Many people confronting mental health problems are excluded from participation in paid work. Supervisor engagement is essential for successful job placement.
OBJECTIVE:
To elicit supervisor perspectives on the challenges involved in fostering integration to support individuals with mental health problems (trainees) in their job placement at ordinary companies.
METHODS:
Explorative, qualitative designed study with a phenomenological approach, based on semi-structured interviews with 15 supervisors involved in job placements for a total of 105 trainees (mean 7, min-max. 1–30, SD 8). Data were analysed using qualitative content analysis.
RESULTS:
Superviors experience two interrelated dilemmas concerning knowledge of the trainee and degree of preferential treatment. Challenges to obtaining successful integration were; motivational: 1) Supervisors previous experience with trainees encourages future engagement, 2) Developing a realistic picture of the situation, and 3) Disclosure and knowledge of mental health problems, and continuity challenges: 4) Sustaining trainee cooperation throughout the placement process, 5) Building and maintaining a good relationship between supervisor and trainee, and 6) Ensuring continuous cooperation with the social security system and other stakeholders.
CONCLUSIONS:
Supervisors experience relational dilemmas regarding pre-judgment, privacy and equality. Job placement seem to be maximized when the stakeholders are motivated and recognize that cooperation must be a continuous process.
KinnLG, HolgersenH, AasRW, DavidsonL. “Balancing on Skates on the Icy Surface of Work”: A Metasynthesis of Work Participation for Persons with Psychiatric Disabilities. J Occup Rehabil2013;8:8.
PerkinsR, RinaldiM. Unemployment rates among patients with long-term mental health problems. A decade of rising unemployment. Psychiatric Bulletin2002;26(8):295–298.
4.
KaplanK, SalzerMS, BrusilovskiyE. Community participation as a predictor of recovery-oriented outcomes among emerging and mature adults with mental illnesses. Psychiatric Rehabilitation Journal2012;35(3):219–229.
5.
FlynnRJ, LemayR, A Quarter-century of normalization and social role valorization: Evolution and impact. Ottawa:University of Ottawa Press; 1999.
6.
SpjelkavikØ. Supported Employment in Norway and in the other Nordic countries. Journal of Vocational Rehabilitation2012;37:163–172.
7.
SpjelkavikØ, HagenB, HärkäpääK. Supported Employment i Norden. Oslo: Arbeidsforskningsinstituttet:2011.
8.
BullH, LystadJU. Betydningen av arbeid for personer med schizofreni. Tidsskrift for Norsk Psykologforening2011;48:733–738.
9.
DrakeRE, McHUgoGJ, BeboutRR, BeckerDR, HarrisM, BondGR, QuimbyE. A randomized clinical trial of supported employment for inner-city patients with severe mental disorders. Archives of General Psychiatry1999;56(7):627–633.
10.
LloydC, KingR. Implementation of supported employment: What are the implications for clinical services?Journal of Rehabilitation2012;78(1):25–29.
11.
BurnsT, WhiteSJ, CattyJ. Individual Placement and Support in Europe: The EQOLISE trial. International Review of Psychiatry2008;20(6):498–502.
12.
BorgM, DavidsonL. The nature of recovery as lived in everyday experience. Journal of Mental Health2008;17(2):129–140.
13.
MajorEF, DalgardOS, MathisenKS, NordE, OseS, RognerudM, AarøLE. Bedre føre var.. Psykisk helse: Helsefremmende og forebyggende tiltak og anbefalinger. Oslo: Folkehelseinstituttet, 2011.
14.
BurnsT, CattyJ, BeckerT, DrakeRE, FiorittiA, KnappM, LauberC, RosslerW, TomovT, BusschbachJ, WhiteS, WiersmaD. The effectiveness of supported employment for people with severe mental illness: A randomised controlled trial. The Lancet2007;370:1146–1152.
15.
RinaldiM, PerkinsR. Comparing employment outcomes for two vocational services: Individual Placement and Support and non-integrated pre-vocational services in the UK. Journal of Vocational Rehabilitation2007;27(1):21–27.
16.
BondGR, XieH, DrakeRE. Can SSDI and SSI beneficiaries with mental illness benefit from evidence-basedsupported employment?. Psychiatric Services2007;58(11):1412–1420.
17.
BondGR, DrakeRE, BeckerDR. An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal2008;31(4):280–290.
18.
BondGR. Supported employment: Evidence for an evidence-based practice. Psychiatric Rehabilitation Journal2004;27(4):345–359.
19.
BorgM, KristiansenK. Working on the edge: The meaning of work for people recovering from severe mental distress in Norway. Disability & Society2008;23(5):511–523.
20.
KinnLG, HolgersenH, BorgM, FjærS. Being candidates in a transitional vocational course: Experiences of self, everyday life and work potentials. Disability & Society2011;26(4):433–448.
21.
KirshB, Stergiou-KitaM, GewurtzR, DawsonD, KrupaT, LysaghtR. From margins to mainstream: What do we know about work integration for persons with brain injury, mental illness and intellectual disability?. Work2009;32(4):391–405.
22.
van NiekerkL. Participation in work: A source of wellness for people with psychiatric disability. Work2009;32(4):455–465.
23.
GewurtzRE, RushB, CottC, KirshB. The Shift to Rapid Job Placement for People Living With Mental Illness: An Analysis of Consequences. Psychiatric Rehabilitation Journal2012;35(6):428–434.
24.
TsangHWH, FungKMT, LeungAY, LiSMY, CheungWM. Three year follow-up study of an integrated supported employment for individuals with severe mental illness. Australian & New Zealand Journal of Psychiatry2010;44(1):49–58.
25.
BiggsD, HoveyN, TysonPJ, MacDonaldS. Employer and employment agency attitudes towards employing individuals with mental health needs. Journal of Mental Health2010;19(6):505–516.
26.
RussinovaZ, GriffinS, BlochP, WewiorskiNJ, RosoklijaI. Workplace prejudice and discrimination toward individuals with mental illnesses. Journal of Vocational Rehabilitation2011;35(3):227–241.
27.
BrohanE, HendersonC, WheatK, MalcolmE, ClementS, BarleyE, SladeM, ThornicroftG. Systematic review of beliefs, behaviours and influencing factors associated with disclosure of a mental health problem in the workplace. BMC Psychiatry2012;12(1):11–24.
28.
GewurtzR, KirshB. Disruption, disbelief and resistance: A meta-synthesis of disability in the workplace. Work2009;34(1):33–44.
29.
RollinsAL, BondGR, JonesAM, KuklaM, CollinsLA. Workplace social networks and their relationship with job outcomes and other employment characteristics for people with severe mental illness. Journal of Vocational Rehabilitation2011;35(3):243–252.
30.
RoganP, MankD. Looking back, moving ahead: A commentary on supported employment. Journal of Vocational Rehabilitation2011;35(3):185–187.
31.
CorriganPW, McCrackenSG. Place First, Then Train: An Alternative to the Medical Model of Psychiatric Rehabilitation. Social Work2005;50(1):31–39.
32.
CrowtherRE, MarshallM, BondGR, HuxleyP. Helping people with severe mental illness to obtain work: Systematic review. BMJ: British Medical Journal (International Edition)2001;322:204–208.
33.
CurranC, KnappM, McDaidD, TómassonK. Mental health and employment: An overview of patterns and policies across Western Europe. Journal of Mental Health. 2007;16(2):195–209.
34.
DrakeRE, BeckerDR. The individual placement and support model of supported employment. Psychiatric Services (Washington, DC)1996;47(5):473–475.
35.
SeckerJ, MembreyH, GroveB, SeebohmP. Recovering from Illness or Recovering your Life? Implications of Clinical Versus Social Models of Recovery from Mental Health Problems for Employment Support Services. Disability & Society2002;17(4):403–418.
36.
WadeDT, de JongBA. Recent advances in rehabilitation. BMJ: British Medical Journal (International Edition)2000;320(7246):1385–1388.
37.
Arbeidsdepartementet. Forskrift om arbeidsrettede tiltak mv. 2008.
38.
PomakiG, FrancheR-L, MurrayE, KhushrushahiN, LampinenT. Workplace-Based Work Disability Prevention Interventions for Workers with Common Mental Health Conditions: A Review of the Literature. Journal of Occupational Rehabilitation2012;22(2):182–195.
39.
MartinM, NielsenM, PetersenS, JakobsenL, RuguliesR. Implementation of a Coordinated and Tailored Return-to-Work Intervention for Employees with Mental Health Problems. Journal of Occupational Rehabilitation2012;22(3):427–436.
40.
AndersenMF, NielsenKM, BrinkmannS. Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scandinavian Journal Of Work, Environment & Health2012;38(2):93–104.
41.
HolmgrenK, IvanoffSD. Supervisors’ views on employer responsibility in the return to work process. A focus group study [corrected] [published erratum appears in J OCCUP REHABIL Jun353]. Journal of Occupational Rehabilitation2007;17(1):93–106.
42.
LemieuxP, DurandM-J, HongQ. Supervisors’ Perception of the Factors Influencing the Return to Work of Workers with Common Mental Disorders. Journal of Occupational Rehabilitation2011;21(3):293–303.
43.
AasRW. Workplace-based sick leave prevention and return to work. Exploratory studies [Ph.D. Thesis]. Stockholm: Karolinska Institutet; 2011.
44.
AasRW, EllingsenKL, LindøeP, MöllerA. Leadership qualities in the return to work process: A content analysis. Journal of Occupational Rehabilitation2008;18(4):335–346.
45.
BlitzCL, MechanicD. Facilitators and barriers to employment among individuals with psychiatric disabilities: A job coach perspective. Work2006;26(4):407–419.
46.
SchafftA. Ansettelse av personer med psykiske lidelser i ordinære bedrifter –Vi må forstå arbeidsgivernes grunner Tidsskrift for psykisk helsearbeid. 2007;4(3):254–261.
47.
ShawL, MacahonicP, LindsayR, BrakeP. Evaluating the support needs of injured workers in managing occupational transitions after injury. Work (Reading, Mass)2009;32(4):477–490.
48.
OseSO, JensbergH, KaspersenSL, KalsethB, LilleengS. Kunnskapsstatus: Arbeid, psykisk helse og rus (06/08). Trondheim: SINTEF Helse, 2008.
49.
ShawL, RudmanDL. Guest editorial. Using occupational science to study occupational transitions in the realm of work: From micro to macro levels. Work2009;32(4):361–364.
50.
RinaldiM, MillerL, PerkinsR. Implementing the individual placement and support (IPS) approach for people with mental health conditions in England. International Review of Psychiatry2010;22(2):163–172.
51.
KvaleS, BrinkmannS. Interviews: Learning the craft of qualitative research interviewing. Los Angeles, Calif.:Sage; 2009.
52.
GuestG. Collecting qualitative data: A field manual for applied research. NameyEE, MitchellML, editors. London:Sage; 2013.
53.
VaismoradiM, TurunenH, BondasT. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences2013;15(3):398–405.
54.
MalterudK. Kvalitative metoder i medisinsk forskning: En innføring. Oslo:Universitetsforlaget; 2003.
55.
StigeB, MalterudK, MidtgardenT. EPICURE –an agenda for evaluation of qualitative research [Norwegian]. Nordic Nursing Research / Nordisk Sygeplejeforskning2011;13(1):33–56.
56.
GraneheimUH, LundmanB. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today2004;24(2):105–112.
57.
HsiehH, ShannonSE. Three approaches to qualitative content analysis. Qualitative Health Research2005;15(9):1277–1288.
58.
EloS, KyngäsH. The qualitative content analysis process. Journal of Advanced Nursing2008;62(1):107–115.
59.
DeCuir-GunbyJT, MarshallPL, McCullochAW. Developing and Using a Codebook for the Analysis of Interview Data: An Example from a Professional Development Research Project. Field Methods2011;23(2):136–155.
60.
SchafftA. Om å komme seg i arbeid. In: NorvollRR, editor. Samfunn og psykisk helse Samfunnsvitenskapelige perspektiverOslo:Gyldendal Akademisk; 2013.
61.
AnvikCH. Mellom drøm og virkelighet?: Unge funksjonshemmede i overganger mellom utdanning og arbeidsliv. Bodø:Nordlandsforskning; 2006.
62.
RinaldiM, PerkinsR, GlynnE, MontibellerT, ClenaghanM, RutherfordJ. Individual placement and support: From research to practice. Advances in Psychiatric Treatment2008;14(1):50–60.
63.
omsorgsdepartementet AȃoiHȃo. Nasjonal strategiplan for arbeid og psykisk helse. Arbeids- og inkluderings depratementet/Helseȃ og omsorgsdepartementet, 2007ȃ2012.
64.
SalyersMP, McGuireAB, BondGR, HardinT, RollinsA, HardingB, HainesM. What makes the difference? Practitioner views of success and failure in two effective psychiatric rehabilitation approaches. Journal of Vocational Rehabilitation2008;28(2):105–114.
65.
SeckerJ. Supporting mental health service users back to work. Journal of Public Mental Health2009;8(3):38–45.
66.
BorgM, VesethM, BinderP-E, ToporA. The role of work in recovery from bipolar disorders. Qualitative Social Work2013;12(3):323–339.
67.
SchreuderJ, GroothoffJ, JongsmaD, ZweedenN, KlinkJ, RoelenC. Leadership Effectiveness: A Supervisor’s Approach to Manage Return to Work. Journal of Occupational Rehabilitation2013;23(3):428–437.
68.
RamviE, FarstadL. Arbeid og psykisk helse. En kvalitativ studie av lederes erfaringer med å ha unge voksne med psykisk lidelelse i arbeidspraksis. Stavanger: Universitetet i Stavanger; 2011;30.
69.
BergH, EriksenI.M., KlingenbergS,StaalesenP.D.. Nye uførepensjonister. Erfaringer med NAV. Oslo: Proba samfunnsanalyse;2013.
70.
ZoerI, de GraafL, FM, PrinzieP, HoozemansMJM, Frings-DresenMHW. Matching work capacities and demands at job placement in employees with disabilities. Work2012;42(2):205–214.
71.
ECON. Arbeid med bistand: Hva skjer når bistanden opphører? Oslo: Pöyry Management Consulting (Norway); 2004.
72.
CameronJ, WalkerC, HartA, SadloG, HaslamI, The Retain Support G. Supporting workers with mental health problems to retain employment: Users’ experiences of a UK job retention project. Work2012;42(4):461–471.
73.
WheatK, BrohanE, HendersonC, ThornicroftG. Mental illness and the workplace: Conceal or reveal?. Journal Of The Royal Society Of Medicine2010;103(3):83–86.
74.
PetersonD, CurreyN, CollingsS. “You don’t look like one of them”: Disclosure of mental illness in the workplace as an ongoing dilemma. Psychiatric Rehabilitation Journal2011;35(2):145–147.
75.
JonesAM. Disclosure of Mental Illness in the Workplace: A Literature Review.American Journal of Psychiatric Rehabilitation2011;14(3):212–229.
76.
NegriL. Why has a woman with mental illness been fired? Discourses on fairness and diversity management. Work2009;33(1):35–42.
77.
ShawL, WalkerR, HogueA. The art and science of teamwork: Enacting a transdisciplinary approach in work rehabilitation. Work2008;30(3):297–306.
78.
BoyceM, SeckerJ, JohnsonR, FloydM, GroveB, SchneiderJ, SladeJ. Mental health service users’ experiences of returning to paid employment. Disability & Society2008;23(1):77–88.
79.
CookJA, LehmanAF, DrakeR, McFarlaneWR, GoldPB, LeffSH, BlylerC, TopracMG, RazzanoLA, Burke-MillerJK, BlankertzL, ShaferM, Pickett-SchenkSA, GreyDD. Integration of psychiatric and vocational services: A multisite randomized, controlled trial of supported employment. The American Journal of Psychiatry2005;162(10):1948–1956.
80.
SchafftA, GrimsmoA. Gode intensjoner –holder det? –En undersøkelse blant deltakere på gjestebud om arbeid og psykisk helseOslo: Arbeidsforskningsinstituttet.: 2012;9.
81.
SwansonS, BursonK, HarperJ, JohnsonB, LitvakJ. Implementation Issues for IPS Supported Employment: Stakeholders Share Their Strategies. American Journal of Psychiatric Rehabilitation2011;14:165–180.
82.
SchneiderJ, SladeJ, SeckerJ, RinaldiM, BoyceM, JohnsonR, FloydM, GroveB. SESAMI study of employment support for people with severe mental health problems: 12-month outcomes. Health & Social Care in the Community2009;17(2):151–158.
83.
FalkumE. Arbeidet som rehabiliteringsfaktor. Bergen:Fagbokforl.; 2011; p. S.115–128.
84.
Brinchmann. Virksomme faktorer ved integrering av arbeidsrehabilitering. 2012.
85.
StigeB, MalterudK, MidtgardenT. Toward an agenda for evaluation of qualitative research. Qualitative Health Research2009;19(10):1504–1516.
