Stigma and discrimination against people with mental illness have a negative impact on their vocational integration. The rates of their labor force participation worldwide are still low. The reason for this, from the perspective of employers, is their reluctance to employ them due to a number of fears and concerns.
OBJECTIVE:
This review examines the literature of the last 25 years on the employment of people with mental illness to identify employers’ benefits from their employment and to provide recommendations for occupational therapists.
FINDINGS:
The importance of employing individuals with mental illness is emphasized. This review identifies a research gap on the benefits of their employment from the perspective of employers, and presents the findings of studies that explore the benefits of employing individuals with disabilities.
CONCLUSIONS:
Information and greater awareness are pointed out to be the major ways of improving the employment rates of people with mental illness. The proposed challenge for occupational therapists is to demonstrate the effectiveness of their employment to all interested parties. Future research should focus on the economic impact of mental illnesses and on the outcomes of employing individuals with mental illness from the perspective of employers.
Almond, S., &
Healey, A. (2003). Mental health and absence from work: New evidence form the UK quarterly labour force survey. Work, Employment and Society, 17(4), 731–472.
2.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.
3.
BaraM. A. (2015). Employment of persons with disabilities. Procedia – Social and Behavioral Sciences, 191, 979–983.
4.
Baron, C., &
Salzer, M. S. (2002). Accounting for unemployment among people with mental illness. Behavioral Science and the Law, 20(6), 585–599.
5.
Becker, D. R., &
Drake, R. E. (2003). A working life for people with severe mental illness. New York NY. Oxford University Press.
6.
Bejerholm, U. (2010). Occupational balance in people with schizophrenia. Occupational Therapy in Mental Health, 26(1), 1–17.
7.
Bejerholm, U.,
Areberg, C.,
Hofgren, C.,
Sandlund, M., &
Rinaldi, M. (2015). Individual placement and support in Sweden-A randomised controlled trial. Nordic Journal of Psychiatry, 69(5), 57–66.
8.
Biggs, D.,
Hovey, N.,
Tyson, P. J., &
MacDonald, S. (2010). Employer and employment agency attitudes towards employing individuals with mental health needs. Journal of Mental Health, 19(6), 509–516.
9.
Blank, A. A.,
Harries, P., &
Reynolds, F. (2014). ’Without occupation you don’t exist’: Occupational engagement and mental illness. Journal of Occupational Science, 22(2), 197–209.
10.
Boardman, J. (2003). Work, employment and psychiatric disability. Advances in Psychiatric Treatment, 9(5), 327–334.
11.
Bond, G. R.,
Drake, R. E., &
Becker, D. R. (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31(4), 280–290.
12.
Bond, G. R.,
Drake, R. E., &
Campbell, K. (2014). Effectiveness of individual placement and support supported employment for young adults. Early intervention in Psychiatry, 10(4), 300–307.
13.
Bond, G. R.,
Salyers, M. P.,
Dincin, J.,
Drake, R. E.,
Becker, D. R.,
Fraser, V. F., &
Haines, M. (2007). A randomized controlled trial comparing two vocational models for persons with severe mental illness. Journal of Counseling and Clinical Psychology, 75(6), 968–982.
14.
Boyer, G.,
Hachey, R., &
Mercier, C. (2000). Perceptions of occupational performance and subjective quality of life in persons with severe mental illness. Occupational Therapy in Mental Health, 15(2), 1–15.
15.
Brohan, E.,
Henderson, C.,
Wheat, K., …, &
Thornicroft, G. (2012). Systematic review of beliefs, behours and influencing factors associated with disclosure of a mental health problem in the workplace. BMC Psychiatry, 12(11). Retrieved from http://www.biomedcentral.com/1471-244X/12/11.
16.
Brouwers, E. P. M.,
Mathijssen, J.,
Van BortelT.,
Knifton, L.,
Wahlbeck, K., &
Van AudenhoveC. (2016). Discrimination in the workplace, reported by people with major depressive disorder: A cross-sectional study in 35 countries. BMJ Open, 6 doi: 10.1136/bmjopen-2015-009961.
17.
Brown, T. A., &
Barlow, D. H. (2005). Dimensional versus categorical classification of mental disorders in the fifth edition of the diagnostic and statistical manual of mental disorders and beyond: Comment on the special section. Journal of Abnormal Psychology, 114(4), 551–556.
18.
Burke-Miller, J. K.,
Cook, J. A.,
Grey, D. D.,
Razzano, L. A.,
Blyler, C. R.,
Leff., H.S.,
… & Carey, M.A. (2006). Demographic characteristics and employment among people with severe mental illness in a multisite study. Community Mental Health Journal, 42(2), 143–159.
19.
Burns, T.,
White, S. J., &
Catty, J. (2008). Individual Placement and Support in Europe: The EQOLISE trial. International Review of Psychiatry, 20(6), 498–502.
20.
Chi, C. G.-Q., &
Qu, H. (2003). Integrating persons with disabilities into the work force. International Journal of Hospitality & Tourism Administration, 4(4), 59–83.
21.
Cimera, R. E. (2009). The monetary benefits and costs of hiring supported employees: A pilot study. Journal of Vocational Rehabilitation, 30(2), 111–119.
22.
Contreras, N.,
Rossell, S. L.,
Castle, D. J.,
Fossey, E.,
Morgan, D.,
Crosse, C., &
Harvey, C. (2012). Enhancing work-focused supports for People with severe mental illnesses in Australia. Rehabilitation Research and Practice. ID, 863203, doi: 10.1155/2012/863203.
23.
Corrigan, P. W. (2004). Target: Specific stigma change: A strategy for impacting mental illness stigma. Psychiatric Rehabilitation Journal, 28(2), 113–121.
24.
Corrigan, P. W.,
Kerr, A., &
Knudsen, L. (2005). The stigma of mental illness: Explanatory models and methods for change. Applied and preventive Psychology, 11, 179–190.
25.
Corrigan, P. W.,
Morris, S. B.,
Michaels, P. J.,
Rafacz, J. D., &
Rüsch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63(10), 963–973.
26.
Crisp, A. H.,
Gelder, M. G.,
Rix, S.,
Meltzer, H. I., &
Rowlands, O. J. (2000). Stigmatisation of people with mental illnesses. The British Journal of Psychiatry, 177(1), 4–7.
27.
Diksa, E., &
Rogers, S. E. (1996). Employer concerns about hiring persons with psychiatric disability: Results of the employer attitude questionnaire. Rehabilitation Counseling Bulletin, 40(1), 31–44.
28.
Drake, R. E., &
Bond, G. R. (2008). The future of supported employment for people with severe mental illness. Psychiatric Rehabilitation Journal, 31(4), 367–376.
29.
Falkum, E.,
KlungsøyrO.,
Lystad, J. U.,
Bull, H. C.,
Evensen, S.,
Martinsen, E. W., …, &
UelandT. (2017). Vocational rehabilitation for adults with psychotic disorders in a Scandinan welfare society. BMC Psychiatry, 17(24), doi: 10.1186/s12888-016-1183-0.
30.
Fioritti, A.,
Burns, T.,
Hilarion, P.,
van WeeghelJ.,
Cappa, C., &
Suñol, R. (2014). Individual placement and support in Europe. Psychiatric Rehabilitation Journal, 37(2), 123–128.
31.
French, M. T., &
Zarkin, G. A. (1998). Mental health, absenteeism and earnings at a large manufacturing worksite. Journal of Mental Health Policy and Economics, 1(4), 161–172.
32.
Gewurtz, R. E.,
Cott, C.,
Rush, B., &
Kirsh, B. (2014). The shift to rapid job placement for people living with mental illness: An analysis of consequences. Psychiatric Rehabilitation Journal, 35(6), 428–434.
33.
Goldberg, R. W.,
Hackman, A.,
Medoff, D. R.,
Brown, C.,
FangL.,
Dickerson, F., …, &,
DixonL. (2008). Physical wellness and employment status among adults with serious mental illness. Community Mental Health Journal, 44(4), 245–251.
34.
Graffam, J.,
Smith, K.,
Shinkfield, A., &
Polzin, U. (2002). Employer benefits and costs of employing a person with a disability. Journal of Vocational Rehabilitation, 17(4), 251–263.
35.
Halliday, G.,
Coveney, J.,
Henderson, J., &
Dip, G. (2014). An exploration of professional careers and living with a mental illness. Journal of Occupational Science, 22(4), 446–458.
36.
HandC. &,
TryssenaarJ. (2006). Small business employers’ views on hiring individuals with mental illness. Psychiatric Rehabilitation Journal, 29(3), 166–173.
37.
Hartnett, H. P.,
Stuart, H.,
Thurman, H.,
Loy, B., &
Batiste, L. C. (2011). Employers’ perceptions of the benefits of workplace accommodations: Reasons to hire, retain and promote people with disabilities. Journal of Vocational Rehabilitation, 34(1), 17–23.
38.
Harvey, S. B., &
Henderson, M. (2009). Occupational Psychiatry. Psychiatry, 8(5), 174–178.
39.
Hernandez, B.,
Keys, C., &
Balcazar, F. (2000). Employer attitudes toward workers with disabilities and their ADA employment rights: A literature review. Journal of Rehabilitation, 66(4), 4–16.
40.
Hernandez, B., &
McDonald, K. (2010). Exploring the costs and benefits of workers with disabilities. Journal of Rehabilitation, 76(3), 15–23.
41.
Houtenville, A., &
Kalargyrou, V. (2012). People with disabilities: Employers’ Perspectives on Recruitment Practices, Strategies, and Challenges in Leisure and Hospitality. Human Resource Management, 53(1), 40–52.
42.
Jones, A. M. (2011). Disclosure of mental illness in the workplace: A literature review. American Journal of Psychiatric Rehabilitation, 14(3), 212–229.
43.
Knapp, M. (2003). Hidden costs of mental illness. British Journal of Psychiatry, 183, 477–478.
44.
Knapp, M.,
Patel, A.Curran, C.,
Latimer, E.,
Catty, J.,
Becker, T., … &
Burns, T. (2013). Supported employment: Cost-effectiveness across six European sites. World Psychiatry, 12(1), 60–68.
45.
Krupa, T.,
Kirsh, B.,
Cockburn, L., &
Gewurtz, R. (2009). Understanding the stigma of mental illness in employment. Work, 33(4), 413–425.
46.
Luciano, A., &
Meara, E. (2014). The employment status of people with mental illness: National survey data from 2009 and 2010. Psychiatric Services, 65(10), (1201–1209.
47.
Luciano, A.,
Drake, R. E.,
Bond, G. R.,
Becker, D. R.,
Carpenter-Song, E.,
Lord, S., … &
Swanson, S. J. (2014). Evidence-based supported employment for people with severe mental illness: Past, current, and future research. Journal of Vocational Rehabilitation, 40(1), 1–13.
48.
Marwaha, S.,
Johnson, S.,
Bebbington, P.,
Stafford, M.,
Angermeyer, M. C.,
Brugh, T., … &
Toumi, M. (2007). Rates and correlates of employment in people with schizophrenia in the UK, France and Germany. British Journal of Psychiatry, 191, 30–37.
49.
MacDonald-Wilson, K. L.,
Rogers, E. S.,
Massaro, J. M.,
Lyass, A., &
Crean, T. (2002). An investigation of reasonable workplace accommodations for people with psychiatric disabilities: Quantitative findings from a multi-site study. Community Mental Health Journal, 38(1), 35–50.
50.
McHugo, G. J.,
Drake, R. E.,
Xie, H., &
Bond, G. R. (2012). A 10-year study of steady employment and non-vocational outcomes among people with serious mental illness and co-occurring substance use disorders. Schizophrenia Research, 138(2-3), 233–239.
51.
Mechanic, D.,
Bilder, S., &
McAlpine, D. D. (2002). Employing persons with serious mental illness. Health affairs, 21(5), 242–253.
52.
Modini, M.,
Tan, L.,
Brinchmann, B.,
Wang, M-J.,
Killackey, E.,
Glozier, N., … &
Harvey, S. B. (2016). Supported employment for people with severe mental illness: Systematic review and meta-analysis of the international evidence. The British Journal of Psychiatry, 209(1), 14–22.
53.
Morgan, R., &
Alexander, M. (2005). The employer’s perception: Employment of individuals with developmental disabilities. Journal of Vocational Rehabilitation, 23(1), 39–49.
54.
Morrison, A.,
Burke, E.,
Murphy, E.,
Pyle, M.,
Bowe, S.,
Varese, …, &
Wood, L. (2016). Cognitive therapy for internalised stigma in people experiencing psychosis: A pilot randomised controlled trial. Psychiatry Research, 30(240), 96–102.
55.
Mueser, K. T.,
Becker, D. R., &
Wolfe, R. (2001). Supported employment, job preferences, and job tenure and satisfaction. Journal of Mental Health, 10(4), 411–417.
56.
Mueser, K. T., &
Cook, J. A. (2012). Supported employment, supported education, and career development. Psychiatric Rehabilitation Journal, 35(6), 417–420.
57.
Mueser, K. T.,
Drake, R. E., &
Bond, G. R. (2016). Recent advances in supported employment for people with serious mental illness. Current Opinion in Psychiatry, 29(3), 196–201.
58.
Nota, L.,
Santilli, S.,
Ginerva, M. C., &
Soresi, S. (2014). Employer Attitudes towards the work inclusion of people with disability. Journal of Applied Research in Intellectual Disabilities, 27(6), 511–520.
59.
O’Day, B.,
Kleinman, R.,
Fischer, B.,
Morris, E., &
Blyler, C. (2017). Preventing unemployment and disability benefit receipt among people with mental illness: Evidence review and policy significance. Psychiatric Rehabilitation Journal. 10.1037/prj0000253.
60.
Perkins, R., &
Rinaldi, M. (2002). Unemployment rates among patients with long-term mental health problems. Psychiatric Bulletin, 26(8), 295–298.
61.
Reavley, N. J.,
Mackinnon, A. J.,
Morgan, A. J., &
Jorm, A. F. (2014). Stigmatising attitudes towards people with mental disorders: A comparison of Australian health professionals with the general community. Australian & New Zealand Journal of Psychiatry, 48(5), 433–441.
62.
Rogers, J. (1995). “Work is key to recovery,”Psychosocial Rehabilitation Journal, 18(4), 5–10.
63.
Rosenheck, R.,
Leslie, D.,
Keefe, R.,
McEvoy, J.,
Swartz, M.,
Perkins, D., …, &CATIE Study Investigators Group. (2006). Barriers to employment for people with schizophrenia. American Journal of Psychiatry, 163(3), 411–417.
64.
Scheid, T. L. (2005). Stigma as a barrier to employment: Mental disability and the Americans with Disabilities Act. International Journal of Law and Psychiatry, 28(6), 670–690.
65.
Secker, J.,
Grove, B., &
Seebohm, B. (2001). Challenging barriers to employment, training and education for mental health service users: The service user’s perspective. Journal of Mental Health, 10(4), 395–404.
66.
Shankar, J.,
Liu, L.,
Nicholas, D.,
Warren, S.,
Lai, D.,
Tan, S., …, &
Sears, A. (2014). Employers’ perspectives on hiring and accommodating workers with mental illness. SAGE Open. doi: 10.1177/2158244014547880
67.
Sharac, J.,
Mccrone, P.,
Clement, S., &
Thornicroft, G. (2010). The economic impact of mental health stigma and discrimination: A systematic review. Epidemiologia e Psichiatria Sociale, 19(3), 223–232.
68.
Siperstein, G. N.,
Romano, N.,
Mohler, A., &
Parker, R. (2006). A national survey of consumer attitudes towards companies that hire people with disabilities. Journal of Vocational Rehabilitation, 24(1), 3–9.
69.
Thomas, C. M., &
Morris, S. (2003). Cost of depression among adults in England in. British Journal of Psychiatry, 183(6), 514–519.
70.
Toth, K. E., &
Dewa, C. S. (2014). Employee decision-making about disclosure of a mental disorder at work. Journal of Occupational Rehabilitation, 24(4), 732–746.
71.
Tsang, H. W. H.,
Chan, A.,
Wong, A., &
LibermanR. P. (2009). Vocational outcomes of an integrated supported employment program for individuals with persistent and severe mental illness. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 292–305.
72.
Waghorn, G., &
Chant, D. (2002). Clinical and non-clinical predictors of vocational recovery for Australians with psychotic disorders. Journal of Rehabilitation, 68(4), 40–51.
73.
Waghorn, G., &
Lloyd, C. (2005). The employment of people with mental illness. Australian e-Journal for the Advancement of Mental Health, 4(2), 129–171.
74.
Waghorn, G.,
Saha, S.,
Harvey, C., …, &
McGrath, J. J. (2012). Earning and learning’ in those with psychotic disorders: The second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry, 46(8), 774–785.
75.
Waynor, W. R.,
Gill, K. J., &
Gao, N. (2016). The role of work related self-efficacy in supported employment for people living with serious mental illnesses. Psychiatric Rehabilitation Journal, 39(1), 62–67.
76.
Wehman, P. H. (2011). Employment for persons with disabilities: Where are we now and where do we need to go?Journal of Vocational Rehabilitation, 35(3), 145–151.
77.
Wehman, P.,
Chan, F.,
Ditshman, N., &
Kang, H-J. (2014). Effects of supported employment on vocational rehabilitation outcomes of transition-age youth with intellectual and developmental disabilities: A case control study. Intellectual and Developmental Disabilities, 52(4), 296–310.
78.
Wood, L.,
Byrne, R.,
Varese, F., &
Morrison, A. P. (2016). Phychosocial interventions for internalised stigma in people with a schizophrenia-diagnosis: A systematic narrative synthesis and meta-analysis. Schizophrenia Research, 10.1016/j.schres.2016.05.001
