Individual and environmental factors related to job satisfaction in people with severe mental illness employed in social enterprises

Objective: The purpose of this study was to enhance understanding of the impact of individual and environmental variables on job satisfaction among people with severe mental illness employed in social enterprises.Participants: A total of 248 individuals with severe mental illness employed by social enterprises agreed to take part in the study. Methods: We used logistic regression to analyse job satisfaction. A model with job satisfaction as the dependent variable, and both individual (occupational self-efficacy and severity of symptoms perceived) and environmental (workplace) factors (provision of workplace accommodations, social support from co-workers, organizational constraints) as well as external factors (family support) as predictors, was tested on the entire sample. Results: All findings across the study suggest a significant positive impact of both individual and environmental factors on job satisfaction. People with higher occupational self-efficacy who were provided with workplace accommodations and received greater social support were more likely to experience greater job satisfaction.Conclusions: These results suggest that certain features of social enterprises, such as workplace accommodations, are important in promoting job satisfaction in people with severe mental illness. Further studies are warranted to expand knowledge of the workplace features that support employees with severe mental illness in their work integration process.     

Modeling processes in recovery from mental illness: relationships between symptoms, life satisfaction, and self-concept

For persons with severe mental illness, controlling symptoms, regaining a positive sense of self, dealing with stigma and discrimination, and trying to lead a productive and satisfying life is increasingly referred to as the ongoing process of recovery. Drawing on psychiatric-medical and stress-social support models, and theories of self-concept and stigma, this study examines social-psychological processes in recovery from mental illness. Using longitudinal questionnaire data from 610 persons in self-help groups and outpatient treatment, 1 estimate a series of models of the relationships between key elements identified as part of the recovery process: symptoms, self-concept, and life satisfaction. The results show that these elements affect each other in a reciprocal manner. Moreover, findings indicate a key role for self-esteem, which mediates the effect of life satisfaction on symptoms. The study suggests a general framework for examining processes involved in recovery from mental illness.     

The construction of fear: Americans' preferences for social distance from children and adolescents with mental health problems

Debates about children's mental health problems have raised questions about the reliability and validity of diagnosis and treatment. However, little research has focused on social reactions to children with mental health problems. This gap in research raises questions about competing theories of stigma, as well as specific factors shaping prejudice and discrimination toward those children. Here, we organize a general model of stigma that synthesizes previous research. We apply a reduced version of this model to data from a nationally representative sample responding to vignettes depicting several stigmatizing scenarios, including attention-deficit/hyperactivity disorder (ADHD), depression, asthma, or "normal troubles." Results from the National Stigma Study-Children suggest a gradient of rejection from highest to lowest, as follows: ADHD, depression, "normal troubles," and physical illness. Stigmatizing reactions are highest toward adolescents. Importantly, respondents who label the vignette child's situation as a mental illness compared to those who label the problem as a physical illness or a "normal" situation report greater preferences for social distance, a pattern that appears to result from perceptions that the child is dangerous.     

How can context and discourse affect teachers’ and mental health professionals’ interactions with adults with mental illness?

Patients with severe mental illness may have needs different from those of patients with more limited illnesses and might benefit from other types of intervention than traditional treatment. We interviewed health care professionals from two open, short-term psychiatric wards and teachers from two schools for adults with psychiatric diagnoses. The focus was to explore how differences in contextual factors such as time, tasks, and organizational demands might affect the actions and attitudes of health care professionals and teachers, as well as the potential consequences for patients and students. Data were collected through qualitative interviews. Participants included 14 health care professionals and 14 teachers. The informants worked with patients and students with similar diagnoses and illness durations. All interviews were conducted during the informants’ work time. Findings and interpretations showed that both teachers and health care professionals were engaged in their work and in the wellbeing of students and patients. However, they described marked differences in practice, including the amount of time spent with students/patients, the organization of their work, main tasks, amount of control over their tasks, and social structure. These differences seemed to affect relationships with students/patients, attitudes toward students/patients, norms and values, and opportunities for patient empowerment. Our findings suggest that while existing psychiatric health care might be appropriate for limited short-term problems such as single-episode depression, a model with a supportive environment, based on stable relations and possibility for learning, may improve personal development and mental health for persons with severe mental illness and disturbances in self-experience.     

Another face of health care disparity: stigma of mental illness

In many everyday situations, individuals with mental illness face stigma that leads to discrimination. A growing body of evidence suggests that those with mental illness experience disparities in health care and that their medical needs are often overlooked. The purpose of this article is to increase awareness to this problem. Fictional vignettes in which individuals with mental illness seek medical care are presented, followed by discussion on the role discrimination may play in the level of care these patients received. To help alleviate disparities, nurses are encouraged to advocate and speak out when they suspect discrimination is affecting the quality of care of those with mental illness.     

The Social Process Behind Inequalities in Children's Mental Health: Incorporating an Illness Career Framework

More advantaged children (both in terms of social class and racial/ethnic membership) appear protected from symptoms of mental health problem, but a pattern has emerged in which these children who tend to have better mental health are more likely to be diagnosed with certain mental health disorders. These patterns have led some researchers and professionals to wonder if the qualifications for diagnosis are culturally biased or might unfairly favor the mental health needs of more advantaged individuals in society. Evidence that White and middle‐class children are more likely to be diagnosed with certain mental health disorders raises important and legitimate concerns about the mental health profession, but this problem of social advantage leading to mental health diagnosis has often overlooked the role of social process in how children become diagnosed. Mental health diagnoses represent the culmination of a process that involves several stages and requires initiation and (often times) persistence on the part of the individual being diagnosed. This idea of process has previously been referred to as the “illness career,” and applying this logic to the study of children opens the door for renewed inquiry into understanding who is and who is not diagnosed with a mental health problem.     

The Mark of Madness

Abstract

Stigma is a major barrier to recovery for individuals with mental illnesses. It interferes with community living and attainment of resources and goals and damages self-esteem and self-efficacy. Given that social workers provide much of the mental health care to individuals with mental illnesses, and that actions to reduce stigma support the social justice mission of social work, addressing stigma should be a focus of social work interventions. The goals of this paper are to explore stigma theory in general and for individuals with serious mental illnesses, discuss the implications of this stigma analysis for social work, and make recommendations for action in both practice and research.     

MENTAL ILLNESS AND THE DEMAND FOR ALCOHOL, COCAINE, AND CIGARETTES

This article estimates the effect of mental illness on demand for addictive substances, allowing for structural endogeneity and simultaneity between mental illness and addictive consumption. Results show that individuals with a history of mental illness are 26% more likely to consume alcohol, 66% more likely to consume cocaine, and 89% more likely to consume cigarettes. This high-participation group is also price-responsive, although their price elasticities differ somewhat from those without mental illness. The results provide added justification for higher taxes and supply reduction activities. Furthermore, subsidizing the treatment of mental illness can reduce addictive consumption.(JEL I1 )     

Geneticization of deviant behavior and consequences for stigma: the case of mental illness

One likely consequence of the genetics revolution is an increased tendency to understand human behavior in genetic terms. How might this "geneticization" affect stigma? Attribution theory predicts a reduction in stigma via reduced blame, anger, and punishment and increased sympathy and help. According to "genetic essentialist" thinking, genes are the basis of human identity and strongly deterministic of behavior. If such ideas are commonly accepted, geneticization should exacerbate stigma by increasing perceptions of differentness, persistence, seriousness, and transmissibility, which in turn should increase social distance and reproductive restrictiveness. I test these predictions using the case of mental illness and a vignette experiment embedded in a nationally representative survey. There was little support for attribution theory predictions. Consistent with genetic essentialism, genetic attributions increased the perceived seriousness and persistence of the mental illness and the belief that siblings and children would develop the same problem. Genetic attribution did not affect reproductive restrictiveness or social distance from the ill person but did increase social distance from the person's sibling, particularly regarding intimate forms of contact involving dating, marriage, and having children.     

Understanding and influencing the stigma of mental illness

Life goals and the opportunities that define them are impaired by the stigma of mental illness. Three kinds of stigma may act as barriers to personal aspirations: public stigma, self-stigma, and label avoidance. Challenging mental illness stigm is essential in helping individuals accomplish recovery-related goals. Public stigma may be changed through protest, education, and contact. Self-stigma can be addressed by fostering group identity, changing the perceived legitimacy of stigma through cognitive rehabilitation, and making strategic decisions about disclosing one's mental health history. Stigma change for label avoidance is not as well understood but may include the education and contact approaches used for public stigma. Evidence-based approaches to stigma change need to be substantiated by rigorous investigations.     

Providing nursing leadership in a community residential mental health setting

The worldwide burden of mental illness is increasing. Strong leadership is increasingly emerging as a core component of good mental health nursing. The aim of this article is to demonstrate the ways in which nurses can provide strong and consistent leadership in a values-based practice environment that embodies respect for individuals' dignity and self-determination within a community residential mental health service, which provides a structural foundation for effective action. This is accomplished through the presentation of two vignettes, which highlight how the seemingly impossible becomes possible when an economic paradigm such as agency theory is exchanged for a sociological and psychological paradigm found in leadership as stewardship at the point of service. It is through stronger nursing leadership in mental health that stigma and discrimination can be reduced and better access to treatments and services can be gained by those with mental illness. Nurse leadership in mental health services is not new, but it is still relatively uncommon to see residential services for "high needs" individuals being led by nurses. How nurses meet the challenges faced by mental health services are often at the heart of effective leadership skills and strategies.     

Living Stigma: The Impact of Labeling, Stereotyping, Separation, Status Loss, and Discrimination in the Lives of Individuals with Disabilities and Their Families

In this study, we examine the direct and vicarious impact of the social processes of felt and enacted stigma and their impact on the lives of individuals with disabilities and their families. Specifically, findings of interactive interviews with eight adults with disabilities and seven mothers of children with disabilities were analyzed for themes related to components of stigma described by Link and Phelan (2001) : labeling, stereotyping, separation, status loss, and discrimination within the context of power differential. Findings suggest that while these social processes can have important negative psychosocial consequences for individuals living with disabilities, the severity of the consequences varies among the components. Findings also indicate that these individuals find varied and creative ways to resist and actively counter the negative effects of stigma in their lives. Findings support the complexity of the experience of stigma and the importance of the socio/cultural context to the lived experience of disability.     

Reducing mental illness stigma and fostering empathic citizenship: Community arts collaborative approach

An art therapy-informed community arts project to reduce stigma towards people living with mental illness in Hong Kong included three phases: 1) a public exhibition to raise awareness; 2) a workshop for viewers to create response art and generate approaches to alleviate stigma; and 3) a forum for people living with mental illness and viewers to create art and discuss programmatic recommendations. Results suggested that: 1) art exhibits paired with reflection fostered empathy; 2) creating art promoted a wider perspective and initiated dialogue; and 3) collaborative art making facilitated meaningful interaction. These findings offer promising strategies for art and social change.     

The variation in family background amongst young homeless shelter users in Denmark

This article analyses variation in the family background of young homeless people in a cohort of young Danes. The study is based on administrative data for individuals who were 18 years old in 2007 and their parents. Homelessness is measured by shelter use over a five-year period. Data also cover education, employment, mental illness, substance abuse problems and placement outside home in childhood for the young persons, and education, employment, civil status, mental illness and substance abuse problems for their parents. A cluster analysis identifies two groups, each comprising half of the young shelter users. In the first group, social marginalisation is transmitted between generations, as most parents have low education and mental illness or substance abuse problems, and are unemployed. In contrast, the young people in the second group come from wider socioeconomic backgrounds, with few of their parents having mental illness or substance abuse problems. These young people develop psychosocial problems and become homeless without strong predictors from their family background. Amongst the young shelter users from families with severe social problems a higher share are in the Not in Education, Employment or Training group. They also have more shelter stays, compared to young shelter users from families with fewer social problems.     

Deinstitutionalization, social rejection, and the self-esteem of former mental patients

Modified labeling theorists have long argued that the stigma of mental illness has important consequences for the lives of people with mental illness. We propose that social rejection is an enduring force in the lives of people with mental illness and that these experiences are central to understanding the poor self-concepts described by many former psychiatric patients. We explore changes in a cohort of recently deinstitutionalized mental patients' (N = 88) self-esteem and experiences with social rejection using data from a three wave panel survey conducted while institutionalized and over a two-year period following the patients' discharge from a long-term state hospital. Our results indicate that social rejection is a persistent source of social stress for the discharged patients. Moreover, these experiences increase feelings of self-deprecation that, in turn, weaken their sense of mastery. Where the patients' received their follow-up care--whether in a community setting or in another state hospital--had little impact on their self-related feelings or on their experiences of social rejection. Our results provide further support for modified labeling theory and underscore the need to consider the dynamic relationship between stigmatizing experiences and self-related changes.     

Schizophrenia,Community Integration,and Recovery

Abstract

Rooted in deinstitutionalization policy, the community inclusion required by the Olmstead case, and the grass roots recovery movement, community integration for those who have diagnoses of serious mental illnesses has become an increasingly important policy goal. The purpose of this project was to examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in the schizophrenias. Studies chosen for review all involved direct survey or interview data from people with psychiatric disabilities and examined subjective experiences with social relationships or linked social participation with clinical, functional, or quality of life outcomes. Experiences involving the dynamics of social stigma, the achievement of personal agency, and innovative pathways to satisfying social inclusion are core themes found that are highly relevant for practitioners. Social work, with its ecological perspective, is well suited to address the complexities of conflicting interests and objectives that have arisen in mental health care in the pursuit of community integration. Suggestions for fruitful responses are presented.     

Exploring Knowledge through Peer Tutoring in a Transitional Learning Community: An Alternative Way of Teaching Counseling Skills to Students in Social Work Education

This article is a critical review of Crossing Bridges, a Department of Health training pack for those working with 'mentally ill' parents and their children. The author argues, on the basis of both personal and professional experience, that although the pack pays lip-service to the significance of structural factors, the training resources are primarily rooted in an individual and family-focused pathology model of mental illness. Three arguments are put forward for the necessity of a wider framework: the significance of shame and stigma to those experiencing mental distress and their families; the predominance of understandings of mental illness that translate social phenomena into individualised problems, notably genetic explanations and attributions of risk and dangerousness; and the contribution of motherhood to the experiencing of mental distress in women. Initiatives within the mental health survivor movement are highlighted as examples promoting positive images of mental distress, and the implications of the issues raised for social work education are considered. The article concludes that efforts to help the children of 'mentally ill' parents, not to mention the parents themselves, must incorporate wider strategies to promote openness, respect, acceptance and ultimately, social inclusion, of those who experience mental distress.     

Telling Others How You Live—Refining Goffman's Stigma Theory Through an Analysis of Housing Strugglers in a Homeowner Nation

This article revisits Goffman's stigma theory from the perspective of housing studies. We elaborate on Goffman's approach by exploring how housing tenure can work as a proxy for moral character. We interviewed twenty‐seven people who are excluded from access to homeownership in two cities in Norway, which is a “homeowner nation.” These individuals are unable to enter the dominant “homeowner class” for different reasons, including drug‐dependency, mental illness, refugee background, low socioeconomic status; thus, they must access housing through other tenures; private renting or social housing. To many of them, housing becomes a stigma, in Goffman terms, an “undesired differentness.” Social housing is known to carry stigma in Norway. It was thus a paradox, that those with the softest differentness—private rental—were most likely to practice (Goffman:) “information control” over their housing situation. Goffman's theoretical apparatus, and his distinction between the discreditable and the discredited in particular, helped us make this paradox comprehensible. Through this analysis, refinements to Goffman's theory were discovered. We suggest that “multiple stigmas,” which was not seen clearly by Goffman himself, should be a key notion in stigma studies. We use this notion to distinguish between possible sub‐types to the discredited‐discreditable distinction.     

The Social Relationships and Social Support of Aging Mothers Whose Adult Daughters Are Mentally Ill

Guided by a conceptual framework highlighting multiple facets of social relationships and social support, this study examined the extent to which aging mothers of adult daughters with a serious mental illness were socially integrated with members of their network. It further examined the relational content of these mothers’ social ties as tangible or intangible support and the nature of their supportive exchanges with network members, particularly their adult daughters with mental illness. A structured face-to-face interview was conducted with 22 aging mothers of these adult daughters. Two methods of analysis were used to analyze data: counting and content analysis. Findings showed aging mothers of daughters with mental illness were socially integrated with relatives and nonrelatives, evidenced relational content of tangible and intangible support in their social ties and engaged in bidirectional and asymmetrical support exchanges with network members, including their daughters with mental illness. These findings suggest that social resources in the form of social relationships and support are embedded in the networks of aging mothers who have adult daughters with serious mental illness. Practitioners should assess support contributions to the aging mothers of adult daughters with serious mental illness from a wide range of social relationships including their daughters.