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Work Integration 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). LEADERSHIP in MENTAL HEALTH OT COMPENDIUM K. KEYES, N. NZEAKOR – WORK INTEGRATION 6 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.
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