Zlatka Russinova

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.

Benefits and Mechanisms of Recovery Among Peer Providers With Psychiatric Illnesses

Providing peer support to individuals with psychiatric disabilities has emerged as a promising modality of mental health services. These services are delivered by individuals who experience mental illnesses themselves. The purpose of this study was to explore how working as a peer provider can enhance personal recovery. The study was conducted with 31 peer providers employed in a variety of mental health agencies. Data were collected through face-to-face semistructured interviews and analyzed using a grounded theory approach. Qualitative analysis revealed a wide range of recovery benefits for the peer providers. The benefits span across five wellness domains: foundational, emotional, spiritual, social, and occupational. In addition, analysis revealed five role-related and five work-environment-related mechanisms of beneficial impact. The role of sharing one’s personal story is highlighted as contributing to positively reauthoring one’s self-narrative. Implications for peer training, job development, and workplace supports are discussed.

Challenges Experienced by Paid Peer Providers in Mental Health Recovery: A Qualitative Study

Peer providers are increasingly employed in mental health services. We explored challenges experienced by 31 peer providers in diverse settings and roles using in-depth interviews, as part of a larger study focusing on their recovery (Moran et al. in Qual Health Res, 2012). A grounded theory approach revealed three challenge domains: work environment, occupational path, and personal mental health. Challenges in the work environment differed between conventional mental health settings and consumer-run agencies. Occupational domain challenges included lack of clear job descriptions, lack of skills for using one’s life story and lived experience, lack of helping skills, and negative aspects of carrying a peer provider label. Personal mental health challenges included overwork and symptom recurrence. Implications for all domains are discussed, with focus on training and skill development.

A framework for health promotion services for people with psychiatric disabilities.

The concepts of wellness and its complement, health promotion, have popularized the notion that health itself is more than simply the absence of disease. Furthermore, the wellness concept has advanced the idea of the importance of engaging in certain health promoting behaviors within healthy environments, not simply for the purpose of preventing or better managing a disease, but also to enhance ones well-being and quality of life (Green & Kreuter, 1991; Mullen, 1986). Encouraging this emphasis on wellness is Healthy People 2010 (U.S. Department of Health and Human Services, 2000), a national ten-year plan intended to increase quality and years of life and eliminate disparities which for the now features a new area that recognizes the importance of health promotion and disease prevention in the lives of people with disabilities. Increasingly, the value of promoting wellness--including for people with disabilities--is being recognized (Rimmer & Braddock, 2002).

Personal perspectives about the meaning of religion and spirituality among persons with serious mental illnesses.

This paper examines the various meanings persons with serious mental illnesses attribute to the concepts of religion and spirituality. In-depth semi-structured interviews were conducted with forty individuals with serious mental illnesses who have incorporated alternative healing practices into their recovery process. The qualitative data analysis revealed that study participants differentially defined religion and spirituality using two sets of descriptors: (a) core characteristics describing the nature of each concept, and (b) functional characteristics describing the impact of religion and spirituality on the individual. Implications for clinical practice and future research on the role of religion and spirituality in recovery are discussed.

Motivations of persons with psychiatric disabilities to work in mental health peer services: a qualitative study using self-determination theory.

Introduction Individuals with psychiatric disabilities have low rates of employment and occupational rehabilitation success. Mental health peer services are a new occupational modality that opened a promising occupational path: persons with serious mental illnesses employed to provide support to others with psychiatric conditions. However challenges to successful peer work exist. Work motivation is central to understanding and supporting peer workers, yet little is known about sources of motivation to work as mental health peer providers. The aim of this study was to identify what drives individuals to mental health peer work using self determination theory (SDT). Methods Motivations of 31 mental health peer workers were explored as part of a larger study. A theory driven approach was employed to emerging qualitative data using SDT concepts: external motivation and internally regulated motivations derived from basic needs (autonomy, competence, relatedness). Results External motivations included generic occupational goals and getting away from negative work experiences. Internal motivations corresponded with SDT basic needs: autonomy met-needs was reflected in having freedom to disclose and finding that work accords with personal values; competence met-needs was reflected in using personal experience as a resource to help others; and relatedness met-needs were reflected in having opportunity to connect intimately and reciprocate with consumers. Conclusion This study identified external and internal motivations of persons with psychiatric disabilities to work as peer providers—a novel occupation in mental health. Employing personal experience and enabling peer contact emerge as major motivational tenets of mental health peer work. According to SDT instrumental occupational goals are considered more external than satisfaction of basic psychological needs. The study demonstrates the applicability of SDT in the design of autonomy supported environments to promote work engagement and sustenance of mental health peer providers.

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.

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.