Working with mental health problems: clients’ experiences of IPS, vocational rehabilitation and employment

  • Marsha Koletsi
  • Astrid Niersman
  • Jooske T. van Busschbach
  • Jocelyn Catty
  • Thomas Becker
  • Tom Burns
  • Angelo Fioritti
  • Rana Kalkan
  • Christoph Lauber
  • Wulf Rössler
  • Toma Tomov
  • Durk Wiersma
  • for the EQOLISE Group
Original Paper

Abstract

Background

Although the effectiveness of individual placement and support (IPS) has been well established, little is known about clients’ perceptions of the model compared to usual vocational rehabilitation, nor about their experiences of searching for and returning to work with this kind of support. This qualitative study aimed to explore clients’ views of the difficulties of obtaining and maintaining employment, their experiences of the support received from their IPS or Vocational Service workers and the perceived impact of work on clients’ lives.

Method

Semi-structured interviews were conducted with 48 people with psychotic disorders participating in a six-centre international randomised controlled trial of IPS compared to usual vocational rehabilitation. To assess their experiences of the services and the perceived effects of working, two IPS and two Vocational Service clients at each centre who had found work during the study period were interviewed, along with two IPS and two Vocational Service clients at each centre who had not.

Results

IPS clients reported having received more help seeking and maintaining employment, whereas Vocational Service clients reported having received more help in finding sheltered employment or placements. Clients who had worked associated this with financial stability, improved social lives, increased self-esteem, integration into society and amelioration of their symptoms, as well as reduced feelings of boredom and isolation, but also reported increased levels of stress. IPS clients as well as Vocational Service ones reported not receiving enough follow-up support, despite this being proposed as a key feature of the model.

Conclusion

Findings from the in-depth interviews reflect differences in service models that have also been tested quantitatively but further work in disaggregating the IPS model and assessing the impact of each component would be valuable.

Keywords

Severe mental illness Employment Vocational rehabilitation Qualitative assessment 

References

  1. 1.
    Becker DR, Drake RE (2003) A working life for people with severe mental illness. Oxford University Press, New YorkCrossRefGoogle Scholar
  2. 2.
    Becker DR, Drake RE, Bond GR, Xie H, Dain BJ, Harrison K (1998) Job terminations among persons with severe mental illness participating in supported employment. Community Ment Health J 34:71–81CrossRefPubMedGoogle Scholar
  3. 3.
    Becker DR, Whitley R, Bailey EL, Drake RE (2007) Long-term employment trajectories among participants with severe mental illness in supported employment. Psychiatr Serv 58:922–928CrossRefPubMedGoogle Scholar
  4. 4.
    Boardman J, Grove B, Perkins R, Shepherd G (2003) Work and employment for people with psychiatric disabilities. Br J Psychiatry 182:467–468CrossRefPubMedGoogle Scholar
  5. 5.
    Bond GR, Becker DR, Drake RE, Rapp CA, Meisler N, Lehman AF, Bell MD, Blyler C (2001) Implementing supported employment as an evidence-based practice. Psychiatr Serv 52:313–322CrossRefPubMedGoogle Scholar
  6. 6.
    Bond GR, Becker DR, Drake RE (2008) An update on randomized controlled trials of evidence-based supported employment. Psychiatr Rehabil J 31:280–290CrossRefPubMedGoogle Scholar
  7. 7.
    Buchanan J (1995) Social support and schizophrenia: a review of the literature. Arch Psychiatr Nurs 9:68–76CrossRefPubMedGoogle Scholar
  8. 8.
    Burns T, Catty J, Becker T, Drake RE, Fioritti A, Knapp M, Rössler W, Tomov T, White S, Wiersma D, the EQOLISE Group (2007) The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial in six European countries. Lancet 370:1146–1152CrossRefPubMedGoogle Scholar
  9. 9.
    Burns T, Catty J, White S, Becker T, Fioritti A, Koletsi M, Rössler W, Tomov T, van Busschbach J, Wiersma D, Lauber C, for the EOQLISE Group (2008) The impact of supported employment and working on clinical and social functioning: results of an international study of individual placement and support. Schizophr Bull [online publication 21 April 2008]Google Scholar
  10. 10.
    Catty J, Lissouba P, White S, Becker T, Drake RE, Fioritti A, Knapp M, Lauber C, Rössler W, Tomov T, van Busschbach J, Wiersma D, Burns T, for the EQOLISE Group (2008) Predictors of employment and IPS effectiveness for people with severe mental illness: results of an international six-centre RCT. Br J Psychiatry 192:224–231CrossRefPubMedGoogle Scholar
  11. 11.
    Drake RE, Bond GR (2008) The future of supported employment for people with severe mental illness. Psychiatr Rehabil J 31:367–376CrossRefPubMedGoogle Scholar
  12. 12.
    Dunn EC, Wewiorski NJ, Rogers ES (2008) The meaning and importance of employment to people in recovery from serious mental illness: results of a qualitative study. Psychiatr Rehabil J 32:59–62CrossRefPubMedGoogle Scholar
  13. 13.
    Ellison ML, Russonova Z, MacDonald-Wilson KL, Lyass A (2003) Patterns and correlates of workplace disclosure among professionals and managers with psychiatric conditions. J Vocat Rehabil 18:3–13Google Scholar
  14. 14.
    Honey A (2004) Benefits and drawback of employment: perspectives of people with mental illness. Qual Health Res 14:381–395CrossRefPubMedGoogle Scholar
  15. 15.
    Lindner JR (1998) Understanding employee motivation. J Ext 36:3Google Scholar
  16. 16.
    Marrone J, Balzell A, Gold M (1995) Employment supports for people with mental illness. Psychiatr Serv 46:707–711PubMedGoogle Scholar
  17. 17.
    Marwaha S, Johnson S (2004) Schizophrenia and employment: a review. Soc Psychiatry Psychiatr Epidemiol 39:337–349CrossRefPubMedGoogle Scholar
  18. 18.
    Marwaha S, Johnson S (2005) Views and experiences of employment among people with psychosis: a qualitative descriptive study. Int J Soc Psychiatry 51:302–316CrossRefPubMedGoogle Scholar
  19. 19.
    Mueser KT, Becker DR, Wolfe R (2001) Supported Employment, job preferences, job tenure and satisfaction. J Ment Health 10:411–417CrossRefGoogle Scholar
  20. 20.
    Priebe S, Warner R, Hubschmids T, Eckle I (1998) Employment, attitudes towards work and quality of life among people with schizophrenia in three countries. Schizophr Bull 24:469–477PubMedGoogle Scholar
  21. 21.
    Provencher HL, Gregg R, Mead S, Mueser KT (2002) The role of work in the recovery of persons with psychiatric disabilities. Psychiatr Rehabil J 26(2):132–144CrossRefPubMedGoogle Scholar
  22. 22.
    Reinhinghaus UA, Morgan C, Simpson J, Dazzan P, Morgan K, Doody DA, Bhugra D, Leff J, Jones P, Murray R, Fearon P, Craig TKJ (2008) Unemployment, social isolation, achievement-expectation mismatch and psychosis: findings from the AESOP study. Soc Psychiatry Psychiatr Epidemiol 43:743–751CrossRefGoogle Scholar
  23. 23.
    Rüesch P, Graf J, Meyer PC, Rössler W, Hell D (2004) Occupation, social support and quality of life in persons with schizophrenic or affective disorders. Soc Psychiatry Psychiatr Epidemiol 39:686–694CrossRefPubMedGoogle Scholar
  24. 24.
    Salyers MP, Becker DR, Drake RE, William TC, Wyzik PF (2004) A ten year follow-up of a supported employment program. Psychiatr Serv 55:302–308CrossRefPubMedGoogle Scholar
  25. 25.
    Strickler DC, Whitley R, Becker DR, Drake RE (2009) First person accounts of long-term employment activity among people with dual diagnosis. Psychiatr Rehabil J (in press)Google Scholar
  26. 26.
    Tsang HWH, Angell B, Corrigan PW, Lee Y-T, Shi K, Lam CS, Jin S, Fung KMT (2007) A cross-cultural study of employers’ concerns about hiring people with psychotic disorder: implications for recovery. Soc Psychiatry Psychiatr Epidemiol 42:723–733CrossRefPubMedGoogle Scholar
  27. 27.
    Van Dongen CJ (1996) Quality of life and self esteem in working and non-working persons with mental illness. Community Ment Health J 32:535–548CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Marsha Koletsi
    • 1
  • Astrid Niersman
    • 2
  • Jooske T. van Busschbach
    • 2
  • Jocelyn Catty
    • 1
  • Thomas Becker
    • 3
  • Tom Burns
    • 4
  • Angelo Fioritti
    • 5
  • Rana Kalkan
    • 3
  • Christoph Lauber
    • 6
  • Wulf Rössler
    • 6
  • Toma Tomov
    • 7
  • Durk Wiersma
    • 2
  • for the EQOLISE Group
  1. 1.Division of Mental HealthSt. George’s, University of LondonLondonUK
  2. 2.University Medical Centre, University of GroningenGroningenThe Netherlands
  3. 3.Department of Psychiatry IIUniversity of Ulm, BKH GunzburgGunzburgGermany
  4. 4.University Department of Psychiatry, Warneford HospitalOxfordUK
  5. 5.Programma Salute Mentale, Azienda USL RiminiRiminiItaly
  6. 6.Psychiatric University HospitalUniversity of LiverpoolZurichSwitzerland
  7. 7.Bulgarian Institute of Human RelationsSofiaBulgaria

Personalised recommendations