Academic journal article The Qualitative Report

Understanding the Employment Barriers and Support Needs of People Living with Psychosis

Academic journal article The Qualitative Report

Understanding the Employment Barriers and Support Needs of People Living with Psychosis

Article excerpt

Employment of people living with psychosis is important in promoting the social and economic inclusion of this marginalised group. It is increasingly apparent that clinical treatment alone is insufficient to ensure a good quality of life for people living with persisting mental health conditions and that more attention needs to be focused on psychosocial rehabilitation, including supporting people to maximise their employment potential. The increasing prominence of the recovery movement over the past decade has focused attention on the importance of living a meaningful and contributing life despite the presence of mental health issues (Brown, 2013). Rather than considering recovery a necessary precursor to work, this approach regards work as a significant stage in the recovery of people living with psychosis (Secker, Grove, & Membry, 2005). Indeed some authors have suggested that meaningful work is integral not only to functional recovery but to clinical recovery as well (Bond et al., 2001; Repper & Perkins, 2003).

Epidemiological studies show that employment rates of people living with severe and persisting mental health conditions are very low, at approximately 20% in Western cultures (Marwaha & Johnson, 2004). In Australia this percentage is much lower than the 53% employment rate for people living with all disability types and the 83% employment rate for people without disability (Australian Bureau of Statistics, 2012).

Previous studies have identified a wide variety of employment barriers associated with psychotic conditions. Several studies have found an association between the severity of psychotic symptoms and employment outcomes (Christenson, 2007; Neuchterlein et al., 2011; Rosenheck et al., 2006). Whilst psychotic conditions and the effects of anti-psychotic treatment are associated with disruptive symptoms that can be difficult to manage, research indicates that non-clinical factors including demographic factors, racial discrimination, stigma, financial disincentives, models of employment support and employer concerns, also play an important role in determining employment outcomes (Bassett, Lloyd, & Bassett, 2001; Blitz & Mechanic, 2006; Bond, Drake, & Becker, 2008; Olney & Lyle, 2011; Peckham & Muller, 2000; Rosenheck et al., 2006; Waghorn, 2011). Grove, Secker, and Seebohm (2005) suggest that psychological variables such as self-efficacy and goal orientation may be more important than clinical status in determining employability. Social-cultural and economic factors also play an important role. The International Study of Schizophrenia found higher employment rates in some developing countries for individuals living with psychosis. Leon and Leon (2007) reported that during a 2-year follow-up period in Columbia, more than two thirds of a cohort of people diagnosed with schizophrenia (68%) were in paid work and 59% had been in full time work for over 2 years. Moreover, for 90% of those who had been working for 12 months, the quality of their work performance was rated positively. This is a superior outcome to employment rates achieved by people living with psychosis in Western countries even with evidence-based disability employment support. Similarly, Srinivasan and Tirupati (2005), in a study of cognition and work functioning among 88 patients diagnosed with chronic schizophrenia in an urban area of India, found 67% were employed, most in mainstream employment. Interestingly, they also found that severity of cognitive symptoms associated with schizophrenia was unrelated to employment outcomes.

Previous studies have investigated the employment-related needs of people living with psychosis. Peckham and Muller (2000) identified the need for better understanding of the employment assistance needs of individuals living with schizophrenia. Since then a substantive body of research has investigated the relative effectiveness of different models of employment support for people living with psychosis. …

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