A serial mediation model of workplace social support on work productivity: the role of self-stigma and job tenure self-efficacy in people with severe mental disorders

Abstract

Purpose: Compared to groups with other disabilities, people with a severe mental illness face the greatest stigma and barriers to employment opportunities. This study contributes to the understanding of the relationship between workplace social support and work productivity in people with severe mental illness working in Social Enterprises by taking into account the mediating role of self-stigma and job tenure self-efficacy.

Method: A total of 170 individuals with a severe mental disorder employed in a Social Enterprise filled out questionnaires assessing personal and work-related variables at Phase-1 (baseline) and Phase-2 (6-month follow-up). Process modeling was used to test for serial mediation.

Results: In the Social Enterprise workplace, social support yields better perceptions of work productivity through lower levels of internalized stigma and higher confidence in facing job-related problems. When testing serial multiple mediations, the specific indirect effect of high workplace social support on work productivity through both low internalized stigma and high job tenure self-efficacy was significant with a point estimate of 1.01 (95% CI?=?0.42, 2.28).

Conclusions: Continued work in this area can provide guidance for organizations in the open labor market addressing the challenges posed by the work integration of people with severe mental illness.

• Implications for Rehabilitation:

• Work integration of people with severe mental disorders is difficult because of limited access to supportive and nondiscriminatory workplaces.

• Social enterprise represents an effective model for supporting people with severe mental disorders to integrate the labor market.

• In the social enterprise workplace, social support yields better perceptions of work productivity through lower levels of internalized stigma and higher confidence in facing job-related problems.

     

Rational-emotive therapy vs general cognitive-behavior therapy in the treatment of low self-esteem and related emotional disturbances

The present study compared the relative effectiveness of “preferential” rational-emotive therapy (RET) and general cognitive-behavior therapy (CBT) in the treatment of low self-esteem and related emotional disturbances. Thirty-three subjects were randomly assigned to RET, CBT, and waiting-list control (WLC) groups. Therapy consisted of 8 weekly 1 1/2hour group sessions. At posttest, both the RET and CBT groups changed significantly more than the WLC group on all measures: self-esteem, depression, general and social-evaluative anxiety, anger, and rational thinking. On the self-esteem and self-efficacy measures, the CBT group changed significantly more than the RET group. At a six-month follow-up, both the RET and CBT groups maintained their gains, and there were no significant differences between groups on any measure.     

Evaluating clinical outcome and staff morale in a rehabilitation team for people with serious mental health problems

Tameside and Glossop rehabilitation team (in England) have developed a progressive and targeted service for people with serious mental health problems through the systematic implementation of research-based evidence in practice and service configuration. This study was undertaken to provide a method of auditing the clinical outcome of the service and monitoring staff morale in a manner which could be integrated in the day to day delivery of services, and which could inform future service developments. Changes in the functioning of the total population of rehabilitation team clients were assessed over a 1-year period by Health of the Nation Outcome Scales (HoNOS) ratings at 6-monthly intervals. Factors causing stress and stress levels among all staff were assessed using the Mental Health Stress Questionnaire. The findings give clear indications of areas of the service which needed improving or changing, and identify ways in which the ongoing process of data collection might be refined.     

Difficulties in the measurement of outcome in people who have serious mental health problems

In the present drive towards evidence-based health care it is essential for nurses to be able to define and measure their contribution in the health services and thereby ensure that resources are deployed to provide maximum improvement in the health of the population. Yet there exist few rigorous studies which examine the impact of the nursing contribution on patient health gain. One explanation for this is the sheer complexity of outcome measurement. This paper considers the multitude of factors which must be taken into account when designing studies to measure the impact of interventions for people with serious mental health problems. The heterogeneous nature of the population, the range of services these people might use, the composite of possible interventions and the paucity of adequate measurement tools are among the issues to be tackled. Although no single methodology can be prescribed, a number of principles are offered to guide study design.     

Implementing research findings into practice: improving and developing services for women with serious and enduring mental health problems

This paper discusses the process that is currently being undertaken to improve and develop services for women with serious and enduring mental health problems in one specialist psychiatric service. The paper begins by highlighting the particular service needs of this group of women. The process of translating the research evidence into practice is then explored by highlighting the comprehensive preparatory work that was required, how a women's special interest group was established, the choice of a model to guide change and development, and a review of progress to date. The paper concludes by arguing that one of the means of maintaining the current momentum for change will be the celebration and acknowledgement of success.     

The reality of practice development for nurses working in an inpatient service for people with severe and enduring mental health problems

Nursing practice development is a growing priority for the British National Health Service. However, the nature of practice development remains poorly articulated. Despite the growing number of papers on practice development in nursing, there is insufficient guidance in the literature for the practical day-to-day management of the role, particularly in the inpatient environment. This paper explores the tensions experienced by practitioners engaged in practice development within a service for people mainly with a diagnosis of psychosis. The entrenched culture of the environment is described, which was resistant to change therefore did not easily embrace practice development. Within such a culture it is important to balance effective management with team development and support. Although this balance is essential for positive change, it is the maintenance of the balance that often leads to the tensions experienced by practice development practitioners. The paper describes numerous tensions including the competing agendas, influencing 'hearts and minds' rather than forcing change and working where people are at. Each tension is explored alongside possible survival strategies. The material presented aims to be realistic and although it may not be generalizable to other settings and staff groups, the authors hope to stimulate debate about similar or contrasting experiences of practice development.     

团体心理训练对提高急诊科护士心理健康水平的实证研究

目的探讨团体心理训练对提高急诊科护士心理健康水平的作用。方法运用团体心理训练方案对急诊科护士开展5个单元为期12周的训练。结果急诊科护士的心理健康状况较差;经过团体心理训练后,症状自评量表得分在躯体化、强迫症状、人际关系敏感、抑郁、焦虑、恐怖维度及总均分均降低(P0.05)。结论团体心理训练能够有效缓解急诊科护士的心理压力,改善其心理健康状况。     

Home visiting programme for older people with health problems: process evaluation

AIM: This paper is a report of a process evaluation of the content, patient compliance and participant experiences of a home visiting programme for older people with self-reported health problems. BACKGROUND: Systematic home visits by nurses to older people are a public health strategy to improve their functional abilities and prevent institutionalization. Evidence of the usefulness of these visits is conflicting, partly due to a lack of information on the intervention process in these programmes. METHOD: One hundred and sixty people (aged 70-84 years) participated in the programme and were visited eight times during an 18-month period (February 2003-October 2004) by experienced home nurses. The nurses recorded key elements of each visit on standard forms: topics discussed, interventions regarding health problems and risks, and compliance with these interventions. Participants' and nurses' opinions on the visits were obtained through interviews at the end of the programme. FINDINGS: Nearly 80% of the group received the complete programme. Problems were detected in nearly all visits, mainly regarding social and psychological functioning, circulatory and musculoskeletal problems, and vision or hearing impairment. On average, ten problems and 11 interventions were recorded per participant. Nearly 40% of interventions related to referrals, 45% to advice and 17% consisted of information-giving. The compliance rate was 65% for referrals and 58% for advice. Both nurses and participants were positive about the programme. CONCLUSION: A health visiting programme, performed by home nurses, is feasible and appreciated by frail elders. The latter seem to be a relevant target population in view of the many and varied problems detected.     

Attendance at a psychological support group for people with multiple sclerosis and low mood

Purpose: A cognitive behavioural group promoting psychological adjustment for people with multiple sclerosis (MS) was found to reduce psychological distress. Not all those offered treatment attended the group sessions. The aims were to examine the rates of attendance and to evaluate feedback from participants. Method: Participants with MS and low mood were recruited to a randomized trial comparing attendance at a psychological support group with a usual care control group. The attendance at each session was determined and those who attended were compared with those who failed to attend using a Mann–Whitney U-test or chi-squared. A sample of participants completed a telephone feedback questionnaire to determine their views of the group. Results: The 44 participants who attended four or more sessions were not significantly different from the 28 who attended fewer than four sessions on demographic variables, disability, self-efficacy or quality of life, but significantly fewer men attended than women (p?=?0.03). Participants’ feedback from the group was mainly positive, and no factors were identified associated with non-attendance. Conclusions: Men were less likely to attend group treatment sessions than women, but no other variables were associated with non-attendance. Attendance rates influence the effectiveness of interventions and reasons for non-attendance need to be determined.

Implications for Rehabilitation

• Not all people with multiple sclerosis (MS) and low mood offered psychological support will attend group sessions.

• Women are more likely to attend psychological support groups for people with MS than men.

• In clinical practice it may be possible to adjust the membership of groups to increase attendance more than in randomized trials.

     

A phenomenological exploration of the lived experience of mental health nurses who care for clients with enduring mental health problems who are parents

This paper is a report of a study to explore mental health nurses' lived experience of caring for adults with enduring mental health problems who are parents. With the advent of community care, more people with enduring mental health problems have contact with their families and are parents. Ultimately, rehabilitative strategies for parents with mental health problems are focused towards functioning effectively within their own family unit and hopefully enabling them to fulfil their parental role. Mental health nurses working with this client group have competing demands to reconcile. For example, advocating for client rights versus protecting the child and supporting the family. This phenomenological study took place within adult mental health services in the UK. Semi-structured interviews were conducted with six nurses. A thematic analysis was conducted on the data. Five themes were identified from the data: support, remaining impartial, addressing the specific needs of a client who is a parent, models of care and interagency communication. The findings suggest that neither a family-centred nor a person-centred approach to care completely meets the needs of this client group. An integrated model of care is proposed that applies person-centred and family-centred approaches in tandem.     

Return to the asylum: the search for clients with enduring mental health problems in Italy

Deinstitutionalization and community care were the most influential movements in the field of mental health in the last 30 years. In 1978 Italy was the first country to pass laws that would eliminate mental hospitals and replace them with community-based services. Italian ideas about community care provided inspiration for care in the community legislation when this was introduced in the UK. In order to be able to fairly assess and describe the benefits of Italian mental health care, the author visited a range of care facilities in a prescribed region in the north of Italy. In the course of investigation, the author sought to discover if the implementation of what were regarded by some as radical community attitudes in the care of people with mental health problems had led to innovative approaches when dealing with patients/clients requiring long-term care and treatment. Although the Italian approach is enlightened in many areas of care, the system still has to face up to the problems presented in caring for clients/patients with enduring mental health problems. The circumstances relating to care were unexpected and caused the author to revise his opinion of the Italian approach to community care.     

团体心理训练干预对急诊护士心理健康与自我和谐状况的效果研究

目的评价团体心理训练干预对急诊护士心理健康和自我和谐状况的效果。方法成立心理训练团体,制订4个阶段10次训练计划,并按训练内容实施团体心理训练。结果急诊护士躯体化、人际关系敏感、抑郁、焦虑、敌对、偏执、精神病性及其他维度得分和自我和谐各维度及总分与训练前差异均具有统计学意义(P0.01或P0.05)。结论团体心理训练可提高急诊护士心理健康和自我和谐水平。     

An evaluation of short-term group therapy for people with aphasia

This paper reports an evaluation of a group therapy intervention conducted with aphasic people (n = 6). The intervention comprised 10 sessions of approximately 90 min duration and included two participants with stuttering difficulties. The therapy programme consisted of communication activities within the group which encouraged sharing of personal experiences, videotaping of role-play activities for self- and group-evaluation and practice tasks completed outside the group. Measures of functional communicative ability, attitudes to communication and psychological adjustment were obtained before and after the intervention. Findings showed significant improvements in communicative competence and attitudes to communication over the course of the intervention. Before the intervention self-esteem and communicative competence were highly intercorrelated. By the end of the therapy sessions the correlation between self-esteem and communicative competence was significantly smaller and was non-significant. This indicates that communicative function was not related to feelings of self-worth by the end of the intervention. Improvements in attitude to communication, greater attendance and completion of assignments were each predictive of reduced levels of depression. There was also evidence that stronger beliefs about the role of personal effort in improving speech were predictive of improvements in communication attitudes. A measure of satisfaction showed extremely positive evaluation of the intervention by participants. It is concluded that short-term group therapy can produce improvements in communicative abilities and attitudes, and have psychological benefits for participants. Several suggestions for future research are outlined.     

Supporting mental health nurses to address the physical health needs of people with serious mental illness in acute inpatient care settings

There is overwhelming evidence that the physical health needs of those with serious mental illness have been neglected by health service professionals. Mental health nurses (MHNs) could play a key role in meeting these needs particularly during hospital admissions, yet they are uncertain about their role, have variable levels of confidence and lack appropriate skills and training. This study investigated MHNs' views and practices of physical health management for adults receiving acute inpatient treatment and found a difference between MHNs' perceived responsibility and their practice, which highlighted a need for role clarification and further skills training.     

Dilemmas in professional education: responding effectively to students with mental health problems

Students on professional training programmes have the status of embryonic professionals as well as that of students in higher education. When such students either bring a history or show evidence of current mental health problems, those teaching on these programmes face dilemmas in both responding to the needs of the individual and meeting their broader responsibilities to the profession, the purchasers of training and the wider community. This article explores these issues in the contexts of nursing and social work qualifying programmes, drawing on research which details educators' experiences of supporting students with mental health problems. The key transitional stages of admission and exit from such programmes are discussed. The article calls for a response to individual cases which balances potential dangers and benefits and advocates the development of transparent guidelines to assist in the resolution of such dilemmas.     

'Painting a path to wellness': correlations between participating in a creative activity group and improved measured mental health outcome

Responding to a call for quantitative outcome evidence about the therapeutic relationship between creative activity and mental health, this study examined the mental health outcomes of inpatients participating in art- and craft-based creative therapies at a private psychiatric hospital over a 5-year period. The creative activity group sample (n= 403) improved from admission to discharge across four different psychometric measures with moderate to strong mean effect sizes. Reductions from pre- to post-treatment in both self-reported and clinician-rated symptoms are clearly demonstrated for the creative activity group participant sample. Research findings establish that participation in creative activity has potential benefits for people experiencing mental health problems.