Employment Support Needs of People with Schizophrenia: A Scoping Study

Strategies for relapse prevention among people with schizophrenia in KwaZulu-Natal Province, South Africa: Healthcare providers' perspectives

INTRODUCTION

Relapse is a significant challenge among people with schizophrenia and is broadly recognized by the aggravation of positive or negative symptoms, the need for re-hospitalization, more intensive case management, and/or changes in medication. The quality of inpatient care and proper transition to outpatient care are crucial in reducing the risk of relapse. Healthcare providers play vital roles in ensuring the continuity of care after patients are discharged from the hospital. Little is known about the roles of preventing relapse from the perspective of healthcare providers. This study explored the currently existing strategies for preventing relapse from the perspective of healthcare providers.

METHODS

We captured the view of healthcare providers providing services to psychiatric patients using a qualitative methodological approach with descriptive phenomenology. We conducted audio-recorded, in-depth interviews with 15 consenting clinical providers from a public psychiatric hospital in Durban, South Africa. To facilitate analysis, we used Dedoose software (SocioCultural Research Consultants, LLC [www.dedoose.com]), and the themes were inducted from the data.

RESULTS

Six major themes inducted from the analysis: Preparing patients and caregivers for discharge; Developing consistent and caring therapeutic relationships; Using an active approach to transition; Working with patients and caregivers concurrently; Creating and sustaining interagency connections; and Facilitating alternative forms of treatment.

CONCLUSIONS

Discharge planning and preparation are needed to ensure smooth transitions from hospital to outpatient care for relapse prevention. The healthcare system should ensure the availability of human resources for health at all levels of health facilities, and multidisciplinary teamwork will help a successful transition.

Predicting satisfaction with vocational status among people with serious mental illness in vocational services: the role of perceived skills and support

Background

This study aimed to explore the role of perceived skills and support in satisfaction with vocational status to better address the vocational needs and recovery goals of individuals with serious mental illness (SMI). It focuses on three service types: individual placement and support (IPS), sheltered workshops, and vocational support centers.

Method

The study is a cross-sectional analysis of the nationwide Israeli PR-PROM project data. A sample of 2,968 participants diagnosed with SMI and their service providers self-reported their perceived skills, support, and satisfaction with vocational status.

Results

We found perceived skills and support to be primary predictors of vocational satisfaction across all groups. There were significant differences in satisfaction with vocational status among the three service types: IPS users reported higher satisfaction than sheltered workshop and vocational support center users. The service-provider evaluations reflected similar trends, with higher satisfaction ratings for more integrative services. Additionally, discrepancies were observed between participant and provider satisfaction ratings, varying by vocational service type.

Discussion

The study highlights the importance of perceived skills and support in enhancing satisfaction with vocational status for people with SMI regardless of the vocational service type. Whereas objective factors like employment status and salary contribute to vocational rehabilitation and quality of life, subjective perceptions of skills and support play a significant role in satisfaction with vocational status. The results suggest that vocational rehabilitation services should monitor consumers' perceptions of skills and support to improve their vocational satisfaction, which can promote personal well-being and social integration.

Employment Experiences and Employability of People in China Living With Schizophrenia: A Qualitative Study

OBJECTIVE

Employment support for people living with schizophrenia in China currently focuses only on patient-level factors. The authors' aim was to assess the employment experiences of this population and to identify factors related to their employability.

METHODS

In-depth interviews were conducted with 24 purposively selected respondents. A thematic analysis was performed.

RESULTS

A framework for examining the employment experiences and factors affecting employability of people living with schizophrenia was developed. Employability varied by individual characteristics, personal circumstances, and external factors. Individual-level characteristics, such as health and well-being, work skills and experience, educational attainment, personal social network, gender, and age, influenced individuals' work motivation and performance. Personal circumstances, such as family socioeconomic status and caregiving responsibilities, affected whether individuals decided to seek employment. External factors, such as labor market conditions, macroeconomic context, stigma and discrimination, mental health services, and policy factors, determined how likely individuals were to be employed and the types of jobs they were likely to obtain.

CONCLUSIONS

A multifaceted combination of factors was found to influence employability among people living with schizophrenia. This research provided a thematic framework to structure effective employment support for people in China living with schizophrenia.

Exploring the tipping point: a qualitative study of labour marked experiences among young people with first episode of schizophrenia

PURPOSE

Work holds significant value in the lives of most individuals, impacting various aspects such as identity, health, and the economy. However, young individuals with schizophrenia often encounter challenges in accessing and maintaining employment. Despite this, knowledge regarding their experiences with labor market is sparse. The study aimed to explore perspectives on labor market affiliation and vocational intervention in relation to quality of life and health among young people with schizophrenia.

METHODS

A qualitative approach was employed, applying individual interviews as data collection method. Twelve patients with first episode of schizophrenia were recruited from two outpatient clinics. Thematic analysis was used, following an inductive process. A user panel was established to ensure quality and relevance of the study.

RESULTS

Three key themes were identified from the analysis: 1. "Work is simultaneously rewarding and demanding", highlighting the struggle to balance the benefits of employment with the difficulties of meeting labor market requirements; 2. "Mental health, stigma and work: A complex interplay", which concerned how work simultaneously contributes to stress and reduces psychiatric symptoms; 3. "Supported employment: Facilitating work-life balance", concerning how supported employment intervention facilitated a better work-life balance, enhancing overall quality of life, under specific conditions.

CONCLUSION

Young individuals with schizophrenia are highly motivated to work, yet encounter significant barriers to labour market participation, related both to their mental health condition and societal stigma. Supported employment programmes emerge as crucial in empowering individuals with schizophrenia to navigate the complexities of the labour market while managing their mental health effectively.

Marital concerns of long-term hospitalised patients with diagnosed schizophrenia: A descriptive phenomenological study

Marital concerns can trigger emotional stress, especially among long-term hospitalised individuals diagnosed with schizophrenia, significantly affecting their treatment and recovery. Unfortunately, rehabilitation programs tend to overlook the marital needs of individuals with diagnosed schizophrenia. This research aimed to investigate the content related to marital concerns of Chinese individuals diagnosed with schizophrenia who were undergoing extended hospitalisation. Fifteen participants diagnosed with schizophrenia were recruited through purposive sampling for face-to-face semi-structured interviews. The gathered data were analysed using Colaizzi's method, revealing three themes: (1) manifestations of marriage-related concerns, (2) effects of marriage on disease progression, and (3) the need for support from family and the hospital. This study offers new insights into marital concerns among long-term schizophrenia inpatients and underscores the significance of screening and intervention for such concerns. Healthcare professionals and family members should extend support to patients to foster confidence within their marital relationships.

Longitudinal outcomes of a work inclusion program in mental health departments in the city of Milan

BACKGROUND

Work functioning impairment is a key diagnostic and prognostic criterion in patients with psychiatric disorders and work inclusion is a major goal of their therapeutic pathway. Since 2009, the Regional Innovative Program (PIR) TR106, promoted by ASST Fatebenefratelli-Sacco of Milan in collaboration with other Departments of Mental Health and Addictions (DSMDs) in the town of Milan (Italy), has been developing the employment inclusion of psychiatric patients.

AIMS

The objective of this study is to evaluate its outcomes over 8 years of observation.

METHOD

We reported the results of a retrospective epidemiologic analysis on 2,142 interventions on 1,066 patients recruited, investigating PIR TR106 outcomes per year focusing on different subgroups. We focused on 'positive', 'negative', and 'other' outcomes.

RESULTS

We preliminary calculated job maintenance interventions (5%, 107) and excluded these interventions from the overall. We observed 29 job firing (1.4%) and 15 job resignations (0.7%) as negative results (equal to 2.2% of the total) and 388 job hiring (16.6%), 647 traineeships (31.8%), and 413 work formation (20.3%) as positive outcomes (equal to 68.75%). In other outcomes (29.1%) we found 305 dismissals from PIR TR 106 (15%) and transitory outcomes (14.1%).Job hiring increased from 8.9% in 2012 to 23.8 % in 2019 (p < .001), while the dismissals diminished from 26.7% to 13.3% (p < .001). The effectiveness of traineeships in terms of job hiring increased in the ratio of annual job hiring versus job traineeship (+48.8%). The majority of hired patients (15.1%) were affected by a psychotic disorder. A significant hiring increase was observed in patients with psychotic disorders and personality disorders (p < .005).

CONCLUSIONS

PIR-TR106 represents a territorial employment inclusion program with progressively increasing effectiveness and specificity, as suggested by changes in outcomes during the 8-year observation. The adaptive capacity and sustainability of the intervention are worth further investigation.

Employment trajectories until midlife in schizophrenia and other psychoses: the Northern Finland Birth Cohort 1966

PURPOSE

Psychoses are associated with poor labour market attachment, but few studies have compared schizophrenia (SZ) and other psychoses (OP). Moreover, studies on long-term employment trajectories over individuals' working life courses are lacking. We compared 30 year employment trajectory patterns in a general population sample among individuals with SZ, OP, and those with no psychosis (NP).

METHODS

Utilising the Northern Finland Birth Cohort 1966, we collected survey data on employment from ages 16 to 45 and detected individuals with register-based history of SZ (n = 62), OP (n = 87), or NP (n = 6464) until age 46. Through gender-specific latent class analyses on annual employment roles, we identified traditional, highly educated, self-employed, delayed and floundering employment trajectories with distinct socioeconomic characteristics. We addressed attrition by conducting weighted analyses.

RESULTS

Floundering trajectories were common among individuals with SZ (79% of men, 73% of women) and OP (52% of men, 51% of women). In NP, a traditional employee trajectory was most common in men (31%), and a highly educated trajectory in women (28%). A history of psychosis was associated with heightened odds ratios (ORs; 95% confidence intervals (CIs)) for floundering trajectories in both men (SZ: 32.9 (13.3-81.4); OP: 7.4 (4.0-13.9)) and women (SZ: 9.9 (4.6-21.5); OP: 3.9 (2.1-7.1)) compared to NP. Weighted analyses produced similar results.

CONCLUSION

Most individuals with SZ or OP have floundering employee trajectories reflecting an elevated risk of unemployment and part-time work until midlife. These results indicate the importance of improving labour market attachment during the early phases of psychoses.

"I Felt Supported by the Peers in My Group": Analyzing Experiences of Youths with Mental Health Challenges of a Supported Employment Program in Canada

PURPOSE

The objectives of this study were to gain an understanding of the experiences of youths with mental health conditions who have undergone a 16-week supported employment program (SEP) conducted in an urban centre in Canada.

METHODS

Focus groups and individual semi-structured interviews were used to capture the experience of youths who had completed the program. Youths were eligible if they were aged 19 to 30 years diagnosed with a mental illness and enrolled in the program. Purposeful sampling was used to recruit participants. Thematic analysis was conducted to analyze the data. Primary codes were organized and mapped onto Donebedian's Structure-Process-Outcome Model.

RESULTS

Altogether, 34 participants, aged 17 to 30 years old, described their experiences participating in this 16-week supported employment program. Participants' experiences of this program and with employment were categorized into four main themes focusing on the (1) structure of program, (2) process of care (3) outcomes of program, and (4) improvements to the program.

CONCLUSION

Overall, the experience of a supported employment program was perceived as valuable, with unexpected benefits of the program beyond employment including the establishment of routine, friendship, and self-confidence. The proposed model can be used as a structure for monitoring and evaluating SEP.

Social determinants of health in male forensic patients admitted at a tertiary psychiatric hospital in South Africa

INTRODUCTION

Social factors are increasingly being used to determine health outcomes. The concept of social determinants of health has been used to shape policies that address disparities. There is a paucity of such studies in the forensic setting. This study aimed to use social determinants of health to identify social factors that are associated with being a male forensic patient.

METHODS

The study was a retrospective two-group (forensic and non-forensic) comparison clinical record review. Association was identified through independent and multivariate statistical analysis.

RESULTS

The study sample comprised of 296 patients, 56.4% (n = 167) of which were non-forensic. The majority of the sample was black African, 50 years and older, single, unemployed and had attended main-stream schooling. Race (p < .01), employment status (p < .02), not completing high school (p < .01), previous imprisonment (p < .01), drug use (p < .01) and not being on medication prior to admission (p < .01) were significantly associated with being a forensic patient. Multivariate logistic regression analyses also confirmed these associations.

CONCLUSION

Social determinants of health ought to be targeted to improve health outcomes of psychiatric patients. Collaborations between mental health, public health, law and policy makers as well as non-/governmental agencies may lead to change. Human rights of individuals with mental illness may thus be enhanced in the long run.

Psychotic Disorders in Adolescence and Later Long-term Exclusion From Education and Employment

BACKGROUND AND HYPOTHESIS

Psychotic disorders have been associated with not being in education, employment, and training (NEET). There is a lack of knowledge on the importance of risk markers for NEET among people with psychotic disorders and what rehabilitation they receive.

STUDY DESIGN

We based our research on the register-based 1987 Finnish Birth Cohort study, which included all live births in Finland during that year. The study cohort were 288 people who had been diagnosed with psychotic disorders during 2004-2007, when they were 16-20 year old, and 55 883 who had not. We looked at the national register data for those subjects in 2008-2015, when they were 20-28 year old, and compared any associations between sociodemographic factors and NEET status.

STUDY RESULTS

NEET for more than 5 year affected 2.2% of those without psychosis, 35.8% of those with any nonaffective psychotic disorder, and 57.0% of those with schizophrenia or schizoaffective disorders. Family-related risk factors were weaker predictors of long-term NEET in subjects with psychotic disorders than other cohort members. Having a psychotic disorder plus long-term NEET was associated with not applying for upper secondary education, not finishing upper secondary education, parents receiving welfare benefits, being diagnosed with schizophrenia or schizoaffective disorders and being hospitalized for psychosis. Only 24.3% with psychotic disorders had participated in vocational rehabilitation.

CONCLUSIONS

A diagnosis of psychosis in adolescence is independently associated with serious long term functional disability. Among those with psychotic disorders, educational problems are markers for adverse labor market outcomes. Despite this, vocational rehabilitation is seldom provided.

Meaning in life and flow experiences among people with psychiatric disabilities who are engaged in peer-helping vs. non-helping work-roles

BACKGROUND: Finding meaning in life and wellbeing through vocational work-roles are central to recovery of persons with psychiatric disabilities. However, there is a disconnect between positive concepts and vocational rehabilitation, rendering meaning and wellbeing rarely explored in vocational rehabilitation. OBJECTIVE: We assume higher meaning and wellbeing exists among individuals engaged in peer helping work-roles (meaningful role) as compared to non-helping work-roles. We examine this and additional questions to learn about relationships between positive concepts and vocational work-roles illuminating mental health recovery. METHODS: 114 individuals with psychiatric disabilities (ages 20-70) from various vocational-services participated. Sixty-nine worked in peer-helping roles (i.e. consumer-providers/peer-supporters) and 45 engaged in non-helping work-roles (vendors/clerical work, etc.). Participants filled in the Meaning in Life and Work-related Flow (assessing wellbeing at work) scales. Additionally, participants in peer-helping work-roles filled a peer-developed scale estimating their salience of peer-role characteristics. RESULTS: Individuals in peer-helping work-roles had significantly higher meaning in life levels than those in non-helping roles. Having meaning in life also predicted higher work-related flow across the sample. Finally, meaning in life positively mediated relations between salience of peer-role characteristics and work-related flow experiences. CONCLUSION: Researching meaning and wellbeing can broaden theoretical understanding and bear practical implications for enhancing vocational work-role fit and recovery.

The Meaning of Volunteering among People with Severe Mental Disorders: A Phenomenological Qualitative Study

This study aimed to describe the perspectives of people with severe mental disorders who volunteer regarding the relationship between volunteering and work, from the framework of personal recovery. A qualitative phenomenological study was undertaken. Purposive sampling was conducted on people with severe mental disorders who participated in volunteering. In-depth unstructured and semi-structured interviews were used, during which researchers took handwritten field notes. An inductive thematic analysis was applied. Twenty-three participants with severe mental disorders were included (16 men and 7 women) with a mean age of 47 years. Three themes emerged: (a) the relationship between volunteering and working; (b) thinking about a possible future job; and (c) disclosing a mental health condition. Volunteering is perceived as a substitute to working, although not all participants feel able to work, and they do not always disclose that they suffer from a mental health condition.

Getting back to work: Experiences of the individual placement and support model from those with mental health conditions, an interpretative phenomenological analysis

BACKGROUND

Evidence continues to build on the value of Individual Placement and Support (IPS), enabling those with long-term mental health conditions to find mainstream employment. Many of these individuals would like to work; however, unemployment for this population remains high. IPS research thus far has targeted the effectiveness of the model, with less emphasis on how individuals perceive and experience IPS and the return to work.

OBJECTIVE

This study explores the barriers, enablers, meaning and personal experience of being supported to find work through IPS, for individuals with long-term mental health conditions. Findings based on lived experiences of nine participants from two Scottish centres running IPS, should be useful to enhance and develop services.

METHODS

This study involves qualitative data collection, using semi-structured interviews and Interpretative Phenomenological Analysis (IPA).

RESULTS

Transcript analysis revealed three master themes: 1) "Working is good for me": positive aspects to working; 2) "Rome wasn't built in a day": time-unlimited supported journey and 3) "My inner critic": negative aspects to working. Participants praised IPS for the on-going practical and emotional support in overcoming self-identified occupational barriers.

CONCLUSION

Paid employment was greatly associated with financial freedom, social inclusion, increased self-esteem and alleviation of depressive symptoms. Participants described the person-centred, time-unlimited approach taken by the employment specialists (ESs) or occupational therapists (OTs), as the main enabler to maintaining paid employment. Barriers, such as anxiety and work-related stress were identified, however, participants felt supported to overcome some of these negative symptoms.