'I am more than my diagnosis': Amplifying the voice of consumers in the design and delivery of mental health services

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.

Perspectives of service providers on vocational rehabilitation for mental health service users in Namibia: a qualitative study

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.

The Efficacy of Outsourced Employment Services for Adults Exiting Australian Prisons

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.

Employment and emotional well-being in veterans with mental illness

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.

A relational perspective of schizophrenia at work

Purpose

Despite a plethora of research on diversity and inclusion, workplace-related issues pertaining to individuals with schizophrenia (SCZ) remain grossly underexplored. This paper seeks to develop a relational, multilevel perspective of issues and challenges faced by individuals with SCZ in the work and career.

Design/methodology/approach

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

Findings

The findings highlight the interconnected nature of multilevel issues faced by schizophrenic individuals and indicate that at the societal level, social stigma, economic conditions and inadequate government policies are the key challenges faced by them. At the organizational level workplace support and job suitability and design affect individuals’ employment. At the individual level, self-stigma affects the employability in a negative way whereas personal motivation and resilience, family and social support and realization of illness are the facilitating factors.

Originality/value

The study adds to disability and diversity literature by developing a relational perspective that holistically captures the issues faced by schizophrenic individuals and suggests that the work and employment-related issues may be simultaneously addressed at multiple levels.

A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis

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.

Can employment in a café change Clientele Attitude towards the staff when they are Persons with Mental Illness?

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.

Discrimination reported by older adults living with mental health conditions: types, contexts and association with healthcare barriers

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.

Prevalence and correlates of job loss among schizophrenia outpatients at St. AmanuelMental Specialized Hospital, Addis Ababa, Ethiopia; cross sectional study

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.

Household Food Insecurity: Comparison between Families with and without Members with Disabilities

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.

Effects of Psychotic Symptoms and Social Cognition on Job Retention in Patients with Schizophrenia in Korea

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.

Factors associated with vocational disengagement among young people entering mental health treatment

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.

Vocational engagement among young people entering mental health treatment compared with their general population peers

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.

A Comparison of Vocational Engagement Among Young People with Psychosis, Depression and Borderline Personality Pathology

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.

Motor skills, cognition, and work performance of people with severe mental illness

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.

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

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

The Relationship Between Neurocognitive Functioning and Occupational Functioning in Bipolar Disorder: A Literature Review

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.

Implementing Evidence-Based Employment Services in New Zealand for Young Adults with Psychosis: Progress during the First Five Years

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.

The Importance of Vocation in Recovery for Young People with Psychiatric Disabilities

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.

Employment Benefit Receipt Among Ontario Public Disability Benefit Recipients with a Disability Related to a Mental Disorder

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.

Access to dental care and dental ill-health of people with serious mental illness: views of nurses working in mental health settings in Australia

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.

Clubhouse model of psychiatric rehabilitation: how is recovery reflected in documentation?

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.

Alienation

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.

The contributions of persons in the work environment to the self-identity of persons with mental health problems: a study in Israel

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.

Perspectives on barriers to employment for job seekers with mental illness and additional substance-use problems

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.

The impact of Vocational, Education, Training and Employment Coordinator positions on attitudes and practices in a NSW mental health service

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.

Work, employment, and mental illness: expanding the domain of Canadian social work

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.

How depression and other mental health problems can affect future living standards of those out of the labour force

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.

Quantifying the effect of early retirement on the wealth of individuals with depression or other mental illness

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.

Supported employment can reduce social exclusion and improve schizophrenia

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.

Can employment positively affect the recovery of people with psychiatric disabilities?

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.

Preliminary Outcomes from an Individualised Supported Education Programme Delivered by a Community Mental Health Service

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.

A pan-Canadian evaluation of supported employment programs dedicated to people with severe mental disorders

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.

An international perspective on worker mental health problems: who bears the burden and how are costs addressed?

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.

The slow death of psychiatric nursing: what next?

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.