Restricted accessResearch articleFirst published online 2025-4
“The more we dive into life,the more this illness fades away and gets better”: A qualitative study on the competitive work experiences of people with serious mental illness (SMI)
Employment is widely recognized for its crucial role in fostering recovery, promoting wellness, and facilitating community integration among individuals diagnosed with serious mental illness (SMI), despite facing inherent challenges. However, there exists a notable gap in comprehending the nuanced experiences of individuals with SMI engaged in long-term competitive employment.
Objective
This study sought to explore the long-term working journeys and narratives of recovery among individuals with SMI.
Methods
Qualitative interviews conducted from August to October 2022 employed a phenomenological method, delving into the experiences of 8 participants to explore their interpretations and constructions of workplace encounters.
Results
Following the Interpretative Phenomenological Analysis (IPA), four overarching themes emerged: (1) personal recovery through employment, (2) navigating challenges related to employment, (3) developing future plans and objectives, and (4) suggestions for peers.
Conclusion
Based on the analysis, regular engagement in competitive employment emerges as a crucial component in the journey of recovery for individuals with SMI. The personal accounts of individuals underscore the significance of fostering a supportive environment to enable individuals with SMI to pursue and maintain employment opportunities. Moreover, the study shows that work plays a pivotal role in facilitating social inclusion, productivity, and enhanced social connections for individuals with SMI within society.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th ed. Washington, DC: American Psychiatric Publishing, 2013.
2.
ChapleauA. Schizophrenia and other psychotic disorders. In: AtkisonBDiretteD (eds) Conditions in OT-effect on occupational performance. Lippincott Williams & Wilkins, 2012, pp.69–78.
3.
DrakeREWhitleyR. Recovery and severe mental illness: description and analysis. Can J Psychiatry2014; 59: 236–242.
4.
WaghornGLloydC. Employment and people with mental illness. In: LloydC (ed) Vocational rehabilitation and mental health. Blackwell Publishing Ltd, 2010, pp.1–18.
5.
HielscherEWaghornG. Self-stigma and fears of employment among adults with psychiatric disabilities. Br J Occup Ther2017; 80: 1–8.
6.
ArbesmanMLogsdonDW. Occupational therapy interventions for employment and education for adults with serious mental illness: a systematic review. Am J Occup Ther2011; 65: 238–246.
7.
BlankAAHarriesPReynoldsF. Without occupation you don’t exist’: occupational engagement and mental illness. J Occup Sci2015; 22: 197–209.
8.
De PinhoLMGPereiraAMSChavesCMCB,et al.Quality of life scale and symptomatology of schizophrenic patients- a systematic review. Eur J Psychiatry2018; 32: 1–10.
9.
LeufstadiusCErlandssonLEklundM. Time use and daily activities in people with persistent mental illness. Occup Ther Int2006; 13: 123–141.
10.
IannelliSWildingC. Health-enhancing effects of engaging in productive occupations: experiences of young people with mental illness. Aust Occup Ther J2007; 54: 285–293.
11.
CookJARazzanoL. Vocational rehabilitation for persons with schizophrenia: recent research and implications for practice. Schizophr Bull2000; 26: 87–103.
12.
DunnECWewiorskiNJRogersES. The meaning and importance of employment to people in recovery from serious mental illness: results of a qualitative study. Psychiatr Rehabil J2008; 32: 59–62.
13.
LeufstadiusCEklundMErlandssonL-K. Meaningfulness in work: experiences among employed individuals with persistent mental illness. Work2009; 34: 21–32.
14.
ThomasTLMuliyalaKPJayarajanD, et al.Vocational challenges in severe mental illness: a qualitative study in persons with professional degrees. Asian J Psychiatr2019; 42: 48–54.
15.
GunnarssonABJanssonJÅEklundM. Is there any job for me? Qualitative exploration of support needs among young Swedish adults with psychosis envisioning productive activities. Work2023: 1–13.
16.
EklundMHanssonLAhlqvistC. The importance of work as compared to other forms of daily occupations for wellbeing and functioning among persons with long-term mental illness. Community Ment Health J2004; 40: 465–477.
17.
EklundM. Work status, daily activities and quality of life among people with severe mental illness. Qual Life Res2008; 18: 163–170.
18.
DoroudNFosseyEFortuneT. Recovery as an occupational journey: a scoping review exploring the links between occupational engagement and recovery for people with enduring mental health issues. Aust Occup Ther J2015; 62: 378–392.
19.
AndersenLNStochkendahlMJRoesslerKK. En route to flourishing-a longitudinal mixed methods study of long-term unemployed citizens in an interdisciplinary rehabilitation program. BMC Public Health2022; 22: 675.
20.
KirshB. Work, workers, and workplaces: a qualitative analysis of narratives of mental health consumers. J Rehabil2000; 66: 24–30.
21.
Gahnström-StrandqvistKLiukkoAThamK. The meaning of the working cooperative for persons with long-term mental illness: a phenomenological study. Am J Occup Ther2003; 57: 262–272.
22.
HusserlE. Logical investigation. New York, NY: Humanities Press, 1970.
23.
SchutzA. Phenomenology and the social sciences. In: NatansonM (ed.) Collected papers I: the problem of social reality. Dordrecht: Springer Netherlands, 1962, pp.118–139.
24.
BurawoyM. Reconstructing social theories. In: BurawoyMBurtonAArnett FergusonA, et al. (eds) Ethnography unbound: power and resistance in the modern metropolis. Berkeley: University of California Press, 1991, pp.8–27.
25.
FrankelJRWallenNE. How to design and evaluate research in education. 6th ed.New York NY: McGraw Hill, 2006.
26.
QueirósAFariaDAlmeidaF. Strengths and limitations of qualitative and quantitative research methods. Eur J Educ2017; 3: 369–387.
27.
PietkiewiczISmithJA. A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Psychol J2014; 20: 7–14.
28.
BiggerstaffDThompsonAR. Interpretative phenomenological analysis (IPA): a qualitative methodology of choice in healthcare research. Qual Res Psychol2008; 5: 214–224.
29.
SmithJAJarmanMOsborneM. Doing interpretative phenomenological analysis. In: MurrayMChamberlainK (eds) Qualitative health psychology: Theories and methods. London: Sage, 1999.
30.
RodhamKFoxFDoranN. Exploring analytical trustworthiness and the process of reaching consensus in interpretative phenomenological analysis: lost in transcription. Int J Soc Res Methodol2015; 18: 59–71.
31.
RolfeG. Validity, trustworthiness and rigour: quality and the idea of qualitative research. J Adv Nurs2006; 53: 304–310.
32.
YardleyL. Demonstrating validity in qualitative psychology. In: SmithJA (ed) Qualitative psychology: a practical guide to methods. 2nd ed.London: Sage, 2008, pp.235–251.
33.
AlaseA. The interpretative phenomenological analysis (IPA): a guide to a good qualitative research approach. IJELS2017; 5: 66–71.
34.
BrockiJMWeardenAJ. A critical evaluation of the use of interpretative phe- nomenological analysis (IPA) in health psychology. Psychol Health2006; 21: 87–108.
35.
AnthonyWA. Expanding the evidence base in an era of recovery. Psychiatr Rehabil J2003; 27: 1–2.
36.
DrakeREWallachMA. Employment is a critical mental health intervention. Epidemiol Psychiatr Sci2020; 29: e178.
37.
EklundMHanssonLBejerholmU. Relationship between satisfaction with occupational factors and health-related variables in schizophrenia outpatients. Soc Psychiatry Psychiatr Epidemiol2001; 36: 79–85.
38.
DamsgaardJBAngelS. Living a meaningful life while struggling with mental health: challenging aspects regarding personal recovery encountered in the mental health system. Int J Environ Res Public Health2021; 18: 2708.
39.
GoodsmithNCohenANPedersenER, et al.Predictors of functioning and recovery among men and women veterans with schizophrenia. Community Ment Health J2023; 59: 110–121.
40.
SolankiRKSinghPMidhaA,et al.Schizophrenia: impact on quality of life. Indian J Psychiatry2008; 50: 181.
41.
BerghöferAMartinLHenseS, et al.Quality of life in patients with severe mental illness: a cross-sectional survey in an integrated outpatient health care model. Qual Life Res2020; 29: 2073–2087.
42.
GunnmoPFatouros BergmanH. What do individuals with schizophrenia need to increase their well-being. Int J Qual Stud Health Well-Being2011; 6: 5412.
43.
MakdisiLBlankABryantW, et al.Facilitators and barriers to living with psychosis: an exploratory collaborative study of the perspectives of mental health service users. Br J Occup Ther2013; 76: 418–426.
44.
ChristiansenC. Occupation and identity: becoming who we are through what we do. In: ChristiansenCTownsendE (eds) Introduction to occupation: the art and science of living. Upper Saddle River, NJ: Pearson Education Inc, 2004, pp.121–139.
45.
ErolAÜnalEKAydinET,et al.Predictors of social functioning in schizophrenia. Turk J Psychiatry2009; 20: 1–8.
46.
EklundMTjörnstrandC. Psychiatric rehabilitation in community-based day centres: motivation and satisfaction. Scand J Occup2013; 20: 438–445.
47.
TurnerNFergusonLHillM, et al.An exploratory study of the extent of social inclusion among people with psychosis and psychotic-related conditions. Int J Soc Psychiatry2017; 63: 195–202.
48.
DavidsonL. Living outside mental illness: Qualitative studies of recovery in schizophrenia. NYU Press, 2003.
49.
BejerholmUEklundM. Occupational engagement in persons with schizophrenia: relationships to self-related variables, psychopathology, and quality of life. Am J Occup Ther2007; 61: 21–32.
50.
WoodLByrneRVareseF,et al.Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: a systematic narrative synthesis and meta-analysis. Schizophr Res2016; 176: 291–303.
51.
StrongSRebeiroK. Creating supportive work environments for people with mental illness. In: LettsLRigbyPStewartD (eds) Using environments to enable occupational performance. Thorofare NJ: Slack Inc., 2003, pp.197–206.
52.
JaiswalACarmichaelKGuptaS, et al.Essential elements that contribute to the recovery of persons with severe mental illness: a systematic scoping study. Front Psychiatry2020; 11: 586230.
