Working with schizophrenia: Experts' views on barriers and pathways to employment and job retention (original) (raw)
Related papers
Schizophrenia and Employment: a review
Social Psychiatry and Psychiatric Epidemiology, 2004
Background: Little is known about the extent to which work contributes to the recovery of people with schizophrenia. There is increasing interest in the subject because of new service models and the economic cost of unemployment in people with severe mental illness. Methods: A literature search was carried out with the aim of investigating: a) employment rates in schizophrenia and first-episode psychosis and the extent to which they have changed over time; b) the barriers to work; c) the factors associated with being employed among people with schizophrenia; and d) whether employment influences other outcomes in schizophrenia. Results: There are wide variations in reported employment rates in schizophrenia. Most recent European studies report rates between 10 % and 20%, while the rate in the US is less clear. There is a higher level of employment among first-episode patients. The employment rate in schizophrenia appears to have declined over the last 50 years in the UK. Barriers to getting employment include stigma,discrimination, fear of loss of benefits and a lack of appropriate professional help. The most consistent predictor of employment is previous work history. Working is correlated with positive outcomes in social functioning, symptom levels, quality of life and self esteem, but a clear causal relationship has not been established. Conclusions: Very low employment rates are not intrinsic to schizophrenia, but appear to reflect an interplay between the social and economic pressures that patients face, the labour market and psychological and social barriers to working.
■ Abstract Background Little is known about the extent to which work contributes to the recovery of people with schizophrenia. There is increasing interest in the subject because of new service models and the economic cost of unemployment in people with severe mental illness. Methods A literature search was carried out with the aim of investigating: a) employment rates in schizophrenia and first-episode psychosis and the extent to which they have changed over time; b) the barriers to work; c) the factors associated with being employed among people with schizophrenia; and d) whether employment influences other outcomes in schizophrenia. Results There are wide variations in reported employment rates in schizophrenia. Most recent European studies report rates between 10 % and 20 %, while the rate in the US is less clear. There is a higher level of employment among first-episode patients. The employment rate in schizophrenia appears to have declined over the last 50 years in the UK. Barriers to getting employment include stigma, discrimination, fear of loss of benefits and a lack of appropriate professional help. The most consistent predictor of employment is previous work history. Working is correlated with positive outcomes in social functioning, symptom levels, quality of life and self esteem, but a clear causal relationship has not been established. Conclusions Very low employment rates are not intrinsic to schizophrenia, but appear to reflect an interplay between the social and economic pressures that patients face, the labour market and psychological and social barriers to working. ■
Work, 2019
BACKGROUND: There is limited research available regarding the coping skills of individuals living with schizophrenia and the strategies used in the open labor market, particularly from a South African context. OBJECTIVE: The aim of the study was to explore and describe the barriers, facilitators and coping strategies that individuals with schizophrenia use when returning to the open labor market after participating in a vocational rehabilitation program to improve work skills. PARTICIPANTS: Four individuals diagnosed with schizophrenia and two key informants (occupational therapists) participated in the study. METHODS: The research study was positioned within the interpretive paradigm, specifically utilizing an exploratory and descriptive design. Semi-structured interviews were used in order to gather data from the participants. RESULTS: Theme one reflects the barriers related to returning to work (i.e. society's acceptance of an individual's work potential). The second theme relates to the enabling factors related to returning to work (i.e. the usefulness of work preparation programs to enhance open labor market employability). Theme three relates to the coping skills that individuals with schizophrenia utilize (i.e. holistic support enhances participation in the worker role). CONCLUSION: In conclusion, the findings indicate individuals with schizophrenia experience barriers that prevent them from being able to adapt to their work environments. However, with the support of the occupational therapist, family, and employer, together with improvements to the vocational rehabilitation program, these barriers may be alleviated, and there could be an improvement in the reintegration of individuals with schizophrenia into the open labor market. The findings suggest that the disclosure of an individual's medical diagnosis, in order to facilitate the return to work of an individual diagnosed with schizophrenia, could be viewed as a barrier and a facilitator.
Studies in Social Science Research, 2020
Occupational participation in a supported-employment is a rehabilitation strategy to improve both vocational and non-vocational domains of people with psychiatric disabilities, enabling them to access and/or re-enter employment. This study aims to identify the factors associated with unsatisfactory job-termination among the participants of supported-employment to inform future intervention. A cross-sectional survey was conducted on a group (with a diagnosis of schizophrenia) who participated in a supported-employment program in a large psychiatry institution in Malaysia. Within the first week of job termination, interviews were conducted with three subgroups independently-the participants, the employers and the hospital employment specialists, using the Job-Termination Interview. Factors linked to job-termination and job-accommodation were analysed using univariate and multivariate logistic regression.
Views and Experiences of Employment Among People With Psychosis: a Qualitative Descriptive Study
International Journal of Social …, 2005
BACKGROUND: Work is important for mental health but we are only just beginning to understand why so few people with psychosis in the UK work. AIMS: To identify the opinions of a purposive sample of patients with psychosis on themes related to employment. METHOD: A thematic analysis of 15 semi-structured interviews with people with schizophrenia or bipolar affective disorder. RESULTS: Participants identified a range of advantages to working but also expressed substantial doubts. Symptoms, medication and potential damage to health are the problems that people believe affect their ability to work. Most people would not tell their employers about their illness because they feared discrimination during the selection process, but believed it could help their chances of retaining a job if employers knew. A number reported a lack of encouragement to work from mental health professionals and not enough helpful employment services. CONCLUSIONS: Although most people want to work, given the pressures they face some may choose not to. Barriers that people face are both internal and external and these interact.
Clinical Schizophrenia & Related Psychoses, 2008
Prior studies of supported employment efficacy for individuals with schizophrenia have yielded mixed results, with some finding poorer outcomes for those with this diagnosis and others finding no differences. Aims: This multi-site effectiveness trial examined the relative impact of diagnosis with schizophrenia and evidence-based practice supported employment on the likelihood of competitive employment. Method: At seven U.S. sites, 1,273 outpatients with severe mental illness were randomly assigned to either an experimental supported employment program or to a comparison/services as usual condition and followed for two years. Data collection involved semi-annual, in-person interviews, and weekly recording of all paid employment by vocational and research staff. Mixed-effects random regression analysis was used to examine the effects of study condition, schizophrenia diagnosis, and their interaction, on the likelihood of competitive employment. Results: Subjects in experimental group programs and those with diagnoses other than schizophrenia (predominantly bipolar disorder and major depression) were significantly more likely to be competitively employed than those in control programs and those with diagnoses of schizophrenia. However, an interaction effect between study condition and diagnosis was observed in which experimental group treatment ameliorated the negative effects of diagnosis on employment outcome. Discussion: Evidence-based supported employment interventions are superior to services as usual/comparison programs in assisting individuals with schizophrenia to attain competitive employment. Given recent evidence of this model's effectiveness outside the U.S. and interest in its promotion internationally, it has global potential to further the recovery potential of individuals with psychiatric disabilities.
Rates and Correlates of Employment in People with Schizophrenia
Background Little is known about international variations in employment rates among people with schizophrenia or about the factors associated with employment in this disorder. Aims To describe employment patterns and the variables associated with working in an international sample of people with schizophrenia. Method An analysis was made of baseline data from the European Schizophrenia Cohort study, a 2-year investigation of people with schizophrenia in contact with secondary services and living in France, Germany and the UK (n=1208). Results Participants were working in all sections of the job market. People who had a degree, were living with their families or had experienced only a single episode of illness were more likely to be working. A continuous illness course, more severe non-psychotic symptoms and drug misuse reduced the odds of employment. There were large variations between centres in employment rates, which were highest in the three German study sites. These differences persisted after adjustment for individual characteristics. Conclusions Local social contexts may be as important as individual or illness-related factors in explaining employment status.
Predictors of employment status change over 2 years in people with schizophrenia living in Europe
"SUMMARY. Aim – To examine the associations of job acquisition and loss in a representative, prospective community sample of people with schizophrenia living in the UK, France and Germany. Method – A representative sample of twelve hundred and eight people with schizophrenia were recruited from selected secondary mental health services in the U.K, France and Germany and followed up for 2 years. Information on demographic details, psychotic symptoms and work status was collected. Results – The odds of getting jobs were increased by being resident in Marseille, Leipzig, Hemer and Heilbronn and by a higher regional general population employment rate. The odds were reduced by living in Lyon, a later illness onset, a longer length of illness, a continuous illness course and more severe negative psychotic symptoms. Previous vocational training reduced the odds of losing employment, whilst living in Lyon or Leipzig, harmful use of alcohol and more positive psychotic symptoms at baseline all increased the odds. Conclusions – In addition to illness related factors, area of residence and local labour market conditions appear to be important in explaining employment status change in people with schizophrenia. Declaration of Interest: All authors declare there are no conflicts of interest. This study was funded by grants from Lundbeck A/S and from the German Federal Ministry of Education and Research. "
Clinicians' Attitudes to the Employment of People With Psychosis
Social psychiatry and …, 2009
BACKGROUND: Negative staff attitudes have been cited as a factor in explaining the low rates of employment in people with psychosis. We aimed to conduct the first systematic survey of staff attitudes in UK community mental health teams. METHODS: A questionnaire survey of clinicians working in community mental health teams in North London, UK. RESULTS: Clinicians believed that many more people with psychosis were capable of working than were actually doing so. Nevertheless they believed that about two thirds of their caseloads were either incapable of working or able only to do voluntary or sheltered work. The work roles they saw as suitable tended to be ones requiring lower levels of technical skills. Clinicians saw helping people get back to work as a core part of their role, but felt they had little relevant training and limited confidence in the vocational services currently available for their clients. CONCLUSIONS: In this London catchment area, clinicians believed the majority of people with psychosis to be capable of some kind of work, albeit not always open market, but they had few resources available to them to facilitate this. They give priority to the development of place and support vocational services.