E. Sally Rogers

Research on Evidence-Based Practices: Future Directions in an Era of Recovery

Many mental health systems are trying to promote the adoption of what has come to be known as evidence-based practices while incorporating a recovery vision into the services they provide. Unfortunately, much of the existing, published, research on evidence-based practices was conceived without an understanding of the recovery vision and/or implemented prior to the emergence of the recovery vision. As result, evidence-based practice research that has been published to date is deficient in speaking to a system being built on a recovery philosophy and mission; these deficiencies are detailed, and suggestions are advanced for new directions in evidence-based practice research.

The meaning and importance of employment to people in recovery from serious mental illness: results of a qualitative study.

OBJECTIVE Given the high rates of unemployment and underemployment among individuals with psychiatric disabilities, only a small number of studies have investigated the role work has in the lives of people who have been successful vocationally during their recovery from serious mental illness. This study sought to add to existing literature by determining how individuals perceive work and its effect on their recovery. METHODS We purposefully recruited self-referred participants at moderate to advanced levels of recovery and qualitatively analyzed semi-structured interviews conducted with 23 individuals to identify themes related to work in the context of recovery from serious mental illness. RESULTS Participants described myriad positive benefits associated with paid employment, which conceptually fell across two main domains: work has personal meaning and work promotes recovery. Participants discussed the ways in which work fostered pride and self-esteem, offered financial benefits, provided coping strategies for psychiatric symptoms, and ultimately facilitated the process of recovery. Participants also discussed the importance and benefits associated with working in a helper-role and as consumer providers. CONCLUSIONS Overall, individuals reported that employment conferred significant benefits in their process of recovery from mental illness and that work played a central role in their lives and identities. The themes from this study should be considered when developing employment or other recovery-oriented programs for people with serious mental illness.

An Investigation of Reasonable Workplace Accommodations for People with Psychiatric Disabilities: Quantitative Findings from a Multi-Site Study

Despite the requirement of many employers to provide accommodations in the workplace for individuals with disabilities under Section 504 of the Rehabilitation Act of 1973, the preponderance of accommodations that have been described in the literature concern physical rather than psychiatric disabilities. This study was an exploratory, descriptive, longitudinal, multi-site investigation of reasonable workplace accommodations for individuals with psychiatric disabilities involved in supported employment programs. We discuss the functional limitations and reasonable accommodations provided to 191 participants and the characteristics of 204 employers and 22 service provider organizations participating in the study. Implications for service providers and administrators in supported employment programs are discussed.

The Nature and Dimensions of Social Support Among Individuals with Severe Mental Illnesses

Recent research suggests that social support is associated with recovery from chronic diseases, greater life satisfaction, and enhanced ability to cope with life stressors. To further research in the area of social support and serious psychiatric disabilities, more reliable and valid measures are needed to assess this construct. The purpose of this study was to assess the psychometric properties of a widely used measure of social support (the Interpersonal Support Evaluation Checklist) among people with severe mental illness. We collected data on the ISELs relationship to quality of life, self-esteem, psychiatric symptoms and vocational status among 147 participants. Factor and reliability analyses, as well as correlational analyses were undertaken. We found evidence for the reliability and validity of the ISEL when used with persons with severe mental illness. Taken together, our findings suggested that self-esteem, quality of life, and psychiatric symptoms were able to predict 38% of the variance in perceived social support. More favorable social supports increased the odds of being employed at 9months into the study and social support was predictive of experiencing fewer psychiatric symptoms. Some forms of social support were perceived less favorably with age, but no other demographic or clinical variables significantly predicted perceived social supports.

Assessing readiness for Change among persons with severe mental illness

Studies focusing on the readiness of persons to change have burgeoned in recent years. Assessing readiness for change is viewed as important for interventions aimed at promoting health behaviors, such as smoking cessation and substance abuse programs. This study is the first to examine readiness for change, as conceived by Prochaska and his colleagues, among a sample of persons with severe mental illness who were about to participate in a vocational rehabilitation program. We examined the reliability, validity, and other psychometric properties of the Change Assessment Scale and its ability to predict attrition and actual change.

Characteristics of mental health case management: results of a national survey

In the last several years, state mental health authorities throughout the United States have assigned a high priority to the funding, development, and operation of case management programs. Although the concept of case management has been in existence for over a decade, there is still confusion regarding the definition of case management and the identification of alternative case management approaches. Recognizing this confusion, the Center for Psychiatric Rehabilitation undertook a comprehensive study to determine the state of case management practice today. This article reports on the results of a national survey of case management programs and describes the characteristics of the programs themselves, the case managers, the clients they serve, and the systems within which they operate. Implications of these findings for a definition of case management are discussed.

A Randomized Clinical Trial of Vocational Rehabilitation for People With Psychiatric Disabilities

In this study, the researchers examined the effectiveness of two vocational rehabilitation interventions in improving employment, educational, clinical, and quality-of-life outcomes for people with psychiatric disabilities. The authors recruited participants in waves over a 2-year period and randomly assigned them to receive either psychiatric vocational rehabilitation (PVR) or enhanced state vocational rehabilitation (ESVR) services. Although both groups improved significantly over time in their vocational and educational outcomes, no differences were found between the two interventions on any outcomes. In this article, the authors explore why ESVR achieved better outcomes than previous research would have suggested.

Correlates of vocational recovery for persons with schizophrenia

The correlates of vocational recovery and vocational success among persons with schizophrenia were examined to identify prospective attributes that might be malleable and accessible to intervention. A national, non-representative sample of 109 individuals with a selfreported diagnosis of a schizophrenia spectrum disorder that met criteria for vocational recovery completed a survey on sustained employment of people with serious mental illness. Eighty-two participants (75%) had uninterrupted employment during the two years prior to entering the study while the rest sustained employment for at least 12 months during the same period of time. Respondents worked from 10 to 64 hours per week in jobs ranging from unskilled to professional and managerial positions. In multivariate analyses, previous work history and current receipt of Supplemental Security Income (SSI)/Social Security Disability Income (SSDI) were correlated with current work hours per week; educational level and employment in consumer self-help/advocacy settings were associated with occupational status; and current receipt of SSI/SSDI was correlated with current salary per hour.This study provides evidence that some individuals with a schizophrenia spectrum disorder have the capacity to achieve and maintain successful employment despite the challenges presented by this serious mental illness.

A Randomized Controlled Trial of a Peer-Run Antistigma Photovoice Intervention

OBJECTIVE Psychiatric stigma is a major barrier to the recovery of persons with serious mental illnesses. This study tested the efficacy of an innovative peer-run photography-based intervention, called antistigma photovoice, which targets self-stigma and promotes proactive coping with public stigma. METHODS A total of 82 individuals with serious mental illnesses enrolled at a university-based recovery center were randomly assigned to the antistigma photovoice program or to a wait-list control group. Mixed-effects regression models were used to examine the impact of photovoice on self-stigma, coping with stigma, empowerment, perceived recovery, self-efficacy, and depression. RESULTS Participation in the photovoice intervention was associated with significantly reduced self-stigma, greater use of proactive coping with societal stigma, greater increase in a sense of community activism, and perceived recovery and growth. CONCLUSIONS The photovoice intervention demonstrated promise for reducing self-stigma and enhancing proactive coping with prejudice and discrimination.

Disclosure of Mental Health Disabilities in the Workplace

There are a number of barriers that contribute to the low employment rates of people with mental health disabilities; these barriers exist at the individual level, the programs and services level, and the systems, policy, and societal level (Anthony et al. 2002). One issue that intersects with all three is disclosure of psychiatric disability in the workplace. Individuals with mental health disabilities must weigh the personal benefits and risks of disclosing their psychiatric disability and make a number of decisions about disclosure given their particular employment circumstances. In addition, employment programs and services, and especially supported employment practitioners, must determine how to represent their services to employers, decide how to inform employers that they work with people with mental health disabilities, and plan with the individual to handle disclosure. Employers must be aware of state and federal policies regarding disability-related employment issues in the face of societal stereotypes, personal experiences with, and misunderstandings about people with mental health disabilities. And while legislation such as the Americans with Disabilities Act (ADA 1990) is in place to protect rightful access to employment, people with mental health difficulties may have little knowledge or understanding of these policies or how disclosure of disability and reasonable accommodations may allow them to enjoy full access to employment opportunities.