Community rehabilitation for persons with psychiatric disabilities: comparison of the effectiveness of segregated and integrated programs in Israel

This study compares the effectiveness of a segregative and an integrative psychosocial recreational program for persons with psychiatric disabilities in Israel. Comparison of changes in 97 members of a segregated social club with those of 89 participants in an integrative program in their local community center shows that both reported significantly greater satisfaction with their social life, having more friends than previously, increased support from friends, less loneliness, greater social support, and engaging in more leisure activities. The only significant differences were that the participants in the segregative program reported making more new friends, while those in the integrative program reported a greater increase in the number of leisure activities in which they engaged. With this, the findings also show that the participants in the integrative program were generally stronger and in better clinical condition than those in the segregative program. These findings point to the need for different types of recreational programs to meet the needs of persons with different levels of disability.     

Leisure provision for persons with profound intellectual and multiple disabilities: quality time or killing time?

Background Information on the duration, frequency and content of leisure activities for persons with profound intellectual and multiple disabilities (PIMD) in residential facilities during weekends was not available. Method The project was carried out in 2003 and included seven facilities. Interviews were held with direct support professionals of 112 living units. Consequently, the actual leisure provision of 160 persons with PIMD was recorded over a period of four weekends. This study also investigated the relationship between setting characteristics and the distribution of the content, frequency and duration of leisure activities. Age and gender of persons with PIMD were under investigation. Results A total mean of 3.8 h of leisure activities is provided for during the full weekend, almost half of which includes watching television or listening to music. Leisure activities are almost exclusively offered by professionals. Parents or volunteers only provide a minimum of activities during weekends. The results suggest that the leisure provision for persons with PIMD is severely restricted and not bound to any service provider in particular. Generally, with increasing age the leisure provision for persons with PIMD declines in number and in variety. No effect was found for gender. Conclusions Leisure time for persons with PIMD contains more empty hours than quality time.     

Vocational rehabilitation in psychiatry: a re-evaluation

OBJECTIVE: To highlight the vocational gap in the provision of psychiatric rehabilitation, to outline the goals and conceptual framework of psychiatric rehabilitation, and to discuss rehabilitation interventions with specific reference to vocational rehabilitation and the evidence base for supported employment. CONCLUSIONS AND SERVICE IMPLICATIONS: Vocational psychiatric rehabilitation has been a neglected area of practice in Australian psychiatry. Psychiatric treatment needs to adopt a more balanced approach in the provision of a range of services, including vocational rehabilitation, in order to improve long-term outcomes for people suffering from psychiatric disability. A vocational focus should be included in psychiatric rehabilitation and better integration between mental health services and vocational services needs to take place. Supported employment is an evidence-based practice that is designed to help people with psychiatric disabilities participate as much as possible in the competitive job market.     

Patterns and determinants of leisure participation of youth and adults with developmental disabilities

Background People with developmental disabilities are at high risk for a limited participation in leisure activities. The aim of this study was to investigate the participation in, preference for and interest in leisure activities of young and adults with developmental disabilities, and to examine the factors associated with leisure activity. Methods A cross‐sectional design was used with a convenience sample of 237 people aged 17 to 65, living in the community. Leisure participation was assessed with the Spanish version of Leisure Assessment Inventory. Percentages were calculated by types of activity, and repeated measures anova s were used to analyse the differences between types of activities, and mixed anova s to analyse the factors that explain differences in leisure activity participation, preference and interest. Results Leisure social activities and recreation activities at home were mostly solitary and passive in nature and were identified as those being most commonly engaged in. Respondents expressed preference for more social and physical activity, and they were interested in trying out a large number of physical activities. Age and type of schooling determine participation in leisure activity. The results underscore the differences in leisure activity participation, preference and interest depending on the severity of the disability. Conclusions The findings reveal interesting patterns of participation in leisure activities from the viewpoint of youngsters and adults with developmental disabilities. Leisure participation among people with developmental disabilities is likely to be more affected by environmental factors than by personal factors.     

Understanding the Policy Context for Supporting Students with Psychiatric Disabilities in Higher Education

Interest in postsecondary education for persons with psychiatric disabilities is high among consumers and advocates. However, the existence of program supports for higher educational goals is very uneven across U.S. states. This study was designed to examine the policy context in which states and educational institutions address needs of individuals with psychiatric disabilities to attend and succeed in postsecondary education. In 10 selected states, telephone interviews were conducted with key informants in state agencies of mental health, vocational rehabilitation, and higher education, as well as representatives of state-level advocacy organizations. Additionally, a search of websites relevant to state policy was conducted. The findings identify factors that facilitate and inhibit the development of policy and programs supportive of students with psychiatric disabilities. Facilitating factors include a strong community college system, progressive philosophy of the state mental health agency, and interest of consumers and the advocacy community. Inhibiting factors include political and budgetary uncertainty, competing priorities in the mental health system, emphasis on a medical rather than rehabilitative model, regulations of the VR system, and lukewarm enthusiasm of the advocacy community. Implications for community mental health services are included, particularly related to further policy development in support of students with psychiatric disabilities.     

Vocational integration services in community mental health: Professionals' perceptions of training needs

Vocational integration in mental health is part of a national initiative to make quality, community-based work a possibility for persons with psychiatric disabilities. While effective delivery of these services requires trained staff, preparing professionals to provide relevant vocationally oriented services is complex and challenging. This study examines perceived priority training needs in vocational integration services from the perspectives of professionals in mental health, rehabilitation, and education organizations in Mississippi. Findings suggest that vocational integration activities are perceived differently across organizations and across occupational specialties. Implications for staff development in community support and psychosocial rehabilitation programs are discussed.Susan D.M. Kelley, Ph.D., CRC, was Public Academic Linkage Visiting Professor in Psychosocial Rehabilitation at Mississippi State University at the time this study was completed. Win Belgard, ACSW, is Coordinator of Case Management Services for the Mississippi Department of Mental Health. Dana L. Cooper, Ph.D., received her doctoral degree at MSU and is currently Assistant Professor, Department of Counseling & Human Services, St. Mary's University, San Antonio, TX.     

Can SSDI and SSI beneficiaries with mental illness benefit from evidence-based supported employment?

OBJECTIVE: Individuals with psychiatric disabilities are the fastest-growing subgroup of Social Security Administration disability beneficiaries and have negligible rates of return to competitive employment. Nevertheless, a new approach to vocational rehabilitation, termed supported employment, has increased the optimism regarding employment for this population. METHODS: Aggregating data from four randomized controlled trials of evidence-based supported employment for persons with severe mental illness, the investigators compared 546 Social Security Administration disability beneficiaries with 131 nonbeneficiaries. Three employment measures were examined: job acquisition, weeks worked, and job tenure. RESULTS: Beneficiaries receiving supported employment had better employment outcomes than those receiving other vocational services. Similar results were found for nonbeneficiaries. Overall, nonbeneficiaries had better employment outcomes than beneficiaries. However, the effect sizes measuring the improved outcomes with supported employment were similar for beneficiaries (d=.52-1.10) and nonbeneficiaries (d=.78-.89). CONCLUSIONS: Evidence-based supported employment could enable many Social Security Administration beneficiaries with psychiatric disabilities to attain competitive employment even though receipt of disability benefits operates as a barrier to employment.     

Chinese cultural dynamics of unemployability of male adults with psychiatric disabilities in Hong Kong

Work and employment has long been regarded as crucial for the mental health of human beings. Unemployment may lead to deterioration of physical and mental health. Nevertheless, for adults with psychiatric disabilities, discontinuity of employment is common. They may have various reasons to discontinue their employment. In Hong Kong, only 2.5% of people with psychiatric disabilities discharged from sheltered workshops are able to seek open employment. By means of illustration, the authors will show that traditional Chinese work culture tends to reinforce the discontinuity of employment of adult males with psychiatric disabilities. In Chinese culture, work is a means to occupy time, control misbehavior, show consistency of words and deeds, and to glorify parents and ancestors. All these factors contribute to the fulfillment of an adult male role and identity in traditional Chinese culture. In this case history, instead of finding realistic employment, a male adult with psychiatric disability tried to indulge himself in what he felt was his ideal job to fulfill all requirement as an adult male in Chinese culture. The imaginative ideal job gave him excuses to discontinue open employment. Its implications to vocational rehabilitation with male adults with psychiatric disability are also discussed.     

Analyzing vocational outcomes of individuals with psychiatric disabilities who received state vocational rehabilitation services: a data mining approach

This study examines factors affecting vocational outcomes in the vocational rehabilitation process for individuals experiencing psychiatric disabilities who had received state vocational rehabilitation (VR) services. A data mining approach was used to analyze the Rehabilitation Services Administration FY 2001 Case Service Report (RSA-911). Receiving job placement services was found to be the most important variable differentiating individuals who were working from those who were not working. Results regarding vocational outcomes suggest a positive effect for persons receiving job placement services.     

Employing people with psychiatric disabilities to engage homeless individuals through supported socialization: the Buddies Project

This article describes the Buddies Project, a small time-limited grant that employed two part-time formerly homeless persons on a community-based mental health outreach team to participate in social activities with "difficult to engage" homeless individuals. We offer clinical examples that point to the success of this small supported socialization project. We suggest that employing people with psychiatric disabilities to participate in social activities with homeless persons with psychiatric disabilities can be an important tool to decrease homeless persons' social isolation and engage them into mental health treatment and independent housing.     

Prediction of Vocational Outcome Based on Clinical and Demographic Indicators Among Vocationally Ready Clients

This study examined the clinical and demographic correlates of work skills and vocational outcome for persons with psychiatric disabilities. The same clinical, demographic, work skills, and vocational outcome instruments were administered to 275 persons working toward their vocational goals at three psychosocial rehabilitation centers. Data regarding vocational outcomes were collected quarterly over a period of 3 1/4 years. Using multivariate statistical techniques, clinical and demographic variables that predict work skills and future vocational outcomes were identified. The implications of the findings for program administrators, system planners, and researchers are discussed.     

Psychiatric rehabilitation: Past myths and current realities

Psychiatric rehabilitation treatment has a unique and complementary contribution to make to the treatment of persons with a severe psychiatric disability. However, the development of the psychiatric rehabilitation field, and the adoption of its philosophy and techniques by mental health agencies, has been hampered by past myths. Research carried out in the 1960s and 1970s has exposed these myths as a part of the past, no longer relevant to the present practice of rehabilitating persons with severe psychiatric disabilities.     

Leisure activities during school break among children with learning disabilities: preference vs. performance

Participation in leisure activities may contribute to the development of social, motor, and language skills, and is therefore especially important for children with learning disabilities. Leisure activities of students in educational settings are performed mostly during breaks. While there have been some studies of the effect of breaks on classroom performance, none have been conducted among children with learning disabilities. Moreover, the role of breaks as a leisure agent was never addressed. The purpose of the study was to examine break activities of children with learning disabilities, through exploration of the correlation between their preferences for break activities and the activities in which they actually engaged. The study found no such correlation. It is therefore suggested that leisure education should provide students with the skills they need in order to choose leisure activities and evaluate the efficacy of the choice they had made.     

DGPPN-Teilhabekompass zu beruflichen Integrationsmaßnahmen für Menschen mit psychischen Erkrankungen

Working and living for persons with mental illnesses are a major concern of rehabilitative psychiatry. In Germany the definition of rehabilitation for persons with mental illnesses is closely linked to different sectors of social welfare and to the strongly organized supply chain of prevention, acute treatment, rehabilitation and care. In successfully supporting people with mental health problems in terms of vocational integration, professionals face various obstacles. Besides finding the correct content, structural and organizational difficulties can also arise. The welfare system with its specific institutions and settings is complicated which often leads to delays in the onset of rehabilitation. Some essential reasons are insufficient knowledge about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. Also information and (positive) experiences from pilot projects working in an inclusive, cross-sectional way and across different settings are practically unavailable in Germany. The presented compass of participation from the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for vocational integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both the paper and planned online versions should help professionals to help people, particularly those with severe mental illnesses to navigate the system of services for vocational integration in Germany.     

What affects self-esteem of persons with psychiatric disabilities: the role of causal attributions of mental illnesses

This study addresses the factors which affect the self-esteem of persons with psychiatric disabilities, with a specific focus on the role of causal attributions of mental illnesses. It is based on data collected from 461 persons with psychiatric disabilities (consumers) served through psychiatric rehabilitation agencies. The results of regression analyses revealed that household income, diagnosis, psychiatric symptoms, service satisfaction, perceived stigma, and perceptions of social roles were all related to self-esteem. Consumers' causal attributions did not have direct effects on self-esteem, but the effects of causal attributions on self-esteem were moderated by psychiatric symptoms and by perceptions of social roles, suggesting that self-esteem enhancement strategies should be tailored to consumers' psychiatric and cognitive characteristics.     

Prediction of work rehabilitation placements using the Chinese Work Personality Profile

This study aims to evaluate the application of a situational assessment instrument, the Chinese Work Personality Profile (CWPP), to predict the work rehabilitation placements of persons with psychiatric disabilities. Using the five CWPP subscale scores as predictors, both discriminant and classification and regression tree analysis showed that the CWPP scores correctly identified more than 80% of the work rehabilitation placements of the 179 participants. Social skills, self-control, and task orientation factors of the CWPP were the most important predictors of work rehabilitation placements, and clinical implications for these results were discussed.     

Personal factors and perceived barriers to participation in leisure activities for young and adults with developmental disabilities

Participation in leisure activities has been identified as a factor that favors inclusion in the community and it also contributes to a better quality of life. This study analyzed the influence of certain personal characteristics and environmental factors in the participation in leisure activities of youngsters and adults with developmental disabilities. A cross-sectional design was used with a convenience sample of 237 people, aged 17-65, living in the community. The participants completed the Spanish version of the Leisure Assessment Inventory, and information about the personal and disability-related factors was obtained through a questionnaire. Multiple regression analyses were conducted to determine the personal factors, disability-related factors, and perceived barriers to leisure participation. The results show that participation in leisure activities is determined more by personal factors and perceived barriers than by disability-related factors.     

Job ending among youth and adults with severe mental illness

This study examined job leaving over a 36-month period among 326 persons (74 youth and 252 adults) with severe mental illness who were participating in an urban vocational rehabilitation program. Data from 627 job endings indicated that younger clients displayed job-ending patterns that were different in some aspects from such patterns for nondisabled youth (such as displaying a lower average job tenure) yet similar to job-ending patterns for nonhandicapped youth in other ways (such as displaying a high frequency of job changing). Youth and their adult counterparts with mental illness displayed similar tenure on agency-sponsored placements but significantly different tenure on independent jobs. While adults held their independent jobs for an average of seven months, youth averaged only three months at competitive employment. Youth also were significantly more likely than adults to be fired from both placements and independent jobs. These findings and others are discussed in terms of their implications for development of public policy and service delivery models for providing on-going job support to youth and adults with severe psychiatric disabilities.