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DOI:10.3233/WOR-230311
IOS Press
1
Is there any job for me? Qualitative
exploration of support needs among young
swedish adults with psychosis envisioning
productive activities
A. Birgitta Gunnarssona,b,∗, Jan- ˚
Ake Janssonc,1and Mona Eklundd,2
aDepartment of Research and Development, Region Kronoberg, V¨axj¨o, Sweden
bDepartment of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden.
cDepartment of Psychology, Lund University, Lund, Sweden
dDepartment of Health Sciences, Lund University, Lund, Sweden
Received 5 June 2023
Accepted 10 November 2023
Abstract.
BACKGROUND: Unemployment is high not only among people with mental illness, but also among young adults in general.
The combination of having a severe mental illness and being young entails a particularly problematic situation for young
people with psychosis. This study aimed to understand how this group envision their future possibilities for entering the
labour market or engaging in other productive activities.
OBJECTIVE: To explore how young adults with psychosis perceive their possibilities, wishes and support needs for gaining
employment or engaging in other productive activities.
METHODS: A descriptive design with qualitative individual in-depth interviews was used. Eighteen young adults with
psychosis, aged 18–30 years, were interviewed. Data was analysed with qualitative content analysis.
RESULTS: Four categories based on the experiences of the participants as being vital for having work or other productive
activities were generated: “Wishing for a role in the community”, “Being my own coach”, “Needing personal support” and
“Having a supportive workplace”. Each of them included sub-categories.
CONCLUSION: The young adults with psychosis were a long way from having paid work, but they desired to have a worker
role in the community. They are a heterogeneous group, which entails that it is important that professionals and employers
have a person-centered and holistic approach, listening to the individuals themselves.
Keywords: Activity, employment, interviews, mental health, occupations, qualitative research, work
∗Address for correspondence: Birgitta Gunnarsson, FoU Kro-
noberg, P.O. Box 1223, SE-351 12 V¨
axj¨
o, Sweden, E-mail:
birgitta.gunnarsson@kronoberg.se, ORCID id 0000-0002-6976-
5154.
1ORCID ID: 0000-0002-6972-4686.
2ORCID ID: 0000-0002-0136-3079.
1. Background
Young adults with psychosis or other severe and
persistent mental illnesses are at risk of a psychiatric
disability, defined by the Swedish Social Board of
Health and Welfare as a condition that lasts for con-
siderable time and causes restrictions in coping with
everyday life [1]. An important consequence is the
ISSN 1051-9815 © 2023 – The authors. Published by IOS Press. This is an Open Access article distributed under the terms
of the Creative Commons Attribution License (CC BY 4.0).
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2A.B. Gunnarsson et al. / Is there any job for me?
threat that they will never complete their education
and thus have difficulty in entering the labour mar-
ket [2, 3]. Unemployment is high not only among
people with mental health issues, but also among
young adults in general, and the combination of hav-
ing a severe mental illness and being young entails
a problematic situation [3, 4]. Having employment
is essential for human beings [5]. Salaried work is
generally desired by both individuals themselves and
society, for reasons such as providing for oneself and
others and being part of society [6, 7].
Research has shown that although people living
with a severe mental illness have found mean-
ing through engaging in various types of everyday
occupations, employment was particularly important.
Many meant that having a job was more important
than being able to take care of oneself or having rela-
tionships [8]. Notwithstanding, people with mental
health issues tend to have a broad perspective on
what they see as “work”. It may not only include
salaried work but also semi-market activities such
as performing subcontracted work or providing dif-
ferent types of services at a day centre [9]. Some
examples of activities seen as work are food cater-
ing, car washing, and running a cafeteria [10]. Even
if these are not salaried employment they contribute
to society and meet the needs of others as work does.
We therefore use the term “productive activities” in
the current study as a common denotation to cover
salaried work and semi-market activities perceived as
work.
It was shown in a study of young people with psy-
chosis who attended day centres focusing on what
they perceived as meaningful activities and whether
they were longing for salaried work or not, that they
were limited because of their mental health issues and
thus did not think they had the capability for salaried
work. However, they still wanted to do right thing
for themselves and contribute to others, at the day
centre as well as in the community in general. They
also longed for a possibility to learn and perform new
things, be able to go to school or a workplace, and
they wanted to be economically compensated for their
contributions [11].
Young adults with psychosis were also included in
a study comparing work and related factors in three
groups of people with mental illness [12, 13]. The
two other groups were people who, in addition to
their mental illness, had a substance use disorder or
had newly arrived in Sweden as immigrants. Young
adults with psychosis scored lower on work expe-
riences and on resources for having a worker role
in comparison to the two other groups, even though
they were generally more satisfied than the others
with their everyday activities and with their quality
of life. This indicates that young people with psy-
chosis both have specific needs in terms of resources
and complicating circumstances. In-depth research
is needed to shed further light on how this group
envision their future possibilities for entering the
labour or engaging in other productive activities, and
what kind of support they would need for gaining
employment.
The aim of the study was to explore how young
adults with psychosis perceive their possibilities,
wishes and support needs for gaining employment
or engaging in other productive activities.
2. Materials and method
2.1. Design
The present study was part of a project named
“Productive activities for people with mental illness:
Supporting vulnerable groups”, focusing on people
who were likely to have a special need for support
regarding productive activities [12, 13]. The present
part focused on young adults with psychosis and used
a descriptive design with qualitative individual in-
depth interviews as the method for data collection.
The principles stated in the Declaration of Helsinki
[14] were followed, and the study was approved by
the Regional Ethical Review Board in Lund, Swe-
den (Reg Nr 2015/357). All participants gave their
informed consent to participation.
2.2. Context
Psychosis units (n= 7) in two counties in the south
of Sweden were invited to participate and six units
consented. Staff in these units identified and selected
patients who met the project’s inclusion criteria based
on each unit’s register. The inclusion criteria were: a
young adult, aged 18–30 years, and a main diagnosis
of psychosis (F20–F29) according to ICD-10 [15].
The exclusion criteria were: dementia or intellectual
disability, or current acute psychotic episode. A staff
member at each of the units served as a key infor-
mant/gatekeeper [16] in the selection process, and
contacted the identified young adults with psychosis
and asked them about participating.
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2.3. Participants
A total of 46 participants agreed to take part in
the larger project and signed their informed con-
sent. The present qualitative study was based on
in-depth interviews with a purposeful subsample of
these, representing variation with respect to age, gen-
der, educational level, work experiences, and from
each of the included six units. Eighteen participants
were selected this way. Their socio-demographic
characteristics are presented in Table 1. Most of
the participants had completed high school. There
were also participants who had started higher edu-
cation, but none of them had managed to take an
exam. Ten of the participants were occupied with
productive activities at the time for the interview.
Several of them had previously or at the time for
the interview were engaged in short-term produc-
tive activities, such as internships or holiday work.
There were participants who had occasionally had
salaried work, and a few currently had salaried work
they had received with the help of relatives. There
were those who were in an organized occupation at a
day centre, e.g., in dog day care service or a bakery
project, and there were also a few who studied part-
time or full-time with the goal of attaining a high
school qualification. Although several of the partic-
ipants lacked organized occupations at the time for
the interviews, they occupied themselves by creating
routines and organizing their everyday lives at home.
All of them had ongoing contacts within the commu-
nity psychiatry services, such as meeting a doctor or a
nurse.
2.4. Data collection
The first author (ABG) and two project assistants,
all occupational therapists, performed the interviews,
which took place at the psychosis unit to which
the participant belonged. The data collector first
introduced herself and the intention with this study,
and after receiving informed consent the participants
were interviewed for about one hour each. The inter-
views, based on a semi-structured guide, focused
on their everyday life, their experiences and hopes
regarding productive activities, and their expressed
needs for support to gain and maintain a job. Follow-
up questions were used when adequate, such as “Can
you please describe that further?” or “Can you give
me an example?” The interviews were audio-taped
and transcribed verbatim.
Table 1
Characteristics of the young adults with psychosis (N= 18)
Age; mean years (SD, range) 26 (2.8; 21–29)
Gender; number men/women/non-binary 11/6/1
Born in Sweden; number 15
Type of household; number
Single 11
Living with partner/family 7
Having children; number 2
Having a friend; number 18
Educational level; number
Completed 9-year school 6
Completed high school 12
Employment status; number
Employed 2
Student 4
Work rehabilitation 4
Unemployed 8
2.5. Data analysis
Data was analysed with qualitative content anal-
ysis based on the inductive approach proposed
by Graneheim and Lundman [17]. Theoretically,
content analysis can vary on a continuum, from
manifest content that is close to the text, termed phe-
nomenological description, to more latent content
that is more distant to the text, termed hermeneu-
tical interpretation. Additionally, the researcher can
take a distant approach and conduct their analy-
sis on an abstract level, or take an approach that
is close to the text and keep the analysis con-
crete [18]. The current study was at the middle of
the phenomenological—hermeneutical continuum,
as was its approach on the abstract—concrete contin-
uum. The trustworthiness of the analysis process was
strengthened by the varied, professional and scien-
tific backgrounds of the researchers (psychology and
occupational therapy) and thereby also their preun-
derstandings. All of them, one man and two women,
had experience from clinical work and research with
the target group and of qualitative analysis. Data
was read through several times in the first step. The
text was then divided into meaning units and sub-
sequently condensed into codes, which were sorted
based on similarities and differences. Different sub-
categories and categories emerged from the codes
in a subsequent iterative process. The three authors
then discussed and modified the sub-categories and
categories. In order to further strengthen the trust-
worthiness [17] and to ensure that the essence of the
participants’ experiences was captured, all authors
reflected and discussed in the final step until consen-
sus was reached.
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Table 2
Participants’ wishes and support needs for having work or other productive activities
Categories Wishing for a role
in the community
Being my own coach Needing personal
support
Having a supportive
workplace
Sub-categories Imagining myself
in a working role
Having a personality
that fits in
Having supportive
relationships with
family and friends
Coping with challenges at
the work place
Being one among
others
Maintaining my
motivation
Getting support from
professionals
Expectations from
employers, and how they
could facilitate for work
participation
Access to training
and education
Using my competence
and abilities
Getting along with
colleagues
3. Results
Four categories based on the experiences of the
participants as vital for gaining and maintaining a pro-
ductive activity were generated: “Wishing for a role in
the community”, “Being my own coach”, “Needing
personal support” and “Having a supportive work-
place” (Table 2).
3.1. Wishing for a role in the community
3.1.1. Imagining myself in a working role
Most participants could imagine themselves in a
student or working role. Those who saw themselves
in a student role wanted to complete high school,
go to college, and then work with something in line
with what they were trained for. Participants had
different preferences for how much they could be
occupied with productive activities, ranging from
25 percent to 100 percent. They expressed hope and
wished for a job in their future: “There may perhaps
be a possibility for me to get a job” (P14), but they
maintained that they had to recover and get healthier
first. The participants commonly mentioned jobs in
services and social care, i.e., they wished to work
with children as a nurse or as a teacher, or with
elderly people. One participant spoke of becoming
“a volunteer ... for example, they suggested at the
Employment Service that could become a volunteer
for pensioners and keep them company, I’m used
to it, and it would be fun” (P9). There were also
those who wanted to work as case managers or
work as shop assistants. Some of them also dreamt
of blue-collar work as, e.g., a janitor within the
municipality. Some gave examples of situations
where others had suggested what they should do,
such as when a career guidance counsellor suggested
to a participant to train in the nursing profession.
3.1.2. Being one among others
The participants wanted to be one among equals,
feeling accepted and socializing with peers, not only
with their families, who were the ones they met most
often. Participants experienced it as difficult to get in
touch with others, because they had lived withdrawn
lives due to their mental health issues. Even though
it would take courage to leave safe environments as
the mental health care and day centres, they longed
for being part of a group, and meeting people without
any mental health issues.
There were participants whose goal was to get
a qualification, because a professional title was an
important aspect of being one among others. That
would also lead to work, development, and a possi-
bility to make a career, which in turn would improve
their well-being and a sense of being proud of them-
selves: “if I get a title and do what is right for me then
I think I’ll feel well” (P13).
Gaining an employment or other productive activ-
ity was seen as a means to enter a social context,
although it had to be on their own terms. Meeting
other people who were in the same situation as them-
selves was also positive. If they felt accepted and
respected, the participants experienced real compan-
ionship and being one among others: “Yes, but it was
the atmosphere, everybody was pleasant and talked
to me, like, and I was able to do it at my own pace,
that was what had been the best” (P10). Moreover,
having a job also involved longing for a partner and
friends.
Furthermore, having their own housing and earn-
ing money would mean that participants could adapt
to the norm, become financially independent and be
able to pay off their debts. Participants would like to
live a tolerable life, and for example be able to go to
a store and buy what they needed without worrying
about whether they could afford it or not:
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A.B. Gunnarsson et al. / Is there any job for me? 5
I have dreams of being able to work and get by
financially, that’s a dream I have, to be financially
independent. And then that it also means a lot
to me / ... / it means that in one’s own eyes and
in the eyes of others to maintain some... decency
and respect / ... / and then on top of that you then
sort of maintain a certain self-respect and respect
for.... or others respect you and / ... / and to assert
myself (P13).
3.1.3. Access to training and education
Gaining employment or engaging in other produc-
tive activities was not seen as an easy task. There
were participants whose goal was to first get a qual-
ification, while others were more focused on getting
a job directly. The participants said that they needed
help to become aware of their mental and physical
condition as well as their limitations before enter-
ing that job. They also needed training to become
independent and to develop their competence. Some
of them wanted an opportunity to try and test their
skills under the guidance of staff and at their own
pace at a day centre first. The first thing might be
to do a little when they were inspired, and then tak-
ing part in internship or vocational training. Others
wanted support from the social insurance office and
the employment agency, i.e., the mainstream inter-
ventions directed towards getting work. There were
those who expressed a need for help to get on with
studies or work, while others did not wait for any help
and arranged an internship themselves. Some partic-
ipants sought a safe haven for testing a job or other
productive activity, while others wanted to go into
working life directly: “I think it would have been fun
to be able to advance and eventually, because.... a
proper job is more challenging, I think” (P4).
3.2. Being my own coach
3.2.1. Having a personality that fits in
Participants described various characteristics of
their personality, which they meant could facilitate
or limit their possibilities to gain employment, or to
be engaged in productive activities. There were those
who meant that their strengths, such as being positive
and happy, and good at socializing, would be facil-
itating. Being an optimist and looking at the bright
side of life will make it easier to connect with others,
colleagues as well as employers.
Furthermore, it was experienced as important to be
an honest person, an individual who others can trust.
This could concern being open-minded and able to
talk about things related to work, but also being on
time for work: “I have a voice inside me that says that
I have to do a good job on the internship –I have to
get up and out of bed –that voice is like a support for
me” (P13).
The participants described personal limitations,
such as having difficulty to plan and develop a good
structure in everyday life. Another limitation was
being sensitive to stress, which could concern doing
different things simultaneously or be related to finan-
cial difficulties. The difficulty in dealing with stress
could generate a feeling that something was wrong
with them. It was difficult for them to perform work
and other productive activities when they were highly
stressed. Some of the participants conveyed that they
could suddenly become tired and unable to do their
chores, or have difficulties staying focused:
I disappear in my own world and when I then be
... . when I become like that in those situations
... . I become tired or am unable to focus properly
and then it would be good if they could accept,
that they could accept it and think, yes, go and sit
down and have a rest (P5).
3.2.2. Maintaining my motivation
Participants spoke of needing to maintain their
motivation in situations when it could be difficult to
overcome resistance and changes in everyday life.
Being motivated could concern a desire to continue
being alive or wanting to be part of a group and not
feeling lonely. Making one’s own decisions was not
easy for the participants, but they would often manage
by triggering their motivation:
As long as it’s the right thing then I want to be part
of it, but if it feels as though nothing is happening
... then it’s not so good, then I’m prepared to
have to press on, that I’m the one who has to
press on (P18).
There were those who felt that difficulties concern-
ing their motivation at home affected their ability to
perform occupations outside the home, e.g., to cope
with a job. Some talked of a lack of interests, while
others meant that they were not good at getting up in
the mornings, and others stayed in bed all day. Some
who lived alone were not always motivated to take
care of their hygiene. Staying at home was perceived
as boring and monotonous, and one of the participants
said:
I don’t like cleaning and I don’t like eating and I
don’t like cooking and I don’t like washing, so I
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6A.B. Gunnarsson et al. / Is there any job for me?
don’t do that much. ... I have to do it and I kind
of do sometimes, but most of the time it doesn’t
get done. I....so the thing is that I.... well, on one
level I have such a hard time seeing the point with
cleaning, because it always gets dirty again and
you know, I found everyday life difficult / ... / due
to it just gloomily plodding along / ... / I always
want something to happen, so ... .the whole idea
of everyday routines become... it becomes like a
prison for me and I can’t handle it (P15).
Just being at home all day, with no routines and
structure, was perceived as unsatisfactory, when they
just watched the television or simply did nothing after
waking up, making breakfast, and cleaning up. The
participants spoke of having difficulty in planning
ahead, getting away from home and managing a job:
“have been too tired or too lethargic and I haven’t
been able to keep going a whole day and work” (P16).
3.2.3. Using my competence and abilities
Participants described the competences and abili-
ties they had, which could be useful when being at
work or engaged in other productive activities. There
were those who thought good grades in school, e.g.,
in mathematics, were useful. There were also par-
ticipants who wanted to use their education to help
others, e.g., someone who had a nursing education.
Other participants said that they were good with chil-
dren and felt they had the ability to work with them,
e.g., as a teacher. In general, the pursuit of an inter-
est was a good way to use their abilities, e.g., one
participant who had a voluntary job: “got a job at an
ecological farm for children, because I’m interested
in ecological things and I’m interested in children”
(P6).
There were participants who experienced that they
were good at practical/physical tasks but were never
good at precision and completing details. Others said
that they had previously found it difficult to concen-
trate on tasks, but that they had improved now and
were able to be focused when carrying out a task.
There would be possibilities to feel well when they
felt they were in balance and had structure in every-
day life. The participants conveyed that one way to
strengthen their mental well-being and develop their
abilities might be physical training. Others had tested
going to the swimming baths or learning foreign lan-
guages to boost their skills, although that had not
worked for them. Having a mental illness may also
entail difficulties in relating to others, such as mak-
ing and keeping friends, which in turn could have
an impact on their ability to manage jobs and other
productive activities, even though they were highly
motivated for this: “to be able to cope with the symp-
toms and feel that I am in control at work, I’d like to
be able to do all the aspects of the work” (P10).
3.3. Needing personal support
3.3.1. Having supportive relationships with
family and friends
The participants spent a considerable amount of
time at home alone, but they also had a social network
of family and friends, who knew how mental health
issues could affect the individual in everyday life.
That type of supportive relationship was perceived as
a prerequisite for being able to get to studies, a job,
or other productive activities, e.g., a wake-up call in
the morning. Parents would support with practical
things, such as transport to and from a job or other
productive activity, sometimes as a daily routine. Par-
ents also encouraged the participants to relax and be
calm and wanted to help them in their recovery pro-
cess. Both families and friends were supportive when
it came to looking for a job, e.g., how to write a CV,
or just answering questions about how to get a job.
Sometimes parents and other relatives had contacts
in working life; in fact, those participants who had
a job, were employed in their parents’ company or
workplace. One participant, who did not get the job
that he/she had applied for, spoke about support from
friends: “It was of course difficult, but I talked with a
few friends then and it happens to everyone, then it
felt better when I could think of that. It can happen
to anyone” (P1).
3.3.2. Getting support from professionals
Some of the participants already had support
from in-house staff from the social services, others
expressed a need for such support. They needed help
to carry out household chores, to continue medica-
tion, and to get to their productive activity. Another
kind of support that was spoken of was to have
an emphatic and active listener, with knowledge of
everything that needs to be considered before look-
ing for a job or other productive activity. It seemed
important to have all the time one needed to recover,
and not speed up the process, everyone should take
their time at their own pace.
The participants were generally satisfied with the
support they received from the mental health care
services, even though they sometimes thought that
the staff ought to help them even more and alleviate
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A.B. Gunnarsson et al. / Is there any job for me? 7
their relatives’ situation. The participants expressed
that they had not only received supportive therapy
and medication but also support concerning how to
manage one’s finances and finding motivation for
studying and managing one’s job. This type of support
was seen as valuable;
I talk to her, the nurse, so we have... try to have
a conversation once a month. And then I’ve said
that it feels good to have someone to exchange
ideas with like that, because it’s a little... it feels
good, it usually helps a little, I think so. So that you
don’t... sit at home by yourself like that, because
it can get a bit isolated (P4).
The participants emphasized the importance of
having connections with people who could pep them
up. It could be staff from the social insurance office,
the employment agency, and/or Supported Employ-
ment programs. The participants who had received
support from case managers perceived them as com-
panions in the community, who could help with one’s
personal economy, but also with compiling CVs and
personal letters that participants submitted to poten-
tial employers. They had received thorough guidance
from their case managers regarding how to manage
everyday life prior to starting an internship or a job.
Some participants had also received wake-up calls so
they could be at their job on time. The participants
found it important to have case managers who lis-
tened to them and could take their fluctuating mental
health into consideration. A case manager needed to
be calm and let participants do things at their own
pace, i.e., someone “who listens and tries to adapt
what one does to how much one is able to do” (P8).
The participants found it desirable to have case man-
agers who were close, but still not intrusive, someone
who gave them constructive feedback at different
stages and at the right time.
The participants expressed that staff whose job it
was to assist them should see to the individual and
their characteristics in order to be able to help them
to an adequate job or other productive activity. They
could, however, give several examples of the oppo-
site and of feeling confused in the contact with the
authorities. They said that the social insurance office
and the employment agency generally had long pro-
cessing times, and that different authorities referred
to each other and no one took responsibility for the
whole. They were given numerous forms to fill in,
for example, to receive financial support, but the par-
ticipants had difficulty understanding how the system
works and which rights they have. For example, there
could be difficulties when they wanted to study a sin-
gle course; and they hesitated about studying, because
they did not know the rules for sickness benefits ver-
sus study loans in the Swedish system, “when I’m
unable to study full-time then it becomes very wrong”
(P5). There could also be difficulties in terms of the
professionals’ attitude towards the participants, e.g.,
when they went to college and met teachers who did
not understand that students may have specific needs.
3.4. Having a supportive workplace
3.4.1. Coping with challenges at the workplace
A few aspects facilitated participation in produc-
tive activities, these included the alignment of the
work tasks with their personal interest, the chal-
lenges being just right for their capabilities, and the
close vicinity of the workplace to their home. They
needed calm jobs that did not stress them. Working
with productive activities other than salaried work
was positive as the participants could choose what
they wanted to do and for how long. This often
entailed a slower pace and adjusting the work tasks to
their capacity. There were participants who enjoyed
more monotonous routine tasks, while others needed
greater variety to be motivated to continue working.
Being allowed to stay at a workplace for a longer
time, so that the participants could learn the work
and develop new skills was an advantage: “you know
and they are very good at coaxing my strengths, they
are very good at and you know getting me involved
in what they’re doing” (P15).
It could be a challenge to cope with a job or other
productive activity. The participants struggled with
concentration, and it was more difficult if they found
their work tasks less interesting:
Maybe it was because it didn’t work very well, I
didn’t get very well / ... / I can’t manage those
conveyor belt jobs. No, it doesn’t work for me. I
need to have some variety. It was like in industry,
it’s a bit more relaxed there, you can’t lie about
that, but like the three jobs I enjoyed, they were
self-paced jobs, free jobs. You went and sort of
took care of what you needed....it wasn’t so much
of a routine, that it was the same thing every day
or so (P2).
A lack of concentration made it difficult to under-
stand things, especially if theoretical matters were
concerned, and they needed to ask many questions
and receive detailed instructions. There were those
who felt that the work tasks were too difficult due to
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8A.B. Gunnarsson et al. / Is there any job for me?
their mental health issues. Other circumstances that
were inhibiting were if the work was solitary or had
to be done under time pressure, or if the participants
felt forced – that society expected them to have a job
or they felt demands to extend their working hours
with the consequence of being completely exhausted
by the weekend. The participants also talked of an
uncertainty concerning their prospects of getting a
job. They also said that having responsibilities might
be a burden:
It’s a bit scary with the project [work experience
at a garden centre], although I think it’s a lot of
fun and so, I hope it continues... and at the same
time I don’t know how much I can do, because I’ve
been that bad so I hope there’ll be other people
there who can take on more responsibility (P6).
Meeting other people who were in the same sit-
uation as themselves was also positive. Other job
benefits were having something to do, having rou-
tines and regular times, and being able to perform
various work tasks. Working in a caf´
e could be fun
and instructive, as could working in a daycare ser-
vice for dogs or painting and refurbishing furniture,
or providing various types of assistance at nursery
schools and schools.
Although the participants were mostly positive
about being involved in productive activities other
than paid jobs, there were those who were nega-
tive about providing “free services” for which they
received no more than a lunch as compensation.
3.4.2. Expectations from employers, and how
they could facilitate for work participation
The participants spoke about there being only a few
employers who want to hire someone who is on sick
leave due to mental illness. The participants often
lacked higher qualifications and thus had to apply
for low demand jobs. They had sometimes been able
to get a job or other productive activities by using
that strategy. The participants had mixed experiences
regarding the expectations of and the encounters with
the employers. One employer could expect the person
just to relax and do nothing, and the participants then
had had to talk about themselves and how they had
got on at school:
I got the feeling that they are very much used to
the fact that those who come there don’t know
what they want, that they may not be ready to do
anything, that they just relax, and then it became
a bit like they I thought I was the same and it’s a
bit annoying, but I didn’t want to just scream out
loud, but I just had to sort of explain my thoughts
and wishes and dreams and sort of tell them how
I’ve been feeling a little and so, so I guess they
have begun to understand that I wasn’t the type to
skip school or anything like that, so for example
when it comes to school then, I was one of those
who behaved well” (P17).
The participants had sometimes met employers
who organized an internship or employment with-
out waiting for decisions from the authorities. There
were employers who were supposed to act as men-
tors for the participants but failed to do so. Others
paid attention to what the participants did well and
encouraged them. An employer could function as a
role model by, for example, being considerate and
generally educated and calming the person down in
stressful situations.
It was extremely important to have an understand-
ing mentor who had long professional experience and
good knowledge about what was to be done and could
also explain how. The mentor could be the employer
or some experienced employee. They functioned as
good mentors and could adjust the tasks to the individ-
ual, so that there was neither too little nor too much
responsibility. Such mentors also wanted to get to
know the participants, keep in touch and were some-
one the participants could talk to about their mental
health issues, and could provide the needed support.
All of this made it easier for the participants to enjoy
work, and to feel safe.
3.4.3. Getting along with colleagues
To become a member of a group of colleagues at a
workplace and socialize with people the participants
had not previously known could be intimidating. It
could also be difficult to deal with a tough jargon
at work. Some thought that it might help if the col-
leagues knew what type of mental health issues they
had. They had experiences from work colleagues who
facilitated for them to get the work done because
they knew about their difficulties, such as concen-
tration problems. Others maintained the opposite,
that it would not be necessary to know everyone’s
secrets. Some spoke of experiences of prejudice,
e.g., colleagues joking about people with mental
illness;
I had a fear or what can I say, that I could be
ostracized.... if I had, for example, gone to a shop
[that had a certain reputation], and if someone
said that...then I might have been seen as being
CORRECTED PROOF
A.B. Gunnarsson et al. / Is there any job for me? 9
somewhat odd and different.... I don’t know, that’s
my dread (P10).
There were also experiences of being spoken to
as a child, or hardly being treated as a human being
at all. In some cases, and to some extent, this could
depend on the participants themselves: “I didn’t feel
well myself, so I don’t think that they could have
done more, that could have helped me, because I
was so suspicious about them all, so even if they said
something positive I interpreted it in a totally differ-
ent way” (P16). The positive experiences that were
mentioned concerned being greeted with a friendly
attitude at the workplace, having lunch together, talk-
ing and joking with each other, and sharing interests
with others. They could then also share things that
were not workplace-related, such as wanting to get
a driver’s license. It was easier for the participants
to be more open about themselves with open-minded
colleagues.
4. Discussion
The findings showed that the young adults with
psychosis who participated in the current study
desired a worker role in the community. They needed
to be their own coaches, but they also needed support
from others in their environment, including support-
ive workplaces when attempting to reach this goal.
Although all of them wanted something more “than
just being at home” and doing nothing, the par-
ticipants’ wishes varied; some of them imagined
themselves as students or employees while others
wanted some type of semi-market productive activity.
This shows that they are not a homogeneous group,
but individuals with different needs.
Paid work is desired by people with mental health
problems, for reasons such as providing for oneself
and others and belonging to a social context [6, 7].
The participants in this study conveyed that having an
employment meant being one among others, includ-
ing having beliefs in a future worker role. They longed
to fit in and be in a context, socialize and earn their
own money. The identified importance of being in a
context may be linked to Hamell’s [19] concept of
belonging, which in turn can facilitate for the indi-
vidual to become the person he/she wants to be. The
current findings are similar to those in a study by Gun-
narsson and Eklund [11], showing that young adults
with psychosis who attended day centres desired a
future worker role, even though they had never had
such a role. The findings of optimism about the future
in that study and the current one contrast with those
in a study by Jansson et al. [20] on work prospects
among people with substance use disorders. These
had previously had a job, but they now had only
low expectations regarding fitting in and getting a
new job, which they attributed to previous negative
work experiences, including stigma. Helping people
with mental health problems maintain their optimistic
views on future work prospects that have been found
among young people would be an important task for
the support systems involved, including the health-
care and social services, employment agencies, and
workplaces, and would require targeted education
for the staff groups involved. The findings from the
current study regarding support needs and measures
could be included in such educational efforts.
It is important to note that paid work or some other
type of productive activity was not only desired by
the individuals themselves in this study, but they also
conveyed that it was desired by society. This is in
agreement with Nilsson [21] who maintained that
exclusion has a high price, partly in terms of direct
costs, such as assessments, visits to healthcare ser-
vices, and the economic support individuals need for
their livelihood. In addition, there are substantial indi-
rect costs in terms of production losses for the young
unemployed adult, but also for close relatives who
may need to accompany their relative to, for exam-
ple, doctor’s appointments, or even be on sick leave
themselves. A complicating factor for the participants
in this study was employers who were not available
or who put the same demands on an individual with
mental health issues as on others at the working place.
To facilitate for people with mental health problems
to be part of working life, there needs to be a natural
flexibility so that the work demands can align with
the mental health state of the person, which may vary
from one day or period to another. This is obvious
from the current findings and has also been shown in
previous research [22]. This may allow for small steps
to be taken, and each of these would be important
for both the individual and society and bring about
positive economic consequences. For example, being
able to stay at a workplace or as a trainee even on a
bad day can diminish the need for mental healthcare
or alleviate the burden otherwise placed on a close
relative.
The participants in this study said that having a
personality that fits in, e.g., being motivated and hav-
ing a positive mindset, makes it easier to get a job,
while withdrawal and cognitive impairments make it
CORRECTED PROOF
10 A.B. Gunnarsson et al. / Is there any job for me?
more difficult to maintain work participation. This is
in agreement with Lindhardt et al. [23], who showed
an association between withdrawing, unemployment
and being young with psychosis, and with Harvey
et al. [24], who found that social competence and
cognitive impairments are associated with fewer pos-
sibilities for employment, and also with Brouwers
[25], who stated that social stigma implies a high
risk for unemployment. According to the current find-
ings, expectations of having a positive mindset, and at
the same time having various impairments, could be
experienced as stressful, which accentuated the dif-
ficulties in entering the labor market. However, the
role of cognitive impairments should not be over-
rated. Caruana et al. [26], when investigating the
relationship between cognitive skills, job complexity
(higher or lower cognitive demands) and managing
to maintain an employment over time, argued that
what mattered was that the individual was motivated
for the job, enjoyed it, and that the job suited their
personality.
To reach the goal of being engaged in work or
other productive activity, the participants needed a
supportive encounter from different sectors in the
community: their families and friends, healthcare
professionals and various authorities, but also from
present and future employers and work colleagues.
A crucial aspect of experiencing such support was
a mutual and trustful relationship, which the par-
ticipants in this study felt when they were seen
and confirmed as the individuals they were. Unfor-
tunately, however, the participants in this study
experienced difficulties in their communication with
the authorities, which could be seen as a barrier when
most of them were in the initial step of the process
of job seeking. The relationship between client and
helper is seen as essential and as the core of the
support in virtually every sphere of the healthcare
and social services [27], which is also true in the
Supported Employment (SE) context where positive
staff attitudes were essential for successful imple-
mentation [28]. It is vital that the support is based
on facilitating for the person with mental health
problems to find hope, restore identity, find mean-
ing in life, and take responsibility for recovery [29].
Hamovitch et al. maintained that a good therapeutic
relationship is closely linked to person-centered sup-
port, which could result in good outcomes [30]. A
crucial aspect is that the individual feels respected and
involved in their own care and has an open commu-
nication with their supporter, who they experience as
having both personal and professional expertise [31].
A person-centered approach can encourage more
of a holistic and health-oriented focus and less of
one on symptoms and mental illness [32]. Such an
approach would be useful for professionals, as well
as future employers and colleagues at workplaces,
and supports a focus on the individual’s strengths,
i.e., interests, talents and skills, in the working rela-
tionship [33].
Only one of the participants spoke about being
involved in SE. We do not know whether the
participants had been offered, or tried SE previ-
ously, but participation in SE could have a positive
impact on the incidence of participating in pro-
ductive activities [34]. Those authors showed that
participation in programs such as SE and Early Inter-
vention (EI) had a positive impact for young adults
with psychosis in obtaining an employment, but
to maintain the employment remained a challenge.
Continued support, when the individual’s needs and
wishes are listened to, is therefore needed from rela-
tives, professionals, and presumptive employers and
colleagues who aim to provide support for the indi-
vidual when seeking, obtaining and maintaining an
employment.
The participants also had difficulties in their com-
munication with employers, whether they should
tell them about having a mental illness or not, and
whether it would benefit them in terms of complet-
ing tasks and contacts with colleagues. Severe mental
illness has been found to be a significant barrier to
employment in previous studies [35, 36]. However,
the participants in this study hardly mentioned this as
a barrier or stigma, possibly due to them still being far
away from an employment situation and had therefore
hardly ever experiencing it.
Although paid work is generally desired by both
society and the individual for reasons such as pro-
viding for oneself and others and being one among
others, the findings from this study indicated that the
participants were far from having paid work. They
expressed hopes of being able to work as, for exam-
ple, a teacher or a nurse, but the reality right now
was that their first priority was to get structure in
everyday life and hopefully get a semi-market posi-
tion. On the other hand, as described by Boardman et
al. [37], the fact that the participants were occupied
with their daily routines might reflect that profession-
als, as well as staff at workplaces, are focused on
the individual’s psychological status, and not their
capacities and skills. This study can thus be useful
as an eye-opener, initiating a process that, in line
with statements from WHO [38] as well as Killeen
CORRECTED PROOF
A.B. Gunnarsson et al. / Is there any job for me? 11
[33], focuses on the views, priorities and resources of
young adults with psychosis, and not mainly on their
limitations.
Besides SE, which implies direct training with
support in a real workplace [28], other measures to
buttress job establishment among people with mental
illness have been proposed as well, such as increased
work readiness [39]. The latter study concluded that
focusing on individuals’ views of their worker role,
especially their expectations on job success, would
be important in all efforts to support towards work
or other productive activities. The implications from
the current study are similar, that a broad approach
is needed, including both direct paths to work and
possibilities for developing a self-image as a work-
ing person, which could be included in any type of
social and healthcare services.
The trustworthiness [17] of this study needs to be
taken into consideration. Using a descriptive design
with qualitative in-depth interviews to present how
young adults with psychosis experienced their wishes
and needs for getting and having a productive activity
strengthened the credibility. Moreover, the credibility
was strengthened when we recruited participants who
represented variations in terms of age, gender, educa-
tional level, work experiences, as well as all of the six
units included in the larger project. However, we did
not manage to recruit any participant younger than
21 years, maybe because at that age they had not yet
attempted to enter any productive activity. Further-
more, the participants contributed with a variation
of experiences from getting and having a productive
activity, which further strengthened the credibility.
However, variation may sometimes be a limitation,
for example, in terms of transferability. Showing what
reality looks like is a strength; people with psychosis
are not a homogenous group.
The dependability was strengthened by the thor-
ough description of the analysis process. The fact that
the first author interviewed some of the participants,
and had an inside perspective, while the other authors
had an outside perspective, together with the authors’
varied pre-understandings, strengthened the depend-
ability, further supported by the fact that the analysis
was discussed until consensus was reached. Finally,
even though a descriptive design with a qualitative
approach is based on a small number of participants,
and the current study was conducted in a Swedish
context, we argue that the variation obtained concern-
ing the experiences of the wishes and needs related to
getting and having a productive activity also renders
some transferability to the study, although limited
to similar groups and contexts. Another weakness
could be the absence of interviews of caregivers and
employers. A triangulation of findings could have
strengthened the transferability. Moreover, the num-
ber of presumptive participants who declined to be
interviewed could not be calculated due to the selec-
tion procedure relying on gate-keepers. It is possible
that the more severely ill people were among those
who declined.
5. Conclusions
This study showed that young adults with psy-
chosis were far away from having paid work, but
they desired to have a worker role in the commu-
nity. They needed to be their own coaches, but they
also needed support from others in their environment
and wanted supportive workplaces while attempt-
ing to reach their goal. The findings also showed
that the young adults had different experiences of
what they needed, indicating that they are a heteroge-
neous group, i.e., individuals with different wishes,
needs, abilities and skills. It is thus of importance that
professionals, employers, and policy-makers have a
person-centered and holistic approach, listening to
the individual themselves and adapting tasks and
workplaces to match their needs. They should also
acknowledge the importance of both directs paths
to work, via employment offices and SE, and mea-
sures that can be taken in any type of services to
help the individual keep a self-image of being capa-
ble of work and believing in having a future worker
role.
Ethical approval
The study was approved by the Regional Ethical
Review Board in Lund, Sweden (Reg. Nr. 2015/357).
Informed consent
All participants received oral and written informa-
tion about the study and provided written informed
consent. All procedures were in accordance with the
ethical standards of the responsible committee on
human experimentation and with 1975 Declaration
of Helsinki, as revised in 1983 and 2004.
CORRECTED PROOF
12 A.B. Gunnarsson et al. / Is there any job for me?
Conflict of interest
The authors declare that they have no conflict of
interest.
ACKNOWLEDGMENTS
The authors have no acknowledgments.
Funding
This work was supported by the Swedish Research
Council for Health, Working Life, and Welfare
(FORTE) (Grant no. 2014–4732). The funders are not
involved in the design of the study, collection, analy-
sis, interpretation of data or in writing the manuscript.
Conflict of interest
The authors declare that they have no competing
interests.
Data availability statement
The datasets generated and analysed during the
present study are not publicly available due to eth-
ical considerations but could be made available from
the corresponding author on reasonable request.
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