Preference for Competitive Employment in People with Mental Disorders: A Systematic Review and Meta-analysis of Proportions

PURPOSE

The inclusion of people with mental disorders (MD) into competitive employment has become an important political and therapeutic goal. The present paper investigates meta-analytically to which extent people with MD who were unemployed or on sick leave due to MD prefer to work in a competitive job environment.

METHODS

For this systematic review and meta-analysis of proportions, we searched Medline, PsycInfo, Cinahl, Google Scholar, and reference lists for peer-reviewed publications from 1990 to Dec 2023, which provided data on the job preferences of people with MD. Two authors independently conducted full-text screening and quality assessments. Pooled proportions of job preferences were calculated with a random-effects meta-analysis of single proportions, and subgroup analyses were performed to examine characteristics associated with job preferences.

RESULTS

We included 30 studies with a total of 11,029 participants in the meta-analysis. The overall proportion of participants who expressed a preference for competitive employment was 0.61 (95%-CI: 0.53-0.68; I2 = 99%). The subgroup analyses showed different preference proportions between world regions where the studies were conducted (p < 0.01), publication years (p = 0.03), and support settings (p = 0.03).

CONCLUSION

Most people with MD want to work competitively. More efforts should be given to preventive approaches such as support for job retention. Interventions should be initiated at the beginning of the psychiatric treatment when the motivation to work is still high, and barriers are lower.

TRAIL REGISTRATION

The protocol is published in the Open Science registry at https://osf.io/7dj9r.

What role does employment play in dual recovery? A qualitative meta-synthesis of cross-cutting studies treating substance use treatment, psychiatry and unemployment services

Purpose

The role of employment in dual recovery from mental illness and substance use is scarcely addressed in previous studies and a deeper understanding of this issue is needed. The purpose of this paper is to cast further light on the conditions that either facilitate or block the road to employment for dually diagnosed people (DDP) and how these conditions could either promote or hinder recovery.

Design/methodology/approach

Drawing on the principles laid out by health researchers Sandelowski and Barroso (2007), the study is designed as a qualitative meta-synthesis comprising a systematic literature search, a critical assessment of the identified studies and an integrative synthesis of the articles’ findings.

Findings

The synthesis outlines that the findings from the seven identified studies show a recovery process in which unemployed, DDP are becoming employed people – or where there is an attempt to restore their status as working persons – and how this process is driven or hindered by personal, interpersonal and systemic facilitators or barriers.

Research limitations/implications

The synthesis adds nuances to the understanding of employment in dual recovery processes and suggests that unconnected means of, and goals for, intervention among these individuals and systems might reduce the chances of DDP obtaining and maintaining a job.

Originality/value

The paper calls for more advanced research and policy on the multiple – and often contradictory – aspects of gaining and maintaining employment as part of dually diagnosed persons’ recovery.

How do Swedish day center attendees with psychiatric disabilities view their worker role? A structural equation modeling study

AIM

To investigate how day center attendees with psychiatric disabilities perceived their worker role and the importance of current work situation and personal factors in that respect.

METHODS

Two-hundred attendees completed the Worker Role Self-assessment and questionnaires addressing possible predictors of the worker role: current employment situation, satisfaction with that situation, and a personal factor (encompassing self-esteem, self-mastery and engagement). Structural equation modeling was used.

RESULTS

A model indicated two worker role factors; belief in a future worker role (WR1) and current capacities and routines (WR2). WR1 was positively influenced by having a job, younger age and the personal factor. Satisfaction with current work situation (usually unemployment) was negatively associated with WR1. The personal factor was single predictor of WR2. The attendees rated WR2 more positively than WR1.

CONCLUSIONS

The personal factor was crucial for both WR1 and WR2. Work-related factors were only important for WR1. The more negative rating of belief in a future worker role may be interpreted as mistrust in the services. The attendees' positive ratings of capacities indicate, however, that they had a rehabilitation potential to develop. Enhancing self-esteem, mastery and engagement may be an avenue for staff in efforts to support the attendee's worker role.

The Experience of KAI MAHI, an Employment Initiative for People with an Experience of Mental Illness, as Told by Zarna, Zeus, Lulu, Mary, Paul, and Hemi

There is a growing body of evidence endorsing the use of supported employment models for people with an experience of mental illness. However current literature and research regarding the perspective of people with experience of mental illness, as well as alternate models of employment support, is sparse. This study has captured the stories of employment of people with experience of mental illness who participated in KAI MAHI, a group based employment program. Findings identified key components of KAI MAHI, consistent with their overall experiences of employment, which were influential in assisting them to find and sustain employment. These included the opportunity for self-determination, a sense of self-efficacy, and respectful relationships.

An occupational perspective of youth positive mental health: A critical review

Introduction

The experience of youth positive mental health has attracted limited research interest, despite healthcare shifting to a preventative approach, promoting health and wellbeing rather than focusing on illness. The aim of this critical review was to develop an understanding of youth positive mental health from an occupational perspective.

Method

Eight databases were searched and findings from each of the 11 relevant studies were critically reviewed and analysed using the Canadian Model of Occupational Performance and Engagement (CMOP-E). The three core elements of the CMOP-E were used as themes: personal factors, environment and occupation.

Findings

Each of the core components of the CMOP-E were identified as influencing youth positive mental health. The importance of supportive social environments and social occupations were particularly prevalent. Deeper understandings of the influence spirituality and institutional environments have on positive mental health for youth are required.

Conclusion

Youth positive mental health is a complex concept and requires the consideration of personal, environmental and occupational factors. Gaps identified included limited evidence of how young people engaged in mental health services perceive positive mental health. To gain a deeper understanding of positive youth mental health, future research needs to be conducted to obtain the perspective of young people.

'Without Occupation You Don't Exist': Occupational Engagement and Mental Illness

This phenomenological study explores the meanings of work for people living with severe and enduring mental health conditions. The participants were three women and seven men who were attending a mental health day centre. Data were collected through up to three depth interviews with each participant over 18 months. The interviews were digitally recorded, transcribed verbatim, and analysed according to phenomenological principles. Two overarching themes were identified. Building and maintaining an occupational identity expressed the ways in which participants used occupations as the building blocks of an evolving identity. Most of the participants wanted to work, and participation in occupations was seen as essential to recovery from mental ill-health. Work and other ways of belonging encapsulated the need to feel connected to others. Many of the participants envisaged working as a way of achieving this. The longitudinal nature of the study facilitated engagement with the developing narratives and exploration of the changes and consistencies in the participants' meaning making about their occupations. Implications for understanding individuals' occupational participation which enhances a sense of self and promotes feelings of belonging are identified.

In the footsteps of Wilcock, Part two: The interdependent nature of doing, being, becoming, and belonging

The four dimensions of occupation developed by Wilcock in the Occupational Perspective on Health-doing, being, becoming, and belonging-have evolved. Although the inter-relationships between the dimensions have been explored by clinicians and researchers to some degree, the reciprocal and multidimensional nature of these relationships are rarely explicitly addressed. This article will present a critical analysis of the relationships and interaction between doing, being, becoming, and belonging, initially in dyads and then in a multidimensional way. The article proposes provisional understandings of how they combine and influence each other in occupational engagement. Six observations are made on the dimensions of occupation, along with a discussion of the impact of their interrelationships on research and practice.

"Balancing on Skates on the Icy Surface of Work": a metasynthesis of work participation for persons with psychiatric disabilities

PURPOSE

To explore how persons with psychiatric disabilities experience facilitators of and barriers to participation in paid work in transitional, supported, and open employment settings, in order to provide guidance for efforts to attract and retain these persons in gainful employment as a key dimension of recovery and community life.

METHODS

A metasynthesis was conducted using 16 qualitative studies published between 1990 and 2011.

RESULTS

Ten themes, two phases, and an overarching metaphor were identified. The first five themes describe facilitators of and impediments to getting a job (getting off the bench): (1) fighting inertia; (2) taking control; (3) encouraging peers; (4) disruptions related to the illness; (5) lack of opportunities and supports. The next five themes represent facilitators of and impediments to working (skating on the ice); (6) going mainstream; (7) social cohesion; (8) clarity in role and responsibilities; (9) environmental factors; (10) managing self-disclosure. We chose as our overarching metaphor "Balancing on Skates on the Icy Surface of Work," as we view both iceskaters and workers with psychiatric disabilities as needing to achieve and maintain their balance while being "on the edge" between various extremities.

CONCLUSION

We have shown that, for persons with psychiatric disabilities to "get off the bench" and "onto the ice" of employment, they may need to be supported in finding and maintaining their balance in new situations through a combination of learning new skills and competencies (learning how to skate) while receiving in vivo assistance from empathic and knowledgeable supporters (being coached while on the ice).

People with mental illness returning to work: a qualitative evaluation of a Norwegian project

OBJECTIVE

Several studies demonstrate the need for a unified effort by the Norwegian Labour and Welfare Administration (NAV) and health services to support people with mental illness who wish to return to work and simultaneously receive treatment. The aim of the present qualitative evaluation study is to develop a deeper understanding of the participants' experiences of being involved in the NAV project called "Work, Substance Abuse and Mental Health", which helps service recipients to combine work and treatment.

METHODS

The study involved the use of qualitative research interviews. Seven NAV project participants completed an interview and their data were analysed using qualitative content analysis.

RESULTS

The results suggest that this project is effective from both a salutogenic perspective and a recovery-oriented perspective. Increased lust for life as a result of diverse forms of support and a flexible personalized service with rapid intervention was identified. The results also show phenomena that contributed to stagnation and life longings, or a decrease in quality of life.

CONCLUSION

The success of the project depends on the NAV office. Future research should investigate cooperation between therapists and NAV advisers, participants' ambivalence, and explore other factors important for relationship building.