This paper examines the barriers to employment faced by job seekers (JS) with mental illness and additional substance-use issues. Semi-structured interviews concerning barriers to employment for JS with mental illness and substance-use problems and strategies to improve employment outcomes were conducted with stakeholders associated with an employment service provider specialising in mental illness (n = 17). Stakeholders were JS, family members who provide significant support to JS [support persons (SP)] and staff [employment staff (ES)]. Data were collected between May and August 2009 at the premises of the employment service provider in metropolitan Sydney. Thematic analysis of transcribed interview data was conducted to develop a meaningful data framework. The expectations of JS and SP regarding employment outcomes were higher than those of ES. Length of time unemployed was perceived as the most important barrier to future employment associated with mental illness, and substance-use problems were associated with lower, more variable motivation, restrictions on the environments where JS could work and more negative community and employer perceptions. The findings are consistent with studies from non-vocational settings and provide direction for meeting the needs of clients with mental illness and additional substance-use problems. Ensuring alignment between JS and ES concerning service goals and expected timeframes may improve JS motivation, satisfaction with service delivery and ultimately, employment outcomes.
Clinical practice guidelines (CPGs) are defined as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances [1]. Effective guidelines must: have utility for both clinicians and patients; be developed systematically; be specifically used to assist (not dictate) clinical decision making; and be applied on a case by case basis.Six CPGs have been developed as part of the RANZCP Clinical Practice Guideline Project to guide management of schizophrenia, bipolar disorder, depression, panic and agoraphobia, anorexia nervosa and deliberate self-harm. A parallel set of guidelines has been prepared for patients and carers (see http://www.ranzcp. org/publicarea/cpg.asp). The guidelines have been developed on the assumption that the clinician has been fully trained to:
Objectives: To provide an overview on the role of evidence‐based clinical guidelines in the context of the consultation, dissemination and implementation planning phases of the new RANZCP guidelines for psychiatrists and other specialist mental health care providers. Conclusions: Despite a vast literature on guidelines and evidence‐based practice in general medicine and allied health, little is published on these themes in mental health. Anxieties about the introduction of guidelines often surface during the consultation stage of developing new guidelines and provide clues to barriers for implementation. Facilitating discussion about the pros and cons of guidelines is prudent for informing dissemination planning and is a necessary precursor to any programs intended to achieve implementation. Guidelines must reflect a fit between clinician aspirations, the evidence, and consumer expectations if they are to be adopted into routine service delivery. The six RANZCP guidelines will be foundation documents to ensure that all practitioners have access to the basic tools to guide practice. In particular, they will contain the evidence status and rationale behind recommended treatments, so that this information can be at hand or committed to memory to justify and share clinical decision making with consumers.
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