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Johanson S, Gregersen Oestergaard L, Bejerholm U, Nygren C, van Tulder M, Zingmark M. Cost-effectiveness of occupational therapy return-to-work interventions for people with mental health disorders: A systematic review. Scand J Occup Ther 2023; 30:1339-1356. [PMID: 37119175 DOI: 10.1080/11038128.2023.2200576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/03/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Return-to-work (RTW) resources for persons with mental health disorders are limited and costs are typically shared by several stakeholders in society. Occupational therapists (OT) provide RTW interventions for this target group, however, increased knowledge of health, and employment effects, as well as costs are needed to better inform decision makers in their prioritisations. AIMS/OBJECTIVES To identify and summarise evidence of cost-effectiveness of RTW interventions for persons with mental health disorders which OTs provide. MATERIALS AND METHODS A systematic search was applied and resulted in 358 articles. After screening, nine articles met inclusion criteria and were reviewed. Quality assessment was conducted using the economic evaluation tool by Joanna Briggs Institute. RESULTS Supported employment, Individual Placement and Support was cost-effective in several contexts while three studies showed larger effects and higher costs. An OT intervention added to treatment for major depression was indicated to be cost-beneficial and an advanced supported employment was cost-saving. The methodological quality varied considerably between studies. CONCLUSIONS AND SIGNIFICANCE The results of the included studies are promising, however, to further strengthen the economic perspective in OT RTW interventions, the need for conducting more and methodologically robust economic evaluations is crucial in future studies.
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Affiliation(s)
- Suzanne Johanson
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Health Sciences/Centre for Evidence Based Psychosocial Interventions (CEPI), Lund University, Lund, Sweden
| | - Lisa Gregersen Oestergaard
- DEFACTUM Central Denmark Region, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ulrika Bejerholm
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Health Sciences/Centre for Evidence Based Psychosocial Interventions (CEPI), Lund University, Lund, Sweden
| | - Carita Nygren
- Swedish Association of Occupational Therapists, Nacka, Sweden
| | - Maurits van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije University, Amsterdam, The Netherlands
| | - Magnus Zingmark
- Department of Health Sciences, Lund University, Lund, Sweden
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden
- Epidemiology and Public Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Gyamfi N, Bhullar N, Islam MS, Usher K. Models and frameworks of mental health recovery: a scoping review of the available literature. J Ment Health 2022:1-13. [PMID: 35535928 DOI: 10.1080/09638237.2022.2069713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The recovery approach involves providing a holistic and integrated service that is centered on and adapts to the aspirations and needs of consumers, who are seen as the expert on their health and well-being. Evidence is needed to address the current ambiguities related to the concept of recovery and its application. AIM A scoping review was conducted to identify papers describing theories, models, and frameworks of recovery to delineate the central domains of recovery. METHODS Three literature search strategies were used: electronic database searching; hand-searching of key journals; and a reference list review of included papers. Inclusion criteria outlined theories, models and frameworks developed to support consumers' recovery and those supporting mental health professionals (MHPs) to deliver recovery-oriented services. RESULTS Twelve studies (eleven articles and one book) were included in the review. The dimensions of recovery were synthesized into a framework named the Consolidated Framework for Recovery-oriented Services (CFRS). There are three domains within the framework: mechanisms/strategies; recovery as an internal process; and recovery as an external process. Each of these domains, as well as their relationships, are discussed. CONCLUSIONS The CFRS can be used by practitioners, researchers, funders, and collaborative members to conceptualize, implement, and evaluate recovery-oriented services.
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Affiliation(s)
- Naomi Gyamfi
- Faculty of Medicine and Health, School of Health, University of New England, Armidale, Australia
| | - Navjot Bhullar
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, Australia
| | - Md Shahidul Islam
- Faculty of Medicine and Health, School of Health, University of New England, Armidale, Australia
| | - Kim Usher
- Faculty of Medicine and Health, School of Health, University of New England, Armidale, Australia
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Badu E, O'Brien AP, Mitchell R, Osei A. A Qualitative Study of Consumers' Experiences of the Quality of Mental Health Services in Ghana. Issues Ment Health Nurs 2022; 43:172-183. [PMID: 34129434 DOI: 10.1080/01612840.2021.1931584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Integrating consumers' experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers' experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers' subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers' lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity.
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Affiliation(s)
- Eric Badu
- School of Nursing and Midwifery, Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Anthony Paul O'Brien
- School Nursing and Midwifery, Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Rebecca Mitchell
- Health & Wellbeing Research Unit (HoWRU), Macquarie Business School, Macquarie University, Macquarie Park, NSW, Australia
| | - Akwasi Osei
- Ghana Mental Health Authority, Ghana Health Services, Accra, Ghana
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Raeside C, McQueen J. Getting back to work: Experiences of the individual placement and support model from those with mental health conditions, an interpretative phenomenological analysis. Work 2021; 70:973-983. [PMID: 34744044 DOI: 10.3233/wor-213617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Badu E, O’Brien AP, Mitchell R. An Integrative Review of Recovery Services to Improve the Lives of Adults Living with Severe Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168873. [PMID: 34444622 PMCID: PMC8393579 DOI: 10.3390/ijerph18168873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
- Eric Badu
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence: ; Tel.: +61-452414632
| | - Anthony Paul O’Brien
- Faculty of Health, Southern Cross University, East Lismore, NSW 2480, Australia;
| | - Rebecca Mitchell
- Faculty of Business and Economics, Macquarie University, Macquarie Park, NSW 2109, Australia;
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Gyamfi N, Badu E, Mprah WK, Mensah I. Recovery services and expectation of consumers and mental health professionals in community-based residential facilities of Ghana. BMC Psychiatry 2020; 20:355. [PMID: 32631367 PMCID: PMC7339466 DOI: 10.1186/s12888-020-02768-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/29/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In the past decades, considerable global attention has been drawn to recovery services that seek to promote the personal recovery journey of consumers with mental illness. However, in most settings, including Ghana, limited empirical studies have attempted to explore, from the perspectives of Mental Health Professionals (MHPs) and consumers, the effectiveness of recovery services and expectation towards the recovery. This study, therefore, explored consumers' and MHPs perspectives concerning recovery services and expectations towards recovery in two community-based residential facilities in Ghana. METHODS A qualitative method, involving in-depth interviews and observations, were used to collect data from 24 participants (5 MHPs and 19 consumers). Thematic analysis was used to analyze the data. RESULTS The study identified three global themes and nine organizing themes. The global themes were recovery services offered to consumers, expectation regarding personal recovery and challenges in achieving recovery. The study found that recovery services were expected to improve the internal and external recovery processes of consumers. The internal recovery process was independent living whilst the external recovery process were management of illness, economic empowerment and social inclusion. Several systemic and consumer-related factors influenced consumers' and MHPs expectation concerning the recovery journey. CONCLUSION The study concludes that the government should prioritize the use of recovery services through policies, financial incentives, infrastructure support, and adequate training of MHPs.
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Affiliation(s)
- Naomi Gyamfi
- grid.9829.a0000000109466120Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana ,grid.1020.30000 0004 1936 7371School of Health, University of New England, Armidale, Australia
| | - Eric Badu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia.
| | - Wisdom Kwadwo Mprah
- grid.9829.a0000000109466120Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Mensah
- Department of Special Education, University of Education, Winneba, Ghana
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Gyamfi N, Bhullar N, Islam MS, Usher K. Knowledge and attitudes of mental health professionals and students regarding recovery: A systematic review. Int J Ment Health Nurs 2020; 29:322-347. [PMID: 32162835 DOI: 10.1111/inm.12712] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 02/06/2023]
Abstract
This review was conducted to synthesize and critically appraise the literature on knowledge, attitudes, understanding, perceptions, and expectations of mental health professionals (MHPs) and mental health professional (MHP) students' regarding recovery. A systematic search in Scopus, CINAHL, PsycINFO, Web of Science, Medline, and Embase as well as Google scholar and web-based repositories was conducted. The searches were conducted using a combination of key terms: "mental health professionals", "students", 'knowledge', "understanding", "perception" "attitude", "expectation", "recovery". After screening and quality assessment, the review included 29 studies (18 quantitative, 8 qualitative, and 3 mixed-method studies) published in English, from January 2006 to June 2019, and was analysed systematically using a mixed-method synthesis. The findings revealed that there is increasing evidence (especially among MHPs) of knowledge, attitudes, understanding, perceptions, and expectations regarding recovery. However, there are disparities in how MHPs perceive and understand recovery. While some understood it to mean a personal process, others explained it as a clinical process. In addition, there was limited knowledge among the MHPs and MHP students regarding the nonlinearity nature of the recovery process and expectations regarding recovery. The implications from these findings are the need for more in-service training for MHPs, and examination of the curriculum used to educate MHP students. In particular, they should be sufficiently informed about the nonlinearity nature of the recovery process and how to develop hopeful and realistic expectations for consumers throughout the recovery process. The review was preregistered with PROSPERO (Registration No: CRD42019136543).
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Affiliation(s)
- Naomi Gyamfi
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Navjot Bhullar
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
| | - Kim Usher
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, NSW, Australia
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Evensen S, Wisløff T, Lystad JU, Bull H, Martinsen EW, Ueland T, Falkum E. Exploring the potential cost-effectiveness of a vocational rehabilitation program for individuals with schizophrenia in a high-income welfare society. BMC Psychiatry 2019; 19:140. [PMID: 31064371 PMCID: PMC6505225 DOI: 10.1186/s12888-019-2130-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past decades research has shown that employment has a positive impact on quality of life, global functioning and recovery in individuals with schizophrenia. However, access to vocational rehabilitation services for this group is limited and unemployment rates remain high. In this study we explore the potential cost-effectiveness of a novel vocational rehabilitation program (The Job Management Program - JUMP) earmarked for individuals with schizophrenia in Norway. METHODS The JUMP study was a vocational rehabilitation program augmented with either cognitive behaviour therapy or cognitive remediation. In addition to the JUMP protocol, we extracted treatment cost data from comprehensive and mandatory health and welfare registers. The costs over a two-year follow-up period were compared with the costs over the two-year period prior to inclusion in the study. We also compared the cost-effectiveness of JUMP with a treatment as usual group (TAU). RESULTS We identified significant reductions in inpatient services in the JUMP group, both for those who obtained employment and those who did not. Significant reductions were also found in the TAU group, but adjusted for baseline differences the total cost for JUMP participants were € 10,621 lower than in the TAU group during the follow-up period. CONCLUSION In addition to supporting individuals with schizophrenia obtain employment, JUMP appears to have reduced the reliance on mental health services, which should be of interest to stakeholders. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01139502 . Retrospectively registered on 6 February 2010.
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Affiliation(s)
- Stig Evensen
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Wisløff
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - June Ullevoldsæter Lystad
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Helen Bull
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Egil W. Martinsen
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik Falkum
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
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Papakonstantinou D. Why should employers be interested in hiring people with mental illness? A review for occupational therapists. JOURNAL OF VOCATIONAL REHABILITATION 2018. [DOI: 10.3233/jvr-180967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Doxa Papakonstantinou
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54006, Thessaloniki, Greece. Tel.: +30 2310 891403; E-mail:
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Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
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McQueen J, McFeely G. Case management for return to work for individuals living with cancer: A systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.5.203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jean McQueen
- Freelance occupational therapist and health researcher, McQueen Training and Health Consultancy, UK
| | - Gerry McFeely
- Macmillan consultant occupational therapist – vocational rehabilitation, Edinburgh Cancer Centre, UK
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12
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Coombes K, Haracz K, Robson E, James C. Pushing through: Mental health consumers' experiences of an individual placement and support employment programme. Br J Occup Ther 2016. [DOI: 10.1177/0308022616658297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Individual placement and support is recognized as current best practice vocational rehabilitation for people living with a severe mental illness. This study aimed to provide insight into the consumer perspective of factors that impact the success of an individual placement and support programme in Australia. Method A qualitative study was conducted using semi-structured interviews with five participants. Participants were diagnosed with a severe mental illness and were engaged with an individual placement supported employment programme in one area health service in New South Wales, Australia. Data analysis was conducted using grounded theory methods. Results Analysis revealed the core category of pushing through, a three-step process that involved experiencing discomfort, learning to adapt, and getting into a groove. Pushing through described the participants' direct experience of individual placement and support, as well as their management of their health and ability to cope with everyday practicalities and relationships while engaged in the programme. Conclusions The participants in this study described their experiences of being involved in an individual placement and support programme as being characterized by a process of pushing through. The participants' actions and experiences at each stage of this process provide cues for more tailored support within individual placement and support to meet changing needs.
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Affiliation(s)
- Kate Coombes
- Occupational Therapist, Konekt, Newcastle, NSW, Australia
| | - Kirsti Haracz
- Lecturer, School of Health Sciences, University of Newcastle, NSW, Australia
| | - Emma Robson
- Accessibility Advisor, Student Care and Equity, University of Newcastle, NSW, Australia
| | - Carole James
- Associate Professor, School of Health Sciences, University of Newcastle, NSW, Australia
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Viola S, Moncrieff J. Claims for sickness and disability benefits owing to mental disorders in the UK: trends from 1995 to 2014. BJPsych Open 2016; 2:18-24. [PMID: 27703749 PMCID: PMC4995588 DOI: 10.1192/bjpo.bp.115.002246] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 10/07/2015] [Accepted: 11/25/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is international concern about the levels of sickness and disability benefits, with mental disorders known to account for a large proportion of claims. AIMS To examine trends in sickness and disability benefits awarded for mental disorders in the UK. METHOD The researchers analysed UK Government data from 1995 to 2014. RESULTS Mental disorders have become the most common cause of receiving benefits, with the number of claimants rising by 103% from 1995 to 1.1 million in 2014. Claimants with other conditions fell by 35%. In 2014, 47% of claims were attributed to a mental disorder. The number of long-term claimants (claiming over 5 years) with mental disorders increased by 87% from 2000 to 2011. Two-thirds of mental disorder claimants were classified as having a depressive or anxiety disorder. CONCLUSIONS Common mental disorders may involve greater morbidity and social costs than usually recognised. Availability of suitable employment, as well as individual support, may be necessary to reduce benefit levels. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
| | - Joanna Moncrieff
- , MBBS, MD, Division of Psychiatry, University College London, London, UK
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Skarpaas LS, Ramvi E, Løvereide L, Aas RW. Maximizing work integration in job placement of individuals facing mental health problems: Supervisor experiences. Work 2015; 53:87-98. [DOI: 10.3233/wor-152218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lisebet Skeie Skarpaas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
- Presenter, Stavanger, Norway
| | - Ellen Ramvi
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Lise Løvereide
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Randi Wågø Aas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Science, Oslo, Norway
- Presenter, Stavanger, Norway
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
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Kinoshita Y, Furukawa TA, Kinoshita K, Honyashiki M, Omori IM, Marshall M, Bond GR, Huxley P, Amano N, Kingdon D. Supported employment for adults with severe mental illness. Cochrane Database Syst Rev 2013; 2013:CD008297. [PMID: 24030739 PMCID: PMC7433300 DOI: 10.1002/14651858.cd008297.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND People who suffer from severe mental disorder experience high rates of unemployment. Supported employment is an approach to vocational rehabilitation that involves trying to place clients in competitive jobs without any extended preparation. The Individual placement and support (IPS) model is a carefully specified form of supported employment. OBJECTIVES 1. To review the effectiveness of supported employment compared with other approaches to vocational rehabilitation or treatment as usual.2. Secondary objectives were to establish how far:(a) fidelity to the IPS model affects the effectiveness of supported employment,(b) the effectiveness of supported employment can be augmented by the addition of other interventions. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (February 2010), which is compiled by systematic searches of major databases, handsearches and conference proceedings. SELECTION CRITERIA All relevant randomised clinical trials focusing on people with severe mental illness, of working age (normally 16 to 70 years), where supported employment was compared with other vocational approaches or treatment as usual. Outcomes such as days in employment, job stability, global state, social functioning, mental state, quality of life, satisfaction and costs were sought. DATA COLLECTION AND ANALYSIS Two review authors (YK and KK) independently extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% (CI). We employed a fixed-effect model for analyses. A random-effects model was also employed where heterogeneity was present. MAIN RESULTS A total of 14 randomised controlled trials were included in this review (total 2265 people). In terms of our primary outcome (employment: days in competitive employment, over one year follow-up), supported employment seems to significantly increase levels of any employment obtained during the course of studies (7 RCTs, n = 951, RR 3.24 CI 2.17 to 4.82, very low quality of evidence). Supported employment also seems to increase length of competitive employment when compared with other vocational approaches (1 RCT, n = 204, MD 70.63 CI 43.22 to 94.04, very low quality evidence). Supported employment also showed some advantages in other secondary outcomes. It appears to increase length (in days) of any form of paid employment (2 RCTs, n = 510, MD 84.94 CI 51.99 to 117.89, very low quality evidence) and job tenure (weeks) for competitive employment (1 RCT, n = 204, MD 9.86 CI 5.36 to 14.36, very low quality evidence) and any paid employment (3 RCTs, n = 735, MD 3.86 CI -2.94 to 22.17, very low quality evidence). Furthermore, one study indicated a decreased time to first competitive employment in the long term for people in supported employment (1 RCT, n = 204, MD -161.60 CI -225.73 to -97.47, very low quality evidence). A large amount of data were considerably skewed, and therefore not included in meta-analysis, which makes any meaningful interpretation of the vast amount of data very difficult. AUTHORS' CONCLUSIONS The limited available evidence suggests that supported employment is effective in improving a number of vocational outcomes relevant to people with severe mental illness, though there appears to exist some overall risk of bias in terms of the quality of individual studies. All studies should report a standard set of vocational and non-vocational outcomes that are relevant to the consumers and policy-makers. Studies with longer follow-up should be conducted to answer or address the critical question about durability of effects.
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Affiliation(s)
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine / School of Public HealthDepartments of Health Promotion and Behavior Change and of Clinical EpidemiologyYoshida Konoe‐cho, Sakyo‐ku,KyotoJapan601‐8501
| | | | - Mina Honyashiki
- Kyoto University Graduate School of Medicine / School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan601‐8501
| | - Ichiro M Omori
- Toyokawa City HospitalDepartment of PsychiatryKoumei 1‐19ToyokawaAichiJapan442‐8561
| | - Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPreston.LancashireUK
| | - Gary R Bond
- Dartmouth Medical SchoolDepartment of PsychiatryRivermill Commercial Centre85 Mechanic StreetLebanonNew HampshireUSA03766
| | - Peter Huxley
- University of SwanseaApplied Social StudiesVivian BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Naoji Amano
- Shinshu University, School of MedicineDepartment of PsychiatryMatsumotoJapan
| | - David Kingdon
- University of SouthamptonMental Health GroupCollege Keep4‐12 Terminus TerraceSouthamptonUKSO14 3DT
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Abstract
Individual placement and support (IPS) is considered the only evidence-based practice available for providing vocational support within secondary mental health services. Clients are supported into and during competitive employment, with proponents claiming IPS 'reflects client goals' because most service users want to work. The idea that work improves mental health is also involved in promoting IPS in the U.K. This paper examines the evidential basis for these claims in policy documents and cited research. It additionally draws upon qualitative research in representing the value, meaning and challenges of working described by service users, while briefly considering the U.K. socio-economic context for IPS implementation. Statistical claims that most unemployed service users want to work are found misleadingly applied to IPS because only a minority say they want competitive employment. Discussion centres on the power interests such statistics serve and their role in underpinning the relevance of IPS randomized control trials. Assertions that work improves mental health are found confusing as a result of use of a dual continua model of mental illness and mental health. The internalized moral basis for work acting as a seemingly healthy 'normalization' experience is suggested as paradoxically feeding self-stigma in those who feel they cannot work.
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Affiliation(s)
- C Essen
- School of Healthcare, University of Leeds, Leeds, UK.
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Abstract
BACKGROUND Schizophrenia is usually considered an illness of young adulthood. However, onset after the age of 40 years is reported in 23% of patients hospitalised with schizophrenia. At least 0.1% of the world's elderly population have a diagnosis of late-onset schizophrenia which seems to differ from earlier onset schizophrenia on a variety of counts including response to antipsychotic drugs. OBJECTIVES To assess the effects of antipsychotic drugs for elderly people with late-onset schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (January 2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials. We contacted relevant authors of trials for additional information. SELECTION CRITERIA All relevant randomised controlled trials that compared antipsychotic drugs with other treatments for elderly people (at least 80% older than 65 years) with a recent (within five years) diagnosis of schizophrenia or schizophrenia like illnesses. DATA COLLECTION AND ANALYSIS For the 2010 search, two new review authors (AE, AG) inspected all citations to ensure reliable selection. We assessed methodological quality of trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. AE and AG also independently extracted data. For homogenous dichotomous data, we planned to calculate the relative risk (RR) and 95% confidence interval (CI). MAIN RESULTS There were no included studies in the original version of this review (2002 search). The 2010 search for the current update produced 211 references, among which we identified 88 studies. Only one study met the inclusion criteria and was of acceptable quality. This was an eight-week randomised trial of risperidone and olanzapine in 44 inpatients with late-onset schizophrenia. All participants completed the eight-week trial, indicating that both drugs were well tolerated. Unfortunately, this study provided little usable data. We excluded a total of 81 studies, 77 studies because they either studied interventions other than antipsychotic medication or because they involved elderly people with chronic - not late-onset - schizophrenia. We excluded a further four trials of antipsychotics in late-onset schizophrenia because of flawed design. Five studies are still awaiting classification, and one is on-going. AUTHORS' CONCLUSIONS There is no trial-based evidence upon which to base guidelines for the treatment of late-onset schizophrenia. There is a need for good quality-controlled clinical trials into the effects of antipsychotics for this group. Such trials are possible. Until they are undertaken, people with late-onset schizophrenia will be treated by doctors using clinical judgement and habit to guide prescribing.
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Affiliation(s)
- Adib Essali
- Psychiatry Centre, Teshreen Hospital, Damascus, Syrian Arab Republic.
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