Terry Krupa

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.

Employment, recovery, and schizophrenia: integrating health and disorder at work.

The goal of the present study was to advance theory about the processes involved in the recovery of work participation for individuals with schizophrenia. A qualitative, multiple case study design was used to study the work lives of three individuals. This paper focuses on the analysis of experiences of working with schizophrenia and, in particular, efforts to integrate disorder and health in the work domain.

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.

Personal experience of living with knee osteoarthritis among older adults

Purpose. Knee osteoarthritis (OA) is the most common cause of chronic disability amongst community-dwelling older adults. Yet, little is understood about the daily experience of knee OA. As clinicians we fail to understand a large group of individuals that we aim to help. We conducted an exploratory study that aimed to understand the experience of living with knee OA in older adults. Method. We used a descriptive phenomenology, grounded in the phenomenology in practice tradition. We conducted nine interviews with participants with physician-diagnosed knee OA, of different ages, sexes, cultural backgrounds and self-perceptions. Ninety-minute interviews with each participant were audio-taped and transcribed verbatim. We used the vanKaam method of phenomenological analysis, modified by Moustakas, as the framework for data analysis. Findings. The following five themes on living with knee OA emerged: experiencing knee pain is central to daily living, experiencing mobility limitations devalues self-worth, sharing the experience, assessing our own health and managing chronic pain. Conclusions. The implications of these findings highlight the profound impact knee OA has on daily living, which have been poorly documented in the past. Clinicians should consider that the consequences of living with knee OA are significant enough to influence a persons sense of self-worth.

A conceptual definition of vocational rehabilitation based on the ICF: Building a shared global model

Background The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. Method We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. Results Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. Conclusions VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders’ participation.

Involving Clients in Programme Evaluation and Research: A New Methodology for Occupational Therapy

Eliciting client satisfaction with services has become common in mental health settings and in the planning of service delivery systems. It is also compatible with the client-centred practice of occupational therapy. The traditional approach to collecting satisfaction information involves staff interviewing clients using questionnaires developed by staff. However, there is often a lack of variability in responses and the vast majority of clients report being satisfied. A review of the literature reveals that these favourable reports may be a result of social desirability and of clients being interviewed by treatment providers who have the power to give or withhold care. This paper reviews the relationship between occupational therapy and client involvement, examines the rationale for involving clients in programme evaluation and research, reviews the limitations with traditional methods of collecting information about client satisfaction, and discusses how clients are involved in evaluation and research in todays mental health care setting.

Opening minds in Canada: targeting change.

Objective To summarize the ongoing activities of the Opening Minds (OM) Anti-Stigma Initiative of the Mental Health Commission of Canada regarding the 4 groups targeted (youth, health care providers, media, and workplaces), highlight some of the key methodological challenges, and review lessons learned. Method The approach used by OM is rooted in community development philosophy, with clearly defined target groups, contact-based education as the central organizing element across interventions, and a strong evaluative component so that best practices can be identified, replicated, and disseminated. Contact-based education occurs when people who have experienced a mental illness share their personal story of recovery and hope. Results Results have been generally positive. Contact-based education has the capacity to reduce prejudicial attitudes and improve social acceptance of people with a mental illness across various target groups and sectors. Variations in program outcomes have contributed to our understanding of active ingredients. Conclusions Contact-based education has become a cornerstone of the OM approach to stigma reduction. A story of hope and recovery told by someone who has experienced a mental illness is powerful and engaging, and a critical ingredient in the fight against stigma. Building partnerships with existing community programs and promoting systematic evaluation using standardized approaches and instruments have contributed to our understanding of best practices in the field of anti-stigma programming. The next challenge will be to scale these up so that they may have a national impact.

Interventions to Improve Employment Outcomes for Workers Who Experience Mental Illness

Objective: To review employment interventions for individuals who experience mental illness. Method: I reviewed employment interventions described in the mental health, disability, and rehabilitation literature for the period 1990 to 2005 and organized these interventions into a framework. Results: The framework develops 7 distinct individual-level employment interventions as well as interventions directed at the employer and at workplace organization. It also considers factors that will affect access to these interventions. Although there is a sense of optimism about the potential of these interventions, research in the area is limited. Conclusion: Physicians who are knowledgeable about the nature and scope of employment interventions for individuals with mental illness are in a good position to effect positive change in the work lives of the individuals they serve.

The Development of Recovery Competencies for In-patient Mental Health Providers Working with People with Serious Mental Illness

Delivering recovery-oriented services is particularly challenging in in-patient settings. The purpose of this study was to identify the most salient recovery competencies required of in-patient providers. Established methods for the development of competencies were used. Data collection included interviews with multiple stakeholders and a literature review. Data analysis focused on understanding how characteristics of the in-patient context influence recovery-enabling service delivery and the competencies associated with addressing these issues. Eight core competencies with four to ten sub-competencies were identified based on a tension–practice–consequence model. The competency framework can serve as a tool for tailoring workforce education.

Doing daily life: how occupational therapy can inform psychiatric rehabilitation practice.

TOPIC This paper provides an overview of occupational therapy in the context of psychiatric rehabilitation and mental health recovery. PURPOSE The paper delineates practical aspects of occupational therapys involvement in the mental health field with a discussion of occupation and the elements of conceptual models that guide the practice of occupational therapy. SOURCES USED CINAHL, Psych Info, Medline. CONCLUSION Occupational therapy is a key discipline in the field of psychiatric rehabilitation and brings to the field a strong theoretical and knowledge base along with unique procedures and practices. It is important for the psychiatric rehabilitation field to learn from all disciplines, including occupational therapy.