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Paton J, Carrington A, Gentle E, Horsefall D. 'I am more than my diagnosis': Amplifying the voice of consumers in the design and delivery of mental health services. Aust J Rural Health 2024. [PMID: 39031099 DOI: 10.1111/ajr.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 07/22/2024] Open
Abstract
OBJECTIVE In line with the Australian Government's Vision 2030, this research foregrounds consumer experiences of recovery to inform the (co)design and delivery of mental health services for people living with complex needs and/or a severe and persistent mental health condition. SETTING The research takes a specialist focus on the regional setting, with data collected from client experiences within Western NSW, Australia, in the context of the National Disability Insurance Scheme (NDIS) implementation and inclusion of psycho-social disability within the NDIS service environment. PARTICIPANTS Thirty-seven people aged 19-70 years living with complex needs and/or a diagnosis of a severe and persistent mental health condition were recruited from services where they had a care plan or where they were members of a consumer reference group for recovery-oriented services. DESIGN A tripartite framework integrating recovery oriented, trauma-informed and collective impact approaches for a qualitative, arts-based (photovoice) study. RESULTS In areas of the mental health service system that had not yet applied a personalised understanding of recovery or embraced trauma-informed practice there were a range of issues and gaps in service delivery relating to authentic relationships, belonging and connection, service cultures, trauma-informed care, and workforce investment. CONCLUSION Clinical and non-clinical services need to ensure consistent person-centred and trauma-informed practice is implemented throughout the mental health service system to meet the needs of the consumer. An eight-point checklist serves as the basis for services to reflect on how they are working with consumers and to support the review of systems and clinical governance frameworks.
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Affiliation(s)
- Joy Paton
- Arts Therapy & Counselling, School of Social Sciences, Translational Health Research Institute, Western Sydney University, Parramatta, New South Wales, Australia
| | - Amie Carrington
- Domestic Violence Action Centre, Ipswich, Queensland, Australia
| | - Emma Gentle
- Arts Therapy & Counselling, School of Social Sciences, Western Sydney University, Parramatta, New South Wales, Australia
| | - Debbie Horsefall
- School of Social Sciences, Western Sydney University, Parramatta, New South Wales, Australia
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Chimara M, van Biljon H, Adams F, van Niekerk L. Perspectives of service providers on vocational rehabilitation for mental health service users in Namibia: a qualitative study. Disabil Rehabil 2024:1-9. [PMID: 38850044 DOI: 10.1080/09638288.2024.2362944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE Chronic mental illness disrupts the ability to work, often resulting in the need for vocational rehabilitation in which occupational therapists play a role. Namibia does not have an occupational therapy vocational rehabilitation practice framework for service users with chronic mental illness. This study explored the contextual factors that should be considered for a vocational rehabilitation practice framework in Namibia. MATERIALS AND METHODS A qualitative collective case study design was utilized. In-depth interviews were conducted with nine mental health service providers that were purposively selected from two study sites. An inductive thematic analysis of data was done using ATLAS.ti. RESULTS The need for collaborative advocacy for service users to raise awareness and engage stakeholders such as family members, employers and policy makers was highlighted. Vocational rehabilitation resources needed include sheltered workshops, financial resources and trained human resources. Recognition that vocational rehabilitation services are too limited to meet the needs of mental health service users. A vocational rehabilitation policy and strategy is required. Supported employment and self-employment are potential strategies that should be considered. CONCLUSION Vocational rehabilitation for service users with chronic mental illness is limited in Namibia and there is a need to collaboratively improve the service.
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Affiliation(s)
- Munyaradzi Chimara
- Division of Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Cape Town, South Africa
- Department of Occupational Therapy and Physiotherapy, Faculty of Health Sciences and Veterinary Medicine, School of Allied Health Sciences, University of Namibia, Windhoek, Namibia
| | - Hester van Biljon
- Division of Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Cape Town, South Africa
| | - Fasloen Adams
- Division of Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Cape Town, South Africa
| | - Lana van Niekerk
- Division of Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Cape Town, South Africa
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Ollerton J, Giles MJ, Baldry E, Cale J. The Efficacy of Outsourced Employment Services for Adults Exiting Australian Prisons. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024; 68:806-824. [PMID: 35730562 DOI: 10.1177/0306624x221102840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Crime rates in Australia have declined or been steady over the past decade yet prison populations are at all-time highs. Similarly, unemployment rates have been low but unemployment for those ex-prisoners seeking work is very high. In this paper, we draw on the findings of an Australia-wide survey of government-funded employment service providers who support working-aged Australians including ex-prisoners in their search for work. We find that the heterogeneity of the needs of ex-prisoners coupled with the frugality and inflexibility of government policies and practices frustrates the abilities of these agencies to provide services to this target group.
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Affiliation(s)
- Janice Ollerton
- University of New South Wales, Kensington, Australia (Retired)
| | | | - Eileen Baldry
- University of New South Wales, Kensington, Australia
| | - Jesse Cale
- Griffith University, Gold Coast, QLD, Australia
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Umucu E, Lee B. Employment and emotional well-being in veterans with mental illness. Stress Health 2024; 40:e3339. [PMID: 37876154 DOI: 10.1002/smi.3339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/26/2023]
Abstract
The purpose of this study is to examine group differences between employed and unemployed Veterans with mental illnesses utilizing the National Institutes of Health (NIH) emotion toolbox factors including negative affect, psychological well-being, stress, and social relationships. Data was collected from three samples from 2018 to 2020. The first sample (Sample 1) is 156 Veterans with mental illness from Amazon MTurk; the second sample (Sample 2), recruited from a higher education institution, is 232 veterans with posttraumatic stress disorder (PTSD) symptoms; and the final sample (Sample 3), recruited from a higher education institution, is 129 Veterans with disabilities, including psychiatric disabilities. Independent-samples t-tests were carried out to test our objectives. Sample 1 results revealed that employed Veterans with mental illnesses had lower levels of depression and stress and higher levels of positive emotion, life satisfaction, meaning in life, and social relationships compared to unemployed Veterans. Sample 2 results revealed that employed Veterans with PTDS symptoms had lower levels of stress and higher levels of positive emotion and lower levels of stress compared to unemployed Veterans with PTSD symptoms. Sample 3 results revealed that employed Veterans with disabilities including psychiatric disabilities had lower levels of depression and higher levels of positive emotion and social relationships. Our findings are consistent with the previous research documenting that employment plays a central role in optimal psychological and physical health in both civilians and veterans.
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Affiliation(s)
- Emre Umucu
- College of Health Sciences, The University of Texas at El Paso, El Paso, Texas, USA
| | - Beatrice Lee
- College of Health Sciences, The University of Texas at El Paso, El Paso, Texas, USA
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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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A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis. Community Ment Health J 2022; 59:728-755. [PMID: 36463531 DOI: 10.1007/s10597-022-01056-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
Young adults who experience psychosis want to work but are less likely to be employed than their peers. Sixty two studies relating to young adults with psychosis and employment were reviewed following a systematic search of five databases: CINAHL, PsycINFO, MEDLINE, SCOPUS and EMBASE. Publication date ranged from 1973 to 2019 with > 70% between 2010 and 2019. Intervention was considered in 29 papers; critical appraisal revealed 90% of these had moderate to good methodological quality with only three RCTs. Of 11 intervention types "Early Intervention" and "Individual Placement and Support" were most common; both demonstrating positive impact on obtaining employment. The review identified minimal participant perspectives and great variability in: terminology used; the reporting of participant attributes; intervention characteristics and ways employment outcomes were measured. Employment processes identified were preparing for, seeking, obtaining, keeping and re-obtaining employment, with current research efforts focused on obtaining work. More focus is required on keeping and re-obtaining employment.
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Gandhi S, Jayaraman S, Sivakumar T, John AP, Joseph A, Prathyusha PV. Can employment in a café change Clientele Attitude towards the staff when they are Persons with Mental Illness? Int J Soc Psychiatry 2022; 68:541-547. [PMID: 33506712 DOI: 10.1177/0020764021990068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clientele's attitude toward Persons with Mental Illness (PwMI) changes over a period of time. The aim of this study was to explore and understand how and whether perception about PwMI changes when they are seen working like persons without mental illness among those availing services of ROSes café at NIMHANS, Bengaluru. METHODS The descriptive research design was adopted with purposive sampling. Community Attitude toward Mentally Ill (CAMI) a self -administered questionnaire of was administered to measure the clientele attitude towards staff with mental illness in ROSes Café (Recovery Oriented Services). A total of 256 subjects availing services from the ROSes café recruited in the study. Chi-square and Mann-Whitney U test was computed to see the association and differences on selected variables. RESULTS The present study results showed that subjects had a positive attitude seen in health care professionals in the domains of benevolence (BE) (28.68 ± 3.00) and community mental health ideology (CMHI) (31.53 ± 3.19), whereas non-health care professionals had showed negative attitude in the domain of authoritarianism (AU) (30.54 ± 3.42) and social restrictiveness (SR) (30.18 ± 3.05). Education, employment, marital, income, and working status were significantly associated with CAMI domains. CONCLUSION PwMI also can work like people without mental illness when the opportunities are provided. The community needs to regard mental illness in the same manner as chronic physical illness diabetes mellitus and allow PwMI to live a life of dignity by creating and offering opportunities to earn livelihood which would help them recover with their illnesses.
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Affiliation(s)
- Sailaxmi- Gandhi
- National Institute of Mental Health and Neuro Sciences, Bangalore, KA, India
| | - Sangeetha Jayaraman
- National Institute of Mental Health and Neuro Sciences, Bangalore, KA, India
| | - Thanapal Sivakumar
- National Institute of Mental Health and Neuro Sciences, Bangalore, KA, India
| | - Annie P John
- National Institute of Mental Health and Neuro Sciences, Bangalore, KA, India
| | - Anoop Joseph
- National Institute of Mental Health and Neuro Sciences, Bangalore, KA, India
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Temple JB, Brijnath B, Enticott J, Utomo A, Williams R, Kelaher M. Discrimination reported by older adults living with mental health conditions: types, contexts and association with healthcare barriers. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1003-1014. [PMID: 32696302 DOI: 10.1007/s00127-020-01914-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 06/30/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Australian policy-making needs better information on the prevalence, context and types of discrimination reported by people living with mental health conditions and the association of exposure to discrimination with experiencing a barrier to accessing healthcare. METHODS Secondary data analysis using the national representative General Social Survey 2014 to examine discrimination and healthcare barriers. Multivariable logistic regression was used to examine the association between discrimination and barriers to healthcare. RESULTS Around 10% of older adults without mental health conditions reported an instance of discrimination in the last 12 months, compared to 22-25% of those with mental health conditions. Approximately 20% with mental health conditions attributed discrimination to their health conditions, along with other characteristics including age. Discrimination was reported in settings important to human capital (e.g., healthcare, workplace), but also in general social and public contexts. Everyday discrimination (OR = 2.11 p < 0.001), discrimination in healthcare (OR = 2.92 p < 0.001), and discrimination attributed to the person's health condition (OR = 1.99 p < 0.05) increased the odds of experiencing a barrier to care two-to-three-fold. For each type of discrimination reported (e.g., racism, ageism etc.), the odds of experiencing a barrier to care increased 1.3 times (OR = 1.29 p < 0.01). CONCLUSION This new population-level evidence shows older adults with mental health conditions are experiencing discrimination at more than twofold compared to those without mental health conditions. Discrimination was associated with preventing or delaying healthcare access. These findings indicate that future strategies to promote mental healthcare in underserved groups of older people will need to be multidimensional and consideration given to address discrimination.
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Affiliation(s)
- Jeromey B Temple
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bianca Brijnath
- Social Gerontology, National Ageing Research Institute (NARI), Parkville, Australia.
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, Australia
| | - Ariane Utomo
- School of Geography, Faculty of Science, University of Melbourne, Melbourne, Australia
| | - Ruth Williams
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Chafi YK, Amare T, Haile K, Damene W, Tesfaye G, Minichil W. Prevalence and correlates of job loss among schizophrenia outpatients at St. AmanuelMental Specialized Hospital, Addis Ababa, Ethiopia; cross sectional study. PLoS One 2020; 15:e0242352. [PMID: 33370291 PMCID: PMC7769443 DOI: 10.1371/journal.pone.0242352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Job loss in patient with chronic illness like schizophrenia is the most serious public concern in the clinical and socio-economic terms worldwide. Patients with schizophrenia usually have unsatisfactory job termination like quitting or getting fired which results well-established negative outcomes. The complex interplay between one another has made job and mental illness the focus areas. In the developing nations, there is limited study on these areas in spite of higher rates of job loss. OBJECTIVES This study aimed to assess the prevalence and correlates of job loss among schizophrenia outpatient units in Addis Ababa, Ethiopia. METHODS Institutional based cross-sectional study was conducted at Saint Amanuel Mental Specialized Hospital among schizophrenia outpatient units in Addis Ababa from May to June 2018. A total of 421 study subjects were interviewed using Positive and Negative Syndrome Scale and Perceived devaluation and discrimination scale. Out of the total study participants, female populations were slightly higher (50.4%) and the majorities (38.6%) were orthodox religion followers. Study characteristics was summarized using descriptive statistics and bi-variable and multivariable analysis was performed using Statistical Package for Social Science version 24. Furthermore, those factors at p value ≤ 0.05 were considered as statistically significant. RESULTS The prevalence of job loss among patients with schizophrenia was 37.3%. Factors including unmarried [AOR = 2.42:95% CI (1.28, 4.54)], divorced [AOR = 2.34: 95% CI (1.16, 4.71)], severe positive symptoms [AOR = 2.03: 95% CI (1.15, 3.60)], severe general psychopathology [AOR = 1.76: 95% CI (1.01, 3.08)], and poor level of social and occupational functioning [AOR = 5.05: 95% CI (2.81, 9.09)] were significantly associated with job loss among schizophrenia people. CONCLUSION This study suggested that job loss among schizophrenia outpatients was high. There was significant association among people with unmarried, divorced, severe positive symptoms, poor functionality and higher general psychopathology. Therefore, clinical and psychosocial factors were responsible for job loss which warrant further attention and investigation.
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Affiliation(s)
- Yohannes Kifle Chafi
- Department of Psychiatry, College of Health Science, Aksum University, Axum, Ethiopia
| | - Tadele Amare
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kelemua Haile
- Research and Training Department, St. Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Woynabeba Damene
- Research and Training Department, St. Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Getaneh Tesfaye
- Department of Psychiatry, College of Health Science, Aksum University, Axum, Ethiopia
| | - Woredaw Minichil
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Park JE, Kim SY, Kim SH, Jeoung EJ, Park JH. Household Food Insecurity: Comparison between Families with and without Members with Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176149. [PMID: 32847093 PMCID: PMC7504574 DOI: 10.3390/ijerph17176149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
Although the high rate of food insecurity among people with disabilities and their households has emerged as an important concern in public health and nutrition policy, the available data on these issues are still too limited to fully understand this phenomenon. This study aimed to compare the prevalence of food insecurity between households with and without persons with disabilities and to explore which sociodemographic and disability characteristics are associated with household food insecurity among households with members with disabilities. The data of 2690 households with and without members with disabilities from the 2013 Korea National Health and Nutrition Examination Survey were analyzed. Household food insecurity was more prevalent among households including persons with disabilities than among those without such members. The likelihood of experiencing food insecurity was especially high in households having a female head with a disability (odds ratio (OR) = 1.98); working-age adults with disabilities (OR = 1.70); members with disabilities who were not economically active (OR = 1.53); and members with mental disabilities (OR = 2.81), disabilities involving internal organs (OR = 4.38), or severe (grades 1–3) disabilities (OR = 1.73). The findings indicate that the disability status and sociodemographic characteristics of disabled family members are closely associated with household food security status.
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Affiliation(s)
- Jong Eun Park
- Department of Medicine, College of Medicine, Chungbuk National University, Cheongju 28644, Korea;
| | - So Young Kim
- Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea
- College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju 28644, Korea
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Correspondence: (S.Y.K.); (J.H.P.); Tel.: +82-43-269-7620 (S.Y.K.); +82-43-261-2873 (J.H.P.)
| | - Se Hee Kim
- Department of Food and Nutrition, Chungbuk National University, Cheongju 28644, Korea; (S.H.K.); (E.J.J.)
| | - Eun Ju Jeoung
- Department of Food and Nutrition, Chungbuk National University, Cheongju 28644, Korea; (S.H.K.); (E.J.J.)
| | - Jong Hyock Park
- College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju 28644, Korea
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Correspondence: (S.Y.K.); (J.H.P.); Tel.: +82-43-269-7620 (S.Y.K.); +82-43-261-2873 (J.H.P.)
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11
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Han M, Jun SS. Effects of Psychotic Symptoms and Social Cognition on Job Retention in Patients with Schizophrenia in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2628. [PMID: 32290397 PMCID: PMC7216282 DOI: 10.3390/ijerph17082628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 01/25/2023]
Abstract
This research examined the relationship between psychotic symptoms, social cognition, and job retention among people with schizophrenia in Korea. Participants (158 people with schizophrenia from 15 mental health institutions) were divided into two groups: those with a job retention period of less than six months (n = 75), and those with a job retention period of six months or more (n = 83). Participants completed a survey packet containing the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Function (GAF) Scale, Interpersonal Relationship Functioning Assessment Scale, Basic Empathy Scale, Hinting Task, and Ambiguous Intention Hostility Questionnaire (AIHQ), and provided their job retention status. We used binomial logistic regression analysis to examine whether job retention was affected by participants' demographic, clinical, and vocational characteristics, as well as the three components of social cognition, i.e., theory of mind, empathy, and attribution style. Results showed that theory of mind (ToM), attribution style, and psychotic symptoms explained 52.7% of the variance in job retention. A higher theory of mind means a higher ability to grasp the intentions of others. The higher theory of mind, the lesser attribution style, and the lesser psychotic symptoms were related to a longer period of job retention.
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Affiliation(s)
- Mihwa Han
- Department of Nursing Science, Sunlin University, 30, 36beon-gil, Chogok-gil, Heunghae-eup, Pohang-si, Gyeongbuk 37560, Korea
| | - Seong Sook Jun
- College of Nursing, Pusan National University, Beomeo-ri, Mulgeum-eup, Yangsan-si Gyeongnam, Busan 50612, Korea
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Caruana E, Allott K, Farhall J, Parrish EM, Davey CG, Chanen AM, Killackey E, Cotton SM. Factors associated with vocational disengagement among young people entering mental health treatment. Early Interv Psychiatry 2019; 13:961-968. [PMID: 30019851 DOI: 10.1111/eip.12718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 11/27/2022]
Abstract
AIM Most mental disorders have their onset by age 25, disrupting normative vocational engagement. Factors associated with vocational disengagement at first contact with specialist treatment are important for service planning. The aim of this paper was to investigate the association between theoretically important factors and vocational disengagement for youth entering mental health treatment. METHODS A file audit was used to extract vocational data of 145 young people aged 15 to 25 years entering treatment in 2011 at a public youth mental health service in Melbourne, Australia. Comparisons were made across three specialist programs for: psychosis (n = 50), mood disorders (n = 52) and borderline personality pathology (n = 43). Individual characteristics were entered into univariate and multivariate logistic regressions to investigate their associations with vocational disengagement. RESULTS Educational disengagement was associated with being older (OR = 4.38, P = 0.004) and not living with parents (OR = 2.87, P = 0.038). Unemployment and being NEET (Not in Education, Employment or Training) were both associated with not having commenced tertiary education (OR = 0.23, P = 0.022; OR = 0.05, P = 0.002; respectively). Being NEET was also associated with being older (OR = 6.18, P = 0.004). Primary diagnostic grouping was not associated with vocational disengagement, once accounting for other factors. CONCLUSIONS The likelihood of vocational disengagement did not differ across disorder groups, implying that intervention should be "transdiagnostic" and might best target education first, specifically post-secondary qualifications. Other domains or variables not measured in this study are also likely to be important, and this might include young people's support systems and symptom severity. Qualitative studies may be useful for exploring further factors relevant to vocational engagement.
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Affiliation(s)
- Emma Caruana
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria.,North Western Mental Health, Parkville, Victoria
| | - Emma M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Northeastern University, Boston, Massachusetts
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,North Western Mental Health, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
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13
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Caruana E, Farhall J, Cotton SM, Parrish E, van-der-El K, Davey CG, Chanen AM, Bryce SD, Killackey E, Allott K. Vocational engagement among young people entering mental health treatment compared with their general population peers. Early Interv Psychiatry 2019; 13:692-696. [PMID: 29968285 DOI: 10.1111/eip.12712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 11/26/2022]
Abstract
AIM To compare rates of vocational engagement for youth entering specialist mental health treatment with the general population. METHODS A file audit retrieved vocational data for 145 youth aged 15 to 25 entering treatment. Clinical and population data were stratified by age and sex and compared between cohorts. RESULTS Compared to the population, young people entering mental health treatment were less likely to have completed at least Year 11 in school (77% vs 42%, P < 0.001); and demonstrated higher rates of "Not in Education, Employment or Training" (9% vs 33%, P < 0.001). Individuals aged 15 to 18 years entering treatment experienced greater rates of educational disengagement than the population (30% vs 11%, P < 0.001), whereas people aged 19 to 25 years showed higher unemployment rates (52% vs 35%, P = 0.003). CONCLUSIONS Youth entering specialist mental health treatment have marked levels of vocational disengagement compared to demographically-matched peers. Early vocational intervention for these young people is essential.
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Affiliation(s)
- Emma Caruana
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia.,North Western Mental Health, Parkville, Victoria, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Emma Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kristi van-der-El
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Shayden D Bryce
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Monash School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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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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15
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Caruana E, Cotton SM, Farhall J, Parrish EM, Chanen A, Davey CG, Killackey E, Allott K. A Comparison of Vocational Engagement Among Young People with Psychosis, Depression and Borderline Personality Pathology. Community Ment Health J 2018; 54:831-841. [PMID: 29159496 DOI: 10.1007/s10597-017-0197-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 11/04/2017] [Indexed: 12/13/2022]
Abstract
Poor vocational engagement is well documented among young people experiencing first-episode psychosis (FEP). The aim of the present study was to establish and compare rates of vocational engagement across young people with first-episode psychosis, depression, and borderline personality pathology. A file audit was used to collect vocational data of young people aged 15-25 entering tertiary mental health treatment in 2011. Rates of vocational engagement were similar across groups, indicating that like those with FEP, young people with depression and borderline personality pathology experience impaired vocational engagement and are in need of targeted vocational interventions. Post hoc analysis indicated that that the depression group had significantly more people who were partially vocationally engaged compared with the psychosis group, suggesting that vocational interventions might need to be targeted differently across different diagnostic groups. Future research should explore risk factors for vocational disengagement across diagnostic groups in order to inform intervention development.
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Affiliation(s)
- E Caruana
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia. .,La Trobe University, Bundoora, VIC, 3083, Australia.
| | - S M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - J Farhall
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.,North Western Mental Health, Parkville, VIC, Australia
| | - E M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - A Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,North Western Mental Health, Parkville, VIC, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - C G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - K Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
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16
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Lipskaya-Velikovsky L, Elgerisi D, Easterbrook A, Ratzon NZ. Motor skills, cognition, and work performance of people with severe mental illness. Disabil Rehabil 2018; 41:1396-1402. [PMID: 29327599 DOI: 10.1080/09638288.2018.1425744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Employment offers many benefits to people with mental illness, yet their employment rate is much lower than that of the general population. We investigated the effect of work-related motor skills, neurocognition, and job attitudes on the work performance of people with mental illness, comparing those working in sheltered workshops, with controls working in similar jobs. METHODS Twenty-nine adults with severe mental illness and 27 controls matched by gender and age were enrolled into the study using convenience sampling. They were assessed for gross and fine motor hand functioning, job attitudes, work performance, and cognition. RESULTS People with mental illness scored lower on work performance, cognitive functioning, and hand dexterity while sitting and working with tools. They were assigned lower job loads than were controls, and perceived the physical environment at work as more constraining than did controls. Assembling motor skills significantly explained the work performance of people with mental illness. CONCLUSIONS The results expand our understanding of the complexities involved in the employment of people with severe mental illness, and point to new paths for improving vocational outcomes of people with severe mental illness, taking into account their motor skills and job attitudes. Implications for rehabilitation Therapists should be aware that employed people with severe mental illness may have various unmet needs, affecting their work performance and experience of stress. This study results demonstrate importance of motor skills and perception of the work environment for the promotion of vocational outcomes among individuals with severe mental illness. Employment of people with severe mental illness should be viewed from holistic perspective as with general population, rather than focused on traditionally illness-related factors.
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Affiliation(s)
- Lena Lipskaya-Velikovsky
- a Department of Occupational Therapy , School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University , Tel Aviv , Israel
| | - Dikla Elgerisi
- b Beer-Ya'akov-Ness-Ziona Mental Health Center , Beer-Ya'akov , Israel
| | - Adam Easterbrook
- c Alberta Centre for Child, Family, and Community Research , Edmonton , Canada
| | - Navah Z Ratzon
- a Department of Occupational Therapy , School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University , Tel Aviv , Israel
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17
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Hitch D, Dun C, Vernon L. Work and beyond: Vocational participation for mental health service users. Aust N Z J Psychiatry 2017; 51:197. [PMID: 27289129 DOI: 10.1177/0004867416652738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Carolyn Dun
- 2 NorthWestern Mental Health, Melbourne, VIC, Australia
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18
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Factorial Validity of thePerceived Empathic and Social Self-Efficacy Scalefor Adults with Serious Mental Illness: A Brief Report. THE AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2016. [DOI: 10.1017/jrc.2016.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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19
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Duarte W, Becerra R, Cruise K. The Relationship Between Neurocognitive Functioning and Occupational Functioning in Bipolar Disorder: A Literature Review. EUROPES JOURNAL OF PSYCHOLOGY 2016; 12:659-678. [PMID: 27872673 PMCID: PMC5114879 DOI: 10.5964/ejop.v12i4.909] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/21/2016] [Indexed: 01/13/2023]
Abstract
Neurocognitive impairment in Bipolar Disorder (BD) has been widely reported, even during remission. Neurocognitive impairment has been identified as a contributing factor towards unfavourable psychosocial functioning within this population. The objective of this review was to investigate the association between neurocognitive impairment and occupational functioning in BD. A literature review of English-language journal articles from January 1990 to November 2013 was undertaken utilising the PsychINFO, Scopus and Web of Knowledge databases. Studies that made specific reference to occupational outcomes were included, and those that reported on global psychosocial measures were excluded. Majority of the papers reviewed (20 out of 23) identified an association between neurocognitive impairment (particularly in executive functioning, verbal learning and memory, processing speed and attention) and occupational functioning. Several methodological issues were identified. There was a discrepancy in the measures used to assess neurocognitive function across studies and also the definition and measurement of occupational functioning. The clinical features of the samples varied across studies, and confounding variables were intermittently controlled. The review focused on English-language papers only and hence there is a bias toward the Western labour market. These limitations therefore influence the generalizability of the interpreted findings and the reliability of comparisons across studies. Neurocognitive impairment in BD appears to play a role in occupational outcomes. The findings of this review highlight the challenges for future research in this area, particularly in the measurement of neurocognitive and occupational functioning. Incorporating neurocognitive interventions in the treatment of BD, which has traditionally focussed solely on symptomatic recovery, may advance the vocational rehabilitation of these patients.
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Affiliation(s)
- Walace Duarte
- School of Psychology and Social Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rodrigo Becerra
- School of Psychology and Social Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kate Cruise
- School of Psychology and Social Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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20
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Porteous N, Waghorn G. Implementing Evidence-Based Employment Services in New Zealand for Young Adults with Psychosis: Progress during the First Five Years. Br J Occup Ther 2016. [DOI: 10.1177/030802260707001204] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This practice evaluation demonstrates how occupational therapists can play a key role in providing vocational services for young people experiencing a first episode of psychosis. By implementing the evidence-based Individual Placement and Support model, occupational therapists can expand their traditional roles to provide services that integrate functional recovery with clinical recovery. This New Zealand programme achieved vocational outcomes of between 49% and 59% over a 4-year period. The lessons learned from these experiences add to the body of international knowledge on how best to implement evidence-based employment services for young people with mental health problems.
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Affiliation(s)
- Nikki Porteous
- Early Intervention Service, Capital and Coast District Health Board, New Zealand
| | - Geoffrey Waghorn
- The Queensland Centre for Mental Health Research and The University of Queensland
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21
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Lloyd C, Waghorn G. The Importance of Vocation in Recovery for Young People with Psychiatric Disabilities. Br J Occup Ther 2016. [DOI: 10.1177/030802260707000202] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Young people with psychiatric disabilities are particularly disadvantaged when it comes to participating in vocational training or higher education or to seeking and maintaining employment. A review of the literature reveals that this is due to a number of factors, including low expectations by health professionals, stigma and discrimination, symptomatology and the lack of a clear responsibility for promoting vocational and social outcomes. A useful approach for occupational therapists to use is a recovery framework combining evidence-based employment and educational assistance with mental health care, provided in parallel with brief vocational counselling, illness management skills, training in stigma countering and disclosure strategies, context-specific social skills and skills in social network development. It is concluded that there is an urgent need to link evidence-based vocational practices with quality mental health care, in order to restore hope among young people of ever realising their vocational goals and once again feeling included as valued members of society.
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22
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Employment Benefit Receipt Among Ontario Public Disability Benefit Recipients with a Disability Related to a Mental Disorder. Community Ment Health J 2016; 52:203-11. [PMID: 26408430 DOI: 10.1007/s10597-015-9942-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 09/21/2015] [Indexed: 11/27/2022]
Abstract
Using administrative data from the public long-term disability support program in Ontario, Canada, this paper examines the factors related to receipt of a paid employment benefit. These analyses include only ODSP beneficiaries who were primary beneficiaries, who had active files in March 2011 and who were <65 years of age and had a disability-related primary diagnosis (n = 253,492). About 9 % of primary beneficiaries received the employment benefit. Logistic regression results suggest that compared to those who have a disability related to a physical disorder, those who have a psychotic disorder (OR 1.125), a mood disorder (OR 1.139) or a developmental disability (OR 1.618) are significantly more likely to receive the benefit while those who have a substance use disorder were significantly less likely (OR 0.540). These results indicate that a proportion of people who receives public disability benefits are employed. In addition, all things being equal, people with mental disorders are more likely to use this type of program than people with physical disorders.
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23
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A Randomised Controlled Trial of Evidence Based Supported Employment for People Who have Recently been Homeless and have a Mental Illness. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 44:217-224. [DOI: 10.1007/s10488-015-0713-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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24
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Holwerda A, Fokkens AS, Engbers C, Brouwer S. Collaboration between mental health and employment services to support employment of individuals with mental disorders. Disabil Rehabil 2015; 38:1250-6. [PMID: 26287452 DOI: 10.3109/09638288.2015.1076075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Anja Holwerda
- a Department of Health Sciences , Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- b Graduate School for Health Research , University Medical Center Groningen, University of Groningen, Groningen , The Netherlands , and
| | - Andrea S Fokkens
- c Department of Applied Research in Care , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Carola Engbers
- a Department of Health Sciences , Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- b Graduate School for Health Research , University Medical Center Groningen, University of Groningen, Groningen , The Netherlands , and
| | - Sandra Brouwer
- a Department of Health Sciences , Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- b Graduate School for Health Research , University Medical Center Groningen, University of Groningen, Groningen , The Netherlands , and
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25
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Williams PL, Lloyd C, Waghorn G, Machingura T. Implementing evidence-based practices in supported employment on the Gold Coast for people with severe mental illness. Aust Occup Ther J 2015; 62:316-25. [PMID: 26098404 DOI: 10.1111/1440-1630.12202] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Philip Lee Williams
- Early Psychosis Gold Coast; Gold Coast University Hospital; Southport Queensland Australia
| | - Chris Lloyd
- Behavioural Basis of Health; Griffith University Gold Coast Campus; Southport Queensland Australia
| | - Geoffrey Waghorn
- Department of Recovery and Social Inclusion; The Queensland Centre for Mental Health Research; West Moreton Hospital and Health Service; The Park Centre for Mental health; Wacol Queensland Australia
| | - Tawanda Machingura
- Department of Occupational Therapy; Mental Health Recovery Service; Gold Coast University Hospital; Southport Queensland Australia
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26
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Happell B, Platania-Phung C, Scott D, Hanley C. Access to dental care and dental ill-health of people with serious mental illness: views of nurses working in mental health settings in Australia. Aust J Prim Health 2015; 21:32-7. [DOI: 10.1071/py13044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/17/2013] [Indexed: 01/09/2023]
Abstract
People with serious mental illness experience higher rates of oral and dental health problems than the wider population. Little is known about how dental health is viewed or addressed by nurses working with mental health consumers. This paper presents the views of nurses regarding the nature and severity of dental health problems of consumers with serious mental illness, and how often they provide advice on dental health. Mental health sector nurses (n = 643) completed an online survey, including questions on dental and oral health issues of people with serious mental illness. The majority of nurses considered the oral and dental conditions of people with serious mental illness to be worse than the wider community. When compared with a range of significant physical health issues (e.g. cardiovascular disease), many nurses emphasised that dental and oral problems are one of the most salient health issues facing people with serious mental illness, their level of access to dental care services is severely inadequate and they suffer significantly worse dental health outcomes as a result. This study highlights the need for reforms to increase access to dental and oral health care for mental health consumers.
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27
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Rebeiro Gruhl KL. The employment rights of people with serious mental illness in Ontario: considering the influence of dominant ideology on marginalizing practices. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2014. [DOI: 10.1179/otb.2010.62.1.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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28
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Waghorn G, Dias S, Gladman B, Harris M, Saha S. A multi-site randomised controlled trial of evidence-based supported employment for adults with severe and persistent mental illness. Aust Occup Ther J 2014; 61:424-36. [DOI: 10.1111/1440-1630.12148] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Geoffrey Waghorn
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health
- Behavioural Basis of Health; Griffith Health Institute; Griffith University
- The School of Medicine; The University of Queensland
| | - Shannon Dias
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health
| | - Beverley Gladman
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health
| | - Meredith Harris
- The School of Population Health; The University of Queensland; Brisbane Queensland Australia
| | - Sukanta Saha
- Queensland Centre for Mental Health Research (QCMHR); The Park Centre for Mental Health
- The School of Medicine; The University of Queensland
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29
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Raeburn T, Schmied V, Hungerford C, Cleary M. Clubhouse model of psychiatric rehabilitation: how is recovery reflected in documentation? Int J Ment Health Nurs 2014; 23:389-97. [PMID: 24698159 DOI: 10.1111/inm.12068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recovery-oriented models of psychiatric rehabilitation, such as the Clubhouse model, are an important addendum to the clinical treatment modalities that assist people with chronic and severe mental illness. Several studies have described the subjective experiences of personal recovery of individuals in the clubhouse context, but limited research has been undertaken on how clubhouses have operationalized recovery in practice. The research question addressed in this paper is: How are recovery-oriented practices reflected in the documentation of a clubhouse? The documents examined included representative samples of key documents produced or utilized by a clubhouse, including public health-promotion materials and policy and membership documents. Data were subjected to content analysis, supported by the Recovery Promotion Fidelity Scale. The recovery categories identified in the documents included collaboration (27.7%), acceptance and participation (25.3%), quality improvement (18.0%), consumer and staff development (14.5%), and self-determination (14.5%). These categories show how the clubhouse constructs and represents personal recovery through its documentation. The findings are important in light of the role that documentation can play in influencing communication, relationships, and behaviour within organizations. The findings can also be used to inform future research related to recovery-oriented practices in clubhouse settings.
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Affiliation(s)
- Toby Raeburn
- School of Nursing & Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
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30
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Abstract
Purpose
– This study aims to re-examine the concept of alienation, particularly from the perspective of existential psychology. While research interest continues to centre on links between human resource management (HRM) and organizational performance, such as in studies by Beer et al. (1984), Huselid (1995), Becker and Gerhart (1996) and Guest (2011), there is a growing interest in individual attributes such as employee well-being in addition to organizational performance, as mentioned in studies by Macky and Boxall (2007), Wood and de Menezes (2011) and Guest and Conway (2011). In this paper, we focus on issues related to the individual, and in doing so we suggest that HRM theory needs further development, as pointed out by Guest (2011).
Design/methodology/approach
– This is a paper in the tradition of critical theory that draws on both classical and modern research in the business and psychology literature. It outlines the development of the concept of alienation from its classic articulation by Marx through to the perspective offered by existential psychologists such as Blauner (1964). How alienation, thus, defined might manifest in the workplace is then discussed, as are its links to other concepts associated in the literature with positive and negative work experiences is presented.
Findings
– We argue that alienation needs to be addressed at two levels, namely, at the systemic level, in terms of factors external to the individual such as work and organizational systems and processes, and in terms of factors internal to the individual’s “state of mind”. We offer strategies for management to consider counterbalancing the negative effects of residual feelings of powerlessness, meaninglessness, isolation and self-estrangement that systemic change is unable to eliminate.
Originality/value
– The paper refocuses attention on the individual within the context of HRM, the effects of alienation and other outcomes of positive and negative work experiences such as work engagement and job burnout.
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31
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Kidd S, Kenny A, McKinstry C. The meaning of recovery in a regional mental health service: an action research study. J Adv Nurs 2014; 71:181-92. [DOI: 10.1111/jan.12472] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Susan Kidd
- Bendigo Health Care Group; La Trobe Rural Health School; Bendigo Victoria Australia
| | - Amanda Kenny
- La Trobe Rural Health School; La Trobe University; Bendigo Victoria Australia
| | - Carol McKinstry
- La Trobe Rural Health School; La Trobe University; Bendigo Victoria Australia
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32
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Baum N, Neuberger T. The contributions of persons in the work environment to the self-identity of persons with mental health problems: a study in Israel. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:308-316. [PMID: 24330070 DOI: 10.1111/hsc.12085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/04/2013] [Indexed: 06/03/2023]
Abstract
This study explores the contribution of others in the workplace to the self-identity and job integration of persons with severe mental health problems. Thematic content analysis of in-depth, semi-structured interviews conducted in 2009 with 15 Israelis with severe mental health problems who work in a variety of frameworks (protected and supported employment and open market) revealed three main themes: (i) dissatisfaction with the protected work settings in which they were initially employed; (ii) the importance they attributed to their relationships with others in their workplace; and (iii) the change in self-identity they underwent from persons defined by their mental health problems to persons who had worth, abilities and being beyond their illness. The findings underscore the important role of managers and colleagues in integrating persons with mental health problems at work and in strengthening the self-identity of those individuals.
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Affiliation(s)
- Nehami Baum
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
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33
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Harris LM, Matthews LR, Penrose-Wall J, Alam A, Jaworski A. Perspectives on barriers to employment for job seekers with mental illness and additional substance-use problems. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:67-77. [PMID: 23829791 DOI: 10.1111/hsc.12062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2013] [Indexed: 06/02/2023]
Abstract
This paper examines the barriers to employment faced by job seekers (JS) with mental illness and additional substance-use issues. Semi-structured interviews concerning barriers to employment for JS with mental illness and substance-use problems and strategies to improve employment outcomes were conducted with stakeholders associated with an employment service provider specialising in mental illness (n = 17). Stakeholders were JS, family members who provide significant support to JS [support persons (SP)] and staff [employment staff (ES)]. Data were collected between May and August 2009 at the premises of the employment service provider in metropolitan Sydney. Thematic analysis of transcribed interview data was conducted to develop a meaningful data framework. The expectations of JS and SP regarding employment outcomes were higher than those of ES. Length of time unemployed was perceived as the most important barrier to future employment associated with mental illness, and substance-use problems were associated with lower, more variable motivation, restrictions on the environments where JS could work and more negative community and employer perceptions. The findings are consistent with studies from non-vocational settings and provide direction for meeting the needs of clients with mental illness and additional substance-use problems. Ensuring alignment between JS and ES concerning service goals and expected timeframes may improve JS motivation, satisfaction with service delivery and ultimately, employment outcomes.
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Affiliation(s)
- Lynne M Harris
- Australian College of Applied Psychology, Sydney, NSW, Australia
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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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Matthews LR, Harris LM, Jaworski A, Alam A, Bozdag G. Function in job seekers with mental illness and drug and alcohol problems who access community based disability employment services. Disabil Rehabil 2012; 35:460-7. [PMID: 22889352 DOI: 10.3109/09638288.2012.699583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lynda R Matthews
- Ageing, Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Sommer J, Lunt B, Rogers J, Poole R, Singham A. The impact of Vocational, Education, Training and Employment Coordinator positions on attitudes and practices in a NSW mental health service. Australas Psychiatry 2012; 20:295-300. [PMID: 22777501 DOI: 10.1177/1039856212447964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine attitudes and practices of community mental health clinicians in relation to employment and education for consumers and to assess the impact of the establishment of Vocational, Education, Training and Employment (VETE) Coordinator positions. METHOD A snapshot was conducted by surveying community mental health clinicians regarding every consumer on their caseload in 2007. This was repeated in 2010 and the results were compared. RESULTS From 2007 to 2010, the overall rates of VETE interventions increased, including a doubling of the rate of linkage to employment agencies for job seekers. Services with the consistent presence of a VETE Coordinator showed a greater impact on a number of factors, highlighted by a positive shift in clinician attitudes regarding their consumers' capacity to work. CONCLUSION The establishment of VETE Coordination positions in the mental health service appears to be an effective way of raising awareness of VETE issues and improving VETE service provision. An important role has been assisting clinicians to begin implementing the principles of the Individual Placement and Support model of Supported Employment and to incorporate support for employment and education as a routine part of practice.
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Affiliation(s)
- Joanne Sommer
- Mental Health Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia.
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Shankar J, Barlow CA, Khalema E. Work, employment, and mental illness: expanding the domain of Canadian social work. JOURNAL OF SOCIAL WORK IN DISABILITY & REHABILITATION 2011; 10:268-83. [PMID: 22126143 DOI: 10.1080/1536710x.2011.622991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Despite established evidence that work and employment are an important component of recovery for people who experience mental illness, social work education in Canada seldom offers graduate training or courses on the significance of work in peoples' lives or on the practices involved in helping to gain and retain employment for these individuals. In this article the authors argue that the high levels of unemployment among people who experience mental illness, and the rising incidence of mental health and addictions issues in workplaces, offer the opportunity, as well as the mandate, for social work educators to provide professional education in the area of employment support and assistance.
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Affiliation(s)
- Janki Shankar
- Faculty of Social Work, University of Calgary, Alberta, Canada.
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Schofield DJ, Kelly SJ, Shrestha RN, Callander EJ, Percival R, Passey ME. How depression and other mental health problems can affect future living standards of those out of the labour force. Aging Ment Health 2011; 15:654-62. [PMID: 21815858 DOI: 10.1080/13607863.2011.556599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To estimate the extent to which those who exit the workforce early due to mental health problems have less savings by the time they reach retirement age. METHODS Using Health & WealthMOD--a microsimulation model of Australians aged 45-64 years that predicts accumulated savings at age 65, regression models were used to analyse the differences between the projected savings and the retirement incomes of people at age 65 for those currently working with no chronic condition, and people not in the labour force due to mental health problems. RESULTS Females who retire early due to depression have a median value of total savings by the time they are 65 of $300. For those with other mental health problems the median figure was $0. This is far lower than the median value of $227,900 for females with no chronic condition who remained employed full-time. Males showed similar differences. Both males and females who were out of the labour force due to depression or other mental health problems had at least 97% (95% CI: -99.9% to -68.7%) less savings and retirement income by age 65 that those who remained employed full-time. CONCLUSIONS People who retire from the labour force early due to mental health problems will face long term financial disadvantage compared to people who are able to remain in employment.
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Affiliation(s)
- Deborah J Schofield
- NHMRC Clinical Trials Centre, Sydney School of Public Health, University of Sydney, Camperdown, Sydney NSW, Australia.
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Schofield DJ, Shrestha RN, Percival R, Kelly SJ, Passey ME, Callander EJ. Quantifying the effect of early retirement on the wealth of individuals with depression or other mental illness. Br J Psychiatry 2011; 198:123-8. [PMID: 21282782 DOI: 10.1192/bjp.bp.110.081679] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In addition to the health burden caused by mental illnesses, these conditions contribute to economic disadvantage because of their impact on labour force participation. AIMS To quantify the cost of lost savings and wealth to Australians aged 45-64 who retire from the labour force early because of depression or other mental illness. METHOD Cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model built on data from the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers and STINMOD, an income and savings microsimulation model. RESULTS People who are not part of the labour force because of depression or other mental illness have 78% (95% CI 92.2-37.1) and 93% (95% CI 98.4-70.5) less wealth accumulated respectively, compared with people of the same age, gender and education who are in the labour force with no chronic health condition. People who are out of the labour force as a result of depression or other mental illness are also more likely to have the wealth that they do have in cash assets, rather than higher-growth assets such as superannuation, home equity and other financial investments. CONCLUSIONS This lower accumulated wealth is likely to result in lower living standards for these individuals in the future. This will compound the impact of their condition on their health and quality of life, and put a large financial burden on the state as a result of the need to provide financial assistance for these individuals.
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Affiliation(s)
- Deborah J Schofield
- NHMRC Clinical Trials Centre, 92-94 Parramatta Road, Camperdown NSW 1450, Australia.
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Abstract
OBJECTIVE There are significant mental health benefits in schizophrenia associated with integration into society and the workplace. This case examines factors contributing to such reintegration. CONCLUSIONS A hostel team, an employment officer from an employment agency for the disabled and a community clinic collaborated to foster reintegration into the community through supported employment, improved supported accommodation and family support.
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Affiliation(s)
- Ann Solar
- Department of Psychiatry, Sir Charles Gairdner Hospital and Subiaco Community Mental Health Clinic, Perth, WA, Australia.
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Abstract
OBJECTIVE This study explored the relationship between employment and recovery in individuals with psychiatric disabilities and proposed that participants who were employed would have higher levels of recovery than participants who were not employed. METHODS Data were analysed from a pre-existing data-set produced in a large scale NHMRC project conducted as part of the Australian Integrated Mental Health Initiative (AIMhi), High Support Stream. Participants were 344 people with a range of psychiatric illnesses who received support from 11 public sector and non-government mental health organizations in Queensland and New South Wales, Australia. Scores on the Recovery Assessment Scale (RAS) were compared between those participants who were engaged in paid employment and those who were not. RESULTS The results revealed that there was no difference in total recovery scores between those who worked and those who did not work. This finding indicated that higher recovery scores were not associated with participants who were employed. Also contrary to expectations, the results showed that workers scored lower than non-workers on the RAS factor described as "reliance on others" and there was a trend towards significance in the same direction on the factor "willingness to ask for help." CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Further research needs to be conducted to determine if the differences between workers and non-workers on the above factors represent a personal variable such as independence or self-determination that is associated with individuals with psychiatric disabilities that are engaged in employment. Rehabilitation interventions aimed at increasing levels of employment in people with psychiatric disabilities could improve recovery and employment outcomes through focusing on these personal variables.
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Robson E, Waghorn G, Sherring J, Morris A. Preliminary Outcomes from an Individualised Supported Education Programme Delivered by a Community Mental Health Service. Br J Occup Ther 2010. [DOI: 10.4276/030802210x12865330218384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper describes the implementation and preliminary results of a supported education programme designed to complement a youth-oriented supported employment programme. Method: The programme was delivered by occupational therapists employed by a community mental health service in the Hunter New England region, New South Wales, Australia. Twenty mental health service users were assisted with their course of study over an 18-month period. Results: Education outcomes were promising, with 70% of service users either continuing or completing their chosen course of formal study. The education support provided was modelled on the Individual Placement and Support approach to supported employment. Conclusion: Occupational therapists working in public mental health can use this promising approach to supplement supported employment programmes, which should also be closely coordinated with the mental health service.
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Affiliation(s)
- Emma Robson
- Senior Occupational Therapist, Vocational Education, Training and Employment Service, Hunter New England Mental Health Service, Newcastle, New South Wales, and Conjoint Lecturer, University of Newcastle, Callaghan, New South Wales, Australia
| | - Geoff Waghorn
- Head, Social Inclusion and Translational Research, Queensland Centre for Mental Health Research, Sumner Park BC, Queensland, Australia
| | - Joanne Sherring
- Senior Occupational Therapist / Team Leader, Vocational Education, Training and Employment Service, Hunter New England Mental Health Service, Newcastle, New South Wales, and Conjoint Lecturer, University of Newcastle, Callaghan, New South Wales, Australia
| | - Adrienne Morris
- Senior Research Assistant, Vocational Education, Training and Employment Service, Hunter New England Mental Health Service, Newcastle, New South Wales, Australia
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Corbière M, Lanctôt N, Lecomte T, Latimer E, Goering P, Kirsh B, Goldner EM, Reinharz D, Menear M, Mizevich J, Kamagiannis T. A pan-Canadian evaluation of supported employment programs dedicated to people with severe mental disorders. Community Ment Health J 2010; 46:44-55. [PMID: 19536650 DOI: 10.1007/s10597-009-9207-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 06/04/2009] [Indexed: 11/30/2022]
Abstract
Supported employment (SE) is an evidence-based practice that helps people with severe mental disorders obtain competitive employment. The implementation of SE programs in different social contexts has led to adaptations of the SE components, therefore impacting the fidelity/quality of these services. The objective of this study was to assess the implementation of SE services in three Canadian provinces by assessing the fidelity and describing components of SE services using the Quality of Supported Employment Implementation Scale. About 23 SE programs participated in this study. Cluster analyses revealed six profiles of SE programs that varied from high to low level of fidelity with a stronger focus on a particular component, and reflected the reality of service delivery settings. Future investigations are warranted to evaluate relationships between the levels of implementation of SE components and work outcomes while considering individual characteristics of people registered in SE programs.
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Affiliation(s)
- Marc Corbière
- Rehabilitation School, University of Sherbrooke, Longueuil, QC, Canada.
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Iannelli S, Wilding C. Health-enhancing effects of engaging in productive occupation: Experiences of young people with mental illness. Aust Occup Ther J 2007. [DOI: 10.1111/j.1440-1630.2006.00650.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dewa CS, McDaid D, Ettner SL. An international perspective on worker mental health problems: who bears the burden and how are costs addressed? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:346-56. [PMID: 17696020 DOI: 10.1177/070674370705200603] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To discuss the burden of poor mental health in workers, who currently bears it, and how the associated rising costs are being addressed, from an international perspective. METHOD We identify the stakeholder groups and the costs they incur as a result of problems related to mental health in 6 different domains. In addition, we offer examples of programs, services, and strategies being used to either decrease costs or enhance benefits. RESULTS Mental illness is associated with a wide range of costs distributed across multiple stakeholders including government, employers, workers and their families, and the health care system. The costs incurred by the groups are interrelated; an attempt to decrease the burden for one group of stakeholders will inevitably affect other stakeholders. Thus the answer to the question of who bears the costs of poor mental health is "everyone." CONCLUSIONS Everyone could benefit from investment in improved mental health in the workplace. However, because the benefits associated with improved worker mental health are often distributed among several stakeholders, the incentives for any single stakeholder to pay for additional services for workers may be diluted. As a consequence, no one invests. Nevertheless, there is a role for all stakeholders, just as there are potential benefits for all. Along with government, employers, employees, and the health care system must invest in promoting good workplace health.
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Affiliation(s)
- Carolyn S Dewa
- Centre for Addition and Mental Health, Department of Psychiatry, University of Toronto, Ontario.
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Abstract
Nursing has always struggled for recognition and status, and there has always been exploitation and shortages, and no more so than in psychiatric settings. Today, however, nursing is in truly dire straits and, as a consequence, psychiatric nursing is more precariously positioned than ever. In order to think constructively about psychiatric nursing's future, it is crucial that this wider context in which it operates is fully appreciated, and this paper begins by summarizing the key features of this context from an international perspective. It is argued that dramatic changes occurring in 'Western' societies call for radical changes in public and professional thinking, and in their vision for health care in the future. Beginning with the general nursing context, this paper depicts the perilous state of psychiatric nursing and mental health care in Australia and elsewhere, and suggests some of the causal factors. It concludes by arguing that the future mental health workforce should be a graduate specialist who stands outside existing disciplinary identities.
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Affiliation(s)
- C A Holmes
- School of Nursing Sciences, James Cook University, Townsville, Australia.
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