Mental health occupational therapy and supported employment

Supporting young adults experiencing psychosis with their employment: A qualitative exploration of occupational therapists' experiences

INTRODUCTION

Young adults experiencing psychosis have the same plans for work and future careers as their peers; however, many find themselves unable to participate. While there is research available about interventions used to support employment of young adults with psychosis, there is little evidence regarding the experience of occupational therapists working in this field and the vocational rehabilitation interventions and practices they use.

METHODS

A descriptive qualitative study using semi-structured interviews was used to explore the perspectives of occupational therapy practitioners who support young adults experiencing psychosis with employment. Qualitative data analysis was guided by cross case inductive thematic analysis.

CONSUMER AND COMMUNITY INVOLVEMENT

This study did not include consumer and community involvement.

FINDINGS

There were nine participants, two male and seven females (average 14.7 years mental health experience and age 39 years). All occupational therapists in this study were providing employment support interventions to young adults experiencing psychosis. These ranged from support with career exploration and job seeking to support with keeping and changing jobs. Thematic analysis generated five themes that characterised their experience including psychosis can make securing employment harder for young adults, young adults' pathways to work, and employment destinations of young adults. Finally, employment support interventions and strategies for young adults experiencing psychosis and the service system context-providers, problems, and possibilities for change were described.

CONCLUSION

Young adults experiencing psychosis can miss out on the employment support they need when services are not accessible and evidence-based interventions, such as individual placement and support and early intervention, are not available. Occupational therapists prioritise employment when working with young adults experiencing psychosis. Occupational therapists with their person-centred, consumer-directed, and occupation-focussed approach can provide a range of employment support interventions to enable young adults experiencing psychosis to reach their work and career goals.

PLAIN LANGUAGE SUMMARY

Nine occupational therapists shared how they help young people with psychosis find jobs. Not having transport or work experience can make it hard for young people to work. The occupational therapists talked about how it can be hard to work when you have psychosis. They shared ways to find a job. They shared stories of young people finding their own jobs, starting their own companies or getting jobs from family and friends. Sometimes young people wanted help, and they were having trouble getting someone to help them. Occupational therapists were trying to help young people get a job if they asked for help. For example, they helped young people think about jobs they would like to do and helped them with job applications. Young people need all the services and people they work with to help them with finding and keeping their jobs.

Supported employment interventions for workplace mental health of persons with mental disabilities in low-to-middle income countries: A scoping review

OBJECTIVE

To review the evidence of supported employment interventions in low-to-middle income countries, documents their impact for persons with mental disorders in the open labour market and well as support decision making for its wider implementation in the workplace.

DESIGN

The scoping review is conducted following guidelines in the Arksey and O'Malley (2005) Framework.

DATA SOURCES AND ELIGIBILITY

Eleven databases which are PubMed, Scopus, Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX, Open Grey and Sabinet were searched for articles published between January 2006 and January 2022. Both peer-reviewed articles and grey literature were eligible if they were on supported employment interventions in low-to-middle income countries. Only articles published in English were included.

STUDY APPRAISAL AND SYNTHESIS

Articles were screened at title, abstract and full article levels by two independent teams with the use of Rayyan software. Deductive thematic analysis was used to synthesize evidence on the supported employment interventions implemented in LMICs, capturing evidence of their outcomes for persons with mental disabilities securing competitive work.

RESULTS

The search yielded 7347 records and after screening by title and abstract, 188 studies were eligible for full article screening. Eight studies were included in this scoping review. Thematic descriptions of the findings were based on the availability of supported employment interventions within the context, the type of supported employment interventions as well as mental health and vocational outcomes in the workplace.

CONCLUSIONS

There is limited evidence of supported employment interventions in low-to-middle income countries despite the promising potential it has as an intervention to address mental health problems in the workplace and facilitate work participation by persons with mental disabilities.

Impact of Burnout on Daily Activities from an Occupational Therapy Perspective: A Serial Mediation Model with the IDA Scale

BACKGROUND

Burnout syndrome is one of the most frequent health complications among workers. Acknowledging the work perspective as something basic and essential in a person's life means that this disorder can have huge implications in their most basic daily activities.

METHODS

A cross-sectional, quantitative observational design was conducted with data from Spanish workers. A serial mediation model was applied to study the relationship between daily activities and burnout syndrome. For this purpose, the IDA scale was developed.

CONCLUSIONS

The results show us that peoples' work situation has an impact on their daily life. There is quantitative evidence of the impact on daily life occupations and how it further decreases the levels of health and well-being of the person, on their independence and, consequently, on their quality of life.

Employment programmes for schizophrenia and other severe mental illness in psychosocial rehabilitation: a systematic review

Introduction

Employment programmes for people with mental illness vary widely in range, but nonetheless all share the same objectives of restoring or initiating vocational roles to promote recovery in psychosocial rehabilitation. The current interventions available usually focus on the specific vocational outcomes of the intervention rather than focusing holistically on the client’s needs.

Method

This review aimed to examine the effectiveness of intervention programmes and determine the best intervention for schizophrenia and other severe mental illness, considering both vocational and non-vocational outcomes. Searching five databases – CINAHL, Medline via Ovid, Scopus, OT Seeker and Web of Science – a total of 3108 studies was identified; 24 met the selection criteria and were reviewed. Interventions were categorised into five major programmes of supported employment, integrated supported employment, vocational rehabilitation, cognitive intervention and virtual reality-based vocational training.

Results

Integrated supported employment was found to be the most effective approach for a vocational outcome. However, evidence concerning non-vocational outcomes of employment programmes and the use of cognitive training remains unclear.

Conclusion

Clinicians are advised to consider the needs and preferences of the client before selecting the best intervention programme. More research is needed to determine the applicability and the efficacy of intervention programmes.

Inter-sectoral work practice in Zimbabwe: Professional competencies required by occupational therapists to facilitate work participation of persons with disabilities

BACKGROUND

Persons with disabilities experience higher unemployment rates and limited participation in work. Occupational therapy can promote participation and engagement in work by persons with disabilities. However, there is no clarity on the required set of competencies for entry-level occupational therapists with a bachelor's degree to start up and participate in inter-sectoral work practice initiatives in Zimbabwe.

AIMS

To explore what work practice competencies entry-level occupational therapists require to meet the work-related needs of persons with disabilities.

MATERIAL AND METHODS

This exploratory qualitative research sought to explore what professional competencies entry-level occupational therapists required for them to offer collaborative inter-sectoral work practice initiatives for persons with disabilities within the Zimbabwean context. Six participants selected using criterion sampling, participated in semi-structured interviews. Inductive content analysis was conducted. The Stellenbosch Health Research Ethics Committee and Medical Rehabilitation Practitioner's Council of Zimbabwe gave ethical clearance and permissions to conduct the study.

RESULTS

Three themes; core knowledge for work practice, skills for work practice and occupational therapy professional attributes; emerged. These were used in formulation of ten professional competency statements for occupational therapists offering work practice services.

CONCLUSIONS

Although Zimbabwean occupational therapists require similar competencies for work practice as those required in other countries, additional competencies that fall outside traditional health care contexts are essential in order to promote contextually relevant practice.

Outcomes of an individual placement and support programme incorporating principles of the collaborative recovery model

INTRODUCTION

Engaging in employment enhances mental health recovery and is therefore of central focus for many occupational therapists working in mental health. Individual placement and support (IPS) is an evidence-based, supported employment model specifically designed for individuals with severe mental illness who have the desire to work. Despite strong support for IPS in Australia, implementation challenges have been encountered. This study evaluates outcomes achieved by participants engaged with WorkWell, an IPS programme delivered by a large Australian non-government organisation. In addition to following IPS principles, WorkWell was informed by principles of the collaborative recovery model (CRM).

METHOD

De-identified outcomes data for each participant were analysed by an independent research team. The proportion of individuals engaged with the programme who achieved a competitive employment placement was calculated. Average employment duration and weekly wages were calculated for individuals who achieved a competitive employment placement. Finally, the proportion of individuals who achieved some form of vocationally relevant outcome was calculated.

RESULTS

Ninety-seven participants were engaged with the programme. Forty-eight participants (49.5%) gained a competitive employment position. Average employment duration was 151 days (21.6 weeks) and average weekly wage was $478. Overall, 62 participants (63.9%) were supported to achieve some kind of vocationally relevant outcome (e.g. competitive employment, education, work trial or voluntary work) as a result of their engagement with the programme.

CONCLUSION

While the addition of CRM principles appears to have supported positive outcomes for participants, especially in terms of employment duration, results for employment placement rates were lower than expected. While the employment placement rate compares favourably to results from the international literature and numerous programmes in Australia, more development is required to increase the proportion of individuals who are supported into competitive employment positions. Future research should focus on the specific elements of CRM that most contribute to enhancing IPS processes.