A 1-year prospective study of employment in people with severe mental illnesses receiving public sector psychiatric services in India.

Abstract

Objective: Limited research has been conducted on the long-term course of employment in people with severe mental illnesses (SMI) in developing countries such as India. To inform the development of culturally appropriate vocational services in India we prospectively evaluated work status, perceived benefits, and problems related to work in employed participants, and interest in work, barriers to work, and desired job supports among unemployed participants over a 1-year period. Methods: We conducted semistructured interviews with 150 individuals with SMI (90% schizophrenia-schizoaffective) receiving psychiatric outpatient services at a public hospital in an urban district in India at baseline and followed up 1 year later. One-hundred-and-seven participants (71.3%) completed the follow-up interviews. Results: Work status (employed/unemployed) was consistent in 90.7% of participants, with 43.9% working at baseline and 49.5% working at follow-up. Participants who were working in the same job at both assessments were consistent in identifying several work-related problems (e.g., stress) as well as benefits (e.g., money). Interest in work among unemployed participants was consistent, with 78.8% interested at both assessments. Participants who were unemployed but interested in work consistently identified work barriers (e.g., cognitive difficulties) and desired job supports (e.g., assistance with job finding). Conclusions and Implications for Practice: Unemployment rates are moderately high and stable in people with SMI, with most unemployed participants consistently interested in working and desiring job supports. These findings, together with stable employment rates in working participants, suggest that supported employment developed for the Indian context could improve employment in people with SMI. Impact and ImplicationsMost unemployed individuals with severe mental illness in India want to work, yet despite this interest few succeeded in obtaining work during a 1-year follow-up assessment. Unemployed participants wanted several types of assistance for pursuing their work goals, including help finding a job, managing their illness, and coping with cognitive challenges. The findings point to the need to adapt supported employment programs to the cultural context of India.

Supported employment interventions with people who have severe mental illness: Systematic mixed-methods umbrella review

“…Authors suggest unemployment rates among individuals with SMI may be up to 2.5 times higher than the unemployment rates of individuals with physical disabilities [ 2 , 3 ]. In contrast, studies internationally show that the vast majority of people with SMI express a strong desire for work, assistance with getting a job, and support to sustain their workforce participation [e.g., 4 – 6 ]. Persistent high unemployment rates underscore the complex and multifaceted nature of the challenges faced by individuals with SMI in their quest for safe, meaningful, and sustained employment, as well as the need for ongoing research, policy development, and program refinement to address these barriers.…”

“…IPS and The Clubhouse share objectives of enhancing employability and global functioning for individuals with SMIs, however each model varies in its core methodologies, targeted outcomes, and evidence base. Despite the significant body of research documenting the effectiveness of supported employment interventions in enhancing employment opportunities for individuals with SMI [ 38 , 39 ], unemployment rates among people with SMI remain high across the globe [ 1 , 4 , 5 ].…”