Workplace social networks and their relationship with job outcomes and other employment characteristics for people with severe mental illness

A relational perspective of schizophrenia at work

Purpose

Despite 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/approach

The research draws on the findings from in-depth, qualitative interviews with schizophrenic individuals, individuals’ family members, healthcare professionals and nongovernmental organization (NGO) representatives.

Findings

The 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/value

The 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.

Predictors of Job Satisfaction for People with Visual Impairments

Introduction: Job satisfaction research has focused on the general population or specific careers. Little attention has focused on the job satisfaction of persons with visual impairments, particularly using standardized measures of job satisfaction. This study examined how relationships with colleagues and supervisors, opportunities for advancement, and employee demographics predict job satisfaction for employees with visual impairments. Methods: Researchers analyzed data from 195 employed participants from a larger study on job retention and career advancement. The Brief Job Satisfaction Measure II measured job satisfaction, and predictor variables focused on relationships with colleagues and supervisors, promotion opportunities, and demographics. Researchers used multiple linear regression to identify predictors of job satisfaction. Results: Individuals with visual impairments had high job satisfaction if they believed colleagues treated them the same as sighted colleagues and had supervisor support. Underemployed individuals with visual impairments experienced lower job satisfaction. Employees who identified their race as other, those who experienced vision loss after their first job, and participants with an additional disability had higher job satisfaction. Discussion: Social interactions with colleagues and supervisors contributed to the job satisfaction of employees with visual impairments. These interactions may make employees with visual impairments feel comfortable asking for workplace accommodations and more integrated into the workspace. While income was not a predictor of job satisfaction, underemployment was, indicating that individuals with visual impairments may not have achieved their maximum vocational potential. Implications for Practitioners: Individuals with visual impairments and service providers should look for opportunities to promote social interactions at work. Training co-workers and supervisors about working with persons with visual impairments and accommodations could be beneficial. Vocational rehabilitation counselors should also ensure program participants have employment opportunities that are both economically sustainable and commensurate with their interests and abilities.

La discapacidad de especial dificultad. Perspectivas y líneas de actuación

Al tratarse la discapacidad y el empleo en los estudios académicos, normalmente se hace de una forma conjunta, sin tener en cuenta la diversidad que existe dentro de este ámbito. La realidad es que, según el grado y la tipología de discapacidad, la incorporación al mercado laboral resulta más o menos sencilla. De hecho, la legislación española ha definido lo que denominamos discapacidad de “especial dificultad” con la finalidad de diferenciar unos grados y tipos determinados. Este artículo pretende incidir en las características de dicha categoría, mostrando aquellos aspectos que la diferencian del resto. Se proponen asimismo unas estratégicas líneas de acción a seguir por parte de la administración pública. Con la proposición de estas líneas de acción se pretende recibir una respuesta específica de apoyo a estas personas, cuya incorporación al mercado laboral no es tan solo un propósito loable y de responsabilidad social, sino que a su vez genera un impacto positivo en la economía, donde el empleo protegido va cada vez ganando mayor importancia.

Minds@Work: A New Manualized Intervention to Improve Job Tenure in Psychosis Based on Scoping Review and Logic Model

Introduction A significant proportion of people experiencing psychosis are unemployed, despite a strong desire to work. Current supported employment programs appear effective in helping them obtain employment, yet job tenure remains an arduous challenge. The objective of this study was to review the literature and model the results to inform the development of a new manualized group psychosocial intervention-'Minds@Work'-aimed specifically at improving job tenure in psychosis. Methods The study was registered on the Open Science Framework platform ( https://osf.io/he68z ). The literature was searched in Medline, Embase, PsycInfo and Cochrane Library databases for studies examining predictors of job tenure in psychosis and existing occupational psychosocial interventions. Data were extracted using a pre-established form and synthesized using logic models. Results A total of 94 studies were included and their findings were modeled using different categories: intervention typologies, mechanisms of action, predictors of job tenure, outcomes and contextual factors. The 'Minds@Work' program was built based on these modeled findings and aimed to target specific predictors of job tenure while addressing some of the limitations of existing interventions. The program uses evidence-based techniques and is divided into 9 modules covering 4 themes: positive psychology (motivation, character strengths, self-compassion), neurocognitive remediation (attention, memory, problem-solving), cognitive biases training (jumping to conclusions, defeatists beliefs, theory of mind, attributional styles) and socioemotional coping skills (emotion regulation, communication). Conclusions Once validated, this new program is meant to be used either as a stand-alone intervention or integrated in supported employment initiatives, by employment specialists or healthcare workers.

Functional status and return to work in people with major depression: a 3-year national follow-up study

PURPOSE

Major depressive disorder (MDD) affects a person's function of daily activities, including work participation. Such functional impairments often persist even when other symptoms of MDD are remitted. Increasing evidence highlights the health-promoting effects of returning to work (RTW) in various diseases. However, limited data are available regarding the impact of return to work on functional recovery in MDD. We explored the association between RTW and functional improvements in people with MDD using a large nationally representative database and a 3-year follow-up.

METHODS

Data of people with an MDD diagnosis were selected from the Taiwan Data Bank of Persons with disability for the period between July 11, 2012, and October 31, 2018. We included 4038 adults aged 18-64 years. The World Health Organization Disability Assessment Schedule 2.0 was used for functional assessment. The association between RTW and functional improvements was investigated using a multivariable regression analysis adjusted for confounding variables.

RESULTS

Women aged ≥ 45 years with a lower education level were vulnerable to prolonged unemployment. RTW was significantly associated with better functional improvements in cognition, mobility, self-care, getting along, life activity, and participation than unemployment.

CONCLUSIONS

RTW was positively associated with functional improvements in patients with MDD. A referral system targeting re-employment may be suggested during MDD treatment, especially for individuals at risk of prolonged unemployment.

Predictors of competitive employment in individuals with severe mental illness: results from an observational, cross-sectional study in Germany

BACKGROUND

Employment is of great importance as it is associated with various positive effects. Individuals with severe mental illness (SMI) are often excluded from competitive employment. Current data on employment of individuals with mental illness are rare, and influencing factors are under-researched. The present study examines possible predictors of competitive employment among individuals with SMI.

METHODS

This was a cross-sectional and multicentered study of 300 individuals with SMI aged 18 to 65 years. The following inclusion criteria were used: (I) diagnosis of schizophrenia, schizotypal and delusional disorders (ICD-10 F2x), or affective disorders (ICD-10 F3x), (II) duration of psychiatric illness ≥ 2 years, and (III) substantial impact of illness on social functioning. Participants were interviewed by trained staff using standardised instruments. The relationship between potential predictors (age, sex, education, marital status, living situation, migration background, psychosocial functioning, age at first mental problem, physical illness, work ability) and employment was analysed using a hierarchic binary logistic regression model.

RESULTS

Only one-third (34%) of participants were competitively employed. Almost one-third were unemployed (30%), and 28% reported early retirement due to mental illness. Psychosocial functioning was positively associated with competitive employment (OR = 1.09, 95% CI: 1.05 - 1.13, p < 0.001); concurrent chronic physical illness was negatively associated with competitive employment (OR = 0.38, 95% CI: 0.21 - 0.71, p = 0.002).

CONCLUSIONS

Findings confirm a high risk of exclusion from competitive employment among individuals with SMI. Nonetheless, a substantial proportion of individuals are employed. Findings call for efforts to maintain or enhance workforce participation among individuals with SMI. A special focus should be placed on improving physical health and strengthening psychosocial functioning.

TRIAL REGISTRATION

The study was registered in the German Clinical Trials Register (DRKS) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019).

The social support, mental health, psychiatric symptoms, and functioning of persons with schizophrenia participating in peer co-delivered vocational rehabilitation: a pilot study in Taiwan

BACKGROUND

Vocational peer support (VPS) services are recovery-oriented interventions in modern psychiatric care for persons with schizophrenia. However, few VPS services are found in Taiwan. Hence, a pilot program of peer co-delivered vocational rehabilitation to support persons with schizophrenia in Taiwan was proposed and evaluated.

METHODS

Six peers were trained and were willing to co-lead and assist workplace problem-solving groups and care skills training in an extended vocational rehabilitation program from August 2017 to December 2018. The social support, mental health, psychiatric symptoms, and functioning of service users were assessed before and after peer co-delivered services, and the assessments were based on the following: Social Support Scale (SSS), Chinese Health Questionnaire-12 (CHQ-12), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Function (GAF), and the Chinese version of the Social Functioning Scale (C-SFS).

RESULTS

The recruited 46 service users were mostly middle-aged (49.1 ± 9.8), with 27 being male (58.7%). After interventions, 42 service users who completed the program had a significantly increased SSS score (149.1 ± 31.8 vs. 161.2 ± 35.0, df = 41, t = 2.70, p = 0.01) and subscale of friend-peer dimension (44.4 ± 12.0 vs. 53.2 ± 13.2, df = 41, t = 4.72, p < 0.001). The objective (GAF: 69.8 ± 9.8 vs. 72.6 ± 8.8, df = 41, t = 3.50, p = 0.001) and subjective social functional scores (C-SFS: 75.2 ± 8.8 vs. 78.1 ± 9.5, df = 41, t = 2.59, p = 0.01) both significantly increased. The weekly wage elevated significantly (37.5 ± 35.5 vs. 43.6 ± 38.0, df = 41, t = 2.57, p = 0.01) and the BPRS-18 score decreased significantly, too (31.2 ± 6.7 vs. 29.3 ± 5.0, df = 41, t = - 2.83, p = 0.007).

CONCLUSIONS

Peer co-delivered vocational rehabilitation services may enhance the social support received by persons with schizophrenia and improve their occupational outcomes. The pilot program proposed can thus be a model for non-Western countries with limited resources allocated by governments to support persons with schizophrenia.

TRIAL REGISTRATION

ClinicalTrials NCT04767204, retrospectively registered on Feb 23, 2021.

Job satisfaction among disabled people in the sheltered workshop: Differential analysis

This paper analyses job satisfaction and differences in factors affecting it among workers with an intellectual disability and mental illness (MI) depending on their work regime [special employment regime (SER) or occupational service (OS)]. To do so, answers were analysed from 874 participants on a Job Satisfaction Scale used in sheltered workshops in Spain. The results indicate that job satisfaction among workers with intellectual disability and MI in both the SER and the OS regimes is high, with the highest job satisfaction deriving from the Items of communicating problems to resolve them. The lowest levels of job satisfaction are related to the opportunity to take decisions and participate at work. In the majority of the Items analysed, no differences were found on the basis of the age groups considered nor the gender of the participants.

A Pilot Test of Group Based Cognitive Behavioral Therapy to Augment Vocational Services for Persons With Serious Mental Illness: Feasibility and Competitive Work Outcomes

Persons with serious mental illness (SMI) struggle with work functioning even with the assistance of vocational services. The current study sought to address this problem by examining a cognitive-behavioral therapy to augment vocational services. Fifty-two adults with SMI receiving vocational services participated in a pre-post feasibility trial of the Cognitive Behavior Therapy for Work Success (CBTw) intervention. CBTw is a 12-week manualized intervention that addresses cognitive and behavioral factors that impact work functioning. Competitive work outcomes were assessed in the 12 weeks preceding baseline and after the intervention. The results demonstrate strong session attendance and a low attrition rate. There were also significant improvements in work outcomes. Specifically, among participants unemployed at baseline, 50.0% attained work during follow-up. These findings provide preliminary evidence that CBTw may be a feasible intervention to augment vocational services; further controlled research should examine its benefit to work outcomes in people with SMI.

Factorial Validity of thePerceived Empathic and Social Self-Efficacy Scalefor Adults with Serious Mental Illness: A Brief Report

The objectives of this study were (1) to evaluate the measurement structure of thePerceived Empathic and Social Self-Efficacy Scaleamongst 194 individuals with serious mental illness (SMI) and (2) to establish construct validity for thePerceived Empathic and Social Self-Efficacy Scale. Confirmatory factor analysis yielded a two-factor measurement structure of thePerceived Empathic and Social Self-Efficacy Scale, which was positively associated with insight, social support, and life satisfaction. ThePerceived Empathic and Social Self-Efficacy Scaleis a useful measure to assess social skills amongst individuals with SMI in rehabilitation counselling.

A review of job tenure under the Job in Jeopardy programme in first episode psychosis

Introduction

This paper explores what happens to young people with psychosis who have competitive employment when they first engage in treatment.

Method

11 of 39 (28%) of programme participants of an individual placement and support programme who received vocational assistance under the Job in Jeopardy funding were identified. A prospective observational design was used to evaluate programme outcomes over a minimum of 6 months.

Results

It is of interest that the majority of young people who were at risk of losing their job and were receiving assistance did not manage to sustain employment. At the completion of data collection only two people continued to be engaged in competitive employment.

Conclusion

Although the sample is very small, there appears to be a clear trend demonstrating that being engaged in competitive employment at the point of experiencing a first episode of psychosis does not protect an individual against losing that job. It is evident that staff involved with this group of clients need to assist those with employment to maintain it. There is the potential for occupational therapists to play a key role in assisting these young people to secure and maintain meaningful occupation.

Psychological Predictors of Vocational Success for People with Psychotic Illness

People diagnosed with psychotic illness continue to be underrepresented in the workforce despite the widespread provision of vocational rehabilitation services for people experiencing mental illness. A systematic literature review was undertaken using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to identify psychological predictors of successful return to work for this population. The databases searched were PsycARTICLES, PsycINFO, PubMed, ProQuest, Cumulative Index of Nursing and Allied Health (CINAHL), and Taylor & Francis Online. A total of 4,076 articles were located and of these, 29 articles were analysed as part of this review. The data extracted was synthesised using a narrative approach. A number of psychological factors were identified which are predictive of successful return to work. These factors include but are not limited to identity, self-management of illness, social cognition, hope and self-esteem and motivation. On the basis of the reviewed literature, practice guidelines are proposed which support the psychological processes identified as pivotal to vocational success for people diagnosed with psychotic illness.

[Disclosure of a mental disorder in the workplace and work accommodations: two factors associated with job tenure of people with severe mental disorders]

Job tenure for people with severe mental disorders (e.g., schizophrenia) remains a stumbling-block to their work integration. However, the length of job tenure can vary according to the workplace (e.g., provided resources) and the work context (e.g., regular market, social firms). This gap can be explained in part by diverse organisational components, particularly the implementation of work accommodations, which is related to the disclosure of the mental disorder in the workplace. Indeed, in the scientific literature, the principal reason associated with disclosure is in regards to requesting work accommodations. The main objective of this paper is to increase our understanding of the relationships between these three concepts - disclosure of a mental disorder, work accommodations and natural supports, and job tenure - by reviewing the specialized literature and presenting the work of the authors of this paper. To do so, the authors will address the following questions: How do we define 'disclosure' of a mental disorder in the workplace and what are the strategies to consider before disclosing? What is the decision-making process related to disclosure in the workplace? How are the three concepts - disclosure of the mental disorder in the workplace, work accommodations and job tenure - intertwined? Finally, how can employment specialists facilitate the work integration of people with severe mental disorders by considering the three concepts mentioned above? Results from a review of the literature show that disclosure of a mental disorder is a dialectical process that goes beyond the question: to tell or not to tell? In fact, it is not a single binary decision. Several components are associated with the disclosure concept, and can be summarized by the questions: What, how, when and to whom to disclose his/her mental condition? Reasons for disclosing his/her mental disorder in the workplace are numerous, characterized by personal, interpersonal and work environmental factors, on one hand. On the other hand, disclosure has potential consequences, both positive (e.g., to obtain work accommodations) and negative (e.g., stigma). A decision-making process takes place when people with a severe mental disorder think about the possibility of disclosing their mental condition in the workplace - a complex decisional process involving the need to evaluate different aspects (i.e. individual, interpersonal and work environmental factors). Also, the literature supports the fact that requiring work accommodations is often related to the disclosure of the mental disorder, when natural supports in the workplace are not available. The literature is scarce regarding the correlations between the concepts of disclosure, implementation of work accommodations and job tenure; however, a more recent study demonstrated this significant relationship, in which the supervisor and co-worker supports are crucial. Employment specialists or counselors recognise the importance of planned disclosure as a means to obtain access to work adjustments in the workplace and to prevent stigma. The employment specialist working in supported employment programs for instance, could adopt with his/her clients a plan for managing the pros and cons of disclosure of the mental disorder in the workplace; this plan is entitled: Managing personal information. It consists of several steps - for example, to collect details of any sensitive information such as diagnosis, to identify work restrictions with the client, to have a common agreement (employment specialists and clients together) on terms to describe work restrictions - to help clients feel empowered and more confident as productive and valued workers. This plan allows employment specialists to work through the disclosure concept, often negatively connoted, and to adopt a more normalising strategy. Furthermore, additional tools for supporting the management of personal information plan could be used such as the Decision-Making About Disclosure Scale, the Barriers to Employment and Coping Efficacy Scale, and the Work Accommodation and Natural Support Scale, to name a few. To conclude, job tenure for people with severe mental disorders is not a pious vow, several pragmatic ingredients for intervening on this issue are now available.

Factors affecting the acceptance of people with disabilities at work: a literature review

PURPOSE

A lack of social acceptance by non-disabled co-workers is often the reason why employees with disabilities fail to stay in regular organizations for sustained periods. The aim of the study is to present a coherent review of the extant literature on factors affecting the acceptance of people with disabilities in regular employment.

METHOD

We conducted a search of the electronic databases PsychINFO and Web of Science (period: 1996-2011) supplemented with a search for additional relevant articles by means of cross-referencing. In total 48 articles were selected, coded and analyzed by three coders into three overarching themes.

RESULTS

The analysis of included articles shows that the acceptance of employees with disabilities is influenced by three main variable groups: characteristics of co-workers, of the persons with disabilities and of the employers/organizations. Most studies present factors that influence co-workers' or employers' attitudes toward employees with disabilities such as demographic variables.

CONCLUSION

Although, recent research has started to accumulate findings on factors that affect the acceptance of employees with disabilities, many gaps remain in the understanding of the concept of acceptance and its relation to the employment of people with disabilities.

A test of the occupational matching hypothesis for rehabilitation clients with severe mental illness

PURPOSE

This study compared job matching rates for clients with severe mental illness enrolled in two types of employment programs. Also examined was the occupational matching hypothesis that job matching is associated with better employment outcomes.

METHODS

The study involved a secondary analysis of a randomized controlled trial comparing evidence-based supported employment to a diversified placement approach. The study sample consisted of 187 participants, of whom 147 obtained a paid job during the 2-year follow-up. Jobs were coded using the Dictionary of Occupational Titles classification system. Match between initial job preferences and type of job obtained was the predictor variable. Outcomes included time to job start, job satisfaction, and job tenure on first job.

RESULTS

Most occupational preferences were for clerical and service jobs, and most participants obtained employment in these two occupational domains. In most cases, the first job obtained matched a participant's occupational preference. The occupational matching hypothesis was not supported for any employment outcome. The occupational matching rate was similar in this study to previous studies.

CONCLUSIONS

Most clients who obtain employment with the help of evidence-based supported employment or diversified placement services find jobs matching their occupational preference, and most often it is a rough match. Occupational matching is but one aspect of job matching; it may be time to discard actuarial classification systems such as the Dictionary of Occupational Titles as a basis for assessing job match.