Rebecca E. Gewurtz

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.

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.

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.

Qualitative Meta-Synthesis: Reflections on the Utility and Challenges in Occupational Therapy

Background. A qualitative meta-synthesis is an approach to synthesizing relevant findings from across qualitative studies on a particular topic using methods consistent with qualitative research. Purpose. Using examples of recently completed qualitative meta-synthesis projects, the purpose of this paper is to present the meta-synthesis approach; highlight the key steps, processes, and issues involved; and demonstrate its potential to advance knowledge about occupation and occupation-based practice. Key Issues. The qualitative meta-synthesis approach allows us to take stock of the current state of knowledge in a given area in order to ensure that we have explored the phenomenon from different perspectives and to begin to push the field forward by allowing us to develop deeper insights and understandings. Implications. Despite certain limitations and challenges associated with the approach, qualitative meta-syntheses can provide new knowledge through critical analysis and interpretation to inform client, practitioner, and policy audiences.

“Do-Live-Well” A Canadian framework for promoting occupation, health, and well-being

Background. Occupational therapists can bring a unique and valuable perspective to the national dialogue on health promotion. Current approaches have a narrow focus on diet and exercise; a broader focus on occupation has the potential to enrich understanding regarding forces that contribute to health and well-being. Purpose. A new “Do-Live-Well” framework will be presented that is grounded in evidence regarding the links between what people do every day and their health and well-being. Key Issues. Elements of the framework include eight different dimensions of experience and five key activity patterns that impact health and well-being outcomes. Personal and social forces that shape activity engagement also affect the links to health and well-being. Implications. The framework is designed to facilitate individual reflection, community advocacy, and system-level dialogue about the impact of day-to-day occupations on the health and well-being of Canadians.

Promoting an occupational perspective in public health Promouvoir une perspective occupationnelle dans le domaine de la santé publique

Background Although the value of occupation for health and well-being is fundamental to the occupational therapy profession, this view is not well recognized in the field of public health. Purpose In this article, we argue that occupational therapists have a unique and valuable perspective to bring to the field of public health, particularly with respect to the importance of occupational engagement in promoting the health and well-being of Canadians. Key Issues There are many compelling reasons for public health advocacy, including the need to increase awareness of the health benefits and risks of occupational engagement for individuals and communities. Challenges that lie ahead, however, include issues related to terminology, the complexity of occupation, the need to consider multidimensional outcomes, and diversity of evidence. Implications To move forward, the profession of occupational therapy in Canada needs to position health promotion messaging in a way that clearly captures the complexity and value of occupation and resonates with Canadians of all ages and abilities. Description Bien que la valeur de l’occupation pour la santé et le bien-être soit inhérente à la profession de l’ergothérapie, cette vision n’est pas bien reconnue dans le domaine de la santé publique. But Dans cet article, les auteurs défendent l’argument selon lequel les ergothérapeutes peuvent mettre à contribution une perspective unique et judicieuse dans le domaine de la santé publique, particulièrement en ce qui concerne l’importance de la participation occupationnelle pour favoriser la santé et le bien-être des Canadiens. Questions clés De nombreuses raisons impérieuses peuvent justifier la promotion de la santé publique, notamment le besoin de sensibiliser davantage les différents intervenants aux avantages et aux risques associés à la participation occupationnelle pour la santé des individus et des collectivités. Toutefois, il reste de nombreux défis à relever, notamment les enjeux associés à la terminologie, la complexité de l’occupation, le besoin de considérer les résultats multidimensionnels et la diversité des données probantes. Conséquences Pour aller de l’avant, la profession de l’ergothérapie au Canada doit transmettre des messages sur la promotion de la santé qui expliquent clairement la complexité et la valeur de l’occupation et qui interpellent tous les Canadiens, quels que soient leur âge et leurs capacités.

A Canadian model of work integration for persons with mental illnesses

Purpose. The many programmes, services and policy initiatives that focus on work integration for persons with mental illnesses and psychiatric disabilities reflect a multitude of beliefs and practices that lead the field to work in divergent, sometimes conflicting directions. This article presents a framework of the central constructs that dominate the field of work integration and mental illness. Method. Using the principles of constructivist grounded theory, an analysis of Canadian documents was conducted; the sample was comprised of 100 academic publications, 76 government documents, 138 popular press, 5 legal papers and 107 documents from work initiatives across Canada. In addition, semi-structured interviews were conducted with 19 key informants from across Canada. Results. Five central perspectives were identified, around which the field of work integration currently operates: a competency perspective; a citizenship perspective; a workplace health perspective; a perspective focussing on potential, growth and self-construction; a community economic development perspective. Conclusions. Uncovering the varied discourses around work integration enables an understanding of the different ways in which the problem of work integration has come to be seen in todays context; how it is understood, spoken about, dealt with and internalised by individuals and groups. The framework sheds light on the rationale for the range of solutions that have been developed to address the problem of work integration, and it is useful in the analysis of how policy, practice and research initiatives are shaped and promoted.

Hiring people with disabilities: A scoping review

BACKGROUND Many people with disabilities continue to encounter challenges trying to secure employment. OBJECTIVE The purpose of this study was to synthesize existent knowledge about the hiring process for people with disabilities and explore research priorities from the perspective of key stakeholders. METHODS A scoping review of the literature related to hiring processes and practices as they relate to people with disabilities was undertaken. As part of the scoping review, seven key informant consultations were conducted in order to gain further insight into the key issues identified by those most involved in the hiring process for people with disabilities. RESULTS Findings from the literature and consultations revolve around seven inter-related topics: 1) regulationsversus practice, 2) stigma, 3) disclosure, 4) accommodations, 5) relationship building and use of disability organizations,6) information and support to employers, and 7) hiring practices that invite people with disabilities. CONCLUSIONS Although barriers to employment for people with disabilities have been examined in the literature, there remains a paucity of literature examining and evaluating strategies to improve hiring practices and employment opportunities for people with disabilities. Future research must occur in consultation with key stakeholders including employers, people with disabilities, and employment support workers.

The shift to rapid job placement for people living with mental illness: an analysis of consequences.

OBJECTIVE This article reports on the consequences of the revised policy for employment supports within the Ontario Disability Support Program, a disability benefit program administered by the provincial government in Ontario, Canada. The revised policy involves a change from a fee-for-service model to an outcome-based funding model. This revision has encouraged a shift from preemployment to job placement services, with a particular focus on rapid placement into available jobs. METHOD Using a qualitative case study approach, 25 key informant interviews were conducted with individuals involved in developing or implementing the policy, or delivering employment services for individuals living with mental illness under the policy. Policy documents were also reviewed in order to explore the intent of the policy. Analysis focused on exploring how the policy has been implemented in practice, and its impact on employment services for individuals living with mental illness. RESULTS The findings highlight how employment support practices have evolved under the new policy. Although there is now an increased focus on employment rather than preemployment supports, the financial imperative to place individuals into jobs as quickly as possible has decreased attention to career development. Jobs are reported to be concentrated at the entry-level with low pay and little security or benefits. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These findings raise questions about the quality of employment being achieved under the new policy, highlight problems with adopting selected components of evidence-based approaches, and begin to explicate the influence that funding structures can have on practice.

Organizational Culture and Work Issues for Individuals with Mental Health Disabilities

Organizational culture is an important construct in understanding the experiences of individuals in the workplace. Defined as the shared values, beliefs, and expectations among members of an organization (Moran and Volkwein 1992; Spataro 2005), the culture of an organization shapes much of what occurs within it and acts as an informal system of control.