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Vocational Rehabilitation in Psychiatry and Mental Health
Abstract
Vocational rehabilitation offers an exciting and rewarding field of practice to occupational therapists working in the field of psychiatry and mental health as one of the final stages in the rehabilitation process. Cognitive, emotional and motivational difficulties are at the core of most mental illnesses and may affect worker's ability to perform their essential work tasks efficiently and accurately. Various models and theoretical frameworks can be used during the vocational rehabilitation process as applied to clients with mental illness. Workers with mental illness, who are employed at the time of the initial vocational assessment, could return to employment using transitional work programmes (TWPs) where they return to work in a restricted or modified capacity for a specific length of time. Occupational therapists with expertise in vocational rehabilitation are increasingly moving into corporate and industrial work settings as consultants to employers on issues of disability equity and disability management.
... 8 Occupational therapists play an important role in VR of MHSUs with chronic mental illness who are either employed, unemployed or on sick leave. 9 Through VR, occupational therapists help MHSUs to gain work, return to work or maintain an existing worker role. 10 Ross 10 highlights six stages followed in the VR process that are somewhat similar to the occupational therapy process. ...
... Using the VR process, occupational therapists apply various VR strategies, and work with a variety of people and professions spanning both industrial and healthcare sectors. 9 They employ a variety of occupational therapy professional competencies that include activity analysis, job analysis, identification of essential job functions, knowledge of mental health conditions, functional capacity evaluations. 11 In the Namibian context, occupational therapists who provide VR service are institution based regardless of the clientele group they serve. ...
Objective:
To synthesise research published on vocational rehabilitation (VR) interventions offered in institutions, by occupational therapists, to mental health service users (MHSUs) with chronic mental illness, in low-income to upper-middle-income countries (L-UMIC).
Design:
This scoping review used Arksey and O'Malley's methodological framework, the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews and Joanna Briggs scoping review guidelines.
Data sources:
We searched PsycInfo, EBSCOhost, HINARI, Google Scholar, Medline, CINAHL, PubMed, Cochrane Library, Scopus, Science Direct and Wiley online library between 15 July and 31 August 2021.
Eligibility criteria:
Sources, published in English between 2011 and 2021, on institution-based VR in occupational therapy for MHSUs who had chronic mental illness in L-UMIC were included. We included primary studies of any design.
Data extraction and synthesis:
Three reviewers used Mendeley to manage identified references, Rayyan for abstract and full-text screening and Microsoft Excel for data extraction. Data were sifted and sorted by key categories and themes.
Results:
895 sources were identified, and their title and abstracts reviewed. 207 sources were included for full-text screening. 12 articles from 4 countries (South Africa, India, Brazil and Kenya) were finally included. Types of VR intervention included supported employment, case management and prevocational skills training. Client centeredness, support and empowerment were the key VR principles identified. Teaching of illness self-management, job analysis and matching, job coaching, trial placement, and vocational guidance and counselling were the main intervention strategies reported.
Conclusions:
VR intervention in institutions for MHSUs in L-UMIC revealed the multidimensional uniqueness of individual MHSU's vocational ability, needs and contexts. The interventions allowed client-centred approaches that offer support and empowerment beyond the boundaries of the institutions. Occupational therapists offering VR need to expand their interventions beyond their institutions to contexts where MHSUs are working or intending to work.
... Occupational therapy is one of the healthcare professions that play a significant role in vocational rehabilitation of service users with chronic mental illness. Occupational therapists utilize meaningful and purposeful activities to optimize work participation for service users with chronic mental illness, and they bridge the gap between health care facilities and the workplaces of service users [15]. ...
Purpose:
Chronic mental illness disrupts the ability to work, often resulting in the need for vocational rehabilitation in which occupational therapists play a role. Namibia does not have an occupational therapy vocational rehabilitation practice framework for service users with chronic mental illness. This study explored the contextual factors that should be considered for a vocational rehabilitation practice framework in Namibia.
Materials and methods:
A qualitative collective case study design was utilized. In-depth interviews were conducted with nine mental health service providers that were purposively selected from two study sites. An inductive thematic analysis of data was done using ATLAS.ti.
Results:
The need for collaborative advocacy for service users to raise awareness and engage stakeholders such as family members, employers and policy makers was highlighted. Vocational rehabilitation resources needed include sheltered workshops, financial resources and trained human resources. Recognition that vocational rehabilitation services are too limited to meet the needs of mental health service users. A vocational rehabilitation policy and strategy is required. Supported employment and self-employment are potential strategies that should be considered.
Conclusion:
Vocational rehabilitation for service users with chronic mental illness is limited in Namibia and there is a need to collaboratively improve the service.
... Mental health stigma is pervasive in Southern African society due to a lack of mental health literacy, a fear of spiritual aetiologies, and concerns for safety (Kapungwe et al., 2010). As such, young people with mental health disorders have additional barriers to engaging in social and economic activities that could help them achieve psychological well-being, improve their self-esteem and increase their independence (Swart & Buys, 2014). In addition, it is reported that the availability of mental health services is low, with the mental health workforce in the Southern African region ranging between 0.05 and 1.52 psychiatrists per 100,000 population, compared to the European estimate of 9.9 (WHO, 2019a). ...
A significant mental health treatment gap prevails in Southern Africa. Whilst some treatments exist for adults and school children, treatment options for young adults, at a particularly vulnerable time of life, are scarce. Understanding success mechanisms of existing youth mental health interventions is vital for informed development and scaling of interventions to address this critical gap. This rapid review identifies 27 recent health interventions addressing common youth mental disorders in Southern Africa. Eight studies that quantitatively measured success found significant mental health improvements as an intervention result. Studies that identified success via non-statistical means also found, albeit self-reported, generally favourable outcomes. No single best-practice intervention was identified to replicate throughout the region. Our review instead highlights three important mechanisms for intervention success: including youth in intervention design and delivery; indirectly addressing mental health; and developing multi-modal interventions. We recommend collaborative, ecological approaches to youth mental health interventions in Southern Africa.
... In addition, it can be said that psychological counseling and ongoing support about job-related difficulties are beneficial in reducing anxiety symptoms. High levels of anxiety may impair the worker's ability to interact effectively with others or work independently, so ongoing support and consultancy are very important at this state (Swart and Buys, 2014). Similarly, in a case report, a person with severe mental illness could work for 8 months and his quality of life and self-sufficiency of the person improved at the end of a supported ...
Purpose: This study aimed to evaluate the effectiveness of the Work Readiness Program (WRP) on anxiety levels and coping ways of people diagnosed with schizophrenia. Material and Methods: WRP consists of 7 sessions, in which two 1 hr meetings were held weekly for 5 weeks. A total of 7 participants enrolled into WRP were assessed before, immediately after and 6 months after the program. Sociodemographic Form, State/Trait Anxiety Inventory and Coping Styles Inventory were administered. Results: The results revealed that there was a statistically significant difference in terms of the trait anxiety scores (p=0.034) and the total score of coping ways (p=0.002) in pre-intervention, post-intervention and 6-month follow-up; however, no significant difference was found in terms of state anxiety scores (p>0.05). Paired comparisons showed that the trait anxiety scores were higher at 6-month follow-up compared to the scores at baseline (p<0.05). It was found that CSI-total score decreased gradually at post-intervention and at 6-month follow-up compared to the scores at baseline (p < 0.05). Discussion: WRP reduced the trait anxiety levels and improved coping skills of the participants who completed the program. Our study results showed the necessity and importance of work readiness programs in people diagnosed with schizophrenia.
... Evidence indicates that engagement in employment or work by itself is 'associated with reduced symptoms, reduced hospital admissions, improved social skills, improved self-esteem, improved family atmosphere and greater personal independence'. 2 Moreover, work is a significant means for MHSUs to meet their basic needs and is relevant to their social status, feeling of personal accomplishment, freedom and security. 4 Work enables social inclusion and provides opportunity for MHSUs to make a meaningful contribution to the community. ...
Introduction
Work is integral to the occupations of human beings and accounts for up to a third of time spent in an average adult life. Occupational therapists play a role in vocational rehabilitation of mental health service users (MHSUs) with the aim of optimising their work participation. It is advisable that occupational therapists providing vocational rehabilitation to MHSUs with chronic mental illness in mental healthcare settings are guided by a practice framework developed for that particular context. This scoping review aims to summarise existing evidence on vocational rehabilitation for MHSUs in low-income to upper-middle-income countries. The findings will inform subsequent phases of research undertaken to formulate a vocational rehabilitation practice framework for MHSUs in Namibia.
Methods and analysis
The scoping review will employ the five stage methodological framework proposed by Arksey and O’Malley. This will be used in conjunction with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISM-ScR) and Joanna Briggs scoping review guidelines. MESH terms, Boolean operators and truncation strategies will be employed for a comprehensive article search in electronic scholarly databases. These databases will include PsycINFO, EBSCOhost, HINARI, Google scholar, Medline, CINAHL, PubMed, Cochrane Library, Scopus, Science Direct and Wiley Online Library. Mendeley and Rayyan, both open source platforms, will be used for title, abstract and full-text screening, as well as data extraction. Data will be sifted and sorted by key categories and themes using a data charting form.
Ethics and dissemination
The scoping review findings will be published in a peer-reviewed journal and presented at local and international conferences. Ethical clearance for this study will not be required as secondary data will be utilised and there are no patients involved.
... South Africa and Zimbabwe share similar historical, social and geopolitical ties making them comparable contexts, despite the economic differences. Compared to people without disabilities, unemployment rates are higher among persons with disabilities around the world [4][5][6] and even more so for persons with mental disabilities in Zimbabwe and abroad [7,8]. The Living Conditions among Persons with Disability Survey 2013 -Key Findings Report [9] showed that 60.9% of persons with disability are unemployed in Zimbabwe and persons with mental disabilities are greatly affected. ...
Background:
Unemployment rates are generally higher among persons with mental disabilities who experience many barriers and challenges that limit their participation in work and employment. Occupational therapy can play a key role in promoting participation and engagement in work by persons with mental disabilities.
Objective:
This review sought to identify the barriers and facilitators to work participation for persons with mental disabilities globally in comparison to Zimbabwe, and to identify the competencies related to work practice in occupational therapy curricula internationally and regionally.
Methods:
A narrative literature review was conducted using the SALSA (Search, Appraisal, Synthesis and Analysis) framework which informed retrieval and analysis of articles published between 2012 and 2018.
Results:
Fifty-one out of 227 articles were selected to inform the review. A synthesis of the literature provided insights and ideas on facilitators and barriers to work for persons with mental disabilities and the competencies related to work practice in occupational therapy curricula.
Conclusion:
Barriers to participation in work for persons with mental disabilities are real. However, occupational therapists from different contexts have a variety of competencies to facilitate participation in work. There is a need to develop work practice competencies particular to the Zimbabwean context.
... Work is an integral part of life for every adult [1][2][3]. Participation in work leads to improvement of the individual's self-esteem, volition and quality of life [1,4]. Work also fosters a sense of belonging, competence and well-being for extended periods of time [1,4]. ...
Background
Persons with disabilities experience higher unemployment rates and limited participation in work. Occupational therapy can promote participation and engagement in work by persons with disabilities. However, there is no clarity on the required set of competencies for entry-level occupational therapists with a bachelor’s degree to start up and participate in inter-sectoral work practice initiatives in Zimbabwe.
Aims
To explore what work practice competencies entry-level occupational therapists require to meet the work-related needs of persons with disabilities.
Material and Methods
This exploratory qualitative research sought to explore what professional competencies entry-level occupational therapists required for them to offer collaborative inter-sectoral work practice initiatives for persons with disabilities within the Zimbabwean context. Six participants selected using criterion sampling, participated in semi-structured interviews. Inductive content analysis was conducted. The Stellenbosch Health Research Ethics Committee and Medical Rehabilitation Practitioner’s Council of Zimbabwe gave ethical clearance and permissions to conduct the study.
Results
Three themes; core knowledge for work practice, skills for work practice and occupational therapy professional attributes; emerged. These were used in formulation of ten professional competency statements for occupational therapists offering work practice services.
Conclusions
Although Zimbabwean occupational therapists require similar competencies for work practice as those required in other countries, additional competencies that fall outside traditional health care contexts are essential in order to promote contextually relevant practice.
The chapter summarizes key issues in vocational rehabilitation for individuals with intellectual disability, nature of vocational rehabilitation in in mild, moderate and severe intellectual disability, principles of rehabilitation for individuals with intellectual disability, assessment of intellectual disability and it's limitations. Then the chapter reviews the need for vocational rehabilitation, assessment required for rehabilitation and barriers of vocational rehabilitation for individuals with intellectual disability. the chapter then covers vocational rehabilitation process and preparation of the individual for rehabilitation. The chapter ends with social skills training and newer trends in rehabilitation like use of virtual reality and sensory integration.
The past 5 years have seen dramatically increased interest among users, professionals and the Government in enabling people with mental health problems to gain employment. Many new projects have been started, with a range of different approaches including supported employment, training and placement, transitional employment, social firms and cooperatives. There are a number of reasons for this increased interest.
Enhancing the vocational status of persons with severe mental disorders is an important goal of psychosocial rehabilitation programs. Changes in vocational and residential status, and community tenure, were evaluated in relation to subjective client outcomes. Eighty-eight psychiatrically disabled clients of a large mental health center were interviewed regarding their self-efficacy, self-esteem, and life satisfaction. Only 6-month change in vocational status was positively and significantly related to these subjective outcomes. The data support a model wherein improvement in vocational status results in higher self-efficacy, which then affects life satisfaction through its impact on self-esteem.
The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF.
We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models.
Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary.
VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders' participation.
Young people with psychiatric disabilities are particularly disadvantaged when it comes to participating in vocational training or higher education or to seeking and maintaining employment. A review of the literature reveals that this is due to a number of factors, including low expectations by health professionals, stigma and discrimination, symptomatology and the lack of a clear responsibility for promoting vocational and social outcomes. A useful approach for occupational therapists to use is a recovery framework combining evidence-based employment and educational assistance with mental health care, provided in parallel with brief vocational counselling, illness management skills, training in stigma countering and disclosure strategies, context-specific social skills and skills in social network development.
It is concluded that there is an urgent need to link evidence-based vocational practices with quality mental health care, in order to restore hope among young people of ever realising their vocational goals and once again feeling included as valued members of society.
Occupational therapy focuses on complex dynamic relationships between people, occupations and environments. Therapists must clearly communicate their practices and how their practice influences outcomes. This paper explores applications of the Person-Environment-Occupation Model (Law et al., 1996) in occupational therapy practice, and delineates how this particular model helps therapists to conceptualize, plan, communicate and evaluate occupational performance interventions. Three case studies illustrate how the model can be used by occupational therapists to systematically approach analysis of occupational performance issues while considering the complexities of human functioning and experience. The ways in which the model facilitates communication within and outside occupational therapy are explained. The Person-Environment-Occupation Model is offered as a tool for therapists to use in client(s)-therapist alliances to enable clients to successfully engage in meaningful occupations in chosen environments.
This study examined the relationships of measures of cognitive functioning and psychiatric symptoms with work outcomes and use of vocational services for clients with schizophrenia in a supported employment program.
Thirty clients who were newly enrolled in a supported employment program were evaluated with cognitive and symptom measures at program entry and two years later. The clients' amounts of competitive work, wages earned, on-job support, and contact with employment specialists during the two-year follow-up period were documented.
Predictors of clients' work outcomes included previous work history, amount of government entitlement income received, severity of negative symptoms, involvement in sheltered work activity at baseline, and level of cognitive functioning, including scores on measures of executive functioning and verbal learning and memory. The amounts of on-job support and contact with employment specialists were predicted by the cognitive domains of executive functioning, verbal learning, attention, and psychomotor speed as well as by the severity of psychotic symptoms.
Clients with schizophrenia who have higher levels of cognitive impairment may require greater amounts of vocational support than those with lower levels of impairment. A variety of rehabilitation strategies may be required to improve vocational outcomes and reduce the amount of supported employment services needed by clients with schizophrenia.
Most people suffering from severe mental illness (SMI) lack paid employment. This study investigates the relationship between work status and objective as well as subjective quality of life (QoL) in people with SMI.
The sample consists of 261 subjects (102 women, 159 men) aged 35 (men) and 38 (women) years on average, of whom 158 suffer from a schizophrenic disorder (ICD-10: F2) and 103 were diagnosed as having an affective disorder (ICD-10: F3). Subjective QoL was assessed with the WHOQOL-BREF scale.
Subjects with an occupation in general have a larger social network at their disposal and receive more social support. With regard to income, few (12%) of the subjects with a job on the open labour market live below the poverty level, but many (28-38%) of those engaged in sheltered or other work-like activities do. Occupation ameliorates satisfaction with life domains referring to social integration (social relationships, environment), whereas the individual's well-being (psychological, physical) is hardly affected. Social support is an important mediator of the relationship between occupation and subjective QoL. Income is weakly and negatively related to subjective QoL.
Supportive relationships to colleagues at the workplace mainly explain the better subjective QoL of SMI people with an occupation. When designing specific employment possibilities for people with SMI, we should take notice of the social support dimension at the workplace. Mentally ill people have a substantial poverty risk, even when they are working. In particular, payment for sheltered work should be ameliorated.
Numerous state systems and local mental health and vocational rehabilitation programs are currently attempting to implement supported employment. This cross-sectional survey of 26 mental health agencies, partnering with federal-state vocational rehabilitation, identified differences in access to supported employment services and rates of competitive employment (efficiency) as well as predictors of access and efficiency. Access varied from 2 to 100% and was related to the percentage of supported employment specialists per consumers with serious mental illness served by the mental health agency (funding). Efficiency varied from 7 to 75% and was related to implementation of the critical components of evidence-based supported employment and to the local unemployment rate. To help mental health clients achieve their employment goals, state systems and local programs should address consolidation of resources in supported employment and the quality of implementation of supported employment.
A major public policy problem is the extremely low labor force participation of people with severe mental illness coupled with their overrepresentation on the public disability rolls. This situation is especially troubling given the existence of evidence-based practices designed to return them to the labor force. This article reviews research from the fields of disability, economics, health care, and labor studies to describe the nature of barriers to paid work and economic security for people with disabling mental disorders. These barriers include low educational attainment, unfavorable labor market dynamics, low productivity, lack of appropriate vocational and clinical services, labor force discrimination, failure of protective legislation, work disincentives caused by state and federal policies, poverty-level income, linkage of health care access to disability beneficiary status, and ineffective work incentive programs. The article concludes with a discussion of current policy initiatives in health care, mental health, and disability. Recommendations for a comprehensive system of services and supports to address multiple barriers are presented. These include access to affordable health care, including mental health treatment and prescription drug coverage; integrated clinical and vocational services; safe and stable housing that is not threatened by changes in earned income; remedial and postsecondary education and vocational training; benefits counseling and financial literacy education; economic security through asset development; legal aid for dealing with employment discrimination; peer support and self-help to enhance vocational self-image and encourage labor force attachment; and active involvement of U.S. business and employer communities.
Occupational therapy literature has reported on the concept of motivation in great depth and it is evident that motivation has many constructs. Motivation is seen as a key indicator for success in rehabilitation. When assessing a client's vocational skills and performance, occupational therapists in South Africa have found the Model of Creative Ability to be a useful model to determine the quality and quantity of motivation.
This article briefly describes the development of the Model of Creative Ability in South Africa and explains the fundamental concepts and terminology used in the model. Criticism of the model as well as the reasons for the popularity of this model are given. A case study is used as an example to illustrate the unique contribution of the levels of motivation and action to a medico-legal report.
Overall physical work fitness is a prerequisite in numerous industries. Apart from improved productivity, it remains fundamental with regards to the maintenance of good health and safety. To address worker fitness in the mining industry, AngloGold Ashanti and Anglo Platinum Mining Houses developed a Functional Work Capacity (FWC) test battery. The FWC test battery consists of 19 work simulations representing the required functional work capacity to cope with all types of physical work tasks and work environments in the mining industry. This assessment tool is not only used to evaluate injured or medically affected workers for alternative placement but also to ensure that the new employee is placed in a job matching his physical capacity. This paper reviews the design process and application of the FWC test battery in the mining industry.
This is a review of research into the employment of people with experience of mental
illness, and the issues which arise from that subject. The review was conducted by the
Mental Health Foundation (NZ) as part of the Like Minds, Like Mine (LMLM) project, and
is intended to supplement the original research findings of the Mental Health Foundation
report I Haven’t Told Them, They Haven’t Asked (Peterson, 2007). Specifically, this review
is intended to situate the findings of the LMLM study within prior research into the subject
of the employment of people with experience of mental illness, thereby enabling a deeper,
more informed understanding of the study’s results.
Vocational rehabilitation programs have demonstrated limited success for people with severe mental illness (SMI). Reasons for this failure may be found in how rehabilitation professionals label and react to consumers with SMI. The purpose of this article is to address how this population has been stigmatized and neglected. Emphasis will be given to the effects of stigma, labeling, and myths as they relate to persons with severe mental illness. Special attention is also given to the need for qualified rehabilitation counselors to work in psychiatric rehabilitation.
Supported Employment (SE) has consistently shown to be more effective at helping individuals with a serious mental illness acquire a competitive job compared to other models of vocational rehabilitation. Nonetheless, approximately 50% of individuals who receive SE services fail to acquire even one competitive job and another 25% are unable to sustain a job. Barriers to work that limit the impact of SE are reviewed. Three levels of barriers are examined: (1) sociological barriers, (2) agency and programmatic barriers, and (3) disease-based impairments. Numerous interventions have been developed that could enhance the impact of SE and help individuals overcome these three barriers to work. These interventions are reviewed and classified under the three levels of barriers. Recommendations to enhance SE are provided based on the literature review.
Employment outcomes of patients and their significant predictors has been an area of intensive study in mental health research. A literature review shows that, due to conflicting results of research studies, researchers are still not sure whether or not some clinical and demographic variables are consistent predictors of future vocational performance of psychiatric patients. This paper reviews controlled studies since the mid 80's pertaining to the identification of significant predictors of employment outcome of the psychiatric population. A total of 35 relevant studies (screened from a collection of 921 articles extracted from PsycLit, Medline, Allied Health and Nursing Abstracts, and Social Work Abstract) were reviewed by a panel of three university professors and three senior clinicians in the field. The review shows that functioning before the onset of mental illness, work history, and social skills are consistent predictors that are similar to previous studies. Symptomatology which refers to abnormalities in moods, thoughts, and behaviors resulting from the mental illness and diagnosis continued to have contradictory results. The results were discussed in the context of research design, method, and data analysis strategies. Some relatively neglected aspects, such as cognitive function and family relationship, were found to be significant predictors and were discussed. Implications for rehabilitation professionals and recommendations for further research are made.
This book introduces the occupational therapist to the practice of vocational rehabilitation. As rehabilitation specialists, Occupational Therapists work in a range of diverse settings with clients who have a variety of physical, emotional and psychological conditions. Research has proven that there are many positive benefits from working to health and well-being. This book highlights the contribution, which can be made by occupational therapists in assisting disabled, ill or injured workers to access, remain in and return to work.
Objective: To determine the most effective way of helping people with severe mental illness to obtain competitive employment—that is, a job paid at the market rate, and for which anyone can apply.
Design: Systematic review.
Participants: Eligible studies were randomised controlled trials comparing prevocational training or supported employment (for people with severe mental illness) with each other or with standard community care.
Outcome measures: The primary outcome was number of subjects in competitive employment. Secondary outcomes were other employment outcomes, clinical outcomes, and costs.
Results: Eleven trials met the inclusion criteria. Five (1204 subjects) compared prevocational training with standard community care, one (256 subjects) compared supported employment with standard community care, and five (484 subjects) compared supported employment with prevocational training. Subjects in supported employment were more likely to be in competitive employment than those who received prevocational training at 4, 6, 9, 12, 15, and 18 months (for example, 34% v 12% at 12 months; number needed to treat 4.45, 95% confidence interval 3.37 to 6.59). This effect was still present, although at a reduced level, after a sensitivity analysis that retained only the highest quality trials (31% v 12%; 5.3, 3.6 to 10.4). People in supported employment earned more and worked more hours per month than those who had had prevocational training.
Conclusion: Supported employment is more effective than prevocational training at helping people with severe mental illness obtain competitive employment.
With the admission of people who experience psychiatric disabilities in the state-federal vocational rehabilitation system and the Social Security disability rolls in the 1960s, assessment of their capacity to work has been a major concern. Given the rising rates of claims for psychiatric disability in both the public and the private sectors, and the disappointing employment outcomes of people with psychiatric disabilities compared to those with other disabilities, there have been numerous initiatives to accurately assess their employment potential. Historically, such assessment within the Social Security Administration has relied upon evaluation of a person's medical impairment, but numerous studies suggest a weak relationship between measures of psychiatric diagnosis or symptoms and work outcome. Efforts have been undertaken to identify valid and reliable methods of assessing the ability of people with psychiatric disabilities to work. The authors review (a) methods of assessing work function for this population, and (b) the literature on predictors of work functioning and the nature of psychiatric disability, and suggest implications for disability determination policies and for future research.
In England, policy developments in the field of mental health are stimulating interest in employment for mental health service users as a means of mental health promotion. To date, research that might assist in increasing employment rates amongst this group has focused largely on the question of which service users are most likely to benefit from vocational interventions and, more recently, on models of vocational support. Less is known about how employers can assist people in their transition or return to work. In this article we draw on the accounts of 17 employment project clients to identify workplace factors that were associated with job retention. Specific adjustments such as flexibility about working hours, work schedules and job tasks emerged as crucial in enabling clients to deal with the effects of medication, and to regain stamina and confidence. Over and above these, however, 'natural supports' of a kind from which any employee would arguably benefit were equally important. In this respect the main themes revolved around training and support to learn the job, supportive interpersonal relationships at work, workplace culture, and approaches to staff management. These themes might equally provide a productive focus for workplace health promotion more generally, using organization development approaches.
As American workers age, workers with impairments and functional limitations make up a larger percentage of our workforce. This investigation presents data from the National Health Interview Survey Disability Supplement 1994-1995 (NHIS-D) describing the nature of workplace accommodations in the American workforce and factors associated with the provision of such accommodations. Of a nationally representative sample of workers aged 18 to 69 years with a wide range of impairments, 12% reported receiving workplace accommodations. Males (odds ratio (OR) 0.64: 95% confidence interval (CI) 0.53-0.78) and Southerners (OR 0.57; 95% CI = 0.47-0.70) were less likely than others to receive workplace accommodations. Those with mental health conditions were less likely than others to receive accommodations (OR 0.56; 95% CI = 0.44-0.70). College graduates (OR 1.53; 95% CI = 1.22-1.91), older workers, full time workers (OR 3.99; 95% CI = 2.63-3.87), and the self-employed (OR 1.76; 95% CI = 1.28-2.41) were more likely than others to receive accommodations.
The aim of the current study was to investigate whether Case Management and the strengths model could be a successful method in vocational rehabilitation of unemployed people on long term sick leave in Sweden. An additional aim was to further highlight the actual rehabilitation process.
Ten clients, five men and five women aged between 35 and 40, were included in the project. All ten were at the project start both long-term unemployed (2-13 years) and on long term sick leave (2-6 years). The project was evaluated from four perspectives: Quality of life (SF 36), sickness absence, and contact with working life were investigated before and after the project. The rehabilitation process was investigated during and after the project.
The result from the study was positive. Of the 10 clients who participated in the project, six have improved their quality of life, seven have a diminished sickness absence and seven have a closer contact to working life after the project than before. With regards to the rehabilitation process, the results here also impart a positive picture. It should be noted, however, that the study is small and not based on a random sample. The results should not be generalized, but recognized instead as a positive indication.
South African occupational therapists have been involved in the delivery of work practice services since the inception of the profession in this country. Initial development in this area of practice appeared slow but following the acceptance of South Africa's first democratic Constitution in 1996, many opportunities for service delivery were facilitated by the implementation of disability equity legislation. One of the key services offered by practitioners is Functional Capacity Evaluation (FCE). Although the outcomes of FCE are many, the process in essentially the same. This entails: referral, the initial interview, evaluation of performance components and ADL, vocational evaluation, obtaining collateral and the closure interview, the work visit, hypothesis testing and reporting. This article reports on the Functional Capacity Evaluation process as followed by South African occupational therapists in various contexts.
ICF Core Set for vocational rehabilitation: results of an international consensus conference
- M.E. Finger
- R. Esxorpizo
- A. Glässel
Occupational Therapy Work-Related Programs and Assessments
- K Jacobs
Disability and Work Participation in New Zealand: Outcomes Relating to Paid Employment and Benefit Receipt
- J. Jensen
- S. Sathiyandra
- M. Rochford
- D. Jones
- V. Krishnan
- K. Mcleod
A Legacy of Failure: The Inability of the Federal-State Vocational Rehabilitation System to Serve People with Severe Mental Illnesses. National Alliance for the Mentally Ill (NAMI)
- J H Noble
- R S Honberg
- L L Hall
The prediction of vocational outcomes in schizophrenia: do diagnosis and symptomology really matter? A review of the literature
- S W Hill
Quick Reference Dictionary for Occupational Therapy
- K Jacobs
- L Jacobs
A Model of Human Occupation: Theory and Application
- G. Kielhofner
Occupational Outcomes: From Evidence to Implementation
- J. Schneider
- A. Heyman
- N. Turton