How do social firms contribute to recovery from mental illness? A qualitative study

Job demands and resources related to burn-out symptoms and work engagement in supervisors working with people with severe disabilities in social firms: a cross-sectional study

OBJECTIVES

To analyse working conditions, work and health-related outcomes of supervisors working with people with severe disabilities in social firms.

DESIGN

Cross-sectional survey.

SETTING

Social firms who employ between 30% and 50% of people with different types of disabilities on the general labour market.

PARTICIPANTS

Supervisors of social firms in Germany.

PRIMARY OUTCOME MEASURES

Descriptive, bivariate and multivariate analysis was used to analyse relations between job demands (quantitative and emotional demands), job resources (meaning of work, perceived organisational support and influence at work), personal resources (resilience) and burn-out symptoms as well as work engagement. Validated scales, for example, from the Copenhagen Psychosocial Questionnaire were applied.

RESULTS

124 supervisors of social firms in Germany (59.7% were male and 39.5% female) participated within a cross-sectional quantitative online survey. Multiple hierarchical regression analysis indicated an association of quantitative job demands (β=0.236, p<0.05) and perceived organisational support (β=-0.217, p<0.05) and burn-out symptoms of supervisors in social firms. Meaning of work (β=0.326, p<0.001) and perceived organisational support (β=0.245, p<0.05) were significantly associated with work engagement.

CONCLUSIONS

Our study specified main job demands and resources for supervisors in German social firms and their impact on both burn-out symptoms and work engagement. When designing measures for workplace health promotion in social firms, especially supervisors' quantitative job demands need to be reduced and perceived organisational support strengthened.

Evaluation verhaltenspräventiver Gesundheitsförderungsmaßnahmen in Inklusionsbetrieben

Hintergrund

Inklusionsbetriebe nach §§ 215–218 SGB IX bieten schwerbehinderten Menschen eine Beschäftigung auf dem allgemeinen Arbeitsmarkt. Seit 2018 sind Inklusionsbetriebe verpflichtet, Maßnahmen der betrieblichen Gesundheitsförderung (BGF) anzubieten.

Ziel der Arbeit

Das Ziel der vorliegenden Studie ist es, verhaltenspräventive BGF-Angebote in Form von Seminaren für schwerbehinderte Beschäftigte und deren Leitungskräfte in Inklusionsbetrieben zu evaluieren.

Material und Methoden

Anhand eines multimethodischen Studiendesigns erfolgte im Zeitraum von Juni bis November 2021 eine Evaluation der 12 Beschäftigtenseminare (3 Seminarkonzepte, z. B. Selbstfürsorge im Arbeitsalltag) mittels Fokusgruppen (n = 44) und eine Evaluation der 3 Leitungskräfteseminare zur gesunden Führung mittels eines standardisierten Fragebogens (n = 10). Die erhobenen quantitativen Daten wurden deskriptiv ausgewertet und die qualitativen Daten mithilfe der qualitativen Inhaltsanalyse nach Mayring induktiv analysiert.

Ergebnisse

Die Ergebnisse zeigten, dass die durchgeführten Maßnahmen zur BGF von Beschäftigten hinsichtlich der Zufriedenheit, der Seminarlänge, der Verständlichkeit und des erwarteten Nutzens mehrheitlich positiv bewertet wurden. Die Leitungskräfte bewerteten die Seminarinhalte, die Didaktik, die Seminarleitung und den Beitrag der Teilnehmenden mehrheitlich positiv.

Diskussion

Die Studie lieferte erste empirische Erkenntnisse zur Evaluation von BGF-Maßnahmen in Inklusionsbetrieben. Vor allem die auf die Inklusionsbetriebe angepassten Seminarinhalte konnten die Zufriedenheit der Teilnehmenden mit der Gesundheitsförderungsmaßnahme positiv beeinflussen. Insgesamt bedarf es weiterer Studien zur Entwicklung und Evaluation von verhältnis- und verhaltensbezogenen BGF-Maßnahmen in Inklusionsbetrieben.

Supported employment for people with severe mental illness: a pilot study of an Italian social enterprise with a special ingredient

BACKGROUND

People with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the 'social enterprise' (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users.

METHODS

This is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE-on average 5 years before the study recruitment, and at the study recruitment-year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,-year 2016; 1 year before the recruitment - year 2017; and at the recruitment-year 2018. An assessment at the recruitment time-year 2018, of SE users' satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time-year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done.

RESULTS

At the recruitment time - year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE-when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time - year 2016, to good ones at the recruitment time - year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement.

CONCLUSIONS

SE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI.

Capturing and analysing the working conditions of employees with disabilities in German social firms using focus groups

Background

Social firms – a type of social enterprise – provide job opportunities to people with mental or intellectual, sensory, physical or multiple disabilities who are disadvantaged on the general labour market. Given the limited number of studies on working conditions of employees in inclusive workplaces, the aim of this study was to explore job demands and resources experienced by employees with disabilities in German social firms.

Methods

Three focus groups were conducted between September and October 2020 with 14 employees with disabilities from social firms in the catering and cleaning sector in Germany. The Job Demands-Resources model was used as a theoretical basis for developing the semi-structured interview guide. Audiotaped data were transcribed verbatim, analysed deductively and inductively using the qualitative content analysis according to Mayring.

Results

The results show that employees of social firms experience specific job demands and resources regarding work content, work organisation, social relations and work environment. Job demands were mainly reported with respect to work organisation, e.g. high workload, time pressure or challenges in collaboration, whereas social relationships with colleagues and supervisors were most frequently mentioned as important resources at the workplace.

Conclusion

First exploratory study results on the working conditions of employees in social firms in Germany were obtained. Given the pivotal importance of employment for people with disabilities, the identified job demands and resources of this study highlight the relevance of a healthy workplace, especially for employees in social firms. Future interventional research is needed regarding the development, implementation and evaluation of workplace health promotion measures in social firms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12689-w.

Balancing social and economic factors - explorative qualitative analysis of working conditions of supervisors in German social firms

Background

Social firms are companies on the general labour market which provide employment to people with severe disabilities. In this setting different job resources are offered for its employees, including social support or flexibility in terms of working hours, tasks or pace of work. However, to date, only limited evidence exists on the work and health situation of supervisors in social firms. Therefore, the study aims to explore job demands and resources of supervisors in social firms to increase knowledge in a little researched field and to develop recommendations for action on workplace health promotion.

Methods

Sixteen semi-structured telephone interviews were conducted with supervisors of social firms in the North of Germany within July and November 2020. Different sectors such as gastronomy or cleaning services as well as employment opportunities for people with different types of disabilities were included. The interviews were recorded, transcribed verbatim and analysed following the qualitative content analysis according to Mayring (deductive-inductive approach).

Results

Overall, a heterogeneous composition was aimed for in terms of age and gender distribution (68.75% were male and between 32 and 60 years old). Supervisors reported various job demands in social firms, including for instance emotional demands, conflicts between social and economic objectives, conflict management, exposure to heat, heavy lifting or constant standing. In contrast, a high meaning of work, possibilities in shaping the structure of the social firm, social support of colleagues or the management and the provision of an ergonomic work environment were highlighted as job resources. Further person-related demands (e.g. own expectations) and resources (e.g. patience) were underlined as well.

Conclusion

First exploratory insights were provided with reference to job demands and resources for supervisors in social firms. The overview on working conditions underlines the significance of a supportive work environment taking structural and behavioural-related implications into account to reduce demands and strengthen resources. Further interventional research is needed regarding the development, testing and evaluation of workplace health promotion interventions in social firms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12995-021-00342-y.

Vocational rehabilitation via social firms: a qualitative investigation of the views and experiences of employees with mental health problems, social firm managers and clinicians

BACKGROUND

Employment within social firms in the UK is under-developed and under-researched, but a potentially beneficial route to vocational rehabilitation for people with mental health problems. This study explores the views and experiences of employees with mental ill-health, managers of social firms and mental health clinicians, in order to understand the potential value of social firms for the vocational rehabilitation, employment and well-being of people with mental health problems.

METHODS

Semi-structured interviews were conducted with 23 employees with mental health problems in 11 social firms in England. A focus group and individual interviews were conducted with 12 managers of social firms. Two focus groups were held with 16 mental health clinicians. Data were analysed using thematic analysis.

RESULTS

Most employees expressed very positive views about working in a social firm. In responses from both employees and social firm managers, an overarching theme regarding the supportive ethos of social firms encompassed several related features: openness about mental health issues; peer, team and management support; flexibility; and support to progress and develop skills over time. Managers identified benefits of employing people with mental health problems who were sufficiently recovered. Knowledge of social firms within clinician focus groups was very limited, although clinicians thought they could be a welcome additional vocational resource.

CONCLUSIONS

High levels of job satisfaction among social firm employees may be explained by the supportive ethos of these working environments. Social firms have potential to be a helpful addition to the range of vocational pathways available for people with mental ill-health. Further mixed methods investigations of experiences and outcomes in order to understand who engages with and benefits from this form of vocational rehabilitation would be valuable in informing decisions about scaling up the model.

"One of My Basic Necessities of Life Is Work. That's Just Broken Away."-Explorative Triangulation of Personal and Work-Related Impacts for Supervisors and Disabled Employees in German Social Firms during the COVID-19 Pandemic

Social firms are located on the general labor market and employ 30-50% of severely disabled people. Findings on personal and work-related impacts for employees and supervisors during the COVID-19 pandemic are not yet available and will be investigated in the present study. Using the approach of a method triangulation, focus groups with employees and individual interviews with supervisors of several social firms from the North of Germany were combined and collected in parallel. Between July and November 2020, 16 semi-structured telephone interviews with supervisors and three focus groups with 3-6 employees each working within the same team (14 employees in total) were conducted. Both formats were recorded, transcribed, anonymized, and analyzed by using Mayring's qualitative content analysis. Because a large proportion of the employees and supervisors interviewed worked in the gastronomy sector, they were particularly affected by the "restriction of social contacts" beginning in March 2020. Hygiene and distance regulations were implemented and personnel planning and distribution of work were adapted. Challenges were raised for employees with disabilities due to the implementation of hygiene and distance regulations, a sudden loss of work, lacking routines, additional work, a lack of movement, social contacts and financial challenges. Both employees and supervisors reported fears of infection, conflicts, additional work and fears of job loss. Additionally, supervisors dealt with less staffing, challenges in detaching from work and a strained economic situation. Overall, new insights were gained into the work-related impacts for employees and supervisors in inclusive workplaces during the current COVID-19 pandemic but further research on health-promoting structures is needed.

An Integrative Review of Recovery Services to Improve the Lives of Adults Living with Severe Mental Illness

There is an increasing call for recovery-oriented services but few reviews have been undertaken regarding such interventions. This review aims to synthesize evidence on recovery services to improve the lives of adults living with severe mental illness. An integrative review methodology was used. We searched published literature from seven databases: Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, Web of Science, and Scopus. Mixed-methods synthesis was used to analyse the data. Out of 40 included papers, 62.5% (25/40) used quantitative data, 32.5% used qualitative and 5% (2/40) used mixed methods. The participants in the included papers were mostly adults with schizophrenia and schizoaffective disorder. This review identified three recovery-oriented services—integrated recovery services, individual placement services and recovery narrative photovoice and art making. The recovery-oriented services are effective in areas such as medication and treatment adherence, improving functionality, symptoms reduction, physical health and social behaviour, self-efficacy, economic empowerment, social inclusion and household integration. We conclude that mental health professionals are encouraged to implement the identified recovery services to improve the recovery goals of consumers.

When the wheels come off: Actor-network therapy for mental health recovery in the bicycle repair workshop

Professional accounts of emotional distress originate from within mainstream mental illness discourses and are underpinned by largely conjectural biomedical, brain-based conceptions of disorder. Alternative, formulation-based approaches remain delimited by cultural norms and linguistic resources. Service users frequently declare the most ordinary aspects of therapy the most helpful: listening, understanding, and respectfulness; these are not contingent upon the presence of a mental health professional. This paper describes ameliorations in states of emotional distress amongst volunteer trainee mechanics in a bicycle workshop, which has little overtly to do with mental health. Possible explanations for these ameliorations, or 'recoveries', are presented. In an enabling setting that offers the social and material resources conducive to particular ways of being, an applied actor-network approach is introduced as a practical way to disentangle the concomitant complexities of bicycles and everyday life. This approach to analysing states of distress-introduced here as 'actor-network therapy'-combines notions of enactment and enhandedness in the appreciation of 'engrenage' - the intriguing intricacy of locally generated, provisional realities.

Spectrum, rate and unmet needs of sociomedical interventions in outpatient psychotherapy

OBJECTIVE

Psychological disorders often take a long-term course, resulting in impairment in daily life and work. Treatment must therefore target not only symptoms of illness but also capacity limitations and context restrictions, as outlined in the International Classification of Functioning, Disability and Health (ICF). This includes sociomedical and interdisciplinary interventions like coordination with other specialists, contact to employers and employment agencies, social support agencies, debt counselling, self-help and leisure groups. There are no data on the spectrum, rate and unmet needs of sociomedical interventions in outpatient psychotherapy.

METHOD

Following a semistructured interview schedule, 131 psychotherapists in private practice were asked to report on unselected patients. The interviewer assessed to what degree 38 predefined sociomedical interventions were applied so far or should be considered in the future.

RESULT

Reports for 322 patients were gathered. All sociomedical interventions were applied, depending on the sick leave status and course of illness. Cognitive behaviour therapists used more sociomedical interventions than psychodynamic therapists.

CONCLUSION

The data show that sociomedical interventions are a frequent part of psychotherapy. They are used preferably in patients with participation restrictions. Psychotherapeutic concepts and education should include sociomedical aspects.

Social Enterprise, Population Health and Sustainable Development Goal 3: A Public Health Viewpoint

Although there is no consensus on the definition of “social enterprises (SEs),” various scholars have agreed that SEs are “sustainable ventures that combine business principles with a passion for social impact.” Using a public health lens, this viewpoint paper attempts to discuss the potential role SEs might play in the achievement of sustainable population health and Sustainable Development Goal 3 (SDG 3): “Health for all at all ages.” Through their impact on social determinants of health (the conditions in which people are born, grow, work, and age), SEs have a potential to contribute to SDGs, specifically SDG 3. They can do so by acting on and modifying the economic, social and environmental challenges communities face, to help promote health and wellbeing and improve the quality of life among children, adolescents, working adults and elderly across countries, societies and generations. Social enterprises present an opportunity to engage business as partners in health promotion – which is yet to materialize in all societies globally.

Supported Employment, Participation at Work, and Peer Support: A Qualitative, Participatory Case Study Report of the Geesthacht Model

Background: For people who have experienced mental health crises or psychosocial disabilities, it is considerably more difficult to receive support to participate in work on an equal basis with others. In the town of Geesthacht, in Northern Germany, an integrative care network was implemented that allows for acute psychiatric treatment as well as participation in work and activities. This paper aims to explore the principles, advantages, and challenges of this innovative project. Methodology: Within the context of a participatory and collaborative process evaluation of a prospective controlled cohort study (PsychCare), researchers with and without experiential expertise conducted expert interviews and focus groups to evaluate the experiences of 37 employees, with and without lived experience, from various institutions associated with this care network. The data was analyzed using qualitative content analysis. Results: It was the change from financial compensation paid on a daily basis to a global treatment budget that allowed for a significant reduction of hospital beds in Geesthacht and freed up resources to implement a complex care network. Since then, various possibilities for participation, work, and activities for former service users, some of which are compensated financially, have been made available. These developments now allow for a less bureaucratic and often smooth transition from being a service user to involvement in participatory activities in the role of a peer, which is frequently perceived to be empowering and beneficial by participants with lived experience. At the same time, this care model has led to multiple role conflicts and different challenges for all parties involved. Conclusion: This innovative project in Geesthacht demonstrates the multifaceted potential of a global treatment budget system in the field of mental health care. To address certain downsides of the Geesthacht model, further development is necessary.

Working Conditions in Social Firms and Health Promotion Interventions in Relation to Employees' Health and Work-Related Outcomes-A Scoping Review

Background: Social firms—a type of social enterprise—offer people with severe disabilities the possibility of employment and integration into the labor market. Since 01 January 2018, social firms in Germany are obligated to provide health promotion interventions for their employees. Therefore, the study aims to provide an overview of the current state of research on working conditions, coping strategies, work- and health-related outcomes, and health promotion interventions in social firms to derive recommendations for action. Methods: The databases PubMed, MEDLINE, PsycINFO, PSYNDEX, CINAHL, and Web of Science were searched. The study selection was based on predefined inclusion and exclusion criteria in the time period between 2000 and 2019. The quality of the studies was critically appraised in a standardized way using the Mixed-Methods Appraisal Tool. Results: A total of 25 studies were included. The current state of research indicated that employees with disabilities were provided with several environmental resources like social support, flexibility, structured work tasks or options for training. A mix of environmental and personal resources impacted several work- and health-related outcomes like well-being, job satisfaction, productivity, work engagement, the motivation to work, or job tenure. Conclusions: There is a need for further (longitudinal) research concerning the work and health situation of employees working in social firms and the development of health promotion interventions.

Can social firms contribute to alleviating the economic burden of psychiatric disabilities for the public healthcare system?

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Québec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job-seekers. Two complementary datasets were used: a self-report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ-5D-5L), the severity of psychiatric symptoms (18-item Brief Symptom Inventory) and self-declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision-making.

Explication and Definition of Mental Health Recovery: A Systematic Review

This review assessed the concordance of the literature on recovery with the definition and components of recovery developed by the Substance Abuse and Mental Health Services Administration (SAMHSA). Each SAMHSA identified recovery component was first explicated with synonyms and keywords and made mutually exclusive by authors. Inter-rater reliability was established on the coding of the presence of 17 recovery components and dimensions in 67 literature reviews on the recovery concept in mental health. The review indicated that concordance varied across SAMHSA components. The components of recovery with greatest concordance were: individualized/person centered, empowerment, purpose, and hope.

Work productivity of people with a psychiatric disability working in social firms

BACKGROUND

Several factors impact work productivity in employees with a psychiatric condition.

OBJECTIVE

In the context of social firms (SFs) the goal of this study is to test a theoretical model to predict work productivity across time, while considering worker and workplace factors.

METHODS

222 people with a psychiatric disability employed in SFs were enrolled in a longitudinal study (6 month follow up) and completed the baseline battery of questionnaires on health (severity of symptoms), individual (self-esteem as a worker) and organizational factors (organizational constraints and supervisory support), and their work productivity (also measured at follow-up). Path analysis was used to test the hypothetical model, assessing individual and organizational factors in the context of social firms that could facilitate or hamper work productivity in the immediate term (T1), as well as the stability of work productivity in the middle/long term (T2 or 6 month follow up).

RESULTS

Work productivity of people with a psychiatric disability was affected negatively by severity of the symptoms, organizational constraints, and positively by self- esteem as a worker at T1. The stability of work productivity was significant across time (T2). Supervisor support was only related to work productivity at 6 month follow-up.

CONCLUSIONS

The results highlight the importance of the supportive workplaces for people with mental disorders that SFs provide, and the stability of work productivity across time. Supervisor support seems to have a delayed impact on work productivity. In future studies, researchers could determine how individual and organizational variables influence job tenure of employees with a psychiatric disability.

A Comparison of Healthcare Use and Costs for Workers with Psychiatric Disabilities Employed in Social Enterprises Versus Those Who Are Not Employed and Seeking Work

Because of work's contribution to recovery, governments have moved to improve employment rates of people with severe mental disorders (SMDs). Social enterprises (SEs) have been identified as a means to achieve employment. In Ontario, Canada, the Ministry of Health and Long-Term Care (MOHLTC) have provided SEs government subsidies. Public funding arrangements create a potential trade-off for governments that must decide how to distribute constrained budgets to meet a variety of public needs. In Ontario, the government is potentially faced with choosing between supporting employment versus healthcare services. This study addresses the question, are there significant differences in service use and costs from the MOHLTC's perspective for people with SMDs working in SEs versus those who are not working and looking for work? Our results indicate there is a significant difference in healthcare use between the two groups suggesting there could be less healthcare use associated with SE employment.

Accounting for context: Social enterprises and meaningful employment for people with mental illness

BACKGROUND

Many people living with mental illness want paid work, but finding and maintaining mainstream employment remains challenging. In recent decades, social enterprises have emerged as one alternative site for paid employment. Existing research has examined the experiences of people with mental illness working in social enterprises, but less is known about the organizational character of these workplaces.

OBJECTIVE

The objective of this paper is to develop a better understanding of social enterprises as organizational contexts for workers with mental illness.

METHODS

The research employed a qualitative methodology, conducting semi-structured interviews with executive directors and managers at 42 organizations operating 67 social enterprises across CanadaRESULTS:While there are strong similarities in organizational mandate to create meaningful employment there are also important variations between social enterprises. These include variations in size, economic activity and organizational structure, as well as differences in hours of work, rates of pay and the nature and extent of workplace accommodation. These variations reflect both immediate organizational contexts as well as broader economic constraints that enterprises confront.

CONCLUSIONS

Understanding the varied nature of social enterprises is important for thinking about future enterprise development, and the capacity of such organizations to create meaningful employment for people living with mental illness.

Work Accommodations and Natural Supports for Employees with Severe Mental Illness in Social Businesses: An International Comparison

Little is known about the types of work accommodations and natural supports that are useful for people experiencing severe mental illness working in social businesses. We conducted an exploratory, descriptive and cross-sectional investigation in Australia, Canada and Italy to study the nature of work accommodations and natural supports available in social businesses. Study findings are drawn from survey responses of a convenience sample of 90 employees with self-reported psychiatric disabilities. Results showed that, regardless of the country, social businesses provide many work accommodations and natural supports, especially those linked to schedule flexibility and support, while work accommodations related to training and schedule flexibility were linked to longer job tenure. Overall, this study advances our knowledge about the spectrum of work accommodations and natural supports that are available in social businesses for people with severe mental illness. Also, it highlights the type of work accommodations that are likely to support this population to sustain employment.

Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis

BACKGROUND

People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions.

OBJECTIVES

To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness.

SEARCH METHODS

In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials.

SELECTION CRITERIA

We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only.

DATA COLLECTION AND ANALYSIS

Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE.

MAIN RESULTS

We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions.

AUTHORS' CONCLUSIONS

Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.

From the rhetoric to the real: A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula - The eMenthe project

OBJECTIVES

This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master's level in order to bring about significant and positive change to practice.

DESIGN

This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008).

DATA SOURCES

In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health.

REVIEW METHODS

We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice.

RESULTS

A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development.

CONCLUSIONS

This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master's level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.

The contributions of persons in the work environment to the self-identity of persons with mental health problems: a study in Israel

This study explores the contribution of others in the workplace to the self-identity and job integration of persons with severe mental health problems. Thematic content analysis of in-depth, semi-structured interviews conducted in 2009 with 15 Israelis with severe mental health problems who work in a variety of frameworks (protected and supported employment and open market) revealed three main themes: (i) dissatisfaction with the protected work settings in which they were initially employed; (ii) the importance they attributed to their relationships with others in their workplace; and (iii) the change in self-identity they underwent from persons defined by their mental health problems to persons who had worth, abilities and being beyond their illness. The findings underscore the important role of managers and colleagues in integrating persons with mental health problems at work and in strengthening the self-identity of those individuals.

Social Firms as a means of vocational recovery for people with mental illness: a UK survey

BACKGROUND

Employment is associated with better quality of life and wellbeing in people with mental illness. Unemployment is associated with greater levels of psychological illness and is viewed as a core part of the social exclusion faced by people with mental illness. Social Firms offer paid employment to people with mental illness but are under-investigated in the UK. The aims of this phase of the Social Firms A Route to Recovery (SoFARR) project were to describe the availability and spread of Social Firms across the UK, to outline the range of opportunities Social Firms offer people with severe mental illness and to understand the extent to which they are employed within these firms.

METHOD

A UK national survey of Social Firms, other social enterprises and supported businesses was completed to understand the extent to which they provide paid employment for the mentally ill. A study-specific questionnaire was developed. It covered two broad areas asking employers about the nature of the Social Firm itself and about the employees with mental illness working there.

RESULTS

We obtained returns from 76 Social Firms and social enterprises / supported businesses employing 692 people with mental illness. Forty per cent of Social Firms were in the south of England, 24% in the North and the Midlands, 18% in Scotland and 18% in Wales. Other social enterprises/supported businesses were similarly distributed. Trading activities were confined mainly to manufacturing, service industry, recycling, horticulture and catering. The number of employees with mental illness working in Social Firms and other social enterprises/supported businesses was small (median of 3 and 6.5 respectively). Over 50% employed people with schizophrenia or bipolar disorder, though the greatest proportion of employees with mental illness had depression or anxiety. Over two thirds of Social Firms liaised with mental health services and over a quarter received funding from the NHS or a mental health charity. Most workers with mental illness in Social Firms had been employed for over 2 years.

CONCLUSIONS

Social Firms have significant potential to be a viable addition to Individual Placement and Support (IPS), supporting recovery orientated services for people with the full range of mental disorders. They are currently an underdeveloped sector in the UK.

An Analysis of Work Engagement Among Workers With Mental Disorders Recently Integrated to Work

The purpose of this study is to determine the validity of the work engagement construct among mentally ill workers and to develop a nomological network delineating the relationship of work engagement with its antecedents, and its consequences in this specific population. Three hundred and ten people with mental disorders employed in Italian social enterprises accepted to take part in this longitudinal study and filled out the Utrecht Work Engagement scale (UWES-9) and questionnaires on severity of symptoms perceived, social support from coworkers and supervisor, and occupational self-efficacy. Individuals who were still eligible at the 12-month follow-up phase of the study completed a questionnaire on future working plans. Confirmatory factor analysis and path analysis were used to validate the UWES-9 and test its nomological network. The results indicated how work engagement, as well as its drivers, impacted important work outcomes, such as to work in the open labor market, in workers with mental disorders.