Article

First Person Accounts of Long-Term Employment Activity among People with Dual Diagnosis

Dartmouth Psychiatric Research Center, Lebanon, NH 03766, USA.
Psychiatric Rehabilitation Journal (Impact Factor: 1.16). 02/2009; 32(4):261-8. DOI: 10.2975/32.4.2009.261.268
Source: PubMed

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.

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    • "First, employment provides structure, meaning, income, and positive mental health in the general population (Warr, 1987; Blustein, 2008; Butterworth et al., 2011). Second, many people who have been disabled by mental illness report that employment was an essential feature of their recoveries (Rogers, 1995; Bailey, 1998; Steele and Berman, 2001; Clevenger, 2008; Strickler et al., 2009). Third, several studies of supported employment for people with serious mental illness have found that improvements in non-vocational areas, such as self-esteem, friendships, and symptom control accrue to those who become workers (Mueser et al., 1997; Bond et al., 2001; Burns et al., 2009). "

    Full-text · Dataset · Nov 2013
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    • "ly ( Baron & Salzer 2002 , Perkins & Rinaldi 2002 , King et al . 2006 ) . All stakeholders described the social disadvan - tage accruing from episodes of mental illness as significant barriers to employment , disrupting educa - tion and / or availability for work , emphasising that effective illness management is critical to working consistently ( Strickler et al . 2009 ) . SP reported delays in diagnosis and treatment of mental illness , and poor communication across the health sector as contributing to disrupted education and employment , consistent with previous work ( Munro & Edward 2008 ) . Regard - less of the direction of the relationship between social disadvantage , mental illness and employme"
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    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.
    Full-text · Article · Jul 2013 · Health & Social Care in the Community
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    • "First, employment provides structure, meaning, income, and positive mental health in the general population (Warr, 1987; Blustein, 2008; Butterworth et al., 2011). Second, many people who have been disabled by mental illness report that employment was an essential feature of their recoveries (Rogers, 1995; Bailey, 1998; Steele and Berman, 2001; Clevenger, 2008; Strickler et al., 2009). Third, several studies of supported employment for people with serious mental illness have found that improvements in non-vocational areas, such as self-esteem, friendships, and symptom control accrue to those who become workers (Mueser et al., 1997; Bond et al., 2001; Burns et al., 2009). "
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    ABSTRACT: Background: Employment may be an important factor in helping patients with early psychosis to recover rapidly and to avoid involvement in disability and welfare programs. Methods: This study followed 351 patients with early psychoses, either primary psychoses or substance-induced psychoses, for two years to examine their patterns of competitive employment in relation to service use, psychosocial outcomes, and disability and welfare payments. Results: Workers differed from non-workers at baseline and over two years. At baseline, they had better educational and employment histories, were more likely to have substance-induced psychoses rather than primary psychoses, were less likely to have drug dependence, had fewer negative symptoms, and had better psychosocial adjustment. Over two years, baseline psychosocial differences persisted, and the workers used fewer medications, mental health services, and disability or welfare payments. Conclusions: Employment predicts less service use and fewer disability claims among early psychosis patients. Thus, greater attention to supported employment early in the course of illness may reduce federal insurance costs and disability payments.
    Full-text · Article · Mar 2013 · Schizophrenia Research
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