[Professional integration of individuals with a mental illness: an analysis of individual characteristics]

An Integrative Review of the Barriers to Job Acquisition for People With Severe Mental Illnesses

This integrative review analyses and synthesizes specialized literature of 20 years up to 2017 studying barriers/obstacles to employment for people with severe mental illnesses. The inclusion and exclusion criteria led to 35 experimental and nonexperimental studies. Results of the prospective studies were analyzed with the evidence synthesis method to isolate the most salient obstacles. Six main themes emerged from the findings, grouped into personal and environmental barriers. Environmental barriers were related to disability benefits and other physical resources, to stigma and social support, and to vocational services. Individual barriers included those related to illness, to work experience and skills, and to self-perception, fears, and motivation. The most prominent obstacles are lack of work experience and lack of use of effective strategies toward employment. Systematically identifying barriers to employment for people with severe mental illnesses will enable employment specialists to better support their clients in overcoming them, thus facilitating their work integration.

Le fonctionnement cognitif et le travail chez les personnes souffrant de troubles du spectre schizophrénique : l’apport de la Classification internationale du fonctionnement

Cet article dresse un état des lieux de l’implication du fonctionnement cognitif dans le champ de l’insertion professionnelle et du maintien en emploi des personnes qui souffrent de troubles du spectre schizophrénique (TSS). L’objectif est de visualiser comment les déficits cognitifs s’articulent avec les autres dimensions du handicap rapportées dans la Classification internationale du fonctionnement, du handicap et de la santé (CIF), dans le domaine du travail. Les données de la littérature vont dans le sens du modèle de la CIF, à savoir un plus fort impact du fonctionnement cognitif sur les limitations d’activités (LA) plutôt que sur les restrictions de participation (RP). Ce sont en effet davantage les facteurs environnementaux et personnels qui prédisent la participation au travail. En conclusion, ce cadre théorique offre de nouvelles perspectives, notamment que la prise en compte de l’interaction entre les déficits cognitifs et les limitations d’activités peut venir étayer l’accompagnement vers et dans l’emploi des personnes souffrant de TSS.

Narrative development and supported employment of persons with severe mental illness

Background: While the relationship between objective recovery and work among persons with severe mental illness (SMI) is well-established, few studies have examined the link between subjective recovery and employment.Aims: The study investigated the prospective relationship between narrative development at the start of supported employment (SE) and positive work outcomes.Methods: The authors employed a time-limited, mixed-method longitudinal design to examine the relationship between the baseline narrative development of 38 SE participants with SMI and employment outcomes eight months later, as well as whether narratives evolved over the course of the study.Results: While narrative development was unrelated to work for the 59% of participants who were employed at the end of the study, unemployed individuals showed more developed baseline narratives overall, as well as enriched baseline emotional connectedness and social worth. Higher emotional connectedness at the start of SE programs was predictive of fewer hours worked eight months later, controlling for executive functioning, negative symptoms and self-esteem. Although workers showed no narrative changes over time, those without work demonstrated increased agency over the eight months of the study.Conclusion: Further research is warranted to clarify the relationship between richer personal narratives and unemployment.

Does personality influence job acquisition and tenure in people with severe mental illness enrolled in supported employment programs?

BACKGROUND

When employment difficulties in people with severe mental illness (SMI) occur, it could be partly linked to issues not specific to SMI, such as personality traits or problems. Despite the fact that personality has a marked influence on almost every aspect of work behavior, it has scarcely been investigated in the context of employment for people with SMI.

AIMS

We aimed to evaluate if personality was more predictive than clinical variables of different competitive work outcomes, namely acquisition of competitive employment, delay to acquisition and job tenure.

METHOD

A sample of 82 people with a SMI enrolled in supported employment programs (SEP) was recruited and asked to complete various questionnaires and interviews. Statistical analyses included logistic regressions and survival analyses (Cox regressions).

RESULTS

Prior employment, personality problems and negative symptoms are significantly related to acquisition of a competitive employment and to delay to acquisition whereas the conscientiousness personality trait was predictive of job tenure.

CONCLUSION

Our results point out the relevance of personality traits and problems as predictors of work outcomes in people with SMI registered in SEP. Future studies should recruit larger samples and also investigate these links with other factors related to work outcomes.

[Social cooperatives in Italy]

This paper describes the role of social cooperatives in Italy as a type of economic, non-profit organization and their role in contributing to the economic and social growth of the country. The purpose of this paper is to learn more about the experience of the Italian social cooperatives in promoting the work integration process of disadvantaged workers, especially those suffering from mental disorders, from a theoretical and an empirical point of view. Social enterprise is the most popular and consolidated legal and organizational model for social enterprises in Italy, introduced by Law 381/91. Developed during the early 1980s, and formally recognized by law in the early 1990s, social cooperatives aim at pursuing the general interest of the community to promote the human needs and social inclusion of citizens. They are orientated towards aims that go beyond the interest of the business owners, the primary beneficiary of their activities is the community, or groups of disadvantaged people. In Italy, Law 381/91 distinguishes between two categories of social cooperatives, those producing goods of social utility, such as culture, welfare and educational services (A-type), and those providing economic activities for the integration of disadvantaged people into employment (B-type). The main purpose of B-type social cooperatives is to integrate disadvantaged people into the open labour market. This goal is reached after a period of training and working experience inside the firm, during which the staff works to improve both the social and professional abilities of disadvantaged people. During the years, B-type social co-ops acquired a particular relevance in the care of people with mental disorders by offering them with job opportunities. Having a job is central in the recovery process of people suffering from mental diseases, meaning that B-type social co-ops in Italy play an important rehabilitative and integrative role for this vulnerable population of workers. The recent literature has highlighted that difficulties with employment are a feature of mental disorders, with high unemployment rates and short job tenure. Yet, success in employment for this population can be expected when they are provided with adequate support and opportunities. B-type social cooperatives in Italy are found to be very useful in order to help this disadvantaged category of workers find and keep a job. The work environment is more flexible and allows a better integration with less stigma and better work accommodations compared to the open labour market and/or other public/private organizations. Results from B-type Italian social cooperatives studies show that mentally ill workers value the importance of working, are highly satisfied with their job, are motivated to continue working, are engaged in their job and willing to work in the competitive labour market. Also, studies show that environmental characteristics of the social cooperative, such as the implementation of work accommodations and the possibility to work in an environment that is highly supportive, have an impact on increasing the likelihood of being highly satisfied with the job, which in turn is positively related to job tenure. In sum, this article shed light on the historical background that led to the development of social cooperatives in Italy. Furthermore, the features of B-type co-ops that play a central role in facilitating the work integration of people with mental disorders are described in this paper. In general, Italian B-type social cooperatives are found to provide a meaningful work experience to people with mental disorders, that help them increase not only vocational outcomes, but also psycho-social outcomes, and generally to help them better integrate into society.

Job acquisition for people with severe mental illness enrolled in supported employment programs: a theoretically grounded empirical study

INTRODUCTION

The main purpose of this study was to test a conceptual model based on the theory of planned behaviour (TPB) to explain competitive job acquisition of people with severe mental disorders enrolled in supported employment programs.

METHODS

Using a sample of 281 people with severe mental disorders participating in a prospective study design, the authors examined the contribution of the TPB in a model including clinical (e.g., severity of symptoms), psychosocial (e.g., self-esteem) and work related variables (e.g., length of time absent from the workplace) as predictors of job acquisition. Path analyses were used to test two conceptual models: (1) the model of job acquisition for people with mental illness adapted from the TPB, and (2) the extended TPB including clinical, psychosocial, and work related variables recognized in the literature as significant determinants of competitive employment.

RESULTS

Findings revealed that both models presented good fit indices. In total, individual factors predicted 26% of the variance in job search behaviours (behavioural actions). However, client characteristics explained only 8% of variance in work outcomes, suggesting that environmental variables (e.g., stigma towards mental disorders) play an important role in predicting job acquisition. About 56% (N = 157) of our sample obtained competitive employment.

CONCLUSION

Results suggest that employment specialists can be guided in their interventions by the concepts found in the extended model of work integration since most of these are modifiable, such as perceived barriers to employment, self-efficacy, and self-esteem.

A pan-Canadian evaluation of supported employment programs dedicated to people with severe mental disorders

Supported employment (SE) is an evidence-based practice that helps people with severe mental disorders obtain competitive employment. The implementation of SE programs in different social contexts has led to adaptations of the SE components, therefore impacting the fidelity/quality of these services. The objective of this study was to assess the implementation of SE services in three Canadian provinces by assessing the fidelity and describing components of SE services using the Quality of Supported Employment Implementation Scale. About 23 SE programs participated in this study. Cluster analyses revealed six profiles of SE programs that varied from high to low level of fidelity with a stronger focus on a particular component, and reflected the reality of service delivery settings. Future investigations are warranted to evaluate relationships between the levels of implementation of SE components and work outcomes while considering individual characteristics of people registered in SE programs.