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Hagendijk ME, Zipfel N, Melles M, van der Wees PJ, Hulshof CTJ, Zwaan E, van der Burg-Vermeulen SJ, Hoving JL. Patients' Needs Regarding Work-Focused Healthcare: A Qualitative Evidence Synthesis. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10225-8. [PMID: 39052178 DOI: 10.1007/s10926-024-10225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To identify, appraise, and synthesize qualitative research evidence exploring patients' needs regarding work-focused healthcare. METHODS A systematic review was conducted in accordance with the PRISMA statement guidelines to identify studies reporting patients' needs regarding work-focused healthcare. Four databases (MEDLINE, Embase, PsychInfo and Web of Science) were systematically searched from January 2000 until May 2023 and screened in duplicate by pairs of two reviewers. Inclusion criteria were qualitative data collection method, and patients' perspectives regarding healthcare focusing on work when experiencing work-related problems due to chronic medical conditions. Data extraction and synthesis was executed by means of an inductive thematic analysis approach. The quality of the included studies was assessed using the CASP Qualitative Study checklist. Confidence in the review findings was assessed through the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. RESULTS Out of 23,677 records, 97 qualitative studies were included. Needs regarding four main themes were identified: (1) Substantive guidance, which comprises the specific content of work-focused healthcare; (2) Clear and continuous process, which comprises clarification and optimization of the work-focused healthcare process; (3) Supportive attitude and behavior, which comprises a positive and supportive attitude and behavior from professionals towards the patients; and (4) Tailored approach, which comprises the delivery of tailored care to the individuals' needs. 17 subthemes were identified. CONCLUSION The broader insight in patients' needs in work-focused healthcare can help (occupational) healthcare professionals adopt a more patient-centred approach in practice.
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Affiliation(s)
- Marije E Hagendijk
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Nina Zipfel
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Philip J van der Wees
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Carel T J Hulshof
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Elmi Zwaan
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Sylvia J van der Burg-Vermeulen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jan L Hoving
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Dutch Research Center for Insurance Medicine, Amsterdam, The Netherlands
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Noteboom Y, van Nassau F, Bosma AR, van der Hijden EJE, Huysmans MA, Anema JR. A roadmap for sustainable implementation of vocational rehabilitation for people with mental disorders and its outcomes: a qualitative evaluation. Int J Ment Health Syst 2024; 18:7. [PMID: 38341601 DOI: 10.1186/s13033-023-00620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/11/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND People suffering from mental health disorders have lower work participation compared to people without mental challenges. To increase work participation within this group vocational rehabilitation interventions are often offered. Collaboration between the mental health care and social security sectors is needed to enable professionals to perform optimally when carrying out these interventions. Yet, regulatory and financial barriers often hinder sustainable implementation. To overcome these barriers an experimental roadmap for sustainable funding based on a shared savings strategy was piloted in four regions. The aim of the present qualitative study was to gain understanding of the uses of this roadmap and the factors that were important in the experiment's process. METHOD The roadmap consisted of five steps based upon insights from shared savings strategies and implementation science knowledge, and was initiated by a national steering board. The roadmap aimed to make sustainable funding agreements (based on shared savings) for the implementation of a vocational rehabilitation intervention. In four regions, stakeholders from the mental health care and social security services sector followed the roadmap. We conducted interviews (n = 16) with involved participants and project leaders of the experiment and collected 54 sets of field notes and documents to evaluate the roadmap process. A thematic analysis was used to analyse the data. RESULTS Regions perceived improved stakeholder collaboration around vocational rehabilitation after they were guided by the roadmap. Three regions made, or intended to make, agreements on collaboration and funding, yet not based on shared savings. Moreover, going through the roadmap took more time than anticipated. Stakeholder collaboration depended on factors like personal and organizational interests and collaboration conditions and values. Financial legislation and politics were regarded as barriers and personal motives were mentioned as a facilitator in this process. CONCLUSIONS Our study showed that the roadmap supported stakeholders to establish a more sustainable collaboration, even though no sustainable financial agreements were made yet. Although participants acknowledged the function of financial insights and the need for financial resources, the driver for collaboration was found to be more on improving clients' perspectives than on solving unfair financial distribution issues. This suggests modifying the focus of the roadmap from financial benefits to improving clients' perspectives.
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Affiliation(s)
- Yvonne Noteboom
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Femke van Nassau
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Astrid R Bosma
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Eric J E van der Hijden
- Faculteit Der Sociale Wetenschappen, Talma Institute Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Maaike A Huysmans
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Johannes R Anema
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Khalid A, Syed J. A relational perspective of schizophrenia at work. EQUALITY, DIVERSITY AND INCLUSION: AN INTERNATIONAL JOURNAL 2023. [DOI: 10.1108/edi-06-2022-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
PurposeDespite a plethora of research on diversity and inclusion, workplace-related issues pertaining to individuals with schizophrenia (SCZ) remain grossly underexplored. This paper seeks to develop a relational, multilevel perspective of issues and challenges faced by individuals with SCZ in the work and career.Design/methodology/approachThe research draws on the findings from in-depth, qualitative interviews with schizophrenic individuals, individuals’ family members, healthcare professionals and nongovernmental organization (NGO) representatives.FindingsThe findings highlight the interconnected nature of multilevel issues faced by schizophrenic individuals and indicate that at the societal level, social stigma, economic conditions and inadequate government policies are the key challenges faced by them. At the organizational level workplace support and job suitability and design affect individuals’ employment. At the individual level, self-stigma affects the employability in a negative way whereas personal motivation and resilience, family and social support and realization of illness are the facilitating factors.Originality/valueThe study adds to disability and diversity literature by developing a relational perspective that holistically captures the issues faced by schizophrenic individuals and suggests that the work and employment-related issues may be simultaneously addressed at multiple levels.
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van Beukering IE, Smits SJC, Janssens KME, Bogaers RI, Joosen MCW, Bakker M, van Weeghel J, Brouwers EPM. In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:365-379. [PMID: 34487290 PMCID: PMC9576674 DOI: 10.1007/s10926-021-09998-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 05/26/2023]
Abstract
PURPOSE Studies are increasingly showing that health related stigma is a barrier to employment, but it is not known how. The aim of this systematic review is to identify, appraise and analyse studies that have directly or indirectly addressed ways in which stigma affects sustainable employment and well-being at work of people with disabilities. METHODS Using a multiphase screening process, this review is based on a comprehensive literature search (2000-2019) carried out in six electronic databases: Embase, Web of Science, Medline Ovid, Cochrane CENTRAL, PsycINFO and Google Scholar. RESULTS 7.263 publications were identified; 96 studies were found eligible to be included in the review. 72% of the studies were conducted in North America or Europe. Few studies directly assessed how stigma affects the employment of people with disabilities. Most studies highlighted that attitudes and behaviour of employers formed a barrier to employment, as well as anticipated stigma and self-stigma in people with health problems. However, the findings also showed that the attitudes and behaviour of co-workers, health care professionals, reintegration professionals, customers, and family and friends could act as a barrier to employment although these influences are under-researched. Although many similarities were seen in the relevant findings of studies about both physical and mental disabilities, several nuances were found. CONCLUSION Stigma hampers sustainable employment and well-being in multiple ways. Whereas the number of publications on this topic is rapidly increasing, the roles of health care professionals, reintegration professionals, co-workers, customers, and family and friends particularly warrant more attention.
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Affiliation(s)
- I E van Beukering
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
- Inspectorate SZW, Den Haag, The Netherlands.
- , P.O. Box 90513, 5000 LE, Tilburg, The Netherlands.
| | - S J C Smits
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Summa College, Eindhoven, The Netherlands
| | - K M E Janssens
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - R I Bogaers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Brain Research and Innovation Centre, Ministry of Defense, Den Haag, The Netherlands
| | - M C W Joosen
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - M Bakker
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - J van Weeghel
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Phrenos Center of Expertise, Utrecht, The Netherlands
| | - E P M Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Dong S, Hoeflich C, Sirota PV. An examination of the psychosocial factors impacting workplace accommodation requests in individuals with mental disabilities. Work 2022; 72:865-874. [DOI: 10.3233/wor-210518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Individuals with mental health issues experience profound stigma and discrimination, which may contribute to a lack of accommodation utilization to address functional limitations of their work. OBJECTIVES: This study examined how psychosocial factors may predict the request of accommodations by employed individuals with mental disabilities through the framework of social cognitive career theory. METHODS: In the United States, 148 employed adults with mental disabilities completed an online questionnaire to ascertain self-efficacy, outcome expectation, affect, and workplace support. Logistic regression analyses were conducted to examine associations between respondents’ psychosocial factors and request of accommodations. RESULTS: Psychosocial factors (i.e., self-efficacy in accommodation request, outcome expectancy in employers’ compliance with accommodation request, and non-person cost associated with request) were associated with impacting decisions to request accommodations among individuals with mental disabilities. CONCLUSIONS: A focus on bolstering self-efficacy and outcome expectation may assist rehabilitation professionals with facilitating positive occupational outcomes for individuals with mental disabilities. Incorporating increased education on the possible implications of mental disabilities in the workplace may also promote successful employment outcomes.
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Lettieri A, Díez E, Soto-Pérez F, Bernate-Navarro M. Employment related barriers and facilitators for people with psychiatric disabilities in Spain. Work 2022; 71:901-915. [DOI: 10.3233/wor-213642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: People with mental health-related disabilities still experience difficulties in obtaining and maintaining a job. Previous international studies inform about employment barriers and facilitators but there is insufficient research in Spain. OBJECTIVE: To explore what type of employment barriers and facilitators were important for people with psychiatric disabilities with past work experiences in competitive and protected work settings. METHODS: In-depth, semi-structured qualitative interviews with 24 participants selected through purposive sampling. RESULTS: The personal sphere was the content most closely related to barriers, followed by the social environment. Facilitators were more closely related to the interviewees’ social network, followed by elements in their personal sphere and job environment. CONCLUSIONS: The findings suggest the need to implement supported employment services in Spain to promote hiring people with psychiatric disabilities in competitive companies. The results also indicate the need to implement new services aimed at supporting the management of disability information during the process of obtaining and maintaining a job, while there is still a need to conduct anti-stigma and anti-discrimination campaigns.
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Affiliation(s)
- Andrea Lettieri
- Psychology Department, University of Salamanca, Salamanca, Spain
- INTRAS Foundation, Valladolid, Spain
| | - Emiliano Díez
- Instituto Universitario de Integración en la Comunidad (INICO), University of Salamanca, Salamanca, Spain
| | - Felipe Soto-Pérez
- Instituto Universitario de Integración en la Comunidad (INICO), University of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
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Khare C, Mueser KT, Bahaley M, Vax S, McGurk SR. Employment in people with severe mental illnesses receiving public sector psychiatric services in India. Psychiatry Res 2021; 296:113673. [PMID: 33418456 DOI: 10.1016/j.psychres.2020.113673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
The limited literature on employment in people with severe mental illnesses (SMI) in developing countries suggests higher rates than in developed countries. The present study explored rates and associated characteristics of work in people receiving public psychiatric services. Semi-structured interviews were conducted with 150 individuals with SMI (90% schizophrenia-spectrum) receiving public outpatient psychiatric services in an urban district in western India to evaluate employment. Forty percent of participants were employed, most for independent employers (86.7%), and were working an average of 53 hours/week. Earning money was reported as the primary motivation to work. A high proportion (92.2%) of unemployed participants wanted to work. Common barriers to work for unemployed participants who were interested in working were psychological (e.g., stress), mental illness (e.g., symptoms), and work-related factors (e.g., difficulty finding a job). Help finding a job and managing mental illness were the primary desired supports. Rates of employment in people with SMI living in urban areas in India are higher than in developed countries, but much lower than the general population. The high interest in work coupled with specific barriers and desired supports point to the need for vocational rehabilitation for improving the employment functioning of people with SMI in India.
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Affiliation(s)
- Chitra Khare
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave. Boston, MA 02215, USA; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA.
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA; Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA.
| | | | - Sigal Vax
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave. Boston, MA 02215, USA; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA.
| | - Susan R McGurk
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA; Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA.
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Taylor AB, Blackburn N. “It makes me feel part of the society”: Return-to-work decisions of SSDI beneficiaries. JOURNAL OF VOCATIONAL REHABILITATION 2020. [DOI: 10.3233/jvr-201108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The SGA Model Demonstration included a qualitative follow-along study of participants’ return-to-work decision-making. OBJECTIVE: The authors describe the findings, including motivations of SSDI beneficiaries to seek employment and vocational rehabilitation (VR) services, and the social, familial and personal considerations in returning to work. METHODS: This study used a longitudinal qualitative approach, involving a series of in-depth interviews with SSDI beneficiaries who sought services from state VR agencies in Minnesota and Kentucky. RESULTS: Motivations of SSDI beneficiaries to seek employment extend beyond economic need. Fear and confusion associated with balancing financial risks and rewards of returning to work influenced whether participants felt ready to do so. Yet while financial considerations are important, they are often embedded in or superseded by motivations related to family engagement, roles, and responsibilities; activity and social engagement; and the personal meanings of work. Financial and benefits counseling provided through the SGA Model was widely praised by participants, and the informed decision-making process facilitated by the coordinated team approach allowed many to envision pathways that had not previously seemed viable. CONCLUSIONS: Decisions to return to work are governed by multifaceted processes. VR services that are responsive to these complexities can empower individuals to make informed decisions.
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Affiliation(s)
- Allison B. Taylor
- Institute for Community Inclusion, University of Massachusetts, Boston, MA, USA
| | - Nerlie Blackburn
- Institute for Community Inclusion, University of Massachusetts, Boston, MA, USA
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Jennings C, Lhuede K, Bradley G, Pepin G, Hitch D. Activity participation patterns of community mental health consumers. Br J Occup Ther 2020. [DOI: 10.1177/0308022620945166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Previous international research indicates that people with severe mental illness often experience lower levels of activity participation and may therefore be marginalized from occupational opportunities that support recovery. This study aimed to describe activity and participation patterns of consumers of mental health services living in the community and identify significant relationships with demographic characteristics. Method A cross-sectional observational study design was utilized, via data mining of the Activity and Participation Questionnaires completed while receiving services from an area mental health service. Data for 282 consumers, who submitted 333 questionnaires, were included. Results Consumers were mostly engaged in home-based and unpaid work, and their participation in these tasks significantly increased over time. Significant relationships were found between activity participation and age, gender and primary language. Consumers who were older were less likely to participate in employment, education and physical activity, while female and culturally and linguistically diverse consumers were less likely to engage in activities in the community. Conclusion Demographic factors may have a significant impact on the ability of consumers to participate in activities. This may require targeted approaches to activity and participation interventions for specific groups of consumers.
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Affiliation(s)
- Courtney Jennings
- Formerly of Occupational Therapy, Deakin University, Geelong, Australia. Currently LaTrobe Regional Hospital, Traralgon, Australia
| | - Kate Lhuede
- North Western Mental Health, Coburg, Australia
| | | | | | - Danielle Hitch
- North Western Mental Health, Coburg, Australia
- Occupational Therapy, Deakin University, Geelong Australia
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10
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Self-Employment for People with Psychiatric Disabilities: Advantages and Strategies. J Behav Health Serv Res 2020; 46:686-696. [PMID: 29845512 DOI: 10.1007/s11414-018-9625-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Self-employment is an alternative to wage employment and an opportunity to increase labor force participation by people with psychiatric disabilities. Self-employment refers to individuals who work for themselves, either as an unincorporated sole proprietor or through ownership of a business. Advantages of self-employment for people with psychiatric disabilities, who may have disrupted educational and employment histories, include opportunities for self-care, additional earning, and career choice. Self-employment fits within a recovery paradigm because of the value placed on individual preferences, and the role of resilience and perseverance in business ownership. Self-employment creates many new US jobs, but remains only a small percentage of employment closures for people with psychiatric disabilities, despite vocational rehabilitation and Social Security disability policies that encourage it. This commentary elucidates the positive aspects of self-employment in the context of employment challenges experienced by individuals with psychiatric disabilities and provides recommendations based on larger trends in entrepreneurship.
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Abstract
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.
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12
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Thomas TL, Prasad Muliyala K, Jayarajan D, Angothu H, Thirthalli J. Vocational challenges in severe mental illness: A qualitative study in persons with professional degrees. Asian J Psychiatr 2019; 42:48-54. [PMID: 30953884 DOI: 10.1016/j.ajp.2019.03.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Employment is a significant stepping stone towards recovery for persons with severe mental illness. In the last two decades there has been increasing focus on obtaining professional courses and degrees for employment in India. AIM To understand the challenges faced by persons with severe mental illness with professional degrees in obtaining and maintaining employment. METHODS We interviewed 31 individuals with severe mental illness, who had professional degrees, using qualitative interviews. These interviews explored factors that facilitated as well as those that hindered the process of obtaining and sustaining jobs. RESULTS Factors that were identified as facilitators for obtaining and maintaining employment included personal strengths, social support, accommodative work environment, disclosure, support from mental health professionals and services. Factors that were identified as hindering for obtaining and maintaining employment included symptoms of the illness, side effects of medications, stigma, poor social support, academic underachievement, disjointed work history, poor workplace environment and specific cultural, gender issues. CONCLUSION Factors such as workplace accommodations, creating an environment that is permissive of disclosure, using family support and support from mental health professionals will facilitate employment. Addressing factors that hinder such as stigma, academic under-achievement, improving workplace environments, social support will also be important in vocational recovery.
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Affiliation(s)
| | - Krishna Prasad Muliyala
- Psychiatric Rehabilitation Services, Department of Psychiatry, NIMHANS, Bangalore, 560029, India.
| | - Deepak Jayarajan
- Psychiatric Rehabilitation Services, Department of Psychiatry, NIMHANS, Bangalore, 560029, India.
| | - Hareesh Angothu
- Psychiatric Rehabilitation Services, Department of Psychiatry, NIMHANS, Bangalore, 560029, India.
| | - Jagadisha Thirthalli
- I/C Head of Psychiatric Rehabilitation Services, Department of Psychiatry, NIMHANS, Bangalore, 560029, India.
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13
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Ebuenyi ID, Guxens M, Ombati E, Bunders-Aelen JFG, Regeer BJ. Employability of Persons With Mental Disability: Understanding Lived Experiences in Kenya. Front Psychiatry 2019; 10:539. [PMID: 31417437 PMCID: PMC6683784 DOI: 10.3389/fpsyt.2019.00539] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/12/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction: Globally, mental illness affects social and occupational functioning. We aimed to highlight the barriers to employment experienced by persons with mental disabilities in Kenya and how they manage to find work against all the odds. Materials and Methods: Using a mixed-method study design, we purposely sampled persons with mental illness through networks of persons with psychosocial disabilities (Users and Survivors of Psychiatry and Africa Mental Health Foundation, Kenya). Qualitative data were obtained through in-depth interviews (n = 14) and four focus group discussions (n = 30), while a researcher-designed questionnaire was used to obtain quantitative data (n = 72). Results: We identified five major clusters of barriers to employment: mental illness factors, social exclusion and stigma, work identity crisis, non-accommodative environment, and socioeconomic status. Factors that facilitated employment include self-awareness and acceptance, self-employment, provision of reasonable accommodation, improved health services, addressing discriminatory laws and practices, and social development programs and support. Participants considered psychiatric illness the highest barrier to employment (63.2%), while supportive family/friends were considered the highest facilitator of employment (54.5%). Conclusion: The employment experiences of persons with mental disabilities are influenced by various interrelated factors in their social environment. Proactive social support and affirmative action by government may improve their employment opportunities and quality of life.
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Affiliation(s)
- Ikenna D Ebuenyi
- Athena Institute, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Mònica Guxens
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Joske F G Bunders-Aelen
- Athena Institute, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Barbara J Regeer
- Athena Institute, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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14
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Abstract
BACKGROUND Some people who have a mental illness may require vocational rehabilitation and support to assist their participation in activity and employment. The WORKS is a vocational rehabilitation group intervention program, co-facilitated by Peer-Support Workers and Occupational Therapists. These facilitators provide support and guidance to people with a mental illness through practical activities and goal development. OBJECTIVE This study aimed to explore the lived experiences and perceptions of facilitators of The WORKS. METHODS The Integrating Theory, Evidence and Action (ITEA) method was used in this study, employing a phenomenological approach. Facilitators of The WORKS at a metropolitan Australian mental health service were purposively sampled, and four participated in semi-structured interviews. Data was transcribed verbatim and member checked, before being coded and analysed with reference to the Model of Human Occupation. RESULTS Five themes emerged from the data; Consumer Growth [Volition], Facilitator's Occupational Identity [Volition], Role of Facilitators [Habituation], Workload of Facilitators [Performance Capacity], and Adaptation of The WORKS Resources [Performance Capacity]. CONCLUSIONS All participants perceived benefits related to The WORKS however discussed a co-facilitation power imbalance between facilitators. Therefore, more development is needed around the co-facilitation relationship between Occupational Therapists and Peer-Support Workers.
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Affiliation(s)
- Jade Curtin
- Faculty of Health, School of Health and Social Development, Occupational Therapy, Deakin University, Geelong, VIC, Australia
| | - Danielle Hitch
- Faculty of Health, School of Health and Social Development, Occupational Therapy, Deakin University, Geelong, VIC, Australia.,North Western Mental Health, Melbourne, VIC, Australia
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Thisted CN, Nielsen CV, Bjerrum M. Work Participation Among Employees with Common Mental Disorders: A Meta-synthesis. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:452-464. [PMID: 29234956 DOI: 10.1007/s10926-017-9743-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Purpose The aim was to aggregate knowledge about the opportunities, challenges and need for support employees with common mental disorders experience in relation to work participation in order to develop recommendations for practice. Methods A meta-synthesis was conducted using a meta-aggregative approach to accurately and reliably present findings that could be used to meet our aim. Qualitative inductive content analysis was used to analyze and synthesize the findings. Results In all, 252 findings were extracted from 16 papers, and six categories were generated and aggregated into two synthesized findings. One synthesized finding indicates that a strong work identity and negative perceptions regarding mental disorders can impede work participation, creating an essential need for a supportive work environment. The other reveals that the diffuse nature of the symptoms of mental disorders causes instability in life and loss of control, but through the use of internal motivation and external support, employees may be able to regain control of their lives. However, external support is hampered by insufficient cooperation and coordination between vocational stakeholders. Conclusions Based on the synthesized findings, we recommended that the employer is involved in the rehabilitation process, and that rehabilitation professionals seek to strengthen the employee's ability to manage work-related stress. In addition, rehabilitation professionals should provide individualized and active support and ensure meaningful cooperation across the multidisciplinary disciplines involved in the rehabilitation process.
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Affiliation(s)
- Cecilie Nørby Thisted
- Department of Public Health, Section of Nursing, Aarhus University, Bartholins Allé 2, 3., 8000, Aarhus C, Denmark.
| | - Claus Vinther Nielsen
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Merete Bjerrum
- Department of Public Health, Section of Nursing, Aarhus University, Bartholins Allé 2, 3., 8000, Aarhus C, Denmark
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Mellifont D. DESperately Seeking Service: A narrative review informing a disability employment services reform framework for Australians with mental illness. Work 2017; 58:463-472. [DOI: 10.3233/wor-172643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Damian Mellifont
- Centre for Disability Research and Policy, The University of Sydney, NSW, Australia. Tel.: +61 0434 956 400; E-mail:
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