WORK INTEGRATION
By: Katherine Keyes and Natasha Nzeakor
April 2011
K. KEYES, N. NZEAKOR – WORK INTEGRATION 2
How will we become leaders? This question guided the formation of our topic for the
following paper. When brainstorming ideas we came across an article that spoke to the difficulties
faced by individuals with mental illness in finding or remaining in meaningful employment. This story
led us to think more about the role of occupational therapy in vocational rehabilitation and mental
health. We began to consider our fast-approaching role of practicing occupational therapists and
how we may impact change in our practice. We decided that in order to take on leadership roles and
enable individuals with mental illness to engage in meaningful employment we needed to become
more confident in our knowledge within this field.
We decided to focus our paper on increasing our familiarity with this topic in order to become
more effective in our practice when working with individuals with mental illnesses. With increased
knowledge in this field, we hope it will give us the confidence to take on more leadership roles in
future practice. To achieve this end our paper will review issues that surround employment for
individuals with mental illness, how this relates to occupation and health, and look at the benefits
and barriers that employment or work integration can have for individuals with mental illness.
Further, we will determine what is considered to be best practice in vocational rehabilitation for
individuals with mental illness, where occupational therapists fit in, and finally where we think we
have the room to make a difference as future leaders.
Mental illness and Employment - What is the issue? Mental health is something that affects
all human beings. One in five Canadians suffer from mental illness, which accounts for 4.5million of
the Canadian population. (Canadian Mental Health Association, 2011). Worldwide, studies have
continuously shown that individuals living with a serious mental illness face the highest degree of
stigmatization in the workplace, and the greatest barriers to employment over all persons with
disabilities (CAMH, 2009). Although this is well known problem in society and some gains have been
made towards improving this issue, many people living with a mental illness are still experiencing
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 3
difficulties associated with trying to find proper employment while being scrutinized for having a
mental illness.
Although considerable progress has been made in educating the general public about mental
illness, and as well as dispelling many of the myths associated with it, mental illness still remains
one of the most misunderstood social challenges. Despite accounting for a significant social
demographic, mental health remains one of the most stigmatized and perpetually under informed
types of social discrimination. Consequently, people exhibiting signs or people that have their mental
state be a matter of selective public knowledge (i.e. informing employers) have a much greater
probability of experiencing workplace discrimination (CAMH, 2009).
Impact of employment on health. Studies have found that there is a direct correlation
between the effects of occupation on health and health on occupation (Kirsh, Stergiou-Kita, Gewurtz,
Dawson, Krupa, Lysaght, & Shaw, 2009). Smith (1999) found that economic status had a direct
impact on health outcomes such as mortality and morbidity. Furthermore, research indicates that
individuals suffering from unemployment experience higher levels of stress, isolation and financial
difficulties due to unemployment (Krish et.al., 2009). Reversely, we know that occupation, whether it
is related to work or engaging in an activity that is meaningful to an individual is related to health
and social benefits (Krish et al., 2009) and therefore, related to an overall higher level of life
satisfaction.
Barriers to employment. As already highlighted above, individuals living with a serious mental
illness face the greatest barriers to employment over all persons with disabilities (CAMH, 2009); this
is because we live in a society where the lines between fact and fiction are often blurred, which
cause these individuals to be left unemployed or forced to settle for lower paying employment. Due
to this fact, individuals living with a mental illness experience greater difficulties related to
occupation and health as a whole.
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 4
To better understand how occupation and health influence someone’s life it’s important to
look at all variables; the Person, Occupation, and environment. The Person-Environment-Occupation
(PEO) model looks at the dynamics between connected relationship that occurs between the person,
their occupations/roles, and the environment that surrounds their work, play, and daily activities
(Law, Cooper, Strong, Stewart, Rigby & Letts, 1996). Kirsh et al. (2009) determined that in order to
facilitate work integration of someone living with a mental illness the person, the job and the work
environment are important factors in need of examination to realistically predict how well they will
succeed in a specific job. For the purpose of this paper, we will primarily focus on the PEO model in
relation to its application to people living with a mental illness and their occupations, specifically
employment related.
Benefits of employment. When an individual living with a mental illness is matched with a
suitable job, many benefits transpire that attribute to an individual’s overall health. Research in
mental health has found that employment is associated with increased feelings of self-worth, life
satisfaction (Kirsh, Cockburn & Gewurtz, 2005; Scheid & Anderson,1995) as well as, benefits related
to lowered rates of hospitalization and improved function (Mueser, Becker, Torrey, Xie, Bond, Drake,
et al., 1997; Scheid & Anderson,1995). So how do we ensure these benefits happen for this
population? The PEO model helps to break down and analyze how well an individual is coping. The
person incorporates the individual’s skills as well as the illness the individual is living with and how
much it impacts their daily occupations. The Environment looks at the supports that are available for
the individual within their community and work facility, as well as the environmental barriers. Lastly,
the occupation is the activity they are engaging in, specific to this paper their area of employment.
Together the PEO model will identify how well a person is able to keep up with the demands of the
job. Upon analysis, the PEO illustrates the benefits and obstacles an individual living with an illness,
mental or otherwise, is facing in their day-to-day living; which efficiently contextualizes and provides
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 5
an accurate frame of reference for OT’s to design appropriate interventions specifically suited to
meet each patient’s individual needs.
With that understanding it is important to appreciate the possible benefits individuals living
with a mental illness are able to acquire from having a job. Researchers have reported that
employment for people with mental illnesses has shown benefits with finances, regular activity, a
sense of purpose, personal development, socialization opportunities (arguably the most significant of
all), social acceptance, improved mental health, self-esteem, and self-image (Bedell, 1998; Graffam
& Naccarella, 1997; Kirsh, 2000). Strong (1998) examined what makes work meaningful for persons
with mental illness and how this meaningfulness relates to their recovery. Results indicate that the
benefits of employment are individualized and are determined by the relationship the individual has
with their mental illness (Strong, 1998). While Kirsh (2000), stated that it is imperative that those
living with a mental illness find both a proper balance between the positive benefits and benign
consequences associated with steady employment (i.e. structure and the drawbacks, stress, and
everyday workforce demands).
Depending on the severity of the illness, unemployment rates for people living with a serious
mental illness have been commonly reported to range from 70-90% (CAMH, 2011). The fact that
companies that have knowingly employed a person with a mental illness are celebrated is a
testament to how discriminatory practices are accepted by the larger society. Although progress has
been made, today many companies that are knowingly employing a person with an illness are viewed
as philanthropic and/or altruistic. This kind of thinking is laden with insidious effects. A recent study
identifies work integration and employment barriers as: the general populations’ misconception of
their ability to work and hold down a job, social exclusion in the work place, and barrier to achieve a
positive community presence within society (Evans & Repper, 2000).
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This next story discusses the personal struggle of Maurizio Baldini's, a man living with
schizophrenia. It touches on how his relationship with the illness made it nearly impossible to keep a
job at times:
“I have been living with schizophrenia for the past 18 years. I first became ill when I was attending university in Vancouver when I was 22 years old. At that time I was enrolled in my second year at law school at the University of British Columbia, having already completed a Bachelor of Science degree from the University of Victoria the previous year. I was enjoying myself and taking part in many activities. During my first year at law school my grades were in the top quarter of my class and I had no problems handling the stresses of university life. Within a few days in October 1976 all of this came to a crashing halt as I suddenly experienced my first psychosis. I began to have delusions about the state of the world around me. During this first episode of psychosis I fluctuated between wild delusions of grandeur to deep depressions about my future.
During the second day of my psychosis I began to wander in the streets of Vancouver following my disrupted thoughts and hoping to find the answer to all of life's problems. After a few hours I ended up in someone's backyard. I had another delusion that I had been magically transported 20 years into the future and owned a mansion I had at random found. Sitting there was almost blissful, the delusion at that point was even enjoyable; however, within a few minutes a police car arrived and two officers arrived on the scene and asked me what I was doing there. I thought that they were part of the conspiracy to have me made the next prime minister so I was quite friendly towards them as if I had been expecting them to arrive. After a few minutes they made some inquiries over the radio telephone and called for an ambulance. The attendants arrived and took me to the emergency room at the nearest hospital. When I got to the hospital, I got even more paranoid. I thought the nurses and doctors were plotting to kill me.
Upon discharge I returned to my studies at law school; however, trying to cope with university after such an episode of schizophrenia was extremely difficult. I was failing my courses. Luckily, I got my exams postponed that year and was able to write them a few months later. Over the course of the next several months to several years my medication levels were reduced allowing me greater freedom from the horrible side-effects. As I practiced studying my academic skills returned to a point where I was able to pass my exams, although now I was at the bottom of my class instead of at the top.
Over the next few years I got progressively better and was able to finish law school, find an articling position and become a practicing lawyer. After about three years of being treated with medications my doctor decided to take me off all of them to see if I could function without them. I did very well for a number of years after that. Unfortunately, in 1986 I had a sudden relapse in my illness. It was during this psychosis, however, that I believed aliens from outer space were communicating with me and that a fire was started in my house that set the house on fire and caused me to end up in court as a result. Within a few days of the fire I had signed myself into the local psychiatric hospital and was again placed on large doses of antipsychotic medication. I spent two months in hospital this time and upon discharge it was very difficult for me to function again. I had to give up practicing law because of the side-effects of the medication and the lack of motivation and inability to concentrate on my work. I slowly relearned most of the life skills necessary to find
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 7
employment and function independently outside of hospitals. I worked at a drop-in centre working with people with schizophrenia and reconnected with many friends in the community.
Since October of 1992 I have been working with three other people, two consumers of mental health services and one family member, in a partnership education program through the Schizophrenia Society and with the Ministry of Health. We work at educating various groups about serious mental illness using our partnership talks. In them we describe our personal experiences with mental illness and how it has affected our lives. This has proven to be a very powerful and successful way of teaching many people about mental illness. It has also become a way of breaking down the barriers between families, consumers of mental health services and professionals and allowing them an opportunity to work together to further the cause of mental health” (Baldini, 1996).
As demonstrated from the literature reviewed above and Maurizio Baldini's personal story,
returning to work can be a long process where individuals with a mental illness face many barriers
and set backs in finding and maintaining work. As competent practitioners, this story also
demonstrates a further need to be aware of what actually assists individuals with a mental illness in
making a successful entry or return to the workforce.
The following questions seemed very important for us to consider and will be addressed
below. What approaches to vocational rehabilitation positively influence a return to work for
individuals with mental illnesses? What is our role as occupational therapists in enabling this return
to work for individuals with mental illness? What are some barriers that our practice faces in the field
of mental health and return to work and how can we further develop and expand our role to become
leaders within this field?
Best Practice. In order to develop leadership skills as new graduates in this field, we need to
ensure we are familiar with what approaches and strategies have demonstrated efficacy in assisting
individuals with mental illnesses return to and maintain meaningful employment. Approaches to
vocational rehabilitation can be generally broken down into two areas including: prevocational
training and supported employment (Crowther, Marshall, Bond, & Huxley, 2001). Prevocational
training focuses on preparing individuals prior to entering competitive employment whereas
supported employment focuses on placement in competitive employment while offering on the job
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 8
support (Crowther et al., 2001). Increasing evidence demonstrates that supported employment and
individual placement and support models have been more successful in getting people back to work
than other more traditional ways of working in segregated settings (Godby, 2001). Further, supported
employment has been demonstrated to be more effective than prevocational training in helping
people with mental illness to obtain competitive employment (Crowther et al., 2001).
Supported employment can be defined as “involvement in settings where persons without
disabilities are employed, as well as support from a range of activities that helps sustain paid work,
including supervision, training, and transportation” (Kirsh, Stergiou-Kita, Gewurtz, Dawson, Krupa,
Lysaught, & Shaw, 389, 2009). It is premised on the belief that given adequate support and
appropriate interventions, some persons with severe mental illness are capable of working in the
open labor market (Liu, Hollis, Warren, & Williamson, 2007). In a study exploring participants’
experiences of a supported-employment program, Liu, Hollis, Warren & Williamson (2007), discuss
three program outcomes including the removal of barriers to job seeking, improving participants’
psychological well-being, and increased participation in work. These researchers further
demonstrated that participants’ achieved meaningful personal outcomes even though they do not
obtain competitive employment and that personal readiness and efforts in job seeking contributed to
obtaining employment (Liu et al., 2007).
Many researchers have suggested that occupational therapy practice is compatible with the
basic principles of supported employment – so incorporation of supported employment elements
into vocational rehabilitation in our practice should be considered (Kirsh, Cockburn, & Gewurtz,
2005; Liu et al., 2007). Furthermore, research findings in supported-employment literature can
guide our practice or use of strategies with individuals with mental illness who want to achieve
employment. For example, Liu et al.’s (2007) research demonstrates the need to consider how
personal factors, such as readiness, can impact how we could adjust program strategies for the
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 9
needs of individual participants in supported-employment programs. In addition to supported-
employment models, other practice models that we also need to be aware of are consumer-run
community initiatives, employment of consumers within the mental health system, as well as
community care access services (Kirsh et al., 2009).
In thinking about these different models of service delivery, it is important to consider what
aspects of these models have led to the improvement of vocational outcomes for persons with
mental illnesses. By becoming aware of these characteristics, and how they fit into different service
models, we can aim to try and incorporate them where possible in our future practice as new
clinicians. Kirsh, Cockburn, & Gewurtz (2005) outline key characteristics that can influence
vocational outcomes across models which include: a specific focus on work, inclusion of a vocational
or employment specialist on the team, job matching with attention to client preferences and choices,
providing ongoing and available supports, rapid placement and on the job training, use of skills
training to teach a problem solving approach to work and daily living, pay for work, attention to the
work environment, a team approach, support and education for employers and co-workers, a range
of services that are available and accessible, and finally integrated services and systems in the field
of mental health and vocational services.
Where do we fit? Now that we have a better understanding of service models that have
demonstrated efficacy in vocational rehabilitation, we will focus our attention on how occupational
therapists work in field of mental health and employment. Occupational therapists can be found in
many programs, areas, and roles including: on assertive community treatment (ACT) teams, as case
managers, in conventional vocational rehabilitation programs, in group skills training programs, in
individual placement and support programs, in psychosocial rehabilitation, etc (Kirsh, Cockburn, &
Gerwutz, 2005). An emerging role for occupational therapists is one where we act as vocational
leads within multidisciplinary teams, notably in community mental health teams (Godby, 2001).
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Although models vary, the occupational therapist can provide vocational assessment, guidance, and
information to support clients and their care coordinators (Godby, 2001). This list is not exhaustive,
but demonstrates that occupational therapists can be found in many different programs and areas
throughout the field of mental health and employment.
So, what skills and strategies do occupational therapists use in this field? Core skills of
occupational therapists that focus on the importance of occupation and its relationship to health
allow us to play a key role in vocational rehabilitation for persons with mental illness (Godby, 2001).
Mountain, Carmen, & Illot (2001) identify particular skills of occupational therapists that
predispose us to play a key role in employment programs including: assessment of functioning and
pre-vocational assessment, job analysis, restructuring of work tasks, creation of enabling work
environments, and limiting the effects of illness and disability through occupation. As discussed
above, occupational therapists use a person-environment-occupation approach to vocational
rehabilitation that can focus on the individual, but also look at what can be changed in the workplace
environment, as well as the occupation or job itself (Wisenthal, 2004). Occupational therapists also
aim to support the importance of looking to the client in order to understand work-related variables
such as purpose & meaning, self-efficacy, competence, and adaptation to create a ‘good’ fit between
the worker and environment (Woodside, Schell, & Allison-Hedges, 2006).
In addition to skills and strategies mentioned above occupational therapists working in the
area of employment and mental health work with individuals on many different aspects or
components of employment depending on their needs particular. The below diagram (Wisenthal,
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 11
2004) illustrates the many facets of occupational therapy practice in workplace mental health:
Occupational therapists also use a broad array of structured training programs in
prevocational and vocational rehabilitation, including skills training, job finding, and the development
of cognitive skills (Oka, Otsuka, Yokoyama, Mintz, Hoshino, et al. 2004). An example of an
individual-focused skills-based program, used to assist in the development of cognitive skills
preparation for a return to work is, Cognitive Work Hardening. Following a client’s identification of
occupational performance issues, the occupational therapist designs a cognitive work hardening
program that can address a client’s concerns (Wisenthal, 2004).
(from Wisenthal, 2004).
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 12
To address issues related to occupation, work task simulations are developed for a client
that focus on improving the cognitive skills required for the performance of a particular task
(Wisenthal, 2004). Cognitive work hardening is just one example of a person-focused strategy that
can be used when assisting persons with mental illnesses in returning to work. As discussed above,
occupational therapists can apply their understanding of person-occupation-environment
interactions to provide service where they see a lack of fit between these areas when working in the
field of vocational rehabilitation and mental illness.
Our future role, as leaders? Godby (2001) reports that limitations or gaps in services, which
create barriers to people with mental health problems in gaining employment, provide leadership
opportunities for occupational therapists to provide the services needed. He reports that one of the
most frequently identified gaps is that between health and employment services (Godby, 2001).
More specifically that there is a tendency for mental health services to see themselves as supporting
people out of work rather than in work (Godby, 2001). This creates a potential lack of focus on
employment in health services for individuals with mental illness particularly when they may be
experiencing an episode or hospitalization. However, it is very important to note that research
suggests, “that a direct focus on employment within mental health services may lead to positive
employment outcomes” (Kirsh, Cockburn, & Gewurtz, 272, 2005). This lack of focus on
employment, demonstrates an opportunity for us as new occupational therapists to raise awareness
about the importance of considering employment for individuals with mental illnesses, wherever we
work. Whether we come across an individual in the community or in an acute care setting – it is
these areas, where mental health is not at the forefront of care, that we believe we have the
opportunity to make a difference. This impact is even more important to consider in all areas of
practice because we know that individuals with severe and persistent mental illness are motivated to
engage in occupations while trying to maintain and enhance their existing health (Nagle, Cook, &
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 13
Polatajko, 2002). Furthermore individuals “value and aspire to someday obtain competitive
employment” and research demonstrates that “the occupational paths they choose are influenced
by options available to them and their personal evaluation of their readiness to engage” (Nagle,
Cook, & Polatajko, 80, 2002). As new occupational therapists we need to consider all options when
working with individuals with mental illness and keep all of the options open when thinking about our
clients future.
As discussed in class, with individualized supported work programs, a key leadership role for
occupational therapists to further bridge this gap between the healthcare system and employment
can be in fostering and maintaining relationships with employers in the community. For example, a
vocational rehabilitation program in Japan using a combination of supported employment and
occupational therapy services – demonstrated how OT’s can play integral roles in linking individuals
to employers directly from hospital to ensure engagement in meaningful employment (Oka et al.,
2004). Furthermore, occupational therapists can have a more direct role in creating employment
opportunities for individuals with mental illness by developing relationships with employers in the
community. This is an extremely important role to consider because research indicates that, in
general, employers want to accommodate employees with psychiatric disabilities, but lack
information on how to start (Frado, 1993). Occupational therapists can have a huge opportunity to
provide education to workplaces on how they can accommodate the particular needs of an individual
with mental illness.
A piece of this role will be advocating for persons with mental illnesses to increase
awareness of recovery and how providing appropriate support or work accommodation can maximize
their productivity at work. Research demonstrates that supporting the ways individuals assess and
promote their own mental health and recovery will contribute to their success at work (Woodside,
Schell, Allison-Hedges, 2006). This further demonstrates the need for occupational therapists to
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 14
develop relationships with workplaces so individuals can feel encouraged and comfortable – which
appears to be an important factor in vocational success (Woodside, Schell, Allison-Hedges, 2006).
Inspirational message/Conclusion
We wanted to conclude this paper with our final thoughts of how writing this assignment
allowed us to become more confident in our abilities to work in vocational rehabilitation with
individuals with mental illnesses and hopefully impact the lives of individuals we work with in a
positive manner. With increased knowledge in this field, in particular surrounding the issue of
employment for individuals with mental illness as well as the benefits and barriers they may face, we
feel increasingly prepared on how we may potentially take on leadership roles in future practice.
Having a better understanding of best practices such as, the importance of personal choice
and preference in employment, has led us to feel that we are be able to take on more leadership
roles. For instance, even if it is bringing up the topic of employment with an individual in a
community setting or raising awareness to our team members, we feel that in whatever environment
we end up, this information has given us more confidence in our ability to advocate on behalf of
individuals with mental illness to obtain meaningful employment.
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 15
References
Baldini, M. (1996). Maurizio Baldini's Story. Retrieved on March 20 from
http://www.mentalhealth.com/story/p52-sc01.html
Bedell, J.R (1998). A description and Comparison of experiences of people with mental disorders in
supported employment and paid prevocational training. Psychiatric Rehabilitation Journal.
21(3), 279-283.
Canadian Mental Health Association (2011). Take control of your health, Take Control of your mind.
Retrieved on March 20 from http://www.cmha.ab.ca/bins/site_page.asp?cid=284-285-1258-
1404&lang=1
Centre for Addiction and Mental Health. (2011). Mental Health and Addiction Statistics. Retrieved on
March 20 from
http://www.camh.net/News_events/Key_CAMH_facts_for_media/addictionmentalhealthstatis
tics.html
Crowther, R.E., Marshall, M., Bond, G.R. & Huxley, P. (2001). Helping people with severe mental
illness to obtain work: a systematic review. British Medical Journal. 322, 204-208.
Evans, J., and Repper, J. (2000). Employment, Social inclusion and mental health. Journal of
Psychiatric and mental health. 7, 15-24.
Frado, L. (1993). Canadian mental health association diversity works: Accommodations in the
workplace for people with mental illness. Retrieved from
http://www.cmha.ca/bins/content_page.asp?cid=3-109&lang=1
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 16
Godby, S. (2001). Bridging the gaps: The role of occupational therapy and opportunities for its
development. The Mental Health Review Volume, 6(4), 21-25.
Graffam, J. and Naccarella, L. (1997). Disposition toward employment and perspective on the
employmeny process held by clients with psychiatric disabilities. Australian Disability Review.
3, 3-15.
Kirsh, B. (2000). Work, Workers, and Workplaces: A qualitative analysis of narratives of mental
health consumers. Journal of Rehabilitation. 66(4), 24-30.
Kirsh, B., Cockburn, L., and Gewurtz, R. (2005). Best practice in occupational therapy: Program
characteristics that influence vocational outcomes for people with serious mental illnesses.
Canadian Journal of Occupational Therapy. 72, 265– 279.
Kirsh, B., Stergiou-Kita, M., Gewurtz, R., Dawson, D., Krupa, T.,Lysaght, R., and Shaw, L. (2009). From
margins to mainstream: What do we
know about work integration for persons with brain injury, mental illness and intellectual
disability? Work, 32, 391–405
Law,M., Cooper, B., Strong, S., Stewart, D., Rigby, P., and Letts, L. (1996). The Person-Environment-
Occupation Model: A transactive approach to occupational performance. Canadian Journal of
Occupational Therapy. 63(1).
Liu, D., Hollis, V., Warren, S., & Williamson, D.L. (2007). Supported-employment program processes
and outcomes: Experiences of people with schizophrenia. The American Journal of
Occupational Therapy, 61(5), 543-554.
Mountain, G., Carmen, S., & Illot, I. (2001). Workplace Rehabilitation and Occupational Therapy.
London: College of Occupational Therapists
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 17
Mueser, K., Becker, D., Torrey, W., Xie, H., Bond, G., Drake, R. et al. (1997). Work and non-vocational
domains of functioning in persons with severe mental illness: A longitudinal analysis. The
Journal of Nervous and Mental Disease. 185(7), 419–426.
Nagle, S., Valiant Cook, J., & Polatajko, H. (2002). I’m doing as much as I can: Occupational choices
of persons with a severe and persistent mental illness. Journal of Occupational Science, 9(2),
72-81.
Oka, M., Otsuka, K., Yokoyama, N., Mintz, J., Hoshino, K., Niwa, S.I., & Liberman, R.P. (2004). An
evaluation of a hybrid occupational therapy and supported employment program in Japan for
persons with schizophrenia. The American Journal of Occupational Therapy, 58(4), 466-475.
Scheid, T., & Anderson, C. (1995). Living with chronic mental illness: Understanding the role of work.
Community Mental Health Journal. 31(2), 163–176.
Smith, P. (1999). Healthy Bodies and Thick Wallets: The Dual Relation Between Health and
Economic Status. Journal of Economic Perspective. 13(2),145-166
Strong, S. (1998). Meaningful work in Supported environments: Experiences with the recovery
process. American Journal of Occupational Therapy. 52(1), 31-38
Wisenthal, A. (2004). Occupational therapy provides the bridge back to work. Occupational Therapy
Now. Retrieved on March 19 from: http://www.caot.ca/default.asp?pageid=1185
Woodside, H., Schell, L., Allison-Hedges, J. (2006). Listening for recovery: The vocational success of
people living with mental illness. Canadian Journal of Occupational Therapy, 73(1), 36-43.
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 18
Appendix: Activities
Activity 1
As discussed in our paper, employers often want to accommodate employees with mental illnesses but lack information of how to start. Initially, it is important for employers to be comfortable with the notion of talking about mental illness. The following questions may be similar to ones that employers have when considering hiring or assisting an individual with a mental illness maintain their employment position. Please take some time to think about how you may respond as an occupational therapist working with an employer who is interested in supporting your client in employment.
1) You use the terms mental illness and psychiatric disability. What do you mean by them?
2) How does having a mental illness affect a person’s ability to work?
3) What kind of accommodations can I expect to make?
4) I’m never clear on what language to use. How should I talk to or about people with mental illnesses?
5) To be honest, I don’t know how comfortable I would feel working with someone who has a mental illness. Aren’t they potentially violent?
6) What about other mental problems, like lower intellectual abilities?
7) If they don’t have an intellectual disability, then why can’t they overcome heir illness?
8) Are they ever going to recover?
9) Is a person with a mental illness able to tolerate pressure at work?
10) What I am really anxious about is strange behavior. How am I supposed to respond?
11) What will make people who are already working feel comfortable disclosing a, psychiatric disability so that they may be accommodated and be able to work more effectively?
Questions adapted from: Frado, L. (1993). Canadian mental health association diversity works: Accommodations in the workplace for people with mental illness. Retrieved from http://www.cmha.ca/bins/content_page.asp?cid=3-109&lang=1
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 19
Activity 2
Return to Work Plan. Creating a return to work plan for an individual can seem like an overwhelming process. An important part of managing a plan is to ensure it is responsive to both your client and the organization. The following chart provides some guidance of how to organize issues that need to be addressed and strategies that the client and employer can use to address a particular issue. Please use your own thoughts/ideas to fill in the empty boxes.
Issues to Address Client’s Strategy Employer’s Strategy
Return to work date -Meet with manager to agree -Have initial informal meeting on date. -Discuss phased return to -Go with OT to have an work plan with flexibility informal catch up with manager
Hours of work
Pre return contract -Phone manager
-Prepare medical certificates
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 20
Supervision & support -Encourage client to talk to me anytime
-Ensure client is comfortable with amount of supervision given
Workload
Chart adapted from: Mental Health Foundation of New Zealand (2007). Return to work: Returning to work after experiencing mental illness and other mental health issues. Retrieved from: http://www.mentalhealth.org.nz/resources/Returning-To-Work.pdf
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 21
Activity 3
Many of our clients may not have thought about the type of work they’d like to pursue or may not even know what skill set they can bring to a job. It is important that we guide our clients in clearer direction. Activity two is an example of ten sample questions seen on Interest Assessments that help to match a client’s interests/skills with suitable career choices for them.
1. Is there more gratification in: a) Discussing a matter b) Resolving a matter
2. Ideally, are you more drawn to a job that is: a) Scrutinizing and examining b) Compassionate and empathetic
3. Do you generally prefer making day to day decisions: a) With planned consideration b) When they arise
4. In general, are you more: a) Strong-willed b) Soft-hearted
5. Are you more impressed by someone that is: a) Logical b) Sympathetic
6. In general, do you find you are more: a) Objective b) Caring
7. Do you welcome work that: a) Is more firmly grounded in today b) Deals more with potential opportunities
8. Are you a person that is more inclined to: a) Be in control b) Be Adaptable
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 22
9. What is more enjoyable for you: a) Completing a project b) Creating a project
10. Please choose the word that describes you most of the time: a) Literal b) Abstract
Questions taken from: Unknown. (2010). Career Test. Retrieved from www.careerfitter.com
LEADERSHIP in MENTAL HEALTH OT COMPENDIUM