Factors related to the return to work potential in persons with severe mental illness

Abstract

Objective: This cross-sectional study aimed at investigating the relationship between the return to work potential, according to the Worker Role Interview (WRI) assessment, and clinical characteristics and level of empowerment and occupational engagement among persons with severe mental illness who express their own interest in working. Methods: 120 participants entered the study. The WRI, the Brief Psychiatric and Rating Scale, a sociodemographic questionnaire, the Empowerment Scale, and the Profiles of Occupational Engagement in Severe mental illness were used for data collection. Correlation and regression analyses were used for statistics. Results: The return to work potential was significantly associated with having fewer symptoms, rehabilitation support or productive activities, and higher levels of engagement and empowerment. A younger age had an inverse relation to the lifestyle component in WRI. Depressive symptoms and occupational engagement explained 42% of the variance. Conclusions: The findings support the use of an empowerment approach, taking into account the clients’ symptoms, age, and time use. In addition, involvement in vocational support and productive activities may be advantageous early on in the recovery process.     

The effect of first year mental health fieldwork on attitudes of occupational therapy students towards people with mental illness

Background and Aims:  Despite recent initiatives to reduce stigma towards people with mental illness, negative attitudes persist both in the community and among health professionals. Fieldwork experience has been identified as the most powerful way of modifying the attitudes of health professional students. Research to date suggests that later placements tend to have a more positive effect on attitudes than do earlier placements. However, inconsistencies within the literature suggest that it is the nature of the fieldwork experience that is the critical factor. We set out to investigate whether a program of fieldwork that included a tutorial component would bring about positive attitudinal change in first year occupational therapy students.
Methods:  We conducted secondary analysis of data collected from first year students before and after first year fieldwork experience in mental health settings. Student statements were rated to identify positive versus negative attitudes, and attitudinal themes were analysed.
Results:  Quantitative analysis revealed that students made significantly more statements reflecting positive attitudes following fieldwork than they did before. From pre- to post-fieldwork, attitudinal themes changed from: people with mental illness as different, fear of people with mental illness, and a deficit focus of mental illness, to: the 'ordinariness' of people with mental illness, students' understanding of people with mental illness, and an enabling approach to people with mental illness.
Conclusions:  A program of fieldwork that includes a structured tutorial component can bring about positive changes in the attitudes of first year students towards people with mental illness.     

Inpatients' perspectives of occupational therapy in acute mental health

Background:  Research into service users' views of occupational therapy in acute mental health is extremely limited. This collaborative study by the South West London and St George's Mental Health NHS Trust and the Brunel University (UK) obtained inpatients' perspectives of occupational therapy.
Methods:  Service users and occupational therapists were involved in designing a self-report questionnaire and, following training, in recruiting participants and collecting data.
Results:  Sixty-four (28.6%) inpatients responded and most had met an occupational therapist who had explained the purpose of the intervention. The most frequent group interventions were arts and crafts, relaxation, community meetings, cookery, sports and gym, with the latter two rated as the most beneficial. There was much less choice about individual goals and interventions. A highly significant and positive correlation was found between occupational therapy meeting the needs of individuals and it improving the inpatients' daily functioning and quality of their admission.
Conclusions:  Occupational therapists need to provide more individual interventions and more fully involve inpatients in deciding on individual goals. Group interventions, which are meaningful, relevant and with an occupational focus, are most beneficial. Further research examining the effectiveness of cookery and sport and gym and establishing the benefits of engaging in group and individual interventions in acute wards is warranted.     

Empowerment and occupational engagement among people with psychiatric disabilities

Background: Empowerment is essential in the rehabilitation process for people with psychiatric disabilities and knowledge about factors that may play a key role within this process would be valuable for further development of the day centre services. Objective: The present study investigates day centre attendees’ perceptions of empowerment. The aim was to investigate which factors show the strongest relationships to empowerment when considering occupational engagement, client satisfaction with day centres, and health-related and socio-demographic factors as correlates. Methods: 123 Swedish day centre attendees participated in a cross-sectional study by completing questionnaires regarding empowerment and the targeted correlates. Data were analysed with non-parametric statistics. Results: Empowerment was shown to be significantly correlated with occupational engagement and client satisfaction and also with self-rated health and symptoms rated by a research assistant. The strongest indicator for belonging to the group with the highest ratings on empowerment was self-rated health, followed by occupational engagement and symptom severity. Implications: Occupational engagement added to the beneficial influence of self-rated health on empowerment. Enabling occupational engagement in meaningful activities and providing occupations that can generate client satisfaction is an important focus for day centres in order to assist the attendees’ rehabilitation process so that it promotes empowerment.     

Scoping the field: services for carers of people with mental health problems

Mental ill health is very common. Most people with mental health problems live in the community, and as many as 1.5 million people in the UK may be involved in caring for a relative or friend with a mental illness or some form of dementia. Recent legislation and policy initiatives such as the National Strategy for Carers, and the National Service Frameworks for Mental Health and Older People emphasise the importance of providing support for this particular group of carers. The present paper reports the findings of a scoping study to identify what the research tells us about the effectiveness and cost-effectiveness of interventions for the carers of people with mental health problems, and also where there are gaps in the knowledge base. Some 204 evaluation studies were included in the review, just 13 of which had an economic component. The majority of studies were conducted in the USA, and were aimed at carers of people with Alzheimer disease or other forms of dementia. Overall, there was a lack of strong evidence to support any specific interventions, although almost all studies were able to identify some positive outcomes of services provided. In contrast to the relatively narrow approach to effectiveness adopted in most of the studies reviewed, the contributors to a consultation exercise perceived this concept in a far more rounded and holistic way. For them, the process of service delivery was as important as the outcome. There was relatively little research evaluating interventions and services singled out in UK policy initiatives as potentially useful in supporting this group of carers, and further evaluation studies are needed.     

Rural physical health care services for people with serious mental illness: A nursing perspective

Objective: To understand nurse perspectives on the physical health needs of their mental health clients and how well rural services are meeting their overall care needs. Design: Focus groups with semistructured format. Setting: Community mental health care in a regional and rural district of Queensland. Participants: Thirty‐eight nurses in public mental health care. Results: The major themes were (i) stigma of mental illness, (ii) barriers to accessing physical health care services, (iii) nurse adaptations under demands, and (iv) community and integration towards better overall health. Nurses integrate overall care and foster its continuity for people with physical and mental co‐morbidity and can be supported much better in sustaining this. Conclusion: Access and continuity of physical health care experienced by all Australians is exacerbated for people in rural areas. Physical health of people with serious mental illness residing in remote Australia needs to be a national health priority.     

Conceptualizing the outcomes of involving people who use mental health services in policy development

Context

Inclusion of people who use mental health services in policymaking is a goal of many mental health systems. However, the outcomes of such involvement have not been well articulated or researched.

Objectives

The objectives of this research were to explore how the social and personal outcomes of citizen‐user involvement in mental health policymaking were conceptualized by policy actors and to create a conceptual framework to guide the development and evaluation of citizen‐user involvement.

Design

This qualitative instrumental case study explored the phenomenon of citizen‐user involvement using the policy field of mental health and social housing policy in the Province of Manitoba, Canada, as the focal case.

Participants

A total of 21 informants from four policy actor groups, citizen‐users, representatives of advocacy organizations, government officials and service providers, participated in key informant interviews. Data also included policy documents relevant to the policy field.

Analysis

Data collected from interviews and policy documents were analysed using an inductive qualitative paradigm.

Results

Participants identified multiple outcomes of citizen‐user involvement in policymaking. The resulting conceptual framework illustrated how outcomes in personal, substantive, instrumental and normative dimensions influence micro‐, meso‐ and macrosocial structures. The results also provided a cautionary tale by suggesting how attention needs to be paid to managing the risks as well as optimizing the rewards of involvement.

Conclusions

The framework has application in guiding the development and evaluation of mechanisms that aim to involve citizen‐users in policymaking. The framework encourages an approach that takes into account the complexity and multidimensional nature of engaging citizen‐users.     

The application of concept analysis in the occupational therapy treatment process in mental health

The objective of this study was to construct a coding schema for analysing the occupational therapy process, often described as formulating the treatment goal, implementing treatment and evaluating the effect of treatment. The concepts underlying the terms treatment goal, treatment intervention and effect or outcome of treatment, as used in occupational therapy, were defined and an analytical template of questions was constructed, using the analysis method designed by Walker and Avant (1995). The method included a third part; definitions of the three concepts were formulated on the basis of excerpts from occupational therapy textbooks in mental health that are well known in Sweden. The results showed that the concept of treatment goal included the attributive components planning goals, step-by-step goal, and group goal; the concept of treatment intervention included the components planning process, available resources and level; and the concept of effect or outcome of treatment included type and measurement. The excerpts for each of the components were then summarized as statements. These statements were converted into the questions that constituted the template. Third, these questions were used to test the usefulness of the template in analysing the occupational therapy content of 10 scientific reports on individuals with psychosis. All but two questions served to identify attributes of the three concepts. The template was useful for analysing the content of 10 research studies relevant to the occupational therapy process in mental health. Copyright © 1998 Whurr Publishers Ltd.     

Work-related self-efficacy of occupational therapists in mental health

Abstract

Aim: Changes in the mental health field have created new job expectations of occupational therapists (OTs). The present research investigated differences in general self-efficacy (GSE) and work-related self-efficacy (WRSE) between occupational therapists (OTs) working in psychiatric hospitals and OTs working in community-based mental health services. Method: Thirty-four OTs working in psychiatric hospitals and 30 OTs working in community-based settings (n = 60) completed the General Self Efficacy Scale (GSE) and the WRSE in Mental Health Occupational Therapy Scale (WSMOT). Results: The two groups showed no differences in total WRSE score. Both evinced high self-efficacy in direct intervention activities, and low self-efficacy in managing and counseling. Conclusion: Results enlighten an overall high WRSE, which indicates successful adaptation of OTs to changing roles and tasks in mental health, similar to studies in other countries. However, it reveals discrepancies between job demands and self-efficacy of OTs that should be addressed at educational and managerial levels.     

Registering concern: the case of primary care registers for people with severe and enduring mental illness

As the focus of mental health care has shifted from the hospital to the community, so the importance of effectively targeting resources on those with the greatest need has become paramount. One approach to identifying and targeting people deemed to have severe and enduring mental health problems is the establishment of mental health case registers at primary care level. This paper raises a number of conceptual issues associated with these registers and, on the basis of the available literature, offers suggestions to guide those who are contemplating their introduction.     

Satisfaction with Daily Occupations: Construct validity and test–retest reliability of a screening tool for people with mental health disorders

Background/Aim:  In occupational therapy research and in clinical practice there is a need for valid, reliable and easily administered measures. For research and screening purposes, the Satisfaction with Daily Occupations (SDO) instrument was developed. It addresses work, leisure, domestic tasks and self-care and generates a satisfaction and an activity level score. This study investigated its construct validity, internal consistency and test–retest reliability in 55 clients visiting occupational therapists in outpatient mental health care.
Methods:  The SDO was administered on two occasions with a 1-week interval, and data on the Canadian Occupational Performance Measure (COPM), psychosocial functioning and self-rated health were collected on the first of these occasions.
Results:  In contrast to what was expected, the relationships between the SDO scores and the COPM scores were low. The strongest relationship between the SDO satisfaction score and any other variable was to psychosocial functioning. These variables shared 23% of the variance. Internal consistency for the satisfaction score was acceptable, alpha = 0.75 on the second occasion, and the test–retest reliability was good; r _s   = 0.84 for the satisfaction score and r _s   = 0.92 for the activity level.
Conclusions:  The results indicated that the SDO has satisfactory reliability. The instrument targets a specific construct, as compared to the COPM and the measurements of self-rated health and psychosocial functioning. Thus, the SDO and the COPM satisfaction scale seem to assess different phenomena, probably because the SDO has predefined items, not specifically targeting a certain client's problematic occupations, whereas the COPM is based on self-defined problems. The instruments may therefore supplement each other.     

Promoting autonomy of the client with persistent mental illness: a challenge for occupational therapists from The Netherlands, Germany and Belgium

The aim of this study was to determine how occupational therapists from The Netherlands, Germany and Belgium promote the autonomy of clients with persistent mental illness. Sixty occupational therapists working in psychosocial mental health completed two semi-structured questionnaires. Data were analysed by applying the constant comparative method. The results of the study show the importance of handling motivation in relation to personal autonomy and the different strategies occupational therapists use in promoting autonomy. In conclusion, enhancing clients' personal autonomy will empower and help them to discover meaningful occupations. More in-depth information could have been obtained using an interview in combination with observations. Further research is needed to evaluate the effectiveness of strategies used by occupational therapists in promoting clients' autonomy.     

Caregiving in the shadows: National analysis of health outcomes and intensity and duration of care among those who care for people with mental illness and for people with developmental disabilities

BackgroundThe health impacts of caring for people with mental illness (MI) and developmental disabilities (DD) are not well understood.ObjectiveThe present study explored whether health outcomes differed between MI and DD caregivers, and if intensity and duration of care moderated health outcomes.MethodsNationally representative 2016 Behavioral Risk Factor Surveillance System survey data were used to explore how caring for people with MI (n = 1071) and DD (n = 888) impacted general health status and physical and mental health days, and whether intensity and duration of care moderated health outcomes. Logistic regression models and cumulative logistic regression models were used to model health outcomes.ResultsCaregivers had worse health (p = 0.0001) and more poor physical (p < 0.0001) and mental health days (p < 0.0001) than non-caregivers. Relative to DD caregivers, MI caregivers had worse health status (p = 0.02) and more poor physical (p = 0.02) and mental (p = 0.003) health days. As intensity of care increased, MI caregivers had more poor physical health days (p = 0.04) than DD caregivers and as duration of care increased, MI caregivers had worse health status (p = 0.03) than DD caregivers.ConclusionsAlthough the care provided to adults with DD was more intense and for a longer duration, MI caregivers had poorer health outcomes and were more impacted by intensity and duration of care. Implications for supporting MI and DD caregivers are discussed.     

Workers' compensation insurance agents' satisfaction with occupational therapy activities of daily living assessments

Background and Aim:  Little is known about insurance agents' (insurers) satisfaction with the services provided by occupational therapists when they assess injured workers' activities of daily living (ADL). Demonstration of accountability and provision of high-quality services are important to the occupational therapy profession. The aim of this study was to evaluate insurers' overall satisfaction with occupational therapy ADL assessments for injured workers, including communication, timeliness of reports, equipment provision, knowledge of insurers' requirements and the workers' compensation process, and provision of a professional opinion. Relationships between insurers' overall satisfaction with ADL assessments, degree of experience in their job, formal qualifications and roles within their organisation were also investigated.
Method:  A telephone survey was developed and administered to a sample of 40 claims officers and injury management advisors from 10 Victorian Work Cover Authority authorised agents.
Results:  Insurers were generally satisfied with occupational therapy ADL assessments. They were less satisfied with occupational therapists' knowledge of workers' compensation system requirements and how occupational therapists made decisions when recommending household services.
Conclusion:  To improve services to the insurance industry, occupational therapists need to better understand relevant legislative frameworks.     

Behavioral health home impact on transitional care and readmissions among adults with serious mental illness

ObjectiveTo evaluate the impact of Maryland''s behavioral health homes (BHHs) on receipt of follow‐up care and readmissions following hospitalization among Medicaid enrollees with serious mental illness (SMI).Data SourcesMaryland Medicaid administrative claims for 12 232 individuals.Study DesignWeighted marginal structural models were estimated to account for time‐varying exposure to BHH enrollment and time‐varying confounders. These models compared changes over time in outcomes among BHH and comparison participants. Outcome measures included readmissions and follow‐up care within 7 and 30 days following hospitalization.Data Collection/Extraction MethodsEligibility criteria included continuous enrollment in Medicaid for the first two years of the study period; 21‐64 years; and use of psychiatric rehabilitation services.Principal FindingsOver three years, BHH enrollment was associated with 3.8 percentage point (95% CI: 1.5, 6.1) increased probability of having a mental health follow‐up service within 7 days of discharge from a mental illness–related hospitalization and 1.9 percentage point (95% CI: 0.0, 3.9) increased probability of having a general medical follow‐up within 7 days of discharge from a somatic hospitalization. BHHs had no effect on probability of readmission.ConclusionsBHHs may improve follow‐up care for Medicaid enrollees with SMI, but effects do not translate into reduced risk of readmission.