Merging the fields of mental health and social enterprise: lessons from abroad and cumulative findings from research with homeless youths

The health and well-being impacts of a work integration social enterprise from a systems perspective

Recent research has drawn upon the social determinants of health (SDH) framework to attempt to systematize the relationship between social enterprise and health. In this article, we adopt a realist evaluation approach to conceptualize social enterprises, and work integration social enterprises in particular, as 'complex interventions' that necessarily produce differential health outcomes for their beneficiaries, communities and staff. Drawing upon the findings from four social enterprises involving a range of methods including 93 semi-structured interviews with employees, managers and enterprise partners, together with participant observation, we demonstrate that these health outcomes are influenced by a limitless mix of complex and dynamic interactions between systems, settings, spaces, relationships and organizational and personal factors that cannot be distilled by questions of causality and attribution found in controlled trial designs. Given the increased policy focus on the potential of social enterprises to affect the SDH, this article seeks to respond to evidence gaps about the mechanisms and contexts through which social enterprises promote or constrain health outcomes, and thereby provide greater clarity about how research evidence can be used to support the social enterprise sector and policy development more broadly.

Empowering Features and Outcomes of Homeless Interventions: A Systematic Review and Narrative Synthesis

The purpose of this systematic review and narrative synthesis was to identify homeless interventions with empowering features and evaluate their effectiveness for developing the psychological empowerment of services users. To identify and evaluate intervention studies, we combined the theoretical frameworks of empowering settings and psychological empowerment (PE). Our conceptualization of PE included outcomes aligned with the intrapersonal, interactional, and behavioral components. Relational outcomes were also included and conceptualized as antecedents for PE development. After systematic searching and screening, 37 studies were included for review. Interventions with empowering features included supported housing, case management, skills and knowledge acquisition, and mutual support. Interventions that were competency-building effectively improved outcomes aligned with the intrapersonal PE component. Interventions that were collaborative and competency-building effectively improved outcomes aligned with the behavioral PE component. Weak evidence suggested that interventions with empowering features may effectively improve outcomes aligned with the interactional PE component. Interventions that promoted and developed support effectively improved relational antecedents. Findings align the empirical evidence for homeless interventions with theoretical conceptions of empowering features and processes. Findings may be applied to the design and implementation of homeless interventions to incorporate empowering features and to facilitate the development of homeless services users' PE. Highlights Empowerment theory was applied to review homeless interventions literature. Empowering homeless interventions included supported housing and mutual support, for example. Empowering interventions contributed to indicators of emotional and behavioral empowerment. Fewer empowering interventions contributed to indicators of cognitive empowerment. Service user involvement may facilitate improvements in indicators of psychological empowerment.

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.

An assessment of the trainability of beggars and the destitute in Abakaliki Nigeria: implication for policy on their health, vocational rehabilitation and social reintegration

Background

Begging and destitution constitute serious health and social problems in low and middle-income countries (LMICs).

Objectives

The objective of this study was to assess the trainability of beggars and the destitute in Abakaliki Nigeria in order to provide scientific evidence required for the development of a policy on their health, vocational rehabilitation and social reintegration.

Methods

The study was a cross-sectional descriptive survey of 50 purposively selected beggars and destitute persons identified from motor parks, church cathedrals, market places etc. Data was collected using a structured interviewer-administered questionnaire. Analysis was based on mean rating (MNR), median rating (MDR), and range. Interview of each respondent lasted approximately 20 minutes.

Results

Of the 50 respondents who participated in this study, 17 (34%) were females. Most subjects were of age category 31–35 years (30%) and 36–40 years (34%). Fifteen (30%) admitted having sight impairment while 17 (34%) admitted that they were physically challenged. The outcome of the trainability assessment showed relatively high mean ratings (MNRs) ranging from 3.42–4.06 on a scale of 5 points.

Conclusion

The findings of this study clearly suggest that there is a very high potential for the vocational rehabilitation and social reintegration of beggars and the destitute in the study area.

Employment Cessation, Long Term Labour Market Engagement and HIV Infection Risk Among People Who Inject Drugs in an Urban Canadian Setting

The potential for changes in socio-economic status, such as employment exits, to increase HIV infection risk are not well examined among people who inject illicit drugs (PWID). We used longstanding cohort data from Vancouver, Canada, to longitudinally assess associations between employment cessation and outcomes with documented linkages to HIV infection risk among PWID. From 2005 to 2015, 1222 participants reported 1154 employment exits. Employment exits were significantly associated with transitions into unstable housing; moving to the inner-city; initiating informal, prohibited or illegal income generation; high risk drug use practices; and exiting methadone maintenance therapy. HIV infection rates were higher among participants with lower long-term labour market engagement. These findings suggest that employment cessation coincides with initiating exposure to aspects of socioeconomic marginalization and drug use associated with HIV infection risk. Support for employment retention that prevents poverty entrenchment and harmful drug use could contribute to HIV prevention measures for PWID.

Occupation-based practices and homelessness: A scoping review

Background.

Persons experiencing or at risk of homelessness have occupational needs that are seldom addressed in the Canadian system of care. The lack of documented evidence on occupational therapy practices in this field hinders the development of the profession.

Purpose.

This article identifies current and potential practices that aim to enable or support the occupations of persons experiencing or at risk of homelessness.

Method.

A scoping review was conducted, including evidence from both occupational therapy and non–occupational therapy sources.

Findings.

One hundred and seventy-eight papers were selected in the areas of occupational performance skills training, enrichment of occupational repertoire, employment/education, physical rehabilitation services, child/family services, community building, occupational transition from homeless to housed, literacy, and disaster relief.

Implications.

Occupational therapists can build environments and create opportunities that facilitate occupational engagement of individuals experiencing homelessness. Gaps in knowledge include the evaluation of occupational therapy practices, the Canadian context of family homelessness, and the cultural safety of occupational therapy interventions.

The potential of social enterprise to enhance health and well-being: a model and systematic review

In recent years civil society organisations, associations, institutions and groups have become increasingly involved at various levels in the governance of healthcare systems around the world. In the UK, particularly in the context of recent reform of the National Health Service in England, social enterprise - that part of the third sector engaged in trading - has come to the fore as a potential model of state-sponsored healthcare delivery. However, to date, there has been no review of evidence on the outcomes of social enterprise involvement in healthcare, nor in the ability of social enterprise to address health inequalities more widely through action on the social determinants of health. Following the development of an initial conceptual model, this systematic review identifies and synthesises evidence from published empirical research on the impact of social enterprise activity on health outcomes and their social determinants. Ten health and social science databases were searched with no date delimiters set. Inclusion and exclusion criteria were applied prior to data extraction and quality appraisal. Heterogeneity in the outcomes assessed precluded meta-analysis/meta-synthesis and so the results are therefore presented in narrative form. Five studies met the inclusion criteria. The included studies provide limited evidence that social enterprise activity can impact positively on mental health, self-reliance/esteem and health behaviours, reduce stigmatization and build social capital, all of which can contribute to overall health and well-being. No empirical research was identified that examined social enterprise as an alternative mode of healthcare delivery. Due to the limited evidence available, we discuss the relationship between the evidence found and other literature not included in the review. There is a clear need for research to better understand and evidence causal mechanisms and to explore the impact of social enterprise activity, and wider civil society actors, upon a range of intermediate and long-term public health outcomes.

Service provision for mentally disordered homeless people

PURPOSE OF REVIEW

Mentally ill homeless persons are among the most neglected or marginalized patient groups. Their needs for mental healthcare are widely unmet. The current economic crisis probably accelerates the social decline and deterioration of physical and mental health in high-risk groups worldwide and increases the need for appropriate treatments, services, and prevention strategies.

RECENT FINDINGS

Research on service provision for mentally disordered homeless people (from 2010 to 2012) covers the following issues: epidemiology of mental ill health among homeless persons, service delivery and healthcare utilization, specific treatments, specific high-risk groups among homeless persons, and subjective experience with mental health service provision.

SUMMARY

The number of studies published on these issues between 2010 and 2012 may suggest an awareness for the need for adequate service provision of this marginalized clientele. Research evidence is still not sufficient. The majority of studies are from the United States. The methodological quality of the studies is still moderate, being descriptive in nature or applying qualitative approaches to small samples. Included are usually easy to access patients from inner-city regions. There is an encouraging trend to focus on younger age groups that supports the focus on primary or secondary prevention strategies for homelessness and mental disorders.