Academic journal article SA Journal of Industrial Psychology

Cognitive-Behavioural Therapy Effects on Employment-Related Outcomes for Individuals with Mental Illness: A Systematic Review

Academic journal article SA Journal of Industrial Psychology

Cognitive-Behavioural Therapy Effects on Employment-Related Outcomes for Individuals with Mental Illness: A Systematic Review

Article excerpt

Introduction

Mental illness is a term that varies in its breadth and depth but is associated with an emotional or behavioural disorder (American Psychiatric Association, 2013). Approximately one in four people in the general population are affected by mental illness at some point in their lives (Kessler, Merikangas & Wang, 2008; World Health Organization [WHO], 2001). Naturally, mental illness is associated with functional impairments that interrupt life activities (New Freedom Commission on Mental Health, 2003). Specifically, severe mental illness often impairs one's capacity to choose, obtain and keep a job and to earn a living (Tsang, Lam, Ng & Leung, 2000). Furthermore, WHO (2007) viewed the complementary condition of mental health as a state of well-being that allows someone to work. It is recognised that there are critical barriers to employment for people with mental illness (Lysaker, Davis, Bryson & Bell, 2009). These include difficulties with interpersonal relationships and with the completion of tasks at work. There are concomitant issues in coping with stigma and work stress as well as low levels of self-efficacy or self-defeating beliefs (see also Marwaha & Johnson, 2004).

Despite these issues, employment has been considered a key component of recovery from mental illness (see Link, Yang, Phelan & Collins, 2004). It is an essential aspect because it is linked with social, economic and personal advancement (Garske & Stewart, 1999). For people with mental illness, meaningful vocational activities can help develop valued societal roles, reduce stigmatisation, increase social connectedness, serve as a normalising factor and enhance quality of life (Marwaha & Johnson, 2004). In contrast, chronic unemployment is linked with isolation, poverty and a diminishing self-worth that hinder efforts at recovery (Mak, Tsang & Cheung, 2006). Nevertheless, although people with mental illness are eager to work and can be employed successfully, the participation rate of persons with mental disorders was only around 38% in 1990 and continued at this historical low with major schooling and employment restrictions (Australian Bureau of Statistics, 1990:26; Australian Bureau of Statistics, 2013). To date, employment remains a most challenging aspect of recovery for people with mental illness.

Unemployment not only hinders recovery at the individual level but also has an obvious cost to society in the form of the loss of human-resource potential. This is accompanied by massive medical and social-security costs. For instance, in Australia, there are 3.1 million people with a mental illness, and the estimated medical cost alone is some $A2.7 billion (Australian Bureau of Statistics, 2008). In comparison to the direct cost for care of people with mental illness (e.g. medication, clinic visits, hospitalisation), nearly twothirds of the overall loss is indirect costs such as reduced labour supply, public income-support payments, reduced educational attainment, incarceration, homelessness or medical complications associated with mental illness. Insel (2012) reported the estimated overall economic burden of mental illness in the United States of America as $US317 billion and the loss of earnings for people with mental illness at approximately $US193.2 billion. In summary, there are positive consequences to enhancing recovery from mental illness through treatment interventions.

Cognitive-behaviour therapy is one intervention that has been applied to people with emotional psychological and psychiatric difficulties. Rachman (1997) traced its history from a combination of behaviour-modification approaches with cognitive therapies to a short term, focused approach to dealing with a specific problem. This approach centres on changing the thoughts and feelings that influence behaviour. The emphasis is on learning new skills or habits in areas such as mindfulness or acceptance and commitment. The essential component is the formation of new patterns of thinking. …

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