Work and psychiatric disabilities. A person, environment, and occupation perspective on Individual Placement and Support

Detta är en avhandling från Department of Health Sciences, Lund University

Sammanfattning: This thesis adds to the knowledge base of how the Individual Placement and Support (IPS) can be optimized to secure a more sustainable working career for people with severe mental illness (SMI). The thesis has given the IPS-participants an active voice about what it is like to start to work in a Swedish context, visualised the psychiatric disability in relation to work, discerned the support and process in IPS, and emphasized the employers’ experiences in an IPS-context. Study I, a multiple case study, aimed to discern the support and process in IPS that involved job-search support, job-matches, adjustment of the match by providing accommodations by on- and off-worksite support, and organizing an individually adapted IPS-network. The initial job-match was an important factor for increasing or decreasing job-tenure among the IPS-participants. The social work environment was an important accommodation area. Previous work experience, disclosure, and not being in an acute phase of the illness were important for utilization of IPS. The qualitative interview Study II explored the IPS-participants’ perceptions of their worker role and work environment. Work had mostly a positive impact on daily life, although it was a struggle to fit in and the mental illness affected work performance. They perceived supportive and demanding factors in their work environments, such as the employer’s support and the social atmosphere among colleagues. Own personal strategies were needed to cope. The cross-sectional Study III studied the relationships between cognitive functioning, communication and interaction skills, and vocational outcomes among people with SMI attending vocational services for 18 months. Higher scores in planning, reasoning and problem solving best explained the variation in having competitive employment or not, and correlated with increased hours and weeks in competitive employment. Higher scores in delayed verbal recall correlated with having a higher income. Communication and interaction skills differed between the groups of employment status and correlated with hours and weeks in competitive employment, higher income, and higher scores in delayed verbal recall. Study IV, a grounded theory situational analysis study, showed that the employers strove to maintain their social commitment throughout the process from taking on IPS-service users to supporting them at work. The employment specialist’s trustworthiness and professional approach, as well their at-work support was considered crucially important for the employers’ readiness to open the door. In conclusion, the organization of the IPS, and the articulation of the support and process in IPS may be important to address in order to increase job-tenure and employment success among IPS-participants.