Individual Placement and Support is the keyhole: Employer experiences of supporting persons with mental illness

"Navigating Between Unpredictable Icebergs": A Meta-Ethnographic Study of Employment Specialists' Contributions in Providing Job Support for People with Mental Illness

Purpose To explore and synthesize the views of Supported Employment clients, employment specialists and their supervisors on the core contributions of employment specialists to job support within the mental health field. Methods We systematically searched four databases with no time limitations and identified 16 qualitative studies published between 2006 and 2018 to be included in this meta-ethnographic study. Results The overarching metaphor of "Navigating an Unpredictable Iceberg-laden Sea" (a workplace) and seven themes were revealed: (1) "It's you and me looking," which represented the relationship between the client and ES, and (2) taking job seekers' ambitions and needs seriously, (3) mapping the route, (4) exploring the hidden, (5) being on tap, (6) avoiding crashes, and (7) bridging, which embodied the work of employments specialists. Conclusion. Our iceberg metaphor illustrates the importance of employment specialists being competent in addressing clients' work performance difficulties related not only to the individual's illness, age, gender, and cultural-related challenges, but also to psychosocial, behavioral, and environmental workplace factors. Given the effects of the specific characteristics of the working alliance developed in supported employment, we suggest that employment specialists' training and supervision be enriched by paying more attention to these important relational processes.

Changes in rehabilitation actors' mental health literacy and support to employers: An evaluation of the SEAM intervention

BACKGROUND

Lack of mental health literacy among rehabilitation professionals and employers in the return-to-work of persons with mental health problems resulted in the development of a three-day group training program, the Support to Employers from rehabilitation Actors about Mental health (SEAM) intervention.

OBJECTIVE

To evaluate the impact of SEAM on rehabilitation professionals' knowledge and beliefs, attitudes, and supporting behaviors towards people with mental health problems and employers as part of the return-to-work process.

METHODS

In this longitudinal study, 94 rehabilitation professionals were included. Data were collected prior to (T1), immediately after (T2) and 6 months after SEAM training (T3) using knowledge and attitude scales and a questionnaire on supporting behaviors. SEAM includes training in Mental Health First Aid, presentations and discussions on current research on work and mental health, and strategies and communication guidelines to use when meeting service users and employers as part of the return-to-work of persons with mental health problems. SEAM also includes a homepage with targeted employer information. Data were analyzed using non-parametric statistics.

RESULTS

SEAM significantly increased rehabilitation professionals' knowledge of mental health (T1-T2: z = -2.037, p = 0.042; T2-T3: z = -5.093, p = 0.001), and improved their attitudes towards persons with mental health problems (T1-T2: z = 4.984, p = 0.001). Professionals (50-60%) also estimated that they had increased their use of supporting strategies towards service users and employers.

CONCLUSIONS

The study suggests that SEAM can increase mental health literacy among rehabilitation professionals and lead to a greater focus on service users' resources and work ability, as well as on employers' support needs.

Exploring the service and knowledge gap between rehabilitation professionals and employers in the return-to-work process of people with mental health problems in Sweden

BACKGROUND

Research is needed on how to optimize the return-to-work process for persons with mental health problems.

OBJECTIVE

To develop a model that explains how employer and rehabilitation professional mental health literacy may influence strategies used in the return-to-work of persons with mental health problems.

METHODS

A grounded theory study design was used to collect and analyse interview data from 23 employers and 22 rehabilitation professionals.

RESULTS

The analysis resulted in four categories, illustrated in a conceptual process model: 1) seeing mental health problems through past experiences; 2) separating understandable and incomprehensible mental health problems; 3) balancing safeguarding one's personal interest with providing adequate support; and 4) facing conflicts and uncertainty in employee/service user return-to-work. A positional map of employer/rehabilitation types was created based on level of negative attitudes and uncertainty in supporting employees/service users and the employer in relation to the level of comprehensive understanding of mental health problems.

CONCLUSIONS

Professional mental health literacy needs to be increased. Interventions need to be developed that provide employers with targeted support and knowledge in mental health literacy. Education on how to prevent and detect common mental health problems in the workplace is needed.

Experiences and perceptions of facilitators of The WORKS

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.

Enabling the return-to-work process among people with affective disorders: A multiple-case study

BACKGROUND

The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives.

METHODS

Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed.

RESULTS

The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working.

CONCLUSION

Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.