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Martinelli A, Bonetto C, Bonora F, Cristofalo D, Killaspy H, Ruggeri M. Supported employment for people with severe mental illness: a pilot study of an Italian social enterprise with a special ingredient. BMC Psychiatry 2022; 22:296. [PMID: 35473634 PMCID: PMC9040313 DOI: 10.1186/s12888-022-03881-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND People with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the 'social enterprise' (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users. METHODS This is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE-on average 5 years before the study recruitment, and at the study recruitment-year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,-year 2016; 1 year before the recruitment - year 2017; and at the recruitment-year 2018. An assessment at the recruitment time-year 2018, of SE users' satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time-year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done. RESULTS At the recruitment time - year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE-when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time - year 2016, to good ones at the recruitment time - year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement. CONCLUSIONS SE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI.
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Affiliation(s)
- Alessandra Martinelli
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy ,grid.419422.8Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni, 4, 25125 Brescia, BS Italy
| | - Chiara Bonetto
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Federica Bonora
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Doriana Cristofalo
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Helen Killaspy
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. .,Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy.
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von Peter S, Göppert L, Ziegenhagen J, Beeker T, Glück R, Groth B, Groß U, Reinholdt A, Boerma R, Heißler M, Habicht J, Schwarz J. Supported Employment, Participation at Work, and Peer Support: A Qualitative, Participatory Case Study Report of the Geesthacht Model. Front Psychiatry 2021; 12:634080. [PMID: 33967854 PMCID: PMC8102772 DOI: 10.3389/fpsyt.2021.634080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
Background: For people who have experienced mental health crises or psychosocial disabilities, it is considerably more difficult to receive support to participate in work on an equal basis with others. In the town of Geesthacht, in Northern Germany, an integrative care network was implemented that allows for acute psychiatric treatment as well as participation in work and activities. This paper aims to explore the principles, advantages, and challenges of this innovative project. Methodology: Within the context of a participatory and collaborative process evaluation of a prospective controlled cohort study (PsychCare), researchers with and without experiential expertise conducted expert interviews and focus groups to evaluate the experiences of 37 employees, with and without lived experience, from various institutions associated with this care network. The data was analyzed using qualitative content analysis. Results: It was the change from financial compensation paid on a daily basis to a global treatment budget that allowed for a significant reduction of hospital beds in Geesthacht and freed up resources to implement a complex care network. Since then, various possibilities for participation, work, and activities for former service users, some of which are compensated financially, have been made available. These developments now allow for a less bureaucratic and often smooth transition from being a service user to involvement in participatory activities in the role of a peer, which is frequently perceived to be empowering and beneficial by participants with lived experience. At the same time, this care model has led to multiple role conflicts and different challenges for all parties involved. Conclusion: This innovative project in Geesthacht demonstrates the multifaceted potential of a global treatment budget system in the field of mental health care. To address certain downsides of the Geesthacht model, further development is necessary.
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Affiliation(s)
- Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Albertinen Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Lena Göppert
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Albertinen Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Jenny Ziegenhagen
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Albertinen Hospital Rüdersdorf, Rüdersdorf, Germany
- ExPEERienced – Experience With Mental Health Crises – Registered Non-Profit Organization, Berlin, Germany
| | - Timo Beeker
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Albertinen Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Rosa Glück
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Albertinen Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Birte Groth
- Department of Psychiatry, Psychotherapy and Psychosomatics, Johanniter Hospital Geesthacht, Geesthacht, Germany
| | - Uwe Groß
- Department of Psychiatry, Psychotherapy and Psychosomatics, Johanniter Hospital Geesthacht, Geesthacht, Germany
| | - Arne Reinholdt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Johanniter Hospital Geesthacht, Geesthacht, Germany
| | - Robin Boerma
- Department of Psychiatry, Psychotherapy and Psychosomatics, Johanniter Hospital Geesthacht, Geesthacht, Germany
| | - Matthias Heißler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Johanniter Hospital Geesthacht, Geesthacht, Germany
| | - Juri Habicht
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Albertinen Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Albertinen Hospital Rüdersdorf, Rüdersdorf, Germany
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Subramaniam M, Zhang Y, Shahwan S, Vaingankar JA, Satghare P, Teh WL, Roystonn K, Goh CMJ, Maniam Y, Tan ZL, Tay B, Verma S, Chong SA. Employment of young people with mental health conditions: making it work. Disabil Rehabil 2020; 44:2033-2043. [DOI: 10.1080/09638288.2020.1822932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore
| | | | | | | | - Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore
| | | | | | - Yogeswary Maniam
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Zhuan Liang Tan
- Sector Strategy Group, National Council of Social Service, Singapore
| | - Benjamin Tay
- Sector Strategy Group, National Council of Social Service, Singapore
| | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Murray J, Coker JF, Elsey H. Care farming: Rehabilitation or punishment? A qualitative exploration of the use of care farming within community orders. Health Place 2019; 58:102156. [PMID: 31301600 DOI: 10.1016/j.healthplace.2019.102156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/03/2019] [Accepted: 06/18/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Jenni Murray
- Leeds Institute of Health Sciences, Level 10, Worsley Building University of Leeds, Leeds, LS2 9NL, UK.
| | - Joyce F Coker
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Helen Elsey
- Leeds Institute of Health Sciences, Level 10, Worsley Building University of Leeds, Leeds, LS2 9NL, UK
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Altwicker-Hámori S, Dratva J. Disability pension receipt in young adults: an analysis of the Swiss Social protection and labour market (SESAM) data. BMC Public Health 2019; 19:831. [PMID: 31242889 PMCID: PMC6595685 DOI: 10.1186/s12889-019-7098-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 05/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been an overall decreasing trend in the inflow into disability pension in Switzerland since 2003 with the exception of young adults. Disablement in young adulthood reflects a particularly critical phenomenon given the potentially far-reaching long-term social, economic and health consequences. The aim of this study was therefore to identify factors for disability pension in young adults aged 18-39, living in Switzerland. METHODS We used the 2010-2015 cross-sections of the Social protection and labour market; a unique dataset linking microdata from the Swiss Labour Force Survey, the Swiss Central Compensation Office Register, and the Unemployment Insurance Register. Multiple logistic regression was employed to explore the association between demographic, socioeconomic, and health factors and disability pension in young adults living in Switzerland with long-term activity limitation (N = 5306). Alternative specifications of the benchmark model were estimated as robustness checks; and subsample analyses were conducted excluding (i) those aged 18-24 and (ii) those with partial disability pension. RESULTS Our regression results showed that those living without a working partner (OR 2.11; 95% CI 1.51-2.94) and without a child aged 0-14 (OR 2.15; 95% CI 1.48-3.12), born in Switzerland (OR 2.68; 95% CI 1.87-3.84), of higher age (OR 1.16; 95% CI 1.12-1.19), having completed at most lower secondary school (OR 3.26; 95% CI 2.24-4.76), lacking income throughout the four-year period prior to interview (OR 3.94; 95% CI 2.70-5.75), suffering from chronic illness (OR 4.52; 95% CI 2.83-7.19), and severe long-term activity limitation (OR 4.52; 95% CI 2.83-7.19) had higher odds of DP. Our findings were robust to alternative specifications and subsamples; and the alternative specifications revealed differences by learnt occupation, with highest odds for those without an occupational qualification (OR 5.93; 95% CI 3.72-9.46; p-value 0.000) and for those in 'Manufacturing' (OR 3.59; 95% CI 1.91-6.71) relative to 'Health, education, culture, and science'. CONCLUSIONS Most importantly, our results showed that educational and employment factors are of high relevance, as well as chronic morbidity and severe long-term activity limitation. From a policy perspective, early intervention should thus focus on the attainment of vocational and academic qualifications beyond the lower secondary level, facilitating school-to-work transition and labour market integration.
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Affiliation(s)
- Szilvia Altwicker-Hámori
- Research Unit for Health Sciences, ZHAW School of Health Professions, Technikumstrasse 81, 8400, Winterthur, Switzerland.
| | - Julia Dratva
- Research Unit for Health Sciences, ZHAW School of Health Professions, Technikumstrasse 81, 8400, Winterthur, Switzerland.,Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
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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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Elsey H, Bragg R, Elings M, Brennan C, Farragher T, Tubeuf S, Gold R, Shickle D, Wickramasekera N, Richardson Z, Cade J, Murray J. Impact and cost-effectiveness of care farms on health and well-being of offenders on probation: a pilot study. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Care farms (CFs), in which all or part of the farm is used for therapeutic purposes, show potential for improving well-being for disadvantaged groups. We assessed the feasibility of determining the cost-effectiveness of CFs in improving quality of life compared with comparator sites among probationers undertaking community orders (COs).
Objectives
(1) To conduct a systematic review of CF impacts and mechanisms in improving health and logic
model development; (2) to inform future studies by estimating differences
in quality of life and other outcomes, identifying factors driving CO
allocation and ways to maximise recruitment and follow-up; and (3) to assess
feasibility of cost-effectiveness analysis.
Review methods
A mixed-methods synthesis following Campbell Collaboration guidelines. Pilot study: three probation service regions in England, each with a CF and a comparator CO site. Participants were adult offenders (aged ≥ 18 years) serving COs. The primary outcome was quality of life [as measured via the Clinical Outcome in Routine Evaluation–Outcome Measure (CORE-OM)]. Other outcomes were health behaviours, mental well-being, connectedness to nature and reconvictions.
Data sources
In November 2014, we searched 22 health, education, environmental, criminal justice and social science electronic databases, databases of grey literature and care farming websites across Europe. There were no language restrictions. A full list of databases searched is given in
Appendix 1; some examples include Web of Science, Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost), The Campbell Library, Criminal Justice Abstracts (via EBSCOhost), MEDLINE (via Ovid) and Scopus (Elsevier B.V., Amsterdam, the Netherlands).
Results
Our systematic review identified 1659 articles: 14 qualitative, 12 quantitative and one mixed-methods study. Small sample sizes and poor design meant that all were rated as being at a high risk of bias. Components of CFs that potentially improve health are being in a group, the role of the farmer and meaningful work, and interaction with animals. There was a lack of quantitative evidence indicating that CFs improve quality of life and there was weak evidence of improved mental health, self-efficacy, self-esteem, affect and mood. In the pilot study we recruited 134 respondents, and only 21 declined; 37% were allocated to three CFs and the remainder to comparators. This was below our recruitment target of 300. Recruitment proved challenging as a result of the changes in probation (probation trusts were disbanded in 2014) and closure of one CF. We found significant differences between CFs and comparator users: those at CFs were more likely to be male, smokers, substance users, at higher risk of reoffending (a confounder) and have more missing CORE-OM questions. Despite these differences, the use of propensity analysis facilitated comparison. Participants consented to our team accessing, and we were able to link, probation and police reconviction data for 90% of respondents. We gained follow-up questionnaire data from 52% of respondents, including health and social care use cost data. We transformed CORE-OM into CORE-6D, allowing derivation of quality-adjusted life-years. As a pilot, our study was not powered to identify significant differences in outcomes. Qualitatively, we observed that within COs, CFs can be formally recognised as rehabilitative but in practice can be seen as punitive.
Limitations
Changes in probation presented many challenges that limited recruitment and collection of cost data.
Conclusions
Recruitment is likely to be feasible in a more stable probation environment. Retention among probationers is challenging but assessing reconvictions from existing data is feasible. We found worse health and risk of reoffending among offenders at CFs, reflecting the use of CFs by probation to manage challenging offenders.
Future work
A sufficiently powered natural experiment is feasible and of value. Using reconvictions (from police data) as a primary outcome is one solution to challenges with retention. Propensity analysis provides a viable method for comparison despite differences in participants at CFs and comparator sites. However, future work is dependent on stability and support for CFs within probation services.
Study registration
This study is registered as PROSPERO CRD42014013892 and SW2013–04 (the Campbell Collaboration).
Funding details
The National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Helen Elsey
- Academic Unit of Public Health, University of Leeds, Leeds, UK
| | - Rachel Bragg
- Essex Sustainability Institute, University of Essex, Colchester, UK
| | - Marjolein Elings
- Plant Research International, Wageningen University, Wageningen, the Netherlands
| | - Cathy Brennan
- Academic Unit of Public Health, University of Leeds, Leeds, UK
| | | | - Sandy Tubeuf
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Rochelle Gold
- NHS e-Referral Service, Health Digital Services, NHS Digital, Leeds, UK
| | - Darren Shickle
- Academic Unit of Public Health, University of Leeds, Leeds, UK
| | | | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Janet Cade
- Nutritional Epidemiology Group, University of Leeds, Leeds, UK
| | - Jenni Murray
- Academic Unit of Public Health, University of Leeds, Leeds, UK
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8
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Sayce L, Boardman J. The Disability Discrimination Act 1995: implications for psychiatrists. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.9.6.397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Disability Discrimination Act, passed by Parliament in 1995, is an important piece of legislation with the potential to protect the employment rights of people with disabilities. It covers people with physical or mental impairments that have a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. The Act has sections regarding protection from discrimination in employment, in the provision of goods, services and facilities, and in education. These parts of the Act have implications for people working in mental health services when they are considering employment and educational opportunities for service users.
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Rinaldi M, Perkins R, Glynn E, Montibeller T, Clenaghan M, Rutherford J. Individual placement and support: from research to
practice. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.003509] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Vocational rehabilitation for people with severe mental health problems is
poorly developed in the UK. Although there is a clear evidence base
indicating the effectiveness of approaches to helping people with severe
mental health problems gain and retain employment there is generally a lack
of awareness of this evidence. As a result there has been a lack of
implementation within routine clinical practice of the most effective
approaches to improving employment outcomes for such individuals.
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Shooter M. Dancing with the Devil? A personal view of psychiatry's relationships with the pharmaceutical industry. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.29.3.81] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Sayce L, Boardman J. Disability rights and mental health in the UK: recent
developments of the Disability Discrimination Act. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.106.003103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Disability Discrimination Act, passed by Parliament in 1995 and amended
in 2001 and 2005, covers people in Britain with physical or mental
impairments that have a substantial and long-term adverse effect on their
ability to carry out normal day-to-day activities. The Act has been
important in setting a framework for good practice and it can stimulate more
systemic change through formal investigations of organisations or whole
sectors, and through the Disability Equality Duty, in force since December
2006. The Disability Discrimination Act has implications for people working
in mental health services when they are considering employment and
educational opportunities for service users, and when they are considering
how to redress systemic disadvantage, including inequalities in physical
health.
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Socio-demographic and clinical factors associated with relapse in mental illness. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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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Cordier R, Milbourn B, Martin R, Buchanan A, Chung D, Speyer R. A systematic review evaluating the psychometric properties of measures of social inclusion. PLoS One 2017; 12:e0179109. [PMID: 28598984 PMCID: PMC5466312 DOI: 10.1371/journal.pone.0179109] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 05/10/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Improving social inclusion opportunities for population health has been identified as a priority area for international policy. There is a need to comprehensively examine and evaluate the quality of psychometric properties of measures of social inclusion that are used to guide social policy and outcomes. OBJECTIVE To conduct a systematic review of the literature on all current measures of social inclusion for any population group, to evaluate the quality of the psychometric properties of identified measures, and to evaluate if they capture the construct of social inclusion. METHODS A systematic search was performed using five electronic databases: CINAHL, PsycINFO, Embase, ERIC and Pubmed and grey literature were sourced to identify measures of social inclusion. The psychometric properties of the social inclusion measures were evaluated against the COSMIN taxonomy of measurement properties using pre-set psychometric criteria. RESULTS Of the 109 measures identified, twenty-five measures, involving twenty-five studies and one manual met the inclusion criteria. The overall quality of the reviewed measures was variable, with the Social and Community Opportunities Profile-Short, Social Connectedness Scale and the Social Inclusion Scale demonstrating the strongest evidence for sound psychometric quality. The most common domain included in the measures was connectedness (21), followed by participation (19); the domain of citizenship was covered by the least number of measures (10). No single instrument measured all aspects within the three domains of social inclusion. Of the measures with sound psychometric evidence, the Social and Community Opportunities Profile-Short captured the construct of social inclusion best. CONCLUSIONS The overall quality of the psychometric properties demonstrate that the current suite of available instruments for the measurement of social inclusion are promising but need further refinement. There is a need for a universal working definition of social inclusion as an overarching construct for ongoing research in the area of the psychometric properties of social inclusion instruments.
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Affiliation(s)
- Reinie Cordier
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Ben Milbourn
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Robyn Martin
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Angus Buchanan
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Donna Chung
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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[Determinants of social participation and social inclusion of people with severe mental illness]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2016; 31:8-16. [PMID: 27966095 DOI: 10.1007/s40211-016-0211-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Individuals with mental disorders are known to be socially excluded so that improving social inclusion has become a major goal of healthcare provision. However, empirical research on specific determinants of social inclusion is rather scarce. METHODS A cross-sectional survey of adults with a severe mental illness (n =70) was conducted using a measure of participation and social inclusion for individuals with a chronic mental disorder (F-INK). Univariate and multivariate regression analyses were conducted to identify determinants of social participation and social inclusion. RESULTS Social participation increased with the number of friends and was, independently thereof, higher in adults living independently than in adults living in supported housing arrangements. The level of social inclusion was higher in those cohabitating and increased with duration of illness. CONCLUSION Findings on social participation indicate the need for a re-organization of community-based supported housing arrangements, and, with respect to existing settings, an amendment of present conditions. To promote social inclusion, measures to prime a feeling of ongoing social affiliation should be taken during the first years of psychiatric illness.
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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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Castle D, Crosse C, Morgain D, McDowell C, Rossell S, Thomas N, Phillipou A, Gilbert M, Moore G, Fossey E, Harvey C. Helping people with a mental illness obtain work: the Health Optimisation Program for Employment. Australas Psychiatry 2016; 24:337-41. [PMID: 27307449 DOI: 10.1177/1039856216654400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Inclusion in work and education remains problematic for many people with a mental illness. We describe a structured programme - the Health Optimisation Program for Employment - that supported people with a mental illness to gain employment or commence studies. METHOD Twenty hours of the Health Optimisation Program for Employment were delivered to 600 individuals. Participants were asked to complete an evaluation survey encompassing vocational status and ratings of self-efficacy. RESULTS Of the 364 participants who completed the baseline assessment, 168 responded to the evaluation survey 6 months after the delivery of the Health Optimisation Program for Employment. Of these, 21.5% had started a new job, while a further 42.8% were either volunteering or studying. Satisfaction with the programme was high and self-efficacy ratings improved significantly over the short term only. CONCLUSIONS The Health Optimisation Program for Employment requires further evaluation using rigorous scientific methodology but these initial results are encouraging in terms of vocational attainment for people with a mental illness, in the Australian context.
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Affiliation(s)
- David Castle
- Department of Psychiatry, University of Melbourne, St Vincent's Hospital, Fitzroy, VIC, Australia
| | | | - Dea Morgain
- Social Firms Australia, Melbourne, VIC, Australia
| | - Caitlin McDowell
- La Trobe University Melbourne, VIC, and: Social Firms Australia, Melbourne, VIC, Australia
| | - Susan Rossell
- Brain and Psychological Sciences Research Centre, Swinburne University, Melbourne, VIC, and; Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Clayton, VIC, Australia
| | - Neil Thomas
- Brain and Psychological Sciences Research Centre, Swinburne University, Melbourne, VIC, and; Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Clayton, VIC, Australia
| | - Andrea Phillipou
- Department of Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia
| | | | - Gaye Moore
- Department of Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, School of Primary Health Care, Monash University, Clayton, VIC, Australia
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne & North Western Mental Health, Melbourne, VIC, Australia
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Lipskaya-Velikovsky L, Kotler M, Jarus T. Factors discriminating employment status following in-patient evaluation among persons with schizophrenia. Work 2015; 53:469-78. [PMID: 26519016 DOI: 10.3233/wor-152178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Employment is a key element in recovery from schizophrenia. Yet 60%-80% of people with schizophrenia are not involved in work occupations. Factors influencing employment were explored mostly in community settings, while the recovery process begins already during hospitalization. OBJECTIVE The aim of the study was to investigate parameters that can distinguish during hospitalization between people with schizophrenia who will work in competitive employment, in sheltered employment or will not work after discharge. METHODS The research followed 104 participants from acute hospitalization to the community, six months after discharge, to obtain employment related data. The participants' cognitive abilities, schizophrenia symptoms, and functional capacity were evaluated during hospitalization. In addition, demography and illness related factors were collected. RESULTS The results indicate that persons with different employment statuses varied in several parameters during hospitalization. However, the most effective discriminant model includes negative symptoms, functional capacity measure and the number of hospitalizations. CONCLUSIONS The study suggests that people with different employment statuses have unique characteristics already during hospitalization. In the future, appropriate rehabilitation programs may be suggested to each group based on these characteristics to promote employment among people with schizophrenia and contribute to recovery.
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Affiliation(s)
- Lena Lipskaya-Velikovsky
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University and Beer-Ya'akov-Ness-Ziona-Maban Mental Health Center affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Kotler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Jarus
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, Canada
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[Practices and interventions related to the work integration of people with a severe mental illness: work outcomes and avenues of research]. Encephale 2014; 40 Suppl 2:S33-44. [PMID: 24929973 DOI: 10.1016/j.encep.2014.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/23/2014] [Indexed: 11/20/2022]
Abstract
Sustained work integration for people with a severe mental illness or handicap psychique in French (e.g., schizophrenia) is an important issue in our society today. Indeed, work is not only an essential factor in people's social integration but is also a stepping-stone toward recovery for this clientele. Well-defined programs and services related to work integration were developed and studied over the last three decades. Although the work integration of people with severe mental illness has been studied extensively in the Anglo-Saxon literature, the impact of these studies on the traditional beliefs and services in France remains uncertain. In terms of the scope of the studies so far, there has been an initial interest lasting over many years to uncover individual characteristics of people with severe mental illness which would best predict job tenure. Since, studies have been increasingly investigating various supports in order to facilitate the work integration process. These supports can be illustrated as direct supports or accommodations offered in the workplace, as needed, particularly when people with severe mental illness choose to disclose their mental disorder in the workplace. This awareness of the impact of the workplace environment on the work integration of people with a severe mental illness increases the need to find solutions and develop environmentally sensitive clinical strategies to overcome difficulties during the work integration. To illustrate this thematic, in this special issue, we have gathered together studies conducted in different countries but who share the focus on work integration of people with a severe mental illness. To reflect the advancement in this domain, this special issue is divided in three parts. The first part consists of the presentation of different types of vocational programs: supported employment programs, social firms, and hybrid models. Supported employment programs are very well documented in the specialised literature and are recognized as an evidence-based practice across the world to help people get competitive employment. Social firms is an another alternative model for facilitating the work integration of people with severe mental illness but has to date scarcely been studied empirically. Other hybrid vocational programs implemented in Québec (Canada) and France and inspired by supported employment programs and social firms' principles, are also described. The second part of this special issue is related to the presentation of two adjunct clinical interventions for helping people with a severe mental illness in their work integration, and more particularly for increasing job tenure: cognitive remediation and group cognitive behavioral therapy. Cognitive remediation was developed to reduce the impact of cognitive deficits, such as memory or attention, in people with a severe mental illness whereas group cognitive behavioral therapy was developed to change the dysfunctional beliefs and behaviours that might hinder job tenure in people receiving supported employment services. Finally, the third part of this special issue presents two papers on the influence of the workplace, of stakeholders from the organization (e.g., employers, supervisors) and of the work environment on the work integration of people with severe mental illness. The first paper discusses disclosure of the mental illness in the workplace and its positive and negative consequences such as receiving work accommodations and experiencing stigma, respectively. In the last paper, psychological processes during the hiring process are presented to better understand the elements related to discrimination and stigma during the work integration of people with severe mental illness.
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Lillie E, Alvarado BE, Stuart H. Unemployment among Canadians with physical and a co-morbid mental disability: An examination of the 2006 Participation and Activity Limitation Survey (PALS). Disabil Health J 2013; 6:352-60. [DOI: 10.1016/j.dhjo.2013.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 02/25/2013] [Accepted: 03/05/2013] [Indexed: 10/26/2022]
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Gaynor K, Brown JSL. Self-referrers to community workshops: Who are they and why do some participants not consult with their GP about their mental health difficulties? J Ment Health 2013; 22:227-36. [DOI: 10.3109/09638237.2012.734646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Unemployment among patients with newly diagnosed first-episode psychosis: prevalence and clinical correlates in a U.S. sample. Soc Psychiatry Psychiatr Epidemiol 2012; 47:797-803. [PMID: 21541697 DOI: 10.1007/s00127-011-0386-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Although it is well established that people with schizophrenia have markedly high rates of unemployment, less is known about the prevalence and clinical correlates of unemployment in patients newly diagnosed with first-episode psychosis. This analysis documented the prevalence of unemployment and examined previously reported clinical correlates of unemployment in patients with first-episode psychosis hospitalized in an urban, public-sector setting in the southeastern US. METHODS Participants (n = 181) were assessed as part of an overarching study of first-episode psychosis using a variety of standardized research instruments. The rate of unemployment was compared to that documented in the general population according to US census data. Bivariate tests of associations between employment status and a number of variables of interest were followed by a multiple logistic regression model based on a previous study from Dublin, Ireland. RESULTS Some 65.0% of first-episode patients were unemployed in the month prior to hospital admission, which is substantially higher than the rate of unemployment during the same period in the two counties in which recruitment took place. In bivariate tests, unemployment was associated with younger age, fewer years of educational attainment, lower global functioning scores, and more severe negative symptoms. In the logistic regression model, only age and global functioning were independently significant correlates. CONCLUSIONS The remarkably high rate of unemployment in this young, first-episode sample, and the evidence of associations between unemployment, greater symptomatology, and poorer functioning, argue for further research and development on supported employment programs for such patients.
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Nygren U, Markström U, Svensson B, Hansson L, Sandlund M. Individual placement and support - a model to get employed for people with mental illness - the first Swedish report of outcomes. Scand J Caring Sci 2011; 25:591-8. [DOI: 10.1111/j.1471-6712.2011.00869.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rinaldi M, Miller L, Perkins R. Implementing the individual placement and support (IPS) approach for people with mental health conditions in England. Int Rev Psychiatry 2010; 22:163-72. [PMID: 20504056 DOI: 10.3109/09540261003720456] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite the overwhelming evidence of the effectiveness of the individual placement and support (IPS) approach to vocational rehabilitation for people with mental health conditions, there is very limited evidence of implementation in the UK. Both government policy and national clinical guidelines have set out a need for the availability of this effective approach in favour of other approaches, yet implementation appears to be an exception rather than a rule. This paper sets out four key challenges to implementing the IPS approach within mental health services in England: fear on the part of professionals, individuals and their families; a culture of low expectations; a failure to provide the support that we know works, and the global 'credit crunch' recession. Using a framework from implementation science, this review identifies the key features of implementing IPS within routine clinical practice from the experience of two large mental health NHS trusts in England.
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Affiliation(s)
- Miles Rinaldi
- South West London and St George's Mental Health NHS Trust, London, UK.
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Gournellis RJ, Triantafillou ES, Madianos MG, Tsinia NN, Ploumpidis DN, Tomaras VD. Diachronic trends of employment outcome of prevocational training in psychiatric rehabilitation. Ann Gen Psychiatry 2010; 9:2. [PMID: 20148106 PMCID: PMC2820026 DOI: 10.1186/1744-859x-9-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 01/06/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although many rehabilitation programmes of prevocational training for chronic mentally ill persons living in the community have been funded, there is scarce literature about the diachronic trends of their long-term employment outcome. Thus the aim of the present study was to compare the 2-year employment outcome of three groups of chronic psychiatric outpatients, having attended similar prevocational rehabilitation programmes in different periods of time. METHODS The first group (1984 to 1986) comprised 67 rehabilitees, the second (1988 to 1989) 53 rehabilitees and the third (2000 to 2001) 56 rehabilitees. The three groups were compared with regard to employment follow-up achievements and hospitalisation rates assessed at the end of the 2-year follow-up period by a constructed overall index, encompassing employment qualitative and quantitative characteristics. RESULTS The third group compared to the first and second ones presented a worse employment outcome. No differences were found among the three groups with regard to hospitalisation rates. CONCLUSIONS There has been a decline in the employment outcome of prevocational training during the current decade. This decline can be attributed to contextual adverse factors such as unemployment, a more demanding labour market and disability allowances offered by the state (the 'benefit trap'). Moreover, the training itself may be 'old-fashioned' enough, thus providing the trainees with inadequate skills to obtain and maintain a competitive job.
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Affiliation(s)
- Rossetos J Gournellis
- Second Department of Psychiatry, University of Athens, Medical School, Attikon General Hospital, Athens, Greece
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Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2010; 45:1-8. [PMID: 19305936 DOI: 10.1007/s00127-009-0034-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 03/06/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested. METHODS The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not. RESULTS The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not (OR = 3.53, 95% CI = 1.25-10.00). CONCLUSION This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.
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Edwards E, Timmons S. A qualitative study of stigma among women suffering postnatal illness. J Ment Health 2009. [DOI: 10.1080/09638230500271097] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Marwaha S, Johnson S. Views and experiences of employment among people with psychosis: a qualitative descriptive study. Int J Soc Psychiatry 2005; 51:302-16. [PMID: 16400906 DOI: 10.1177/0020764005057386] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Work is important for mental health but we are only just beginning to understand why so few people with psychosis in the UK work. AIMS To identify the opinions of a purposive sample of patients with psychosis on themes related to employment. METHOD A thematic analysis of 15 semi-structured interviews with people with schizophrenia or bipolar affective disorder. RESULTS Participants identified a range of advantages to working but also expressed substantial doubts. Symptoms, medication and potential damage to health are the problems that people believe affect their ability to work. Most people would not tell their employers about their illness because they feared discrimination during the selection process, but believed it could help their chances of retaining a job if employers knew. A number reported a lack of encouragement to work from mental health professionals and not enough helpful employment services. CONCLUSIONS Although most people want to work, given the pressures they face some may choose not to. Barriers that people face are both internal and external and these interact.
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Affiliation(s)
- Steven Marwaha
- Department of Psychiatry and Behavioural Science, Royal Free and University College London Medical Schools, London, UK.
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