. For example: Natalie: It rehabilitates you. I can see that I’ve benefitted from coming to work because I was getting very withdrawn and it sort of brought me out of my shell and helped me to get back into life again and interacting with people. Brad: I tend to, I’ve isolated and I still do. So like I said it just gets you out of the, out of your apartment, gets you socializing, you know. You feel good about yourself. From an assemblage perspective, “action is … an expression of the specific associations an actor is capable of sustaining” (Duff, 2011, p, 152). In this sense, associations made possible through participation at New Day are productive of social action; as Brad suggests, presence in the worksite ‘gets you socializing’. Interestingly, one of the findings during fieldwork was that people working at New Day did not actually talk very much to one another. Observations over the three-month period suggested that only a handful of people conversed with other participants. The absence of conversation during work shifts is perhaps not surprising; indeed one of the VSWs explained that supervisors had recently cracked down on talking to ensure contracts were being ful filled on time. But even during breaks there was relatively little con versation at New Day. Despite this, many people considered their time at the organization to be social in nature. Ann explained that she liked the worksite because it was her only opportunity for “social time” each week. Part of the explanation may lie in the fact that what people
It’s good for your self-esteem … You feel like you’re productive, you know, so you feel better about yourself, you know (Brad) [The work] makes me feel good about myself that I’ve accomplished something at the end of the day” (Jacob). These sentiments are important in the sense that they link, at least in part, the ‘healthful effects’ of employment to the affective states engendered by work activity in a social context that imbues such activity with significant moral value (Frayne, 2015). Yet this was not always the case at New Day; forms of dirty and demeaning work engendered negative feeling states among some participants. Concurrently, very low rates of pay impacted some people’s sense of self-worth. Asked about the training allowance, Roy commented: It’s like a self-esteem thing, that’s how I feel. If you got $10.50 an hour, at least you feel part of it more, like you’re more a part of the system, of the province, instead of just saying, you know, we’re going to pay you x less than that. These data provide a useful illustration of the manifold effects engendered through such programs – ‘sometimes enabling, sometimes 5
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indifferent and sometimes detrimental or harmful’ (Duff, 2011, p, 155) – and the ways in which actors are moved by these disparate effects in a given place. A final theme that had both social and affective resonance concerned feelings of comfort at the worksite. Many people talked about the importance of New Day as a workplace where there was a shared un derstanding of mental ill health and a lack of pressure to either conceal or disclose mental illness to others. For example: What I like is that this [site] is specifically tailored for people with mental illness and I feel comfortable in this environment because of that (Keith). It’s like a family here and they understand that you have a mental illness and sometimes you’ll feel better than other times. That makes life so much easier. It makes life worth living and it gives you hope (Nancy). As these statements suggest, an atmosphere of shared understanding and acceptance of mental ill health represented an important affective resource for many at New Day, engendering feelings of comfort, ease and hopefulness. While supervisory staff recognized this they expressed more critical sentiments about the ‘comfort’ engendered at the worksite. People will usually come in and get comfortable here so it’s kinda like talking to them, ‘hey, you guys are capable of a lot more’. ‘But I’m comfortable here’ and I’m like, ‘you’re comfortable because you got a nice chair to sit on and you can chat (Jared). For some people it’s transitional. For a lot of people it’s a place just to come and stay and I don’t see them anyways moving on [Int: Is that a good thing?] I just think they get a little too comfortable here (Jeff). These sentiments reflect the stated objective of New Day to transition people to competitive employment. For supervisors, the affective affordances of the program need to be managed to ensure this goal can be realized. Too much comfort works against a normative vision of re covery that links improving mental wellness with increasing capacity for ‘mainstream’ employment. This reflects an enduring tension in thera peutic work initiatives “between economically viable employment and specifically therapeutic occupations; between the competing re quirements of protectionism and reality” (Laws, 2011 p, 78). This enduring tension is a fundamental ‘horizon of experience’ with regard to recovery itself, a tension that can be found in the very definition of personal recovery understood not as a goal but rather “a complex, time-consuming process” (Anthony, 1993, p, 527).
worker control, hierarchies of authority and limited comfort – and in so doing produced atmospheres of alienation, difference and impermanence. As such, New Day may be assessed as an assemblage of recovery, but one with a somewhat ambivalent atmosphere. This employment training program combined an array of affects, forces, signs, movements, ex pressions and events that seemed to advance recovery by increasing workers’ capacity to feel productive, connected and important but also, in other respects, induced a retreat in recovery by restricting partici pants’ autonomy, interactions and attachment to the program. In ways, the resultant ambivalence speaks to the broader placement of the pro gramming, and the workers, in relation to a much larger constellation of economic, social and political assemblages. What we find in settings such as New Day is a stalemate between the inclusive relations required for participation in mainstream employment and the alienating relations constituting the labour process under capitalism (Davidson et al., 2010). At the same time, we are mindful that social economy organizations like New Day are themselves precarious, struggling to balance the ten sions inherent in the therapeutic employment endeavor (Laws, 2011), while at the same time negotiating the market logics of the mainstream economy through relationships with suppliers, customers, landlords and other actors (Gibson-Graham, 2006). The ambivalent atmosphere that we have documented at New Day, and the relational processes that underlie it, raise broader questions about the extent to which employ ment training and the transition to competitive employment should be positioned as central to the recovery journey. Alternative spaces of re covery have been highlighted in this regard (see Parr and Davidson, 2010) and a future agenda for the geographies of mental health should prioritize unpacking these assemblages of recovery. Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi. org/10.1016/j.healthplace.2019.102266. References Anderson, B., 2009. Affective atmospheres. Emotion. Space Soc. 2, 77–81. Andrews, G., Chen, S., Myers, S., 2014. The “taking place” of health and wellbeing: towards non-representational theory. Soc. Sci. Med. 108, 210–222. Anthony, W., 1993. Recovery from mental illness. Psychosoc Rehabil. J. 16, 521–538. Battin, C., Bouvet, C., Hatala, C., 2016. A systematic review of the effectiveness of the clubhouse model. Psychiatr. Rehabil. J. 39, 305–312. Bille, M., Bjerregaard, P., Sørensen, T., 2015. Staging atmospheres: materiality, culture, and the texture of the in-between. Emotion Space Soc. 15, 31–38. Conradson, D., 2005. Landscape, care and the relational self: therapeutic encounters in rural England. Health Place 4, 337–348. Davidson, L., Rakfeldt, J., Strauss, J., 2010. The Roots of the Recovery Movement in Psychiatry. John Wiley & Sons, West Sussex, UK. Deegan, P., 1988. Recovery: the lived experience of rehabilitation. Psychosoc Rehabil. J. 11, 11–19. Duff, D., 2011. Networks, resources and agencies: on the character and production of enabling places. Health Place 17, 149–156. Duff, C., 2012. Exploring the role of ‘enabling places’ in promoting recovery from mental illness. Health Place 18, 1388–1395. Duff, C., 2014. Assemblages of Health: Deleuze’s Empiricism and the Ethology of Life. Springer, New York. Duff, C., 2016. Atmospheres of recovery: assemblages of health. Environ. Plan. 48, 58–74. Dunn, E., Wewiorski, N., Rogers, S., 2008. The meaning and importance of employment to people in recovery from serious mental illness: results from a qualitative study. Psychiatr. Rehabil. J. 32, 59–62. Evans, J., Wilton, R., 2019. Well enough to work? Social enterprise employment and the geographies of mental health recovery. Ann. Assoc. Am. Geogr. 109, 87–103. Evans, J., Wilton, R., 2016. Supportive workplaces, mental illness, and recovery. In: Giesbrecht, M., Crooks, V. (Eds.), Place, Health & Diversity: A Canadian Perspective. Ashgate, Burlington, VT, pp. 76–95. Evans, J., Semogas, D., Smallwood, J., Lohfeld, L., 2015. ‘This place gives me a reason to care’: understanding managed alcohol programs as enabling places. Health Place 33, 118–124. Frayne, D., 2015. The Refusal of Work. The Theory and Practice of Resistance to Work. Zed Books, London. Gesler, W., Kearns, R., 2005. Culture/Place/Health. Routledge, London. Gibson-Graham, J.K., 2006. A Postcapitalist Politics. University of Minnesota Press, Minneapolis.
3. Conclusion Increasingly, recovery is being defined as an individual, life-long journey completed in the presence, rather than the absence, of mental ill health (Dunn et al., 2008). Recent scholarship by health geographers has sought to place these journeys by chronicling the enabling role of specific spaces (Parr and Davidson, 2010). Towards this end, we have approached these spaces – and New Day specifically – as assemblages and in doing so conceived personal recovery as the ‘transformation of the myriad assemblages by which the “recovering subject” is expressed’ including assemblages such as the home, family, citizenship and, in the case of our analysis, employment (Duff, 2014, p, 118). Duff elaborates: Each such assemblage must be transformed in the course of the body’s becoming well, in a combinatorial reterritorialization of the af fects, percepts, gestures, forces, signs, utterances, expressions and events by which subjectivity is expressed (2014, p, 118). The preceding account provides a rich description of a range of complex reterritorializations, some that are enabling and some that are disabling. The account invites a more ambivalent assessment of employment training programs and their role in expanding people’s capacity to be empowered, connect to others, and feel hope. In many respects, employment training programs reterritorialize by imposing a structure of routinized activity contributing to an atmosphere of pro ductivity, solidarity and belonging. These atmospheres were conducive to recovery by inducing the feeling of ‘becoming well.’ However, New Day also imposed the structure of the ‘sheltered workshop’ – limited 6
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Health and Place xxx (xxxx) xxx Parr, H., Davidson, J., 2010. Mental and emotional health. In: Brown, T., McLafferty, S., Moon, G. (Eds.), A Companion to Health and Medical Geography. Wiley-Blackwell, Malden, MA, pp. 258–277. Smith, T., 2019. Therapeutic Taskscapes and Craft Geography: Cultivating Well-Being and Atmospheres of Recovery in the Workshop. Social & Cultural Geography. https://doi.org/10.1080/14649365.2018.1562088. Visier, L., 1998. Sheltered employment for persons with disabilities. Int. Labour Rev. 137, 347–365. Strauss, K., 2018. Labour geography 1: Towards a geography of precarity. Prog. Hum. Geogr. 42 (4), 622–630. Villotti, P., Corbiere, M., Dewa, C., Fraccaroli, F., Lecomte, T., 2018. The role of selfstigma and job tenure self-efficacy in people with severe mental disorders. Disabil. Rehabil. 40 (26), 3113–3119. Villotti, P., Corbi�ere, M., Fossey, E., Fraccaroli, F., Lecomte, T., Harvey, C., 2017. Work accommodations and natural supports for employees with severe mental illness in social businesses. Community Ment. Health J. 53, 864–870. Williams, A., Fossey, E., Harvey, C., 2012. Social firms: sustainable employment for people with mental illness. Work 43, 530–562. Wilton, R., 2006. Disability disclosure in the workplace. Just Labour 8, 24–39.
Gorman, R., Cacciatore, J., 2017. Cultivating our humanity: a systematic review of care farming & traumatic grief. Health Place 47, 12–21. Hall, E., Wilton, R., 2015. Thinking differently about work and social inclusion for disabled people. In: Grover, C., Piggott, L. (Eds.), Disabled People, Work and Welfare. Policy Press, Bristol, pp. 128–143. Holmqvist, M., 2009. Disabled people and dirty work. Disabil. Soc. 24, 869–882. Jacobson, N., Greenley, D., 2001. What is recovery? A conceptual model and explication. Psychiatr. Serv. 52, 482–485. Kalleberg, A., 2011. Good Jobs, Bad Jobs: the Rise of Polarized and Precarious Employment Systems in the United States, 1970s-2000s. Russell Sage Foundation, Washington DC. Kirsh, B., Krupa, T., Cockburn, L., Gewurtz, R., 2010. A Canadian model of work integration for persons with mental illnesses. Disabil. Rehabil. 32, 1833–1846. Laws, J., 2011. Crackpots and basket-cases: a history of therapeutic work and occupation. Hist. Hum. Sci. 24, 65–81. Leamy, M., Bird, V., Le Boutillier, C., 2011. Conceptual framework for personal recovery in mental health. Br. J. Psychiatry 199, 445–452. Maija, K., Katri, K., 2019. The moral orders of work and health: a case of sick leave due to burnout. Sociol. Health Illn. 41, 219–233. Nicholson, J., Wright, S., Carlisle, A., 2018. Pre-post, mixed-methods feasibility study of the WorkingWell mobile support tool for individuals with serious mental illness. BMJ Open 8, e019936.
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