Young people with psychiatric disabilities are particularly disadvantaged when it comes to participating in vocational training or higher education or to seeking and maintaining employment. A review of the literature reveals that this is due to a number of factors, including low expectations by health professionals, stigma and discrimination, symptomatology and the lack of a clear responsibility for promoting vocational and social outcomes. A useful approach for occupational therapists to use is a recovery framework combining evidence-based employment and educational assistance with mental health care, provided in parallel with brief vocational counselling, illness management skills, training in stigma countering and disclosure strategies, context-specific social skills and skills in social network development.
It is concluded that there is an urgent need to link evidence-based vocational practices with quality mental health care, in order to restore hope among young people of ever realising their vocational goals and once again feeling included as valued members of society.
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References
1.
AndresenROadesLCaputiP (2003) The experience of recovery from schizophrenia: Towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry, 37, 586–94.
2.
AnthonyWA (1994) Characteristics of people with psychiatric disabilities that are predictive of entry into the rehabilitation process and successful employment. Psychosocial Rehabilitation Journal, 17, 3–13.
3.
Australian Bureau of Statistics (1999) Survey of disability, ageing, and carers, Australia. Technical paper. Confidentialised unit record file1998. Canberra: Commonwealth Government.
4.
BeckerDDrakeRFarabaughABondG (1996) Job preference of clients with severe mental disorders participating in supported employment programs. Psychiatric Services, 47, 1223–26.
5.
BlackWLivingR (2004) Volunteerism as an occupation and its relationship to health and wellbeing. British Journal of Occupational Therapy, 67(12), 526–32.
6.
BlankertzRRobinsonS (1996) Adding a vocational focus to mental health rehabilitation. Psychiatric Services, 47, 1216–22.
7.
BoardmanJGroveBPerkinsRShepherdG (2003) Work and employment for people with psychiatric disabilities. British Journal of Psychiatry, 182, 467–68.
8.
BondG (2004) Supported employment: Evidence for an evidence-based practice. Psychiatric Rehabilitation Journal, 27, 345–59.
9.
BondGSalyersMRollinsARappCZippleA (2004) How evidence-based practices contribute to community integration. Community Mental Health Journal, 40, 569–88.
10.
CaltruaxD (2003) Internalised stigma: A barrier to employment for people with mental illness. International Journal of Therapy and Rehabilitation, 10, 539–43.
11.
CasperEOurslerJSchmidtLGillK (2002) Measuring practitioners' beliefs, goals, and practices in psychiatric rehabilitation. Psychiatric Rehabilitation Journal, 23, 223–34.
12.
CorriganPW (2003) Beat the stigma: Come out of the closet. Psychiatric Services, 54, 1313.
13.
CorriganPWWatsonAC (2002) The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9, 35–53.
14.
DavisCMartinGKoskyRO'HanlonA (2000) Early intervention in the mental health of young people. Adelaide: Australian Early Intervention Network for Mental Health in Young People.
15.
DavisMRinaldiM (2004) Using an evidence-based approach to enable people with mental health problems to gain and retain employment, education and voluntary work. British Journal of Occupational Therapy, 67(7), 319–22.
16.
EPPIC (2001) Case management in early psychosis: A handbook. Melbourne: EPPIC.
17.
GoldJMGoldbergRWMcNarySWDixonLBLehmanAF (2002) Cognitive correlates of job tenure among patients with severe mental illness. American Journal of Psychiatry, 159, 1395–402.
18.
GouldADeSouzaSRebeiro-GruhlKL (2005) And then I lost that life: A shared narrative of four young men with schizophrenia. British Journal of Occupational Therapy, 68(10), 467–73.
HarnoisGGabrielP (2000) Mental health and work: Impact, issues and good practices. Geneva: World Health Organization and International Labour Organisation.
21.
HeasmanDAtwalA (2004) The Active Advice pilot project: Leisure enhancement and social inclusion for people with severe mental health problems. British Journal of Occupational Therapy, 67(11), 511–14.
22.
JablenskyAMcGrathJHerrmanHCastleDGurejeOMorganVKortenA (1999) National survey of mental health and wellbeing. Report 5. People living with psychotic illness: An Australian study. Canberra: Mental Health branch, Commonwealth Department of Health and Aged Care.
23.
KingRWaghornGLloydCMcLeodPMcMahTLeongC (2006) Enhancing employment services for people with severe mental illness: The challenge of the Australian service environment. Australian and New Zealand Journal of Psychiatry, 40, 471–77.
24.
LewisR (2004) Should cognitive deficit be a diagnostic criterion for schizophrenia?Journal of Psychiatry Neuroscience, 29, 102–13.
25.
LibermanRPKopelowiczAVenturaJGutkindD (2002) Operational criteria and factors related to recovery from schizophrenia. International Review of Psychiatry, 14, 256–72.
26.
LloydCWilliamsPLSullivanD (2004) Kick'n'On: Helping young males kick back into life. Australian e-Journal for the Advancement of Mental Health, 3(2).
27.
MacDonald-WilsonKRogersESMassaroJ (2003) Identifying relationships between functional limitations, job accommodations, and demographic characteristics of persons with psychiatric disabilities. Journal of Vocational Rehabilitation, 18, 15–24.
28.
MairsHBradshawT (2004) Life skills training in schizophrenia. British Journal of Occupational Therapy, 67(5), 217–24.
29.
MallickKReevesRDellarioD (1998) Barriers to community integration for people with severe and persistent disabilities. Psychiatric Rehabilitation Journal, 22, 175–80.
30.
MaslowAH (1943) A theory of human motivation. Psychological Review, 50, 370–96.
31.
McGurkSRMueserKT (2003) Cognitive functioning and employment in severe mental illness. Journal of Nervous and Mental Disease, 191, 789–98.
32.
McGurkSRMueserKTHarveyPDLa PugliaRMarderJ (2003) Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment. Psychiatric Services, 54, 1129–35.
33.
MorrowLVerinsIWillisE (2002) Mental health and work issues and perspectives. Adelaide: Auseinet: Australian Network for Promotion, Prevention and Early Intervention for Mental Health. MowbrayCMegivernD (1999) Higher education and rehabilitation for people with psychiatric disabilities. Journal of Rehabilitation, 65, 31–38.
34.
MowbrayCCollinsMBybeeD (1999) Supported education for individuals with psychiatric disabilities: Long-term outcomes from an experimental study. Social Work Research, 23, 89–100.
35.
MowbrayCBybeeDCollinsM (2001) Follow-up client satisfaction in a supported education program. Psychiatric Rehabilitation Journal, 24, 237–47.
36.
MueserKTBeckerDRWolfeRS (2001) Supported employment, job preferences, job tenure and satisfaction. Journal of Mental Health, 10, 411–17.
37.
National Early Psychosis Project Clinical Guidelines Working Party (1998) Australian clinical guidelines for early psychosis. Melbourne: National Early Psychosis Project, University of Melbourne.
38.
Office of the Deputy Prime Minister (2004) Mental health and social exclusion. Wetherby: ODPM Publications.
39.
ProvencherHGreggRMeadSMueserK (2002) The role of work in the recovery of persons with psychiatric disabilities. Psychiatric Rehabilitation Journal, 26, 132–44.
40.
ResnickSRosenheckRLehmanA (2004) An exploratory analysis of correlates of recovery. Psychiatric Services, 55, 540–47.
41.
RickwoodD (2004) Pathways of recovery: Preventing relapse. Canberra: Department of Health and Ageing.
42.
RobdaleN (2004) Vocational rehabilitation: The Enable Employment Retention Scheme, a new approach. British Journal of Occupational Therapy, 67(10), 457–60.
43.
RoderVZornPMullerDBrennerH (2001) Improving recreational, residential, and vocational outcomes for patients with schizophrenia. Psychiatric Services, 52, 1439–41.
44.
RutmanID (1994) How psychiatric disability expresses itself as a barrier to employment. Psychosocial Rehabilitation Journal, 17, 15–35.
45.
ShankarJ (2005) Improving job tenure for people with psychiatric disabilities through on-going employment support. Australian e-Journal for the Advancement of Mental Health, 4(1).
46.
ShankarJCollyerF (2003) Vocational rehabilitation of people with mental illness: The need for a broader approach. Australian e-Journal for the Advancement of Mental Health2(2).
47.
TsangHWH (2001) Applying social skills training in the context of vocational rehabilitation for people with schizophrenia. Journal of Nervous and Mental Disease, 189, 90–98.
48.
TsangWHPearsonV (1996) A conceptual framework for work-related social skills in psychiatric rehabilitation. Journal of Rehabilitation, 62, 61–67.
49.
TsangHLamPNgBLeungO (2000) Predictors of employment outcome for people with psychiatric disabilities: A review of the literature since the mid-80s. Journal of Rehabilitation, 66, 19–31.
50.
VauthRRuschNWirtzMCorriganPW (2004) Does social cognition influence the relation between neurocognitive deficits and vocational functioning in schizophrenia?Psychiatry Research, 128, 155–65.
51.
WaghornGChantD (2005) Labour force activity by people with depression and anxiety disorders: A population level second order analysis. Acta Psychiatrica Scandinavica, 112, 415–24.
52.
WaghornGLewisS (2002) Disclosure of psychiatric disabilities in vocational rehabilitation. Australian Journal of Rehabilitation Counselling, 8, 67–80.
53.
WaghornGLloydC (2005) The employment of people with a mental illness. Australian e-Journal for the Advancement of Mental Health, 4(2) (supplement).
54.
WaghornGChantDWhitefordH (2002) Clinical and non-clinical predictors of vocational recovery for Australians with psychotic disorders. Journal of Rehabilitation, 68, 40–51.
55.
WaghornGChantDWhitefordH (2003) The strength of self-reported course of illness in predicting vocational recovery for persons with schizophrenia. Journal of Vocational Rehabilitation, 18, 33–41.
56.
WaghornGChantDWhitePWhitefordH (2004a) Delineating disability, labour force participation and employment restrictions among persons with psychosis. Acta Psychiatrica Scandinavica, 109, 279–88.
57.
WaghornGStillMChantDWhitefordH (2004b) Specialised supported education for Australians with psychotic disorders. Australian Journal of Social Issues, 39, 443–58.
58.
WaghornGChantDKingR (2005a) Work-related subjective experiences among community residents with schizophrenia or schizoaffective disorder. Australian and New Zealand Journal of Psychiatry, 39, 88–99.
59.
WaghornGChantDKingR (2005b) Work-related self-efficacy among community residents with psychiatric disabilities. Psychiatric Rehabilitation Journal, 29(2), 105–13.
60.
WaghornGChantDJaegerJ (in press–a) Employment functioning among community residents with bipolar affective disorder: Results from an Australian community survey. Bipolar Disorders.
61.
WaghornGChantDKingR (in press–b) Classifying socially-valued role functioning among community residents with psychiatric disorders. American Journal of Psychiatric Rehabilitation.
62.
WhitcherKTseS (2004) Counselling skills in occupational therapy: A grounded theory approach to explain use within mental health in New Zealand. British Journal of Occupational Therapy, 67(8), 361–68.
63.
World Health Organization (2001) The World Health Report: 2001: Mental health: New understanding, new hope. Geneva:WHO.
64.
XieHDainBJBeckerDRDrakeRE (1997) Job tenure among people with severe mental illness. Rehabilitation Counseling Bulletin, 40, 230–39.
