Geoff Waghorn

Prevalence of intellectual disability and comorbid mental illness in an Australian community sample

Objective: The aim of this study was to bring to light the high prevalence of Australians affected by intellectual disability and comorbid serious mental illnesses. Results from a broad scale study are used to explore the reasons for this regularly overlooked phenomenon. Methods: This study was based on secondary analysis of data collected in the national ‘Disability, Ageing and Carers Survey, 1998’. The analysed data consisted of an Australian wide sample of 42 664 individuals living at home or in cared accommodation. Classification of intellectual disability and comorbid psychosis, anxiety and depressive disorder was based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Results: The prevalence of intellectual disability in the sampled population was 1.25%. Of these people 1.3% had a psychotic disorder, 8% had a depressive disorder and 14% had an anxiety disorder that had been present for at least 6 months and was of such severity that it too was disabling. Conclusions: Findings indicate that people with intellectual disability are at high risk of developing comorbid serious mental illness. Dual diagnosis is however, often overlooked due to difficulties associated with establishing a diagnosis of a mental disorder in people with an intellectual disability, a problem which is heightened when the individuals capacity to participate in a clinical assessment is limited.

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.

Disability, employment and work performance among people with ICD-10 anxiety disorders

Objective: To ascertain at a population level, patterns of disability, labour force participation, employment and work performance among people with ICD-10 anxiety disorders in compar ison to people without disability or long-term health conditions. Method: A secondary analysis was conducted of a probability sample of 42 664 individuals collected in an Australian Bureau of Statistics (ABS) national survey in 1998. Trained lay interviewers using ICD-10 computer-assisted interviews identified household residents with anxiety disorders. Results: Anxiety disorders were associated with: reduced labour force participation, degraded employment trajectories and impaired work performance compared to people without disabilities or long-term health conditions. Conclusion: People with anxiety disorders may need more effective treatments and assistance with completing education and training, joining and rejoining the workforce, developing career pathways, remaining in the workforce and sustaining work performance. A whole-of-government approach appears needed to reduce the burden of disease and increase community labour resources. Implications for clinicians, vocational professionals and policy makers are discussed.

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.

Reviewing the theory and practice of occupational therapy in mental health rehabilitation

The delineation of evidence-based practices in supported employment for people with schizophrenia now represents a paradigm shift in the theory and practice of mental health rehabilitation. The principles and methods of traditional vocational rehabilitation and traditional mental health rehabilitation are giving way to evidence-based practices in supported employment, which are consistently proving two to three times more effective at producing competitive employment outcomes. These practices include close coordination with optimal forms of mental health treatment and care and highly individualised forms of intensive supported employment. There is a focus on the vocational services being provided, whereas the traditional and currently prevailing approach follows a more gradual and stepwise process with less of an individual focus, and where individual characteristics are considered important predictors of vocational rehabilitation success. This paradigm shift now challenges occupational therapists working in mental health rehabilitation to revise their theory and practice critically in order to support the implementation of evidence-based practices in supported employment for people with schizophrenia and related psychotic disorders. This article discusses how occupational therapists can adapt to this paradigm shift and revitalise their theory and practice in mental health rehabilitation.

Work-related self-efficacy among community residents with psychiatric disabilities.

A new measure of work-related self-efficacy for people with psychiatric disabilities is reported. The 37-item scale measures self-efficacy in four relevant activity domains: (1) vocational service access and career planning, (2) job acquisition, (3) work-related social skills, and (4) general work skills. The scale was developed in a 12-month longitudinal survey of urban residents diagnosed with schizophrenia or schizoaffective disorder (n=104). Results indicate validity of both a four-factor structure differentiating four core skill domains, and a single factor representing total work-related self-efficacy. The favorable psychometric properties support further research and trial applications in supported employment and psychiatric vocational rehabilitation.

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.

Earning and learning among Australian community residents with psychiatric disorders

At a population level the extent that psychiatric disorders and other health conditions disrupt participation in education and employment is rarely considered simultaneously and remains largely unknown. This is an important issue because policy makers are as concerned with educational attainment, school to work transitions, and workforce skills, as they are with overall labour force participation. We investigated earning or learning, and educational attainment, among Australian community residents by age group and by category of psychiatric disorder. Data files were provided by the Australian Bureau of Statistics (ABS) from a population survey conducted in 2003 using a multi-stage probability sample (N=23,787). Adults with schizophrenia, depression, and anxiety disorders were compared to (1) working age adults with other non-psychiatric health conditions and disabilities; and (2) healthy adults of working age. Participation in formal education and employment was extensively disrupted by all health conditions and by psychiatric disorders in particular. The extent of career-related disruption provides benchmarks for policy makers and service providers attempting to increase participation in formal education and in the labour force.

Supported employment for people with severe mental illness

The unemployment rate for people with severe mental illness hovers around 90% nationally, despite the fact that the vast majority of this population desperately want to work. Research shows the power of work in terms of aiding one’s recovery from mental illness. Yes, we said recovery, in the form of decreased hospitalization, symptom reduction, and increased confidence and self-esteem. This vulnerable population often lacks the necessary educational background, ongoing support, and the kinds of employable skills to make that job a possibility. Spread out over a nation, that’s hundreds of thousands of people ready but unable to work, relying on Social Security Disability Income for their survival.

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.