Readiness for employment: perceptions of mental health service users

Increasing occupational participation: A qualitative analysis within the “Occupational Self-Analysis” program

Introduction:

Occupational participation is a key element to increase the quality of life in the population. One of the effective interventions to increase occupational participation is the “Occupational Self-Analysis” program. The aim of this study was to analyze participant’s reported benefits about the “Occupational Self-Analysis” program.

Method:

This is a qualitative study with 26 participants (12 people with intellectual disability, 7 affected by acquired brain injury, and 7 students) who participated in weekly group sessions and one individual session. The outcomes were measured based on participant diaries and focus group transcriptions.

Results:

Two main themes emerged: (1) supports for occupational participation and (2) barriers for occupational participation. The thematic analysis of the categories was based on the Model of Human Occupation to increase applicability of the program in occupational therapy practice.

Conclusions:

The “Occupational Self-Analysis” program allowed participants to increase their knowledge of supports provided for and the barriers against occupational participation.

Employment related barriers and facilitators for people with psychiatric disabilities in Spain

BACKGROUND: People with mental health-related disabilities still experience difficulties in obtaining and maintaining a job. Previous international studies inform about employment barriers and facilitators but there is insufficient research in Spain. OBJECTIVE: To explore what type of employment barriers and facilitators were important for people with psychiatric disabilities with past work experiences in competitive and protected work settings. METHODS: In-depth, semi-structured qualitative interviews with 24 participants selected through purposive sampling. RESULTS: The personal sphere was the content most closely related to barriers, followed by the social environment. Facilitators were more closely related to the interviewees’ social network, followed by elements in their personal sphere and job environment. CONCLUSIONS: The findings suggest the need to implement supported employment services in Spain to promote hiring people with psychiatric disabilities in competitive companies. The results also indicate the need to implement new services aimed at supporting the management of disability information during the process of obtaining and maintaining a job, while there is still a need to conduct anti-stigma and anti-discrimination campaigns.

"It's a Big Family Here." Becoming and Belonging in a Service Providing Employment-Related Support for People with Mental Health Problems: An Interpretative Phenomenological Analysis

The impact of employment for individuals with mental health problems is complex. However, research suggests that when support is provided for accessing employment and gaining roles and skills that are valued by others, a positive effect can be seen on recovery. Employment-related support can take many forms and there is a need for further research into the experience of accessing different kinds of services. The current paper examines the lived experience of 11 people participating in a UK social enterprise providing work experience, training, and skills development for those with mental health problems. Although 'sheltered', the organisational ethos strongly emphasised service-user empowerment, co-production, equality with staff, provision of valued social roles and person-centred support. Phenomenological analysis revealed that participants valued a sense of belonging and authentic relationships within the service, whilst being given the opportunity to rediscover an identity that may have been lost because of their mental health problem. However, participants also discussed how, although the service improved their self-value, some feared the 'real world' outside of the service and were unsure whether they would be met with the same support. Tensions between field dominant approaches in supported employment and the experiences and values of the participants are explored. We argue that the findings highlight the importance of a nurturing working environment and the value for recovery of a range of meaningful roles, beyond competitive employment.

The Meaning of Volunteering among People with Severe Mental Disorders: A Phenomenological Qualitative Study

This study aimed to describe the perspectives of people with severe mental disorders who volunteer regarding the relationship between volunteering and work, from the framework of personal recovery. A qualitative phenomenological study was undertaken. Purposive sampling was conducted on people with severe mental disorders who participated in volunteering. In-depth unstructured and semi-structured interviews were used, during which researchers took handwritten field notes. An inductive thematic analysis was applied. Twenty-three participants with severe mental disorders were included (16 men and 7 women) with a mean age of 47 years. Three themes emerged: (a) the relationship between volunteering and working; (b) thinking about a possible future job; and (c) disclosing a mental health condition. Volunteering is perceived as a substitute to working, although not all participants feel able to work, and they do not always disclose that they suffer from a mental health condition.

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.

Getting back to work: Experiences of the individual placement and support model from those with mental health conditions, an interpretative phenomenological analysis

BACKGROUND

Evidence continues to build on the value of Individual Placement and Support (IPS), enabling those with long-term mental health conditions to find mainstream employment. Many of these individuals would like to work; however, unemployment for this population remains high. IPS research thus far has targeted the effectiveness of the model, with less emphasis on how individuals perceive and experience IPS and the return to work.

OBJECTIVE

This study explores the barriers, enablers, meaning and personal experience of being supported to find work through IPS, for individuals with long-term mental health conditions. Findings based on lived experiences of nine participants from two Scottish centres running IPS, should be useful to enhance and develop services.

METHODS

This study involves qualitative data collection, using semi-structured interviews and Interpretative Phenomenological Analysis (IPA).

RESULTS

Transcript analysis revealed three master themes: 1) "Working is good for me": positive aspects to working; 2) "Rome wasn't built in a day": time-unlimited supported journey and 3) "My inner critic": negative aspects to working. Participants praised IPS for the on-going practical and emotional support in overcoming self-identified occupational barriers.

CONCLUSION

Paid employment was greatly associated with financial freedom, social inclusion, increased self-esteem and alleviation of depressive symptoms. Participants described the person-centred, time-unlimited approach taken by the employment specialists (ESs) or occupational therapists (OTs), as the main enabler to maintaining paid employment. Barriers, such as anxiety and work-related stress were identified, however, participants felt supported to overcome some of these negative symptoms.

An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study

BACKGROUND

Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes.

METHODS

This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education).

RESULTS

Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R² = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ²(7) = 41.38 p < .001.

CONCLUSION

An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment.

TRIAL REGISTRATION

NCT04083404 Registered 05 September 2019 (retrospectively registered).

The association between volition and participation in adults with acquired disabilities: A scoping review

Background/objective

Physical, cognitive and psychological factors such as self-efficacy and motivation affect participation in populations with acquired disabilities. Volition is defined as a person's motivation for participating in occupation. The concept of ‘volition’ expands similar concepts and theories, which focus mostly on cognitive processes that influence motivation. Although volition seems to affect participation, the association between these two concepts has not been examined in populations with acquired disabilities. This scoping review explored this association.

Methods

The literature review used a structured five-stage framework, according to predefined inclusion and exclusion criteria. Seven electronic databases (CINAHL, PsycINFO, PubMed, Web of Science, SCOPUS, The Cochrane Library-Wiley, OTseeker) and Google Scholar were searched for relevant articles, published in English from January 2001 to May 2018.

Results

A total of 18 articles, relating to populations with various diagnoses were included. Two directly examined volition and participation and showed a positive association between them. Other articles discussed the effect of participants’ chronic condition on their volition and participation, the effect of volition on participation, or the effect on participation of an intervention addressing volition.

Conclusions

An acquired disability affects both volition and participation, and volition seems to affect participation among people with acquired disabilities. Few articles showed positive effects of interventions that addressed clients' volition, on participation. Further research should include additional health conditions and types of literature, to better understand the association between these concepts. This understanding will contribute to the development of occupational therapy interventions that emphasise volition, in order to improve participation outcomes.

Work experiences among attendees of day centres for people with psychiatric disabilities

BACKGROUND

It is possible that people with psychiatric disabilities who visit day centres have previous work experiences that may be seen as resources for their current engagement in day centre activities. Research in this respect seems to lack, however.

OBJECTIVE

To investigate work experiences among attendees at day centres for people with psychiatric disabilities and relationships with current type of day centre (work-oriented, meeting place-oriented or mixed), engagement in day centre activities, motivation and socio-demographic and health-related factors.

METHODS

Seventy-seven attendees responded to questionnaires. Global Assessment of Functioning, GAF, was also used. Work was categorised into Group I (professionals, semi-professionals), Group II (clerical support, services workers) and Group III (e.g. craft workers, elementary occupations).

RESULTS

Almost everyone had previously had open-market employment; more than half for ≥ 10 years. Group I was more common in mixed centres, Group II in meeting place-oriented ones and Group III in work-oriented ones. Group I more frequently had college degree and was rated high on GAF functioning. Women were over-represented in Group II, and men in Group III and in meeting place-oriented centres. Attending mixed centres was more likely when having a college degree, scoring high on GAF functioning and being highly engaged in activities. Attendees at work-oriented day centres were characterised by being motivated for spending time alone and reporting a diagnosis of psychosis.

CONCLUSIONS

The participants had unused working capacity. No clear-cut relationships were found between work experiences and the investigated correlates.

Defining the environment to support occupational therapy intervention in mental health practice

More than 450 million people have been estimated to have mental health disorders worldwide with many more experiencing mental health challenges, according to the World Health Organization. People with mental health challenges can find their environments not supportive of their engagement in meaningful daily activities of self-care, work and leisure. While occupational therapists value having an understanding of how the environment impacts on a person’s occupational participation, it has been argued that the concept has been poorly defined. The Model of Human Occupation provides a clinically useful definition of the environment. Moreover, the Model of Human Occupation provides clinical assessments and outcome measures that measure how the environment facilitates occupational participation.