Christine Avonia Lloyd

The employment of people with mental illness

Abstract People with a mental illness are among the most socially and economically marginalised members of the community. They experience high levels of unemployment and nonparticipation in the labour force. Unemployment has a number of negative effects including the loss of purpose, structure, roles and status and a sense of identity which employment brings. Employment enables social inclusion in the wider community and is an important way that people with a mental illness can meaningfully participate in the wider community. Australia has a mental health strategy, which guides the ongoing reform of mental health services. However, specific strategies to address the social and economic marginalisation of people with a mental illness have not been addressed. A recovery-oriented approach is recommended, which integrates the key sectors involved. To date there has been little intersectoral collaboration between the various sectors such as mental health services, housing, and vocational services. People require more role-specific assistance to enable them to participate in socially valued roles implicit with citizenship. There is a need to formulate improved pathways to assistance and more evidence-based forms of assistance to re-establish career pathways. This report aims to: 1) collect relevant overseas and Australian evidence about the employment of people with mental illness; 2) identify the potential benefits of employment; 3) describe patterns of labour force participation in Australia among people with mental illness; 4) identify how mental illness can cause barriers to employment; 5) outline the type of employment restrictions reported by people with mental illness; 6) identify the evidence-based ingredients of employment assistance; 7) identify relevant policy implications; and 8) suggest strategies to improve employment outcomes and career prospects for people with mental illness.

Subjective and Objective Indicators of Recovery in Severe Mental Illness: a Cross-Sectional Study:

Background: This study aimed to determine whether subjective dimensions of recovery such as empowerment are associated with self-report of more objective indicators such as level of participation in the community and income from employment. A secondary aim was to investigate the extent to which diagnosis or other consumer characteristics mediated any relationship between these variables. Methods: The Community Integration Measure, the Empowerment Scale, the Recovery Assessment Scale, and the Camberwell Assessment of Needs Short Appraisal Schedule were administered to a convenience sample of 161 consumers with severe mental illness. Results: The majority of participants had a primary diagnosis of schizophreniform, anxiety/depression or bipolar affective disorder. The Empowerment Scale was quite strongly correlated with the Recovery Assessment Scale and the Community Integration Measure. Participants with a diagnosis of bipolar affective disorder had signifi cantly higher recovery and empowerment scores than participants with schizophrenia or depression. Both empowerment and recovery scores were significantly higher for people engaged in paid employment than for those receiving social security benefits. Conclusions: The measurement of subjective dimensions of recovery such as empowerment has validity in evaluation of global recovery for people with severe mental illness. A diagnosis of bipolar disorder is associated with higher scores on subjective and objective indicators of recovery.

Art and Recovery in Mental Health: A Qualitative Investigation

Arts programmes are provided as part of the psychosocial rehabilitation for consumers with a mental illness. Consumers have reported that involvement in the arts has facilitated their recovery. This qualitative study was conducted to explore the ways in which involvement in an Australian community arts programme contributed to the recovery process. It also aimed to gain an understanding of intrinsic recovery, which focuses on personal satisfaction and meaning. Eight consumers with a mental illness who were members of a community-based arts programme participated in in-depth semi-structured interviews. The themes that were analysed thematically from the interviews included art as a medium of expression and self-discovery, and changes in internal conditions (spirituality, empowerment and self-validation). The findings revealed the usefulness of arts programmes in providing the external environment that facilitates internal recovery.

The importance of vocation in recovery for young people with psychiatric disabilities

Young people with psychiatric disabilities are particularly disadvantaged when it comes to participating in vocational training or higher education or to seeking and maintaining employment. A review of the literature reveals that this is due to a number of factors, including low expectations by health professionals, stigma and discrimination, symptomatology and the lack of a clear responsibility for promoting vocational and social outcomes. A useful approach for occupational therapists to use is a recovery framework combining evidence-based employment and educational assistance with mental health care, provided in parallel with brief vocational counselling, illness management skills, training in stigma countering and disclosure strategies, context-specific social skills and skills in social network development. It is concluded that there is an urgent need to link evidence-based vocational practices with quality mental health care, in order to restore hope among young people of ever realising their vocational goals and once again feeling included as valued members of society.

Reliability of a composite measure of social inclusion for people with psychiatric disabilities

AIM   To assess the reliability of the components of a proposed composite measure of social inclusion for people with psychiatric disabilities. METHOD   The interview covered sociodemographics, domain-specific socially valued role functioning, social support, stigma experiences, integration within the immediate psychosocial rehabilitation community, and integration within the wider neighbourhood community. Participants (n(1) = 28; n(2) = 26) were recruited from a psychosocial rehabilitation setting. The candidate measures were assessed for short-cycle test-retest reliability and internal consistency. RESULTS   Several items were identified for removal from the stigma experiences and community integration subscales because of low test-retest reliability or for having not sufficiently contributed to internal consistency. CONCLUSIONS   The promising test-retest and internal consistency results warrant continuing the psychometric development of the composite measures of social inclusion and its applicability to community residents with psychiatric disabilities.

Community participation and social inclusion: How practitioners can make a difference

Abstract People with mental disorders are marginalised and socially excluded from many aspects of community life. They often experience difficulty with obtaining employment, participating in community activities, affordable and sustainable housing, financial and legal issues, transportation, and limited information about, and access to, the options that are available to them. In this article, we describe a selected number of activities that promote social inclusion. Social inclusion not only offers us a framework for developing mental health policy, but serves to measure how well mental health services are achieving recovery-orientated outcomes. Examples are provided to highlight how the concept of social inclusion can be applied in the everyday practice of mental health practitioners.

Labour market conditions, labour force activity and prevalence of psychiatric disorders

BackgroundAt a population level, the extent that labour market conditions influence labour force activity among people with psychiatric disorders, remains equivocal. Similarly equivocal is the hypothesised relationship between economic conditions and the reported prevalence of specific psychiatric disorders. We investigated these issues by examining the extent that labour market conditions were associated with change in labour force activity among people with anxiety disorders, affective disorders, and schizophrenia, in comparison to healthy working age adults.MethodsData files were provided by the Australian Bureau of Statistics (ABS) from a population survey conducted in 1998 and replicated in 2003. Multi-stage probability samples were obtained in 1998 (N1 = 37,580) and 2003 (N2 = 36,088). Adults with schizophrenia, depression, and anxiety disorders were compared to healthy working age adults.ResultsGreater labour demand in 2003 was positively associated with increased labour force participation among healthy adults. The proportions actively looking for work declined among healthy adults and among those with anxiety disorders. Full-time employment significantly increased among healthy working age residents. The proportions employed part-time significantly increased in all groups except among people with schizophrenia.ConclusionThese results support policies which remove disincentives and increase access to the more intensive evidence-based employment programs even when labour market conditions are improving.

The psychoeducation needs of parents who have an adult son or daughter with a mental illness

Abstract Since deinstitutionalisation, parents of adults with mental disorders are increasingly utilised as a resource for their relatives’ care. This study used a general phenomenological perspective to capture people’s experiences. Semi-structured in-depth interviews were conducted with eight parents who were members of the Schizophrenia Fellowship of Southern Queensland to explore their perceptions of their psychoeducation needs. The themes that emerged included the usefulness of past experiences with psychoeducation, educational needs, barriers to accessing information and support, and other unmet carer needs, including the need for managing stress and emotional needs, recognition and inclusion of family members in decision-making, and negotiating the best care for their family member within the health care system. This study adds to an increasing body of knowledge that advocates for the greater inclusion and involvement of families in the care and treatment of their relatives. Further research into the needs of families, in particular barriers and supports in accessing information and services, is recommended.

Homelessness and companion animals: more than just a pet?

Purpose: Research identifies the value of animal companionship for people of various ages and with physical and mental health diagnoses. However, there is limited research into the value of animal companionship for the homeless population. Method: This exploratory study aimed to investigate the value that homeless people find in animal companionship; the extent to which homelessness impacts on the ability to have animal companions; and interventions that health professionals can implement to reduce barriers to animal companionship. Twenty-six people were interviewed during Homeless Health Outreach Team outreach. Descriptive analysis of the responses to the semi-structured interviews was carried out. Findings: Results indicated that the majority of participants had given up a pet, and wanted a pet but could not due to their homelessness. The impact of giving up a companion animal was significant. Difficulties associated with pet ownership focused mostly on the living environment and the cost. There were several benefits to having companion animals. Participants viewed that having a pet made a difference to their lives in that it provided friendship and responsibility and contributed to emotional wellbeing. Conclusion: It is suggested that occupational therapists need to be aware of the impact that pet ownership has on the lives of homeless people and to explore ways in which they can assist with this.

Musculoskeletal disorders and comorbid depression: Implications for practice

BACKGROUND   The physical demands of work have a substantial impact on the incidence of work-related musculoskeletal disorders. Depression is often associated with work-related injuries and may influence a persons success or otherwise return to work. There is pressure for occupational rehabilitation providers to produce good return-to-work outcomes in a timely and financially responsible manner. The aim was to examine current evidence for any added impact of depression on return-to-work prospects among people with work-related musculoskeletal disorders. METHODS   A review of the literature was conducted to determine the extent to which depression comorbid with musculoskeletal disorders affected labour force participation and the outcomes obtained in occupational rehabilitation. RESULTS   Australian population level data show that people of working age with depression comorbid with musculoskeletal disorders have extensive labour force disadvantage and reduced return-to-work outcomes when participating in occupational rehabilitation. CONCLUSIONS   Although more research is needed, there is already sufficient evidence to support the introduction of systems and practices to detect and integrate treatment for comorbid depression in order to prevent occupational rehabilitation failure.