First Person Accounts of Long-Term Employment Activity among People with Dual Diagnosis
ABSTRACT Evidence suggests that many individuals with dual diagnosis of mental illness and substance use disorder can be successfully employed in competitive jobs, though there remain barriers and facilitators to consistent work activity in this population. The purpose of this study is to elicit and examine first person accounts of work activity over a 16-year period from people with dual diagnosis, who were not selected for employment readiness or vocational interests.
120 people with severe mental illness and co-occurring substance use disorder participated in this study. Their work activity was self-reported at yearly interviews occurring over a 16-year period. Participants naturally fell into one of four categories: those who (i) never or hardly worked; (ii) worked intermittently; (iii) worked fairly consistently; (iv) worked very consistently. A more in-depth interview occurred at 16 years when participants gave first person accounts of their 16-year work history in answer to open-ended questions. These responses were analyzed using traditional methods of qualitative content analysis, comparing responses across the four categories of work patterns.
Five overlapping themes given by participants as strong influences on work activity arose from the data. These are (i) illness management, including use of psychiatric medication and controlling substance abuse; (ii) personal evaluation of the impact of employment; (iii) congruence between job preference and actual employment; (iv) personal motivation and job-seeking assistance, and (v) the conditioning nature of working or not working.
Longitudinal themes of work activity suggest service improvements consistent with evidence-based supported employment.
[Show abstract] [Hide abstract]
ABSTRACT: AimThe individual placement and support (IPS) model of supported employment was first developed in community mental health centres for adults with severe mental illness. While IPS is an established evidence-based practice in this broad population, evidence on its effectiveness focused specifically on young adults has been limited. The current study aimed to address this gap.Methods To investigate the effects of IPS on young adults, the authors conducted a secondary analysis on a pooled sample of 109 unemployed young adults (under age 30) from four randomized controlled trials employing a common research protocol that included a standardized measurement battery and rigorous fidelity monitoring. Researchers assessed these participants over 18 months on nine competitive employment outcome measures.ResultsOn all measures, the IPS group had significantly better employment outcomes. Overall, 40 (82%) of IPS participants obtained employment during follow-up compared with 25 (42%) of control participants, χ2 = 17.9, P < .001. IPS participants averaged 25.0 weeks of employment, compared with 7.0 weeks for control participants, t = 4.50, P < .001.Conclusions The current analysis supports a small number of previous studies in showing that IPS is highly effective in helping young adults with severe mental illness to attain competitive employment. When young adults acquire competitive jobs and initiate a path towards normal adult roles, they may avoid the cycle of disability and psychiatric patient roles that are demeaning and demoralizing.Early Intervention in Psychiatry 09/2014; DOI:10.1111/eip.12175 · 1.74 Impact Factor
Occupational Therapy in Mental Health 09/2014; 30(3):215-315. DOI:10.1080/0164212X.2014.939933
06/2014; 1(1):27-30. DOI:10.1007/s40737-014-0001-6