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Work, workers, and workplaces: A qualitative analysis of narratives of mental health consumers
Abstract
Literature in the area of work and mental health consumers suggests that employment is beneficial to mental health. However, little is known about effects of work on the lives of consumers or components of the workplace which may facilitate work integration. The purpose of this study is to examine the meaning of work from consumers' perspectives as well as important elements of workplaces. Interviews were conducted with 36 consumers who were employed or who had recently left their jobs in integrated settings. Data were analyzed through inductive analysis and three major themes are presented: the meaningfulness of work to consumers, the impact of the organization on job satisfaction and tenure, and the importance of supervisory and coworker relationships and attitudes.
... Afin d'approfondir notre analyse de la participation sociale de personnes avec des troubles mentaux, nous avons comparé nos résultats à ceux de deux études incluant des adultes ayant subi des lésions à la moelle épinière (Noreau & Fougeyrollas, 1996;2000). Il est intéressant de noter que les rôles sociaux où la réalisation était la plus perturbée étaient le travail et les loisirs, comme dans notre étude (Noreau & Fougeyrollas, 1996;2000). ...
... Afin d'approfondir notre analyse de la participation sociale de personnes avec des troubles mentaux, nous avons comparé nos résultats à ceux de deux études incluant des adultes ayant subi des lésions à la moelle épinière (Noreau & Fougeyrollas, 1996;2000). Il est intéressant de noter que les rôles sociaux où la réalisation était la plus perturbée étaient le travail et les loisirs, comme dans notre étude (Noreau & Fougeyrollas, 1996;2000). Ces deux rôles sociaux présentent de nombreux défis pour ces deux groupes, tels que devoir réaliser des tâches complexes, le stress du rendement ou devoir sortir de chez soi. ...
... Par exemple, en ce qui concerne le travail, domaine qui est ressorti dans notre étude parmi les plus difficiles à réaliser et les moins satisfaisants dans les trois groupes, il est bien documenté que ce domaine est un enjeu important dans le processus de rétablissement. Plusieurs études ont démontré que pour les personnes avec des troubles mentaux, le travail rémunéré ou non rémunéré représente une activité significative (Kennedy-Jones, Cooper, & Fossey, 2005;Kirsh, 2000), qui a plusieurs bienfaits tels que se sentir utile, faire partie de la société, avoir un sentiment d'appartenance à un groupe, procurer de la structure dans la routine quotidienne et donner envie de participer à plus d'activités (Kirsh, 2000;Leufstadius, Eklund, & Erlandsson, 2009;Vallée, 2007). Le travail présente aussi plusieurs défis liés, par exemple, aux fluctuations des symptômes, aux effets secondaires de la médication, à la conciliation avec les autres rôles (comme celui de parent), au stress associé aux exigences de l'emploi, à la discrimination potentielle des employeurs (Corbière, Bordeleau, Provost, & Mercier, 2002;Vallée, 2007). ...
La participation sociale est un concept qui n’a été que peu étudié dans le domaine de la santé mentale. Cet article vise à comparer la participation sociale de 24 personnes avec un trouble psychotique, 22 personnes avec un trouble de l’humeur et anxieux et 28 personnes avec un trouble de la personnalité du groupe B en phase aiguë/subaiguë. La Mesure des habitudes de vie (version abrégée 3.1) a été utilisée pour mesurer la participation sociale. Elle contient 77 habitudes de vie regroupées dans six domaines d’activités courantes et six domaines de rôles sociaux. Les analyses ont démontré que les trois groupes ont sensiblement la même qualité de participation sociale. Les personnes avec un trouble de l’humeur et anxieux en étaient toutefois plus insatisfaites que les personnes avec un trouble psychotique (p = 0,01). Le domaine des soins personnels s’est avéré le plus facilement réalisé et le plus satisfaisant par les trois groupes. Le domaine des loisirs s’est révélé le plus difficilement réalisé par les personnes avec un trouble de l’humeur et anxieux et celles avec un trouble de la personnalité du groupe B. Les domaines de l’éducation et du travail ont présenté des difficultés pour le groupe des troubles psychotiques. Les personnes présentant un trouble de l’humeur et anxieux considèrent que les activités entourant la condition corporelle sont celles accomplies avec le plus d’insatisfaction. Pour les personnes avec un trouble de la personnalité du groupe B se sont les relations interpersonnelles qui représentent le plus d’insatisfaction et chez les personnes avec un trouble psychotique se sont le travail et l’éducation.
... The methods used for qualitative analysis include: grounded theory (7); an unspecified qualitative approach (5); narrative analysis (2); ethnography (1); and interpretative phenomenology (1). However, three are substudies of larger studies that included: an RCT [47]; mixed methods [48]; and a prospective longitudinal study [49]. The data collection methods employed was in-depth and semistructured interviews (15); observation (2); focus-groups (2); or a combination of these. ...
... Several participants saw themselves as their primary motivators. Despite the fact that it was difficult for them to describe specific actions that encouraged them to get off the bench, they nonetheless identified a few helpful ''kickstarts'' they received from others, including sympathetic listening, a high degree of positive comments, respect, accurate and relevant information, access to suitable training, and help with problem-solving in everyday life [2,48,50,55,60]. ...
... Paid work was identified a source of motivation, meaning, respect, building daily routines, increasing autonomy, financial rewards, a passage to mainstream life, and as a way to establish normal behavior [48,54,56,57]. Employed participants described themselves as more selfconfident, more outgoing, and better able to resist feelings of falling apart (i.e., more able to learn new steps in iceskating and also become aware of others' tricks) [2,51]. ...
Purpose: To explore how persons with psychiatric disabilities experience facilitators of and barriers to participation in paid work in transitional, supported, and open employment settings, in order to provide guidance for efforts to attract and retain these persons in gainful employment as a key dimension of recovery and community life. Method: A metasynthesis was conducted using 16 qualitative studies published between1990-2011. Results: Ten themes, two phases, and an overarching metaphor were identified. The first five themes describe facilitators of and impediments to getting a job (getting off the bench): 1) fighting inertia; 2) taking control; 3) encouraging peers; 4) disruptions related to the illness; 5) a lack of opportunities and supports. The next five themes represent facilitators of and impediments to working (skating on the ice): 6) going mainstream; 7) social cohesion; 8) clarity in role and responsibilities; 9) environmental factors; 10) managing self-disclosure. We chose as our overarching metaphor “Balancing on Skates on the Icy Surface of Work,” as we view both ice-skaters and workers with psychiatric disabilities as needing to achieve and maintain their balance while being “on the edge” between various extremities. Conclusion: We have shown that, for persons with psychiatric disabilities to “get off the bench” and “onto the ice” of employment, they may need to be supported in finding and maintaining their balance in new situations through a combination of learning new skills and competencies (learning how to skate) while receiving in vivo assistance from empathic and knowledgeable supporters (being coached while on the ice).
... Studies on U.S. adults with significant disabilities have shown that work enhanced self-esteem and feelings of belongingness (Freedman & Fesko, 1996). For adults with psychiatric disabilities in the U.S., Norway, and Sweden work offered a sense of identity (Auerbach & Richardson, 2005;Borg & Kristiansen, 2008;Leufstadius, Eklund, & Erlandsson, 2009;Paul & Moser, 2009), a boost in self-esteem or self-worth (Kirsh, 2000;Leufstadius et al., 2009), and structure to their daily lives (Kirsh, 2000;Koletsi et al., 2009). Financial reward and independence are also important aspects of the meaning of work among adults with psychiatric disabilities (Auerbach & Richardson, 2005;Kirsh, 2000;Koletsi et al., 2009;Leufstadius et al., 2009). ...
... Studies on U.S. adults with significant disabilities have shown that work enhanced self-esteem and feelings of belongingness (Freedman & Fesko, 1996). For adults with psychiatric disabilities in the U.S., Norway, and Sweden work offered a sense of identity (Auerbach & Richardson, 2005;Borg & Kristiansen, 2008;Leufstadius, Eklund, & Erlandsson, 2009;Paul & Moser, 2009), a boost in self-esteem or self-worth (Kirsh, 2000;Leufstadius et al., 2009), and structure to their daily lives (Kirsh, 2000;Koletsi et al., 2009). Financial reward and independence are also important aspects of the meaning of work among adults with psychiatric disabilities (Auerbach & Richardson, 2005;Kirsh, 2000;Koletsi et al., 2009;Leufstadius et al., 2009). ...
... For adults with psychiatric disabilities in the U.S., Norway, and Sweden work offered a sense of identity (Auerbach & Richardson, 2005;Borg & Kristiansen, 2008;Leufstadius, Eklund, & Erlandsson, 2009;Paul & Moser, 2009), a boost in self-esteem or self-worth (Kirsh, 2000;Leufstadius et al., 2009), and structure to their daily lives (Kirsh, 2000;Koletsi et al., 2009). Financial reward and independence are also important aspects of the meaning of work among adults with psychiatric disabilities (Auerbach & Richardson, 2005;Kirsh, 2000;Koletsi et al., 2009;Leufstadius et al., 2009). Adults diagnosed with psychiatric disabilities reported that employment provided social contact, a sense of belonging and promoted friendships, and connection with others and society (Auerbach & Richardson, 2005;Koletsi et al., 2009;Leufstadius et al., 2009), even in cases where individuals felt isolated and unhappy at work (Blank, Harries, & Reynolds, 2015). ...
Objective:
Despite the increased recognition of the importance of work for social and psychological well-being, the meaning of work for young adults with serious mental health conditions is understudied. This study uses a participatory action research approach to explore the economic, social and psychological significance of work for young adults diagnosed with psychiatric disabilities.
Method:
We conducted 57 one-hour semistructured interviews with young adults between the ages of 18 to 30 enrolled in 3 well established vocational support programs. NVivo 8 software was used to sort and systematically organize the interview data.
Results:
Young adults with psychiatric disabilities work in part for financial independence from their family but also for additional reasons. Work provides the opportunity for social engagement and feelings of contributing to society as a whole. For some young adults, work provides the opportunity to enhance their self-esteem, self-confidence, and a positive self-image. For Latino young adults, work provides a way to cope with their mental illness.
Conclusions and implications for practice:
Our findings provide pertinent information for vocational rehabilitation services, recovery programs, and even parents on the importance of connecting young adults to jobs that enhance self-esteem and self-efficacy and are in line with their personal interests. Future research is needed to understand potential cultural and age differences in the meaning of work. (PsycINFO Database Record
... Participants had gained employment through supported employment (Huff, Rapp & Campbell, 2008) and state vocational rehabilitation (Killeen & O'Day, 2004) in the USA; employment projects in the UK (Secker & Membrey, 2003) and a social firm in Australia (Williams et al., 2012). In three studies, some participants had used various vocational services, while others had obtained jobs independently (Auerbach & Richardson, 2005;Kirsh, 2000;O'Day, Killeen & Goldberg, 2006). Overall, some characteristics of their employment, particularly longer job tenure, mean they differ as a group from those represented in the quantitative studies. ...
... In Huff et al.'s (2008) qualitative study too, the work being interesting was the most common reason reported by workers for staying in their jobs, while their most commonly stated reason for leaving was that the work was uninteresting, boring or monotonous. Kirsh (2000) also found that having the right balance of challenge and predictability at work supported tenure. While these findings related primarily to first jobs obtained through supported employment, workers employed for up to six years in a social firm (Williams et al., 2012) and those obtaining competitive employment through mental health services (Auerbach & Richardson, 2005) also reported interesting, enjoyable and rewarding jobs supported them to remain in work. ...
... Working one's preferred hours, whether full-time or parttime, also appears an important factor in job tenure. For instance, over 60% of participants in the follow-up studies identified that working part-time facilitated their employment (Becker et al., 2007;Salyers et al., 2004); and work accommodations related to work hours and schedules were frequently viewed as supporting tenure (Huff et al., 2008;Kirsh, 2000). In contrast, wanting more flexible work hours may contribute to jobs being unsatisfactorily terminated (Becker et al., 1998), while difficulties with missing transport connections and arriving late were cited reasons for leaving jobs (Huff et al., 2008). ...
Background:
Enabling people with severe mental illness to sustain employment remains a challenge. This is despite most wishing to be employed, and the development of effective vocational interventions and employment supports for this population. To better understand how to enable their sustained involvement in the workforce, this review sought to identify, analyse and summarise studies investigating the factors that impact the job tenure of workers with severe mental illness, irrespective of the type of employment support they received.
Methods:
An integrative literature review approach was employed to locate, appraise and synthesise quantitative and qualitative research focused on job tenure published in the 20 years up to 2013. Findings from nineteen studies were extracted and integrated using thematic analytic strategies.
Results:
Job tenure was mostly conceptualised across the reviewed studies as time spent in individual jobs rather than as ongoing participation in the workforce. Three themes describe the factors contributing to job tenure: (1) the worker's experience of doing the current job; (2) natural supports in the workplace; and (3) strategies for integrating work, recovery and wellness, each of which could either support or impede ongoing employment.
Conclusion:
Occupational therapists, other vocational specialists and mental health staff can use these factors as a guide to supporting people with severe mental illness in employment. More detailed examination of job tenure is required in future research not only on job duration but also on the quality of jobs held, their value for career development and the role of services in supporting tenure.
... Participants had gained employment through supported employment (Huff, Rapp & Campbell, 2008) and state vocational rehabilitation (Killeen & O'Day, 2004) in the USA; employment projects in the UK (Secker & Membrey, 2003) and a social firm in Australia (Williams et al., 2012). In three studies, some participants had used various vocational services, while others had obtained jobs independently (Auerbach & Richardson, 2005;Kirsh, 2000;O'Day, Killeen & Goldberg, 2006). Overall, some characteristics of their employment, particularly longer job tenure, mean they differ as a group from those represented in the quantitative studies. ...
... In Huff et al.'s (2008) qualitative study too, the work being interesting was the most common reason reported by workers for staying in their jobs, while their most commonly stated reason for leaving was that the work was uninteresting, boring or monotonous. Kirsh (2000) also found that having the right balance of challenge and predictability at work supported tenure. While these findings related primarily to first jobs obtained through supported employment, workers employed for up to six years in a social firm (Williams et al., 2012) and those obtaining competitive employment through mental health services (Auerbach & Richardson, 2005) also reported interesting, enjoyable and rewarding jobs supported them to remain in work. ...
... Working one's preferred hours, whether full-time or parttime, also appears an important factor in job tenure. For instance, over 60% of participants in the follow-up studies identified that working part-time facilitated their employment (Becker et al., 2007;Salyers et al., 2004); and work accommodations related to work hours and schedules were frequently viewed as supporting tenure (Huff et al., 2008;Kirsh, 2000). In contrast, wanting more flexible work hours may contribute to jobs being unsatisfactorily terminated (Becker et al., 1998), while difficulties with missing transport connections and arriving late were cited reasons for leaving jobs (Huff et al., 2008). ...
... Work adjustment, accommodation, and social support from managers and colleagues are vital to keep employees with health problems at work [8,9]. Participation for people with health problems requires support in the labor market and willingness Workplace inclusion of employees with back pain and mental health problems: A focus group study about employees' experiences among employers and staff to include them [10]. ...
... Many studies have stressed the need for a supportive and inclusive work environment for employees staying at work despite their health problems [23][24][25]. Our study adds to previous knowledge by expanding on how social support and a flexible working environment for employees with health problems can be achieved [8,9]. The current study transcends previous research in providing the perspectives from employees with health problems in need of accommodation as well as from their colleagues. ...
Aim:
To explore how employees experience workplace inclusion of their colleagues or themselves when having back pain or mental health problems.
Methods:
Three focus group interviews with a sample of 16 kindergarten employees were conducted. Systematic Text Condensation was used for analysis.
Results:
The participants emphasized that it was easier to include colleagues whose health problems were specific, especially when they were open about having problems and expressed their needs for accommodation clearly. Discussions revealed difficulties of acceptance and accommodating colleagues with longstanding health problems, when the burden on the other staff members was heavy, and if it had negative consequences for the kindergarten children. Some of the participants had experienced health problems themselves, which was also described as challenging. Having health problems at work often induced feelings of guilt, being a burden to their colleagues, and experiencing a disparity between the ideals and the realities of inclusion practices.
Conclusions:
Workplace inclusion of employees is difficult when their health problems are unspecific, longstanding, and lead to negative consequences for children or colleagues. System level efforts are necessary to reduce negative stereotypes about employees with health problems and facilitate inclusion practices.
... According to Krupa [38], the role of an employee leads to focusing on work and responsibilities, limiting the disorganizing effect of the symptoms of illness. Our results are consistent with the American and Canadian studies which indicate that work, appropriately adjusted to individual abilities and preferences of an employee, positively effects self-esteem and a sense of achievement and pride [36,39]. Stefan was the only participant in our study who thought his work was boring, assessed his competences as very low and felt useless at work. ...
... The results of our study are consistent with Leufstadius, Eukland and Erlandsson [42] who show that work environment can provide a sense of affiliation and community. Support and good relationships with management or co-workers can become a holding environment that is beneficial for the mental state and shields from relapses [39]. However, conflicts are also an inevitable element of human relationships and can lead to intensification of symptoms. ...
Having the opportunity to work has been found meaningful for individuals suffering from severe mental illness, in order to boost their self-esteem, provide a sense of control over their lives and of belonging to a community. There are no studies in Polish literature on the process of recovery from schizophrenia with reference to work activity. The objective of this research was to explore personal experiences of people employed in Vocational Development Centers. Eight semi-structured interviews were conducted with adult patients. Their transcripts were subject to interpretative phenomenological analysis (IPA). Having the opportunity to work was significant for participants because it mobilized them and encouraged self-care. Going to work helped them overcome social isolation by meeting people with similar difficulties and those who did not suffer from mental illness. Financial gratification enabled a sense of independence and the ability to develop skills to plan and control their budget. This study finds that patients who lost their jobs due to mental illness should be encouraged to utilize rehabilitation institutions to help them undertake work activity and use previously acquired qualifications or develop new skills. Access to appropriate psychological support should be provided during vocation reorientation and adaptation into new work environments. This helps patients regain a sense of control and purpose, and cope with losing valued social roles. We also highlight the need for further studies into challenges in the workplace and the strategies patients use to cope with them.
... According to Krupa [38], the role of an employee leads to focusing on work and responsibilities, limiting the disorganizing effect of the symptoms of illness. Our results are consistent with the American and Canadian studies which indicate that work, appropriately adjusted to individual abilities and preferences of an employee, positively effects self-esteem and a sense of achievement and pride [36,39]. Stefan was the only participant in our study who thought his work was boring, assessed his competences as very low and felt useless at work. ...
... The results of our study are consistent with Leufstadius, Eukland and Erlandsson [42] who show that work environment can provide a sense of affiliation and community. Support and good relationships with management or co-workers can become a holding environment that is beneficial for the mental state and shields from relapses [39]. However, conflicts are also an inevitable element of human relationships and can lead to intensification of symptoms. ...
Having the opportunity to work has been found meaningful for individu-als suffering from severe mental illness, in order to boost their self-esteem, provide a sense of control over their lives and of belonging to a community. There are no studies in Polish literature on the process of recovery from schizophrenia with reference to work activity. The objective of this research was to explore personal experiences of people employed in Vocational Development Centers. Eight semi-structured interviews were conducted with adult patients. Their transcripts were subject to interpretative phenomenological analysis (IPA). Having the opportunity to work was significant for participants because it mobi-lized them and encouraged self-care. Going to work helped them overcome social isolation by meeting people with similar difficulties and those who did not suffer from mental illness. Financial gratification enables a sense of independence and the ability to develop skills to plan and control their budget.
Conclusions. This study finds that patients who lost their jobs due to mental illness should be encouraged to utilize rehabilitation institutions to help them undertake work activity and use previously acquired qualifications or develop new skills. Access to appropriate psycho-logical support should be provided during vocation reorientation and adaptation into new work environments. This helps patients regain a sense of control and purpose, and cope with losing valued social roles. We also highlight the need for further studies into challenges in the workplace and the strategies patients use to cope with them.
... Employment is not inherently beneicial: workplaces can be stressful as well as supportive (Broom et al. 2006). The vocational success of people with severe mental illness is typically characterized by a positive it between the worker's employment interests and skills, the tasks, and the workplace (Kirsh 2000;Leufstadius et al. 2009). The importance of this best it between persons and environments emphasizes the need to attend to barriers in the environment and contextual accommodations, so as to promote social integration of employees with severe mental illness with their co-workers (Kirsh 2000;Roulstone and Warren 2005;Vanhala 2006;Wehman 2003). ...
... The vocational success of people with severe mental illness is typically characterized by a positive it between the worker's employment interests and skills, the tasks, and the workplace (Kirsh 2000;Leufstadius et al. 2009). The importance of this best it between persons and environments emphasizes the need to attend to barriers in the environment and contextual accommodations, so as to promote social integration of employees with severe mental illness with their co-workers (Kirsh 2000;Roulstone and Warren 2005;Vanhala 2006;Wehman 2003). Work accommodation can be deined as any modiication or adjustment to the workplace or workplace procedures, which allows a person with special needs to perform the tasks required (Frado 1993). ...
Little is known about the types of work accommodations and natural supports that are useful for people experiencing severe mental illness working in social businesses. We conducted an exploratory, descriptive and cross-sectional investigation in Australia, Canada and Italy to study the nature of work accommodations and natural supports available in social businesses. Study findings are drawn from survey responses of a convenience sample of 90 employees with self-reported psychiatric disabilities. Results showed that, regardless of the country, social businesses provide many work accommodations and natural supports, especially those linked to schedule flexibility and support, while work accommodations related to training and schedule flexibility were linked to longer job tenure. Overall, this study advances our knowledge about the spectrum of work accommodations and natural supports that are available in social businesses for people with severe mental illness. Also, it highlights the type of work accommodations that are likely to support this population to sustain employment.
... However, Diksa and Rogers (1996) noted in their study that these views may be changed by dispelling the fears of concern hiring them. For example, Diksa and Rogers (1996) and Kirsh (2000) reported that employees with psychiatric disabilities were provided an inclusive atmosphere of respect and care and were accepted as a part of the diverse workforce by the employer. Therefore, the type and severity of disability have a great influence on labour market outcomes, revealing that people with more severe disabilities and mental health are at a greater disadvantage. ...
... Initiatives for hiring people with Colella, 2001;Diksa & Rogers, 1996;Gilbride et al., 2003;Gustaffson et al., 2013;Hunag & Chen, 2015;Kregel & Tomiyasu, 1994;Levy et al., 1992;McFarlin et al., 1991;Popovich et al., 2003;Stone & Colella, 1996;Wiegand, 2008;Zissi et al., 2007. Type of Disability Baldwin & Choe, 2014Bricout & Bentley, 2000;Chima, 2001;Colella, 2001;Diksa & Rogers, 1996;Gustafsson et al., 2013;Harcourt et al., 2005;ILO, 2010;Jones et al., 2011;Kirsh , 2000;Mik-Neyer, 2016;Naraine & Lindsay, 2011;Pinder, 1995;Riach & Rich, 2004;Schneider & Dutton, 2002;Wiegand, 2008;Zissi et al., 2007. Work Performance Concerns Bengisu & Balta, 2011Diksa & Rogers, 1996;Gilbride et al., 2003;Gustafsson et al., 2013;Harcourt et al., 2005;ILO, 2010;Kang, 2013;Kaye et al. ,2011;Kulkarni, 2016;Lengnick-Hall et al., 2008;Popovich et al., 2003;Schur et al., 2009;Stone & Colella, 1996. ...
The significance of employment for people with disabilities has gained interest among researchers. The successful inclusion of people with disabilities in the employment settings depends on the employers’ perspective towards their integration in the mainstream workforce. This review examines literature over the past 25 years with an attempt to assess the employers’ perspective and specifically, the factors influencing their perspective towards inclusion of people with disabilities in employment. A search of electronic databases has resulted in the selection and analysis of 44 articles. The literature indicates that employers’ perspective plays an important role in providing and maintaining employment opportunities for people with disabilities. A number of factors including type of disability and demographic variables affecting employers’ perspective have been identified and discussed.
... Various studies emphasise the value of work in terms of providing them with security, stability and progress towards independent líving, as well as towards improving self-esteem and general functioning in society (Lehman et al., 2002). Although work can on occasions become a source of stress and destabilisation, it is considered to be relevant in helping people with SMI regain control over their lives and interact with their surroundings (Borg & Kristiansen, 2008;Boyce et al., 2008;Honey, 2004;Hvalsøe & Josephsson, 2003;Kinn et al., 2011;Kirsh, 2000;Marwaha & Johnson, 2005). Thus, having a job helps improve self-esteem and raise awareness of the value of their own abilities. ...
... Despite this, most participants look favourably on keeping their current job as an element that provides them with stability in their lives, helps them to continue reinforcing their personal identity and allows them to progress towards economic independence, all of this bringing them nearer to 'normality' . This analysis coincides with the results of others studies (Borg & Kristiansen, 2008;Boyce et al., 2008;Honey, 2004;Hvalsøe & Josephsson, 2003;Kirsh, 2000). ...
The participation of people with mental illness in research is key to their empowerment and provides them with a highly meaningful experience. The aim of this article was to explore the perspectives, views and experiences of people with severe mental illness (SMI) regarding their present life and projection of the future (desires, expectations related to the illness, their personal, working, relational life, etc.). We present the results of a qualitative study in which two personal interviews were conducted with seven people with SMI, incorporating visual elements produced by the participants themselves (photographs and drawings). The results obtained allow us to take a more in-depth look at these people’s reflections with regard to the present and future, while also opening a working path for professionals in the social education services.
... Według Krupy [38] rola pracownika powoduje koncentrowanie się na pracy i obowiązkach z nią związanych, a tym samym ogranicza dezorganizujący wpływ objawów chorobowych. Jak pokazuje nasze badanie, co potwierdzają też wyniki amerykańskich oraz kanadyjskich analiz, praca dostosowana do możliwości i zgodna z preferencjami pracownika pozytywnie wpływa na jego samoocenę i jest źródłem poczucia osiągnięć i dumy [36,39]. Stefan, jako jedyny z badanych, uważał, że praca nie odpowiada jego zainteresowaniom i bardzo nisko oceniał swoje kompetencje jako pracownika oraz czuł się nieprzydatny w pracy. ...
... Nasze badanie potwierdza wnioski Leufstadius, Eklund i Erlandsson [42], wskazujące na to, że praca jest źródłem poczucia przynależności i wspólnoty. Wsparcie ze strony przełożonych i współpracowników oraz dobre relacje z nimi stanowią podtrzymujące środowisko, co pozytywnie wpływa na stan psychiczny i jest swego rodzaju czynnikiem chroniącym przed nawrotem choroby [39]. Jednak sytuacje konfliktowe, które są nieodłącznym elementem relacji międzyludzkich, mogą się też przyczyniać do zaostrzenia objawów, zwłaszcza że osoby chorujące na schizofrenię nadmiernie reagują na wyrażanie przez innych negatywnych emocji [37]. ...
Objectives:
Having the opportunity to work has been found meaningful for individuals suffering from severe mental illness, in order to boost their self-esteem, provide a sense of control over their lives and of belonging to a community. There are no studies in Polish literature on the process of recovery from schizophrenia with reference to work activity. The objective of this research was to explore personal experiences of people employed in Vocational Development Centers.
Methods:
Eight semi-structured interviews were conducted with adult patients. Their transcripts were subject to interpretative phenomenological analysis (IPA).
Results:
Having the opportunity to work was significant for participants because it mobilized them and encouraged self-care. G oing to work helped them overcome social isolation by meeting people with similar difficulties and those who did not suffer from mental illness. Financial gratification enables a sense of independence and the ability to develop skills to plan and control their budget.
Conclusions:
This study finds that patients who lost their jobs due to mental illness should be encouraged to utilize rehabilitation institutions to help them undertake work activity and use previously acquired qualifications or develop new skills. Access to appropriate psychological support should be provided during vocation reorientation and adaptation into new work environments. This helps patients regain a sense of control and purpose, and cope with losing valued social roles. We also highlight the need for further studies into challenges in the workplace and the strategies patients use to cope with them.
... Other studies have found a link between disclosure and increased job tenure (Fabian, Waterworth, & Ripke, 1993;Rollins et al., 2002). Accommodations obtained as a result of disclosure have been found to increase employment duration (Gioia & Brekke, 2003;Kirsh, 2000). Even so, there is still little evidence to suggest that nondisclosure is associated with more negative outcomes than other forms of mental health disclosure (Dinos et al., 2004;Goldberg et al., 2005;Jones, 2011). ...
... employer is viewed as being supportive (Ellison et al., 2003) and trustworthy (Toth & Dewa, 2014). The most commonly reported reasons for disclosing include (a) obtaining needed work accommodations, (b) alleviating stress associated with concealing a mental disorder, (c) facilitating support in the workplace, and (d) explaining symptoms that could affect work performance (Banks et al., 2007;Gioia & Brekke, 2003;Granger, 2000;Jones, 2011;Kirsh, 2000). Even though the multidimensional approach is a substantial improvement upon the binary approach, it is still influenced by the negative connotations associated with the term "disclosure." ...
Objective:
To first provide an overview of studies that explore mental health disclosure in the workplace; including factors that influence the decision to disclose, and differing approaches to disclosure (binary, multidimensional, and evolving and ongoing). Second, to provide a critical overview of existing tools designed to help clients manage their mental health disclosure decisions.
Method:
Electronic searches of PubMed, PsycINFO and ScienceDirect were undertaken, excluding all articles published prior to 1990. The following search terms were used: mental health disclosure, employment, severe and persistent mental illness, psychosis, schizophrenia, supported employment, individual placement and support (IPS).
Results:
We found that mental health disclosure involves a complex decision-making process, and yet clients of IPS supported employment are currently provided with little structured guidance on how to manage their personal information in the workplace.
Conclusions and implications for practice:
More extensive investigations are required of existing mental health disclosure tools before they can be developed into a standardized intervention for practitioners. However, preliminary evidence suggests that facilitating better disclosure decisions and management of personal information is a promising area of future research. This line of investigation is likely to find ways to enhance competitive employment outcomes in supported employment for people with severe and persistent mental illness. (PsycINFO Database Record
... Work has been found to play an important role in maintaining the mental health of all individuals (Falco et al., 2012;Falco, Girardi, Dal Corso, Di Sipio, & De Carlo, 2013). Furthermore, it contributes to establish goals of personal growth and to set people in a planned existence, especially if it is related to a positive fit between the personal worker's characteristics, the tasks, and the workplace (Catty et al., 2008;Fossey & Harvey, 2010;Kirsh, 2000;Leufstadius, Erlandsson, Bjorkman, & Eklund, 2008;Woodside, Schell, & Allison-Hedges, 2006 There are reasons to believe that work could promote the recovery (Huff, Rapp, & Campbell, 2008) of those who suffer from a severe mental illness (SMI) (i.e., people suffering from schizophrenia, bipolar disorder, and other severe forms of depression; National Institute of Mental Health, 1999). Specifically, the support of the supervisor and the chance of experiencing autonomy in the workplace are opportunities to help these people to accept and overcome the challenge of the disability (i.e., recovery ;Deegan, 1988). ...
... Other studies (Graffam & Naccarella, 1997;Kirsh, 2000;Ryan, 1997;Strong, 1998) have illustrated that work provides a framework for renegotiating a new sense of self by providing the opportunity and the vehicle through which persons experience connecting, contributing, challenges and success. Based on these considerations, it may be assumed that: ...
The relationships between social support (i.e., supportive relationship between supervisor-coworker), work engagement, self-esteem, and self-awareness (i.e., identity and perceived personal health), were investigated in a group of patients with severe mental illness (i.e., patients suffering from schizophrenia, bipolar disorder, and mood disorders). Seventy Italian working patients were administered the Italian version of the following scales: a) Utrecht Work Engagement Scale, b) Work Climate Questionnaire, c) Rosenberg Self-Esteem Scale, d) Self-Awareness (identity and perceived personal health)ad hoc scale. Results showed that social support is positively related to work engagement, self-awareness, and self-esteem. Moreover, the relationships between social support and identity appeared to be fully mediated by perceived personal health. Practical implications are discussed.
... Work, a central aspect of daily life, significantly influences the mental and emotional well-being of individuals (Waddell & Burton, 2006). Research suggests that engagement in work offers numerous benefits, including deriving meaning and fulfillment from the occupation, achieving economic independence, and fostering social connections within the work environment (Auerbach & Richardson, 2005;Boyce et al., 2008;Cunningham et al., 2000;Honey, 2004;Kirsh, 2000;Marwaha & Johnson, 2005;Tse & Yeats, 2002). Additionally, safe and healthy working environments can help minimize tension and conflict at work, improve staff retention, work performance, and productivity (World Health Organization, 2022). ...
... Regarding the fact that PwD stand out for their dedication to work, [13]. About half (51%) disagreed that the PwD may adopt inappropriate attitudes/ behaviours in the organisation [14]. ...
This article is about livelihood training and independence of young adults with disabilities. A structured framework for providing and sustaining employment successfully.
... However, Diksa and Rogers (1996) noted in their study that these views may change by dispelling fears about hiring them. For example, Diksa and Rogers (1996) and Kirsh (2000) reported that employees with psychiatric disabilities were provided an inclusive atmosphere of respect and care and were accepted as part of the diverse workforce by employers. Therefore, in the employment process, the type and severity of disability greatly influence the disadvantage experienced by individuals, particularly those with mental and psychiatric issues compared to others. ...
This research entails an assessment of the employment conditions for deaf individuals in Asmara, Eritrea. The study involved the random selection and administration of semi-structured questionnaires to 40 deaf employees and interviews with 10 employers from various organizations. The data collected was analyzed using SPSS and Microsoft Excel. Given that 64.3% of the total deaf population in Eritrea is unemployed, it is evident that there are significant barriers to employment. Communication emerged as one of the major obstacles, with nearly 50% of respondents indicating that communication greatly influences their employment situation. Education was also identified as a barrier, with 61.8% of respondents stating that their level of education significantly affects their employment prospects. Despite these challenges, 73% of respondents expressed high satisfaction with their work environment. Other factors contributing to the low employment rate among deaf individuals include lack of exposure, economic conditions, and limited access to training and diverse courses, negative psychological impacts experienced by deaf individuals, and higher expectations placed on organizations to address their employment issues. To overcome these difficulties, it is recommended that deaf individuals receive moral support from society to enhance their competence and confidence. Additionally, improvements in salary remuneration are necessary to maintain their financial well-being. Providing literacy programs to enhance sign language skills, as well as psychological and social welfare programs, job training, and diversified courses, is also recommended to empower deaf individuals and enhance their employment opportunities.
... Conversely, several studies have highlighted the importance of psychological factors such as self-efficacy, healthy self-concept, and vocational motivation related to the work of people with mental disabilities (Kirsh, 2000;Provencher, Gregg, Mead, & Mueser, 2002). In this regard, it is necessary to ascertain whether the experience of recognizing one's purpose and value through work affects personal life satisfaction. ...
This study examined the mediating effects of acceptance of disability on the relationship between employment and daily life satisfaction in people with a mental disability. Participants included 160 subjects with a mental disability who responded to the second wave of the Panel Survey of Employment for the Disabled (2017). The data were analyzed by means of descriptive statistics and hierarchical regression analyses. The results showed that employment status and acceptance of disability had a significant effect on daily life satisfaction. Acceptance of one’s disability had an indirect mediating effect on the relationship between employment status, people with a mental disability, and daily life satisfaction. These findings suggest a need for practical interventions and policy implementation to improve the daily life satisfaction of people with a mental disability.
... In the context of sickness absence, the need for relatedness may be satisfied when an employee perceives adequate personal support, co-worker interactions, but also interactions with other stakeholders in the RTW process. According to Kirsch, these relations are needed for successful reintegration [15]. Satisfaction of the need for competence concerns the need for the development of new skills and feeling mastery of the environment [13,16]. ...
Background:
Dutch legislation stimulates active participation of employees in their own return-to-work (RTW). In addition, RTW professionals encourage sick-listed employees to self-direct RTW. It remains unclear, however, how employees give meaning to and shape their self-direction.
Objective:
This study aims to conceptualize self-direction using the components of Self-Determination Theory (autonomy, competence, and relatedness) as a framework.
Methods:
Semi-structured interviews were conducted with three long-term sick-listed employees. These results were combined with 14 existing transcripts of semi-structured interviews with long-term sick-listed employees and employees who experienced long-term sick leave during the previous calendar year. All interview transcripts were analyzed thematically.
Results:
Employees generally think of self-direction as making their own decision regarding RTW.They wish to decide by themselves how to shape their RTW-process. Several environmental factors play a role in employees' self-direction. Proximal factors are satisfaction of the need for autonomy, competence, and relatedness. Distal factors are legislation regarding RTW, organizational culture and clarity regarding the roles of various stakeholders in the process of sickness absence and RTW.
Conclusions:
Exercising self-direction in RTW seems to contribute to a personalized RTW-process that takes into account individual needs and wishes. Preconditions for effective self-direction are a supportive environment and good cooperation between employee, employer, and occupational physician.
... Age, educational level, work history, psychotic symptoms, social functioning, and cognitive impairments are identified factors related to the level of social participation [22,36,46,47]. However, since most research in this area is based on small samples of clients of vocational services, generalization is difficult and can lead to contradictory results [48]. ...
Purpose
To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI).
Methods
A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups.
Results
Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender.
Conclusions
Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning.
... Kurumların mevzuatına "klinik sosyal hizmet uzmanı" ya da "klinik sosyal çalışmacı" ünvanının konulması ve bu ünvanı kimlerin nasıl alabileceğinin sosyal hizmet meslek yasası ile düzenlenmesi en ideal durum olacaktır. Örneğin Amerika Birleşik Devletleri'nde klinik sosyal hizmet ya da psikiyatrik sosyal hizmet alanlarında yüksek lisans yapmış kişiler devlet tarafından açılan lisans sınavını geçip gerekli süpervizyon saatlerini tamamladıktan sonra "lisanslı klinik sosyal hizmet uzmanı" (LCSW) ünvanını alırlar (Nişancı, 2018 (Kirsh, 2000), yaşam öyküsü araştırması (Bulut, 2014) gibi yenilikçi araştırma yöntemleri etkili olabilir. Bu araştırmaları sosyal hizmet akademisyenleri yürütebileceği gibi, lisans üstü öğrenciler de iyileşme yaklaşımını geliştirmeye yönelik araştırmalar yürütmeleri konusunda desteklenebilir. ...
Bu makalede iyileşme yaklaşımının kısa tarihsel ve düşünsel arka planı sunulmakta ve yaklaşımın temel unsurları sosyal hizmet ile ilişkisi bağlamında değerlendirilmektedir. İyileşme yaklaşımını temel alarak ortaya konmuş bir uygulama modeli ele alınarak, yaklaşımın psikiyatrik sosyal hizmet uygulamaları, sosyal hizmet eğitimi ve araştırması için önemi ortaya konmaktadır. Psikiyatrik sosyal hizmet alanında özelleşmiş sosyal hizmet uzmanları psikiyatrik tedavi sürecinin tüm aşamalarında yer alabilir, ruh sağlığı sistemlerini ve politikalarını yönetebilir ve yönlendirebilirler. Sosyal hizmet disiplini patoloji odaklı modern psikiyatriye yaptığı eleştiri ile engellilik hareketi, kadın hareketi, hizmet alan hareketi gibi hareketlerle birlikte eleştirel psikiyatri akımının doğmasına zemin hazırlayan kaynaklar arasındadır. Söz konusu modern psikiyatri eleştirileri ruh sağlığı alanında iyileşme yaklaşımını ortaya çıkarmıştır. Son yıllarda ruh sağlığı alanındaki uygulamaları ve ülkelerin ruh sağlığı politikalarını dönüştüren iyileşme yaklaşımı, sosyal hizmet mesleğinin temel ilke ve değerleri ile örtüşmektedir. Bu nedenlerle iyileşme yaklaşımı hem psikiyatrik sosyal hizmet alanındaki sosyal hizmet uygulamalarına yön verebilir, hem de ruh sağlığı sistemlerinin sosyal hizmet bakış açısına uyumlu şekilde dönüştürülmesine öncülük edebilir.
... Disclosure during the process of applying for a job might reduce the chances of getting a job offer due to the stigma of mental illness (Farina & Felner, 1973;Thornicroft et al., 2009;Wahl, 1999). On the other hand, potential advantages of disclosure may include explaining gaps in one's work history, obtaining support at work ( Banks et al., 2007;Rollins et al., 2002), explaining and addressing symptoms or other problems at the workplace ( Banks et al., 2007), and alleviating stress associated with hiding an illness (Kirsh, 2000;Pachankis, 2007). ...
Deciding whether to disclose one’s psychiatric disorder to a prospective employer is a complex decision for people with severe mental illness seeking to return to work, with potential advantages and disadvantages. The present study examined the rates, patterns, and correlates of disclosure in 51 participants (74.5% schizophrenia or schizoaffective disorder) receiving high fidelity Individual Placement Support (IPS) who obtained competitive work over a two-year study period. Most participants (64.7%) disclosed their psychiatric disorder in their first job, and there was a tendency for those with multiple jobs who did not disclose initially to shift to disclosure in subsequent jobs. Participants who disclosed for their first job had worse baseline cognitive scores on the Positive and Negative Syndrome Scale (PANSS), lower self-esteem, and poorer psychosocial functioning than those who did not disclose. However, participants who disclosed to their first employer were more likely to obtain jobs that matched their interests, and worked significantly longer than those who did not disclose (32.55 vs. 12.50 weeks, respectively). The findings suggest that individuals receiving supported employment who disclose their mental illness to prospective employers may have better work outcomes.
... This merges with availability of a valued work role that can be adapted to a lower level of functioning. 16,17 Several narrative writers reflect upon the maintenance of work status a key to their successful living. Elyn Saks, in her memoir, writes extensively about how studying philosophy and having a job that she loves helped her function and cope with her schizophrenia. ...
There is controversy concerning the relationship between stigma and the conceptualization of mental illness as a biomedical disease. Proponents of the biomedical model argue that conceptualizing mental illness as a biochemical disease benefits patients, because it not only enables them to receive medical treatments but also helps them avoid the stigmas associated with mental illness. Opposing this position, others suggest that biomedical causal trajectory further contributes to stigma. When considering individuals' sense of well‐being while living with a mental illness, we believe that this debate detracts us from the most important aspects of removing stigma and enabling patients to develop fulfilling lives. Thus, using patient memoirs, we refocus attention on the patient experience itself, searching for how patients' memoirs can illustrate roads to recovery, resilience, and coping. We examine first what facilitates patients to live a fulfilling life and next, what obstacles they identify to a fulfilling life in the face of their encounter with mental illness.
... Organisational climate was assessed utilising the Workplace Climate Questionnaire (WCP: Kirsh, 2000) . The WCP comprises 25 items to measure various aspects of the social and structural work environment . ...
This study examined influences of organisational climate on hardiness, self-efficacy, and job satisfaction in a military setting. Data were collected from 120 South African National Defence Force (SANDF) military personnel (female = 36%; officers = 90%; age range = 24–64 years). The defence force members completed a military hardiness scale, general self-efficacy scale, workplace climate questionnaire, and the generic job satisfaction scale. Regression analyses were computed to predict job satisfaction from hardiness and self-efficacy. This was followed by moderated multiple regression analysis to examine the influence of organisational climate on the relationship between job satisfaction from hardiness and self-efficacy. The results suggest high levels of hardiness (commitment) and organisational climate to predict 71% of the variance in job satisfaction. Personal hardiness (commitment) and organisational climate strongly influence job satisfaction among military followers.
... Men denne formen for myndiggjøring betyr ikke bare å verbalisere egne behov og å stå opp for seg selv, den innebaerer også å bli tatt på alvor og å gjøre en forskjell i relasjonelle og samfunnsmessige forhold (78). En rekke kvalitative studier (27,79,80,81) ...
Kinn, LG. Arbeid –veien til det gode liv? kapittel 11, side 199-208. I: Underlid, K., Dyregrov, K. Og Thuen, F. (2016). Krevende livserfaringer og psykisk helse. Oslo: Cappelen Damm 1 Kapittel 11 Arbeid –veien til «det gode liv»? Perspektiver på arbeidsintegrering for personer med alvorlige psykiske lidelse Liv Grethe Kinn Jeg har en tendens til «å spille en rolle». Når fasaden min sprekker, stikker jeg … Det er det jeg liker i praksisen på arbeidsavklaringskurset: At arbeidsgiver vet ikke om diagnosen, men om mine spesielle behov. For de kan det vaere vanskelig å skjønne. (1, min oversettelse) Psykiske helsearbeidere skal «bidra til å fremme selvstendighet, tilhørighet og styrke evnen til å mestre eget liv for mennesker med psykiske lidelser» (2, s. 7). Tiltakene skal vaere trygge, brukerorienterte, samordnede, kontinuerlige, effektive, ressursbesparende, tilgjengelige og rettferdig fordelt. Dessuten skal tjenesteapparatet fremme arbeidsdeltakelse for brukere som ønsker det – uansett alvorlighetsgrad og diagnose (2). Eksempelvis må et tverrfaglig helseteam, inklusive en jobbspesialist, bli enige om en tjenestebruker skal tilbys plass på et treffsted, i en tiltaksbedrift, eller plasseres i en vanlig jobb. Da må de ta utgangspunkt i følgende forutsetninger (3, s. 30): • brukerens ressurser, tilretteleggingsbehov og mål formulert i individuell plan • anbefalinger i Nasjonal strategiplan for arbeid og psykisk helse (4) • kliniske retningslinjer eller veilederen Psykisk helsearbeid for voksne i kommunene (5) • tilgjengelige, relevante og evidensbaserte arbeidsrettede tiltak • egne faglige og erfaringsbaserte kunnskaper
... These finding replicate the notion from previous research that organisational sources of support are important in terms of support from co-workers (e.g. Brotheridge & Lee, 2002;Kirsh, 2000;Thompson & Prottas, 2005), supervisors (e.g. Brotheridge & Lee, 2002;Dormann & Zapf, 1999;Yoon & Lim, 1999), and the organisation (e.g. ...
Nurses have a constant emotional involvement with patients and
relatives. This emotional labor has found to have ambiguos correlations
with nurses' well-being. We aim to underscore that handling emotions
with patients is not negative neither positive. The focus of this work is
on how nurses manage with emotional involvement with patients.
Empathy and emotional dissonance are two different states of being
which are involved in the emotional labor.We examine the role played
by empathy and emotional dissonance in (not)promoting quality of
nurses' working life.
... As a result, with the support of his CMHN, John decided to do a college course on catering, which he commenced, successfully completed and subsequently gained employment as a chef in an Italian restaurant. When persons with mental distress do find and keep employment, research indicates that they experience a decrease in symptoms, an increase self-efficacy, self-esteem and improved integration into their communities (Kirsh 2000;Woodside et al. 2006). This was also the case for John, who on a number of occasions stated that he highly valued his work roles. ...
Community mental health nurses are part of community mental health teams that offer care and support to service users with mental distress. They are generally described as " gate keepers " because they ensure service users`users`timely assessment and access to appropriate therapeutic services. Because service users`users`needs are unique and constantly changing, community mental health nurses are required to reconceptualise their approaches to care.
... When considering our findings and other research in relation to the disability construct, cognitive functioning is not the sole factor in the ability to gain, perform, and keep work. Other factors may contribute to work disability, such as stigma [26,40,41], the employer's attitude and engagement [42], and the social work environment [43]. For instance, social disabilities are frequently reported in vocational rehabilitation research among people with serious mental illnesses [18][19][20][21]. ...
Background:
Employment is central to recovery in schizophrenia, but little attention has been paid to its relationship with cognitive functioning.
Objective:
This cross-sectional study adds to the knowledge base of relationships between cognitive functioning and gaining competitive employment, work hours per week, and monthly income among people with schizophrenia in vocational rehabilitation. It also examines which area of cognitive function may be decisive for gaining employment.
Methods:
Thirty-nine vocational rehabilitation participants were administered a cognitive battery based on MATRICS Consensus Cognitive Battery. Socio-demographic, clinical, and vocational data were gathered and analyzed with nonparametric statistics.
Results:
Individuals with competitive employment differed from those without competitive employment in attention and psychomotor speed, delayed verbal recall, immediate visual recall, and planning, reasoning, and problem-solving. Higher scores in immediate and delayed verbal recall and planning, reasoning, and problem-solving correlated with more work hours per week and higher income. Immediate visual recall was related to higher income. Higher scores in planning, reasoning, and problem-solving was an indicator of competitive employment (OR = 1.48).
Conclusions:
Higher order cognitive functioning of planning, reasoning, and problem-solving may have a central role in gaining employment. The findings should be considered in compensation for or improving cognitive functions for vocational rehabilitation participants.
... Although numerous qualitative studies were conducted to capture the unique nature of MOW among specific working populations (Kirsh, 2000;Wrzesniewski et al., 2003), assessing MOW appears to be a challenging but promising direction. Indeed, meaning is a measurable construct and contributes to an understanding of the phenomenon (Proulx et al., 2013). ...
The purpose of this study was to validate a psychometric instrument among French workers for assessing the meaning of work. Following an empirical framework, a two-step procedure consisted of exploring and then validating the scale among distinctive samples. The consequent Meaning of Work Inventory is a 15-item scale based on a four-factor model, and assesses the importance, understanding, direction, and purpose of work. The results indicate that this instrument is reliable for assessing the meaning of work in the French context. Implications for career counseling practices are discussed.
... There is even a "common understanding" that this group of individuals cannot work (Rinaldi & Perkins, 2005). Nevertheless, persons with psychiatric disabilities are more successful in workplaces that accept diversity and have an atmosphere of respect and caring (Kirsh, 2000). ...
BACKGROUND
Rehabilitation professionals are increasingly interested in the vocational rehabilitation approach called Individual Placement and Support (IPS) for persons with serious mental illness.
OBJECTIVE
Since employers play a crucial supporting role for the IPS service user in the workplace, the aim of this study was to explore the experiences and views of employers in Sweden who have participated in the IPS network and taken IPS service users into their workforce.
METHODS
Grounded theory with situational analysis was used to analyze data from nine employers.
RESULTS
The core category being socially committed was identified. Six stages/categories illustrated the employer process, from taking on IPS service users to supporting them at work: 1) IPS is the keyhole, 2) being ready to open the door, 3) making a job offer, 4) removing barriers, 5) achieving the goal, and 6) pride mixed with negative feelings.
CONCLUSION
The study results suggest that collaborative relationships with employers must be based on trust and professionalism, and that employers must be provided with adequate support.
... Work is considered by many rehabilitation specialists a key component in the recovery and rehabilitation of people with severe mental disorders living in the community [5,17,29,30,38,39,56,61,76]. However, the integration into the workforce of this clientele remains difficult, regardless of the country and socioeconomic context [78]. ...
Self-esteem plays an important role in the recovery, particularly the work integration, of people with severe mental disorders. The Rosenberg Self-Esteem Scale, a widely used instrument that taps into global self-esteem, has been adapted to specifically assess self-esteem as a worker. The present study aimed at validating the Rosenberg Self-Esteem as a Worker Scale and determining its sensitivity to change in people with severe mental disorders registered in Supported Employment programs. An exploratory factor analysis showed two emerging factors later supported by a confirmatory factor analyses. The first subscale was named "Individual Self-Esteem as a Worker", and the second subscale, was entitled "Social Self-Esteem as a Worker". A subsequent MANCOVA further showed that the past work experience has a significant main effect on the Individual Self-Esteem as a Worker subscale. Furthermore, results revealed that only the Individual Self-Esteem as a Worker subscale changes significantly when people obtain employment. Finally, work satisfaction and particularly items related to satisfaction regarding the supervisor were significantly related to the Individual Self-Esteem as a Worker subscale. Avenues of research are discussed concerning the crucial role of the supervisor in improving the self-esteem as a worker and the work integration of people with severe mental disorders.
... A quarter (n=10) of the EDSS participants noted that social support was a goal of theirs, but over seventy-five percent cited employment as a goal. Research reports in the area of employment motivations for people with serious mental illnesses note that many people desire employment not only for the monetary benefits, but also for the social benefits that many people enjoy at their workplaces (Honey, 2004;Kirsh, 2000). Shared decision making in mental health may require a heavy emphasis on the partnership aspect of shared decision making (discussed below), in addition to leading to greater health knowledge, or increased self-efficacy in decision making. ...
... However, little is known about what managers experience in these situations and the forms of knowledge required to deal with them. While a number of studies have investigated the experience of employees with mental illness (Bond, Resnick, Drake, Xie, McHugo, & Bebout, 2001;Cunningham, Wolbert, & Brockmeier, 2000;Freedman & Fesko, 1996;Kirsh, 2000), few studies have explored the experiences of managers faced with an employee mental health problem. The two studies that have offered some insight have explored man-agers' and business owners' experiences of employing an individual with a preexisting mental health problem (e.g., Tse, 2004;Mizzoni & Kirsh, 2006) rather than an emergent one. ...
Mental health conditions such as depression and anxiety are prevalent and costly on both social and economic levels. Because a large proportion of the costs are borne by employers, organizations need to develop effective responses. We frame dealing with employee mental health issues as a reasonably common, but complex, managerial job demand that requires adequate preparation. Hence, we position the development of applied management knowledge (AMK) for effectively managing employee mental health issues as a critical objective for management education. Our study presents an analysis of qualitative data related to managers' experiences of working with an employee with a mental health issue that identifies forms of knowledge used and needed in these situations. Our findings indicate that managers reference specific forms of conceptual and procedural knowledge when (1) becoming aware of the employee's mental health issue; (2) exploring the workplace implications and developing an action response; (3) implementing the response and managing it as an ongoing situation, and (4) engaging in reflective learning. In order to begin the work of curriculum development, we provide a preliminary discussion of educational strategies that may aid in the development of this form of AMK and outline a number of priorities for future research and practice.
... Yet, a much smaller proportion-about 11% to 30%actually do (Kooyman, Dean, Harvey, & Walsh, 2007;Waghorn & Lloyd, 2005). Competitive work facilitates integration into community settings and emerges as an important contributor in many recovery narratives (Kirsh, 2000;Larson et al., 2007). Numerous randomized trials have consistently shown that individual placement and support (IPS) is the most effective model of supported employment currently available to help people with mental illness obtain and keep competitive employment (Bond & Drake, 2014). ...
The developing literature on supported employment for people who have a mental illness and recent history of homelessness has yet to explore the relationship between clients and their employment specialists. The objective of the present article is to explore and understand the way in which service users experience supported employment services and how these experiences differ from those receiving usual services.
Semistructured qualitative interviews were conducted with 27 people from a randomized controlled trial of supported employment, 14 receiving supported employment, and 13 receiving usual services. Thematic content analysis was used to generate themes and compare experiences between the 2 groups.
Trust emerged as an important facilitator to development of a collaborative relationship. It developed with time and featured in the narratives of participants who found jobs. Lack of trust and communication was associated with greater difficulty finding work. People receiving usual services rarely had repeated contact with service providers and therefore did not develop working alliances to the same extent as people receiving supported employment.
Without the support of an employment specialist, participants receiving usual services relied more on internal motivation to search for employment opportunities. Programs assisting people to reach their employment goals must be sensitive to homelessness-specific experiences that may make establishing trust difficult. Vocational services should be designed to allow clients to deal exclusively with 1 service provider to permit the development of a working alliance. (PsycINFO Database Record
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There is a lack of empirical data on the experiences of people with mental illness (PMI) who transition from welfare to work, or how policy programs are designed to facilitate this outcome. We explore the factors that facilitate or hinder PMI from exiting disability income support programs in Ontario, Canada. Drawing on a grounded theory approach, we examine the process of exiting the Ontario Disability Support Program (ODSP). Data were collected from semi-structured interviews with current and former recipients with mental illness, service providers who support current and former recipients, and ministry staff. A metaphor for the work exit process emerged with four embedded themes: (a) picking yourself back up, (b) breaking the rules to get ahead, (c) stabilizing illness for employment success, and (d) displaying resiliency and resourcefulness for successful exits. The main finding is that system supports are not the determining factors in a successful transition. Rather, participants describe how recipients exit for employment by leveraging personal resources to successfully transition off income support benefits. A system redesign is needed to address the inherent tension between social and health programs if the policy intent is to promote successful welfare-to-work transitions for PMI.
In un contesto in continuo mutamento e con un livello di complessità e criticità crescenti, l'avvicinamento al lavoro, in tutte le sfumature possibili, porta inevitabilmente a misurarsi con persone che difficilmente riescono a collocarsi rigidamente all'interno delle categorizzazioni tradizionali. L'inserimento di soggetti disabili o svantaggiati, risulta oggi uno svincolo fondamentale sia per la vita di queste persone e delle loro reti sociali, sia per le aziende. La disabilità psichiatrica, nelle sue molteplici sfumature, rappresenta una delle sfaccettate realtà reperibili nel contesto lavorativo. Il lavoro, non nell'ottica di "parcheggio", ma connotato al contrario da temi quali la responsabilità, può ricoprire un ruolo fondamentale per il disagio psichico. Per una buona integrazione alcuni concetti risultano centrali: responsabilità e sicurezza nel contesto lavorativo, e collaborazione di un'ampia rete sociale. INTRODUZIONE Il mondo del lavoro è notevolmente cambiato negli ultimi anni: il lavoro è sempre più orientato alla massima efficienza ed efficacia delle prestazioni. In tutti i settori produttivi, la sfida imposta è la ricerca dell'innovazione e dell'eccellenza. La tecnologia in continuo mutamento e l'apertura di nuovi mercati offrono ogni giorno rinnovate prospettive. In questo clima di trasformazione non meno importanti sono tuttavia, i cambiamenti demografici e, tra questi, l'incidenza delle disabilità fisiche e psicologiche nei luoghi di lavoro: temi e problemi che meritano adeguata attenzione. DISTUBI MENTALI, DIFFUSIONE La prevalenza di disturbi mentali è molto elevata e in continuo aumento. Nel 2020 la malattia mentale diventerà la seconda più importante causa di disabilità (Organizzazione Mondiale della Sanità, 2012). Tra i fattori che, probabilmente, contribuiscono a questo aumento di problemi legati alla salute mentale, ci sono i recenti cambiamenti del mercato del lavoro (contratti precari e facili licenziamenti) e l'incremento dei carichi di lavoro. Studi recenti condotti in Italia hanno mostrato che la prevalenza di disturbi mentali nella popolazione adulta è, come minimo, vicino al 8%. Il 75% dei disturbi psichiatrici emerge nei primi 25 anni di vita, per questa ragione è di grande rilevanza la rilevazione del disagio mentale in età adolescenziale e giovanile (Istat, 2017). Nel corso del 2016 in Italia sono stati assistiti dai servizi specialistici 807.035 utenti psichiatrici, di sesso femminile nel 54% dei casi. I tassi relativi al gruppo diagnostico, variano in relazione al genere: tra le donne vi è una prevalenza di disturbi affettivi, mentre tra gli uomini troviamo una prevalenza di schizofrenia e disturbi correlati. Nonostante lo "stigma sociale" nei confronti di chi soffre di una psicopatologia persista nel mondo, il disagio psichico, in quanto più comune, è oggi più "esprimibile" in diversi contesti, non è più così vergognoso o fuori luogo soffrire di una patologia psichiatrica. Lo stigma, le etichette, i pregiudizi, non sono fenomeni ormai dimenticati, ma la patologia mentale è oggi più diffusa e accettata in molte culture. L'accettazione rende possibile per le persone esprimere quindi il disagio più liberamente. L'identificazione dell'utenza di riferimento è un passaggio importante e propedeutico rispetto alle possibilità e modalità di integrazione dei diversi servizi implicati nell'inserimento lavorativo. Pagina di 1 7
BACKGROUND
Vocational recovery is a concept that has grown out of the mental health recovery model and has been operationalized as a threshold for work capacity for persons working with serious mental illness (SMI). In this article, is it conceptualized as a process towards gainful employment and overall mental health recovery.
OBJECTIVE
This article describes the early phases of the vocational recovery process of individuals with serious mental illness participating in a supported employment program and the factors that make up this process. This study describes the vocational recovery process and the mental health related recovery gains attained through employment.
METHODS
A constructivist grounded theory approach was employed in this study. The primary author conducted participant observations and conducted semi-structured interviews with 10 individuals at a supported employment program to develop a theory about a vocational process that is grounded in data.
RESULTS
A phase like process emerged from the data, which moved individuals from prevocational to early vocational recovery to active vocational recovery process. Participants experienced both mental health and vocational recovery challenges and benefits as they moved through the supported employment program and substantial support from providers, family members, program director, and peers emerged as a driving force to move individuals through the recovery process.
CONCLUSION
Participants in this study rapidly placed into a supported employment program were able to move through their psychosocial barriers to employment and move towards an active vocational recovery process. The phase like progression suggests that appropriate interventions can be formulated that best meets the individual’s vocational and mental health needs depending on where individuals are in their overall vocational recovery process. Follow up research is necessary.
Australia and the United Kingdom have introduced policies to protect employees who experience mental illness, including depression. However, a better understanding of the experiential issues workers face (e.g. sense of moral failure) is needed for the provision of appropriate and beneficial support. We analysed 73 interviews from the United Kingdom and Australia where narratives of depression and work intersected. Participants encountered difficulties in being (and performing as if) ‘authentic’ at work, with depression contributing to confusions about the self. The diffuse post-1960s imperative to ‘be yourself’ is experienced in conflicting ways: while some participants sought support from managers and colleagues (e.g. sick leave, back-to-work plans), many others put on a façade in an attempt to perform the ‘well’ and ‘authentic’ employee. We outline the contradictory forces at play for participants when authenticity and visibility are expected, yet, moral imperatives to be good (healthy) employees are normative.
Purpose: The purpose of this study was to identify the degree of satisfaction of part-time work of the mentally disabled and the factors affecting their job satisfaction. Methods: The subjects of this study were 106 part-time workers with mental illness in the city of B and Y. The data were collected from February 1, 2012 to May 30, 2012 using self-report questionnaires including the measurement scales of job satisfaction, family support, work volition and the degree of satisfaction with work environment. The data were analyzed using t-test, ANOVA, Pearson correlation coefficients, multiple regression with the SPSS/WIN 18.0 program. Results: The mean of score for job satisfaction was 61.8?13.84. Job satisfaction was highly related to family support, work environment and work volition. The associated factor of the subjects job satisfaction were family support, work environment, work volition, and the period of employment. The combination of these four factors showed an explanation for job satisfaction at the rate of 80.2%. Conclusion: The results imply that job satisfaction needs to be increased for the job continuity of employees with mental illness. In addition to this, work environment, work volition and family support should first be improved for the increase of job satisfaction.
Background
Internationally, men with disabilities have higher rates of social and economic disadvantage and poorer health and wellbeing than men without disabilities. No single study has provided comprehensive, population-level information about the magnitude of such differences among adult men using a well-validated instrument to measure disability. Methods
We analysed baseline data from Ten to Men – an Australian longitudinal study of male health. Ten to Men used a stratified multi-stage cluster random sample design to recruit a national sample of males aged 10 to 55 years residing in private dwellings. Data were collected between October 2013 and July 2014 from 15,988 males. This analysis was restricted to 18–55 year old participants with data available on age and disability (n = 13,569). We compared the demographic, socio-economic characteristics and health and wellbeing of men with and without disabilities using chi squared tests for proportions and t tests for continuous variables. Linear regression adjusted for age was used to assess the association between disability status and health and wellbeing, which were measured using the SF-12 mental and physical health component scores and the Personal Wellbeing Index. ResultsMen with disabilities were older and more likely to be born in Australia, speak English at home, be Aboriginal and Torres Strait Islander and were less likely to be married or de facto, or to live in urban areas. They were less likely to have completed secondary school, be employed and live in affordable housing, and were more likely to live on low incomes, in more socio-economically disadvantaged areas, and in rental accommodation and to experience shortages of money. Among employed men, those with disabilities were less likely to be in high skilled jobs, worked less hours on average, and were more likely to report that they would prefer to work more. Men with disabilities had lower levels of social support and community participation and poorer mental and physical health and overall wellbeing. Conclusion
Adult men with disabilities experience marked social and economic disadvantage and poorer health and wellbeing. Improving the health and wellbeing of disabled men should be a priority for public health researchers and policy-makers.
The role of Certified Peer Specialist addresses the growing need for mental health services and improves quality of mental health services. In order for CPSs to successfully fulfill their role they must be satisfied with their work setting. This study examines the impact of communal orientation, workplace integration, job activities, personal job history, and demographics on CPS's job satisfaction. Results indicate CPSs reporting higher organizational support, workplace integration, and a history of lengthy employments report higher job satisfaction than other CPSs. Interestingly, demographic characteristics, sharing personal recovery story, communal orientation and workload did not demonstrate an impact on job satisfaction.
Based on recent data gathered from employees and managers, Work and the Mental Health Crisis in Britain challenges the cultural maxim that work benefits people with mental health difficulties, and illustrates how particular cultures and perceptions can contribute to a crisis of mental well-being at work. Based on totally new data gathered from employees and managers in the UK. Presents a challenge to much of the conventional wisdom surrounding work and mental health. Questions the fundamental and largely accepted cultural maxim that work is unquestionably good for people with mental health difficulties. Illustrates how particular cultures of work or perceptions of the experience of work contribute to a crisis of mental well-being at work . Fills a need for an up-to-date, detailed work that explores the ways that mental health and work experiences are constructed, negotiated, constrained and at times, marginalised. Written in a style that is detailed and informative for academics and professionals who work in the mental health sphere, but also accessible to interested lay readers.
In this chapter we present an overview of qualitative research in the mental health field. We provide an historical account of the vital role that qualitative methods have played in the development of theoretical and practice approaches of psychiatry, and their current use in contemporary mental health practice. We consider how different approaches to qualitative research are used to advance knowledge and understanding of mental health, mental illness, and related services and systems, as well as the contributions of qualitative research to the mental health field. We then provide a synthesis of evidence derived from qualitative research within the mental health sector, spanning four key areas: (1) recovery, (2) stigma, (3) employment, and (4) housing. We conclude this chapter with a review of the ongoing challenges facing qualitative researchers in this area.
The purpose of this study was to identify turnover intentions in part-time workers with psychiatric disabilities.
Mental health service consumers, families, carers and clinicians require a locally relevant comprehensive information resource to provide the knowledge necessary for timely access to suitable public funded employment services. The aim of this paper is to report the development and preliminary evaluation of a new vocational rehabilitation information resource for mental health service consumers, families, carers and clinicians. The package comprises an information booklet targeted primarily to consumers, and a train-the-trainer package for clinicians in mental health service settings. We identified the employment-related information needs of target user groups via a series of focus group consultations with consumers, clinicians and vocational specialists. We also reviewed existing resource materials and searched the relevant research literature. The information content and presentation style of a draft information booklet was then market tested via a second series of focus groups. Initial focus groups and reviews provided guidance on the framework, content, communication techniques, and format of the new booklet. Preliminary market testing indicated that the booklet demonstrates adequate levels of content relevance, quality, user acceptability, and potential utility in clinical services and evidence-based supported employment services. Further evaluation of the resource package is indicated. Feedback about the utility of the booklet when applied with mental health service consumers and clinicians, as well with family members and carers, is needed. The utility of the booklet in applied clinical settings where an employment specialist is not available, and in supported employment settings where health professionals are not available, also requires evaluation. Translation of the booklet into other media is also indicated.
This study was done to identify the degree of job stress for workers with mentally disabled and factors influencing their job stress.
Engagement in worker roles presents significant challenges for individuals with serious mental illnesses. Evolution of vocational rehabilitation programs has yielded evidence-based support for supported employment models. This research presents a phenomenological study of consumer viewpoints concerning participation in earlier vocational rehabilitation programs, followed by a study of supported employment participation perspectives. Initial study themes of Chaos: Living with Disruptions, Mixed Blessings: Vocational Rehabilitation Program, Feelings of Discrepancy, and Searching for Order were reinforced by follow-up study themes of Positive Feelings of Worker Satisfaction and Managing Self/Illness. Consumers identified success in employment outcomes, if able to balance illness and work demands.
This study investigated the relative, combined, and interactive effects of organizational climates and personal orientations on individuals′ attitudes and behaviors in organizations. It was proposed that congruence between organizational climates and individuals′ personal orientations would lead to higher satisfaction, commitment, involvement in work, adjustment to work, and performance, and less stress, turnover intent, and absenteeism. Questionnaires assessing personal orientations and work outcomes were completed by 533 teachers from 29 secondary schools. Climate scores were assigned to these individuals based on the perceptions of their peers. Results of canonical correlational analyses and moderated regressions indicated that work responses could be explained by a joint, additive function of organizational climates and personal orientations. However, multiplicative climate–person interactions did not significantly explain variance in individuals′ behaviors and attitudes beyond that explained by the main effects of climate and personal orientations. Implications of these findings are discussed.
Despite evidence confirming the value of employment in promoting and maintaining mental health, efforts aimed at work integration of mental health consumers have met with limited success. Using qualitative research methods, this study explores the consumer perspective on factors influencing the process of employment integration. A sample of five consumers of the mental health system who were employed at the time of the study was used. Two data collection instruments, a semi-structured interview and demographic questionnaire, were utilized. The study draws on grounded theory (i.e., the constant comparative method of analysis) including unitizing, categorizing, and forming themes to process the data. Descriptive statistics were used to analyze demographic information. Four themes emerged from the data: (a) the importance of recognizing the mind-body connection, (b) the relationship of personal empowerment to work reintegration, (c) the need for skills and supports, and (d) the relationship of the work environment to the outcome of work reintegration.
Results from an investigation of the role of supervisors in the process of adjusting to work with a disabling condition are presented. Workers with disabling conditions were interviewed about the responsiveness of their workplaces to their needs. Analyses showed that successful adjustment to work was related to the ability to complete job requirements, get along with others at work, see a future at work and feel good about work. Many supervisory behaviors were associated with these factors including the extent to which supervisors treat workers fairly, allow workers to participate in decisions related to their work and utilize the workers' skills. Implications for the development of workplace policy and disability management efforts are discussed.
Building on previous research on worker extra-role effort, the authors focus their analysis on the correlates of one subset of behaviors that they call active effort. The authors argue for an exchange model, with organizations offering intrinsic, social, and material inducements in exchange for active effort by workers. Using data from a telephone survey of 270 employed adults in a large midwestern metropolitan area, the authors test a model that measures a variety of structural variables to see how they affect the level of active effort. The authors find that active effort is related to the extent to which a worker is allowed to participate and to recognition. After controlling for other variables, they found that satisfaction has little independent effect on active effort. Relations to supervisors, seniority, and wages have no net effects on active effort, although they are associated with increased satisfaction. Also, high white-collar employees report significantly higher active effort and satisfaction.
In this study we sought to understand the relationship between obtaining competitive employment and changes in nonvocational domains of functioning (symptoms, substance abuse, hospitalizations, self-esteem, quality of life) in persons with severe mental illness. A group of 143 unemployed patients participating in a study of vocational rehabilitation programs were assessed in nonvocational areas of functioning at baseline and 6, 12, and 18 months later. Statistical analyses examined the relationship between work status at the follow-up assessments and nonvocational functioning, controlling for baseline levels of nonvocational variables. Patients who were working at follow-up tended to have lower symptoms (particularly thought disorder and affect on the Brief Psychiatric Rating Scale), higher Global Assessment Scores, better self-esteem, and more satisfaction with their finances and vocational services than unemployed patients. Employment is associated with better functioning in a range of different nonvocational domains, even after controlling for baseline levels of functioning.
It is important that the effects of work on mental health are investigated when work practices are changing rapidly and there is decreasing job security. This has been examined in the Whitehall II Study, a cohort study of 6895 male and 3413 female, London-based civil servants, aged 35–55 years at baseline in 1985. Work characteristics were measured by modified Karasek indices in a self-report questionnaire. Psychiatric disorder was measured by the 30-item General Health Questionnaire (GHQ). In longitudinal analyses in men and women, high work social support predicted lower GHQ scores, and high job demands predicted higher GHQ scores at follow-up. High work social support and high skill discretion were protective against taking short spells of psychiatric sickness absence. The protective effects of social support at work and the potential risk of job demands have implications for management, job design, training, and further research.
This paper is based upon an exploratory study designed to examine the role of work within the lives of those with severe, persistent mental illness (SPMI). In-depth, open ended interviews were conducted with a small number of consumers (n = 10) who attend a clubhouse for those with SPMI where emphasis is placed upon preparation for work. Given that little is known about how work impinges upon or enriches the lives of consumers we asked consumers about their experience of mental illness and work throughout their life trajectories. This paper describes these work experiences, the effect of mental illness and treatment compliance upon their ability to work, and the relationship of work to stress. We found that in general some kind of meaningful activity was important to these consumers, but many had found work experiences to be stressful and were cautious about their subsequent abilities to sustain meaningful employment. We suggest that subsequent research needs to examine the nature of the work environment, and that work environments may be usefully distinguished in terms of level of expressed emotion.
Employment and work can have a positive effect on mental health by providing opportunities for skill development, social contact, self-esteem, and income. Unemployment is a source of anxiety, stress, and depression. At the same time work can be a major source of stress by decreasing opportunities for control and autonomy. This article examines the role of work and unemployment and the relationship of work status to other indicators of community adjustment among a sample of 68 psychiatric clients in outpatient treatment. Comparisons are made between clients who are not working or seeking work, those who are unemployed and seeking work, and those who are currently working. Regression analysis is then used to examine the effect of work status on other indicators of community adjustment: psychiatric symptoms, functioning, social integration, stress, and mental hospitalizations. Working clients are more likely to be male and younger and to have had previous work experience. Working is related to higher levels of functioning in the community, while unemployment is positively related to stress. Work status was not related to social integration, indicating that work may be an alternative source of social support and should receive separate attention in assessments of community adjustment and integration.