Nancy J. Wewiorski

The process of recovery from schizophrenia

To facilitate future research on recovery from schizophrenia a qualitative, longitudinal analysis was conducted with individuals participating in rehabilitation to identify themes associated with improvement in functioning and subjective experience. Twelve individuals with a diagnosis of schizophrenia or schizoaffective disorder were randomly selected from a just concluded two-year study of psychiatric rehabilitation. Each individual was followed for an additional four years. Every four to eight months each person participated in a semistructured,audiotaped interview about his or her current life experiences. Tapes were evaluated independently by three assessors for themes and phases that emerged from these life experiences. The qualitative analysis characterized the process of recovery as having phases, dimensions, indicators, and barriers to recovery. This empirically derived description of the process of recovery, from the perspective of people who are experiencing it, can be used to generate research hypotheses for future studies to further our understanding and to promote recovery from schizophrenia.

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.

Association between demographic and diagnostic factors and employment outcomes for people with psychiatric disabilities: a synthesis of recent research.

Employment outcome for individuals with psychiatric disabilities has been a focus of empirical research over the past decade or so. The purpose of this paper is to review recent literature on the association between demographic and diagnostic factors and employment outcome, and to conduct meta analyses of the results of studies that report the association between these variables. Seventeen studies were included in these meta analyses. Results of the meta analyses tended to corroborate most of the significant findings found in the literature review. The authors review some of the issues for the meta-analyst interested in synthesizing research findings on employment outcome, including the challenges and limitations encountered in the published research currently available.

Use of Alternative Health Care Practices by Persons With Serious Mental Illness: Perceived Benefits

Perceived benefit has been identified as an important factor influencing the decision to use alternative medicine for various health problems.1 Although research examining the use of alternative health care practices in the treatment of psychiatric disorders has been increasing,2–7 little is known about the specific benefits experienced by users with mental illness. A few studies4,5 have attempted to address this issue by having respondents assess the extent to which a given practice was experienced as helpful. This report presents preliminary findings on the perceived benefits of alternative health care practices used by adults with serious mental illness (SMI) who participated in a larger exploratory study on the role of such practices in mental health recovery.

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.

Workplace prejudice and discrimination toward individuals with mental illnesses

Prejudice and discrimination represent a major barrier to the recovery and community integration of individuals with serious mental illnesses. Yet, little is known about the diverse ways prejudicial practices are enacted at the workplace beyond blatant discrimination. This paper presents findings about the manifestations of prejudice and discrimination at the workplace. Data were gathered from a national sample of individuals with serious mental illnesses who reported perceiving negative attitudes at work as part of their participation in a larger study on sustained employment (n = 234) and from a subsequent study on workplace psychiatric prejudice and discrimination (n = 202). Qualitative analyses of data collected through two different surveys informed the development of a comprehensive taxonomy that identified a range of prejudicial and discriminatory practices that fell within two contextual domains: work performance and collegial interactions. The specific categories within each of these domains represented a continuum of more subtle to more blatant expressions of psychiatric prejudice and discrimination that influenced workers with mental illnesses through different impact pathways. Study findings informed the development of a broader conceptual framework for understanding and combating psychiatric prejudice and discrimination in employment settings and improving the workplace inclusion and employment outcomes of individuals with serious mental illnesses.

Toward understanding the usefulness of complementary and alternative medicine for individuals with serious mental illnesses: classification of perceived benefits.

Complementary and alternative medicine (CAM) has been gaining interest among individuals with serious mental illnesses. Yet, very little is known about how CAM may be beneficial to mental health. This study explored the specific benefits attributed to CAM by a national sample of 255 individuals with a serious mental illness who experienced CAM as having a positive impact on their mental health. Data about the CAM benefits were gathered through open-ended questions embedded in a mail survey that examined the patterns of CAM use in this population. Qualitative analysis revealed a wide spectrum of benefits that encompassed all major areas of human functioning, including physical, emotional, cognitive, self, social, spiritual, and overall functioning, and addressed both the improvement of psychiatric symptomatology and the promotion of functional recovery. Study findings provide useful information that can guide both everyday clinical practice and future research on the efficacy of CAM for psychiatric populations.

The integration of psychiatric rehabilitation services in behavioral health care structures: a state example.

This article describes a model for integrating psychiatric rehabilitation services in a managed behavioral health care structure. Psychiatric rehabilitation and managed care are two distinct developments in the provision of mental health services that have proceeded independently though they can have compatible methods and outcomes. Descriptive detail is provided about a state initiative in Iowa to provide psychiatric rehabilitation services to those with serious mental illness through the state-contracted managed behavioral health care corporation. The article describes factors leading to the programs implementation, service delivery structures, reimbursements, personnel requirements, and performance indicators. Evidence for supporting this innovation is provided through a case-controlled outcomes study of mental health service units used and their costs for participants and matched controls.