Bonnie Kirsh

Understanding the stigma of mental illness in employment

BACKGROUND Stigma has been identified as an important barrier to the full community participation of people with mental illness. This study focuses on how stigma operates specifically within the domain of employment. OBJECTIVES The purpose was to advance the development of theory related to the stigma of mental illness in employment to serve as a guiding framework for intervention approaches. METHOD The study used a constructivist grounded theory methodology to analyze over 500 Canadian documents from a diverse range of sources and stakeholders, and interviews with 19 key informants. FINDINGS The paper develops several key components central to the processes of stigma in the work context. These include the consequences of stigma, the assumptions underlying the expressions of stigma, and the salience of these assumptions, both to the people holding them and to the specific employment situation. Assumptions are represented as varying in intensity. Finally specific influences that perpetuate these assumptions are presented. IMPLICATIONS The model suggests specific areas of focus to be considered in developing intervention strategies to reduce the negative effects of stigma at work.

Victims Twice Over: Perceptions and Experiences of Injured Workers:

The authors discuss the qualitative component of a participatory research project conducted in Toronto, Ontario, between 1999 and 2001. Injured workers, who were trained as peer researchers, conducted one-time, semistructured interviews with other injured workers (N = 17) and helped with inductive coding and analyzing the interview transcripts. The qualitative research group consisted of seven peer researchers, four academic researchers, and a community legal worker. The group recruited interviewees by advertising on bulletin boards and in newsletters and newspapers, and selected a diverse group of interviewees who had encountered problems with the return-to-work process. Interviewees believed that the process victimizes them and renders them powerless and dependent on others. Furthermore, they considered that health professionals and bureaucrats impede their rehabilitation. The authors suggest that injured workers should be included in the decision-making process of rehabilitation and rebuilding their lives.

From margins to mainstream: what do we know about work integration for persons with brain injury, mental illness and intellectual disability?

Employment is a right of citizenship and a social determinant of health, but employment rates remain low for persons with disabilities. The purpose of this paper is to examine the principles and practices guiding work integration within the fields of intellectual disability (ID), brain injury, and mental illness and to identify best practices to support transitions to employment across these three groups. This integrative review drew upon an occupational perspective to analyze the current literature. Findings reveal that the need and benefits of working are recognized across disability groups but that philosophical perspectives guiding work integration differ. In the area of mental illness, recovery is seen as a process within which work plays an important role, in ID work is viewed as a planned outcome that is part of the developmental process, and in the field of brain injury, outcomes of employability and employment are emphasized. A common theme across the three disability groups is that in order to facilitate work integration, the person, the job and the work environment are important factors in need of examination. Evidence pointing to the effectiveness of the supported employment model is increasing across these three populations. A framework for guiding the development of further research and for promoting changes to support work integration is presented.

Developing a Comprehensive Understanding of the Working Alliance in Community Mental Health

The concept of a working alliance as a key ingredient within therapeutic processes has been emphasized by many community mental health researchers and practitioners. However, few studies have provided insights into the dimensions and operationalization of the concept. To address this gap, the authors analyzed data on the working alliance derived from two qualitative data sets: (a) interviews conducted with 33 users of community mental health services, family members, and service providers; and (b) content extracted from a systematic review of 48 articles in the area of community mental health services. Three superordinate themes emerged: Building and negotiating trust, I’m on your side, and Tools and strategies. The authors discuss implications for community mental health practice.

A Narrative Approach to Addressing Spirituality in Occupational Therapy: Exploring Personal Meaning and Purpose

Spirituality has been recognized and documented as an essential component to be included by the occupational therapy profession in client-centred service delivery. However, methods of addressing and enhancing spirituality in occupational therapy practice remain relatively unexplored within the profession. This paper discusses the benefits of a narrative approach in addressing spirituality in everyday practice. It explores narrative as a mode of expression, its relationship to occupational therapy and its usefulness in addressing the spiritual component of the individual. A case study is provided to illustrate how a narrative approach enables an understanding of meaning and purpose in ones life.

How Consumers of Mental Health Services Come to Understand their Potential for Work: Doing and Becoming Revisited

Background. Doing and becoming are fundamental constructs in occupational therapy. However, we have little understanding of how these concepts apply to the way that individuals develop ideas about their future in the realm of work. Purpose. This paper examines the doing-becoming interaction and applies it to our understanding of work potential among consumers of community mental health services. Methods. Using a grounded theory approach, 10 consumers were interviewed about their experiences with paid and unpaid work. Data were analyzed inductively according to the constant comparative approach. Results. The findings reveal that doing and becoming are essential to the process of how consumers develop ideas about their potential for work. Through doing work, consumers gain insight into their capacity for future work participation and become persons with possible work futures. Practice Implications. An occupational perspective on career development challenges occupational therapists to create opportunities for doing and becoming among consumers.

Best Practice in Occupational Therapy: Program Characteristics that Influence Vocational Outcomes for People with Serious Mental Illnesses

Background. Despite the known benefits of work for people with mental illnesses, vocational outcomes of this group remain poor. Attempts at comparing the efficacy of various models of service delivery have met with limited success due to variations across studies. Purpose. The purpose of this paper is to provide information about key characteristics related to outcomes in the field of vocational rehabilitation for people with serious mental illnesses. Method. A comprehensive review of literature published between 1990 and 2003 was conducted, resulting in 39 articles for analysis. Results. A set of twelve characteristics was identified that appear to influence vocational outcomes across models. These characteristics relate to the types of services offered, the manner in which services are delivered, and the work environment. Practice Implications. The authors suggest these characteristics can be incorporated across models and practice settings. The findings are discussed in terms of implications for best practice in occupational therapy.

A Pan-Canadian Evaluation of Supported Employment Programs Dedicated to People with Severe Mental Disorders

Supported employment (SE) is an evidence-based practice that helps people with severe mental disorders obtain competitive employment. The implementation of SE programs in different social contexts has led to adaptations of the SE components, therefore impacting the fidelity/quality of these services. The objective of this study was to assess the implementation of SE services in three Canadian provinces by assessing the fidelity and describing components of SE services using the Quality of Supported Employment Implementation Scale. About 23 SE programs participated in this study. Cluster analyses revealed six profiles of SE programs that varied from high to low level of fidelity with a stronger focus on a particular component, and reflected the reality of service delivery settings. Future investigations are warranted to evaluate relationships between the levels of implementation of SE components and work outcomes while considering individual characteristics of people registered in SE programs.

Opening minds in Canada: targeting change.

Objective To summarize the ongoing activities of the Opening Minds (OM) Anti-Stigma Initiative of the Mental Health Commission of Canada regarding the 4 groups targeted (youth, health care providers, media, and workplaces), highlight some of the key methodological challenges, and review lessons learned. Method The approach used by OM is rooted in community development philosophy, with clearly defined target groups, contact-based education as the central organizing element across interventions, and a strong evaluative component so that best practices can be identified, replicated, and disseminated. Contact-based education occurs when people who have experienced a mental illness share their personal story of recovery and hope. Results Results have been generally positive. Contact-based education has the capacity to reduce prejudicial attitudes and improve social acceptance of people with a mental illness across various target groups and sectors. Variations in program outcomes have contributed to our understanding of active ingredients. Conclusions Contact-based education has become a cornerstone of the OM approach to stigma reduction. A story of hope and recovery told by someone who has experienced a mental illness is powerful and engaging, and a critical ingredient in the fight against stigma. Building partnerships with existing community programs and promoting systematic evaluation using standardized approaches and instruments have contributed to our understanding of best practices in the field of anti-stigma programming. The next challenge will be to scale these up so that they may have a national impact.

Disruption, disbelief and resistance: A meta-synthesis of disability in the workplace.

This article presents the findings from a meta-synthesis of qualitative research on the experiences of persons with disabilities in the workplace. The purpose of this review was to explore how organizational culture influences the experiences of people with disabilities in the workplace, and the impact of disability on organizational culture. Findings from seven qualitative peer-reviewed studies on the experiences of people with disabilities at work and organizational culture published between 1995 and 2006 were synthesized using the meta-ethnography approach. The findings highlight how experiences of people with disabilities and organizational culture intersect in the workplace. Specifically, accessibility in the workplace involves more than removing physical barriers. People with disabilities are affected by the degree of acceptance and flexibility in the workplace, and relationships with co-workers and supervisors. However, the presence of disability may be perceived as disruptive to the organization, operation and structure of the workplace, resulting in disbelief and resistance. The findings suggest that attention and resources should be directed supporting the implementation of disability and human rights legislation and increasing tolerance for diversity in the workplace.