Critical factors for the return-to-work process among people with affective disorders: Voices from two vocational approaches

Abstract

BACKGROUND:Depression is among the major causes of disability with a negative impact on both daily life and work performance. Whilst depression is the primary cause of sick-leave and unemployment in today’s workplace there is a lack of knowledge of the needs of individuals with depression regarding their return-to-work (RTW) process.OBJECTIVE:To explore which factors are of critical importance for people suffering from depression and who also are unemployed in their RTW-process and to explore the impact of two vocational approaches on the service users’ experiences. The study included participants in two vocational rehabilitation approaches; Individual Enabling and Support (IES) and Traditional Vocational Rehabilitation (TVR).METHOD:Qualitative methods were applied to explore critical factors in the RTW-process. Individuals with affective disorders including depression and bipolar disorder were included.RESULTSThree themes emerged as critical factors; Experiencing hope and power, professionals’ positive attitudes, beliefs and behaviours, and employing a holistic perspective and integrating health and vocational service. CONCLUSIONThis study has demonstrated critical factors for the return-to-work process as experienced by persons with depression. To experience hope and power, to meet professionals that believe “you can work”, who use a person-centred and holistic service approach, are such factors necessary for gaining a real job. In particular, professionals in TVR need to embrace this understanding since their services were not experienced as including these elements.

Work identity development in young adults with mental health problems

“…Increased awareness among professionals of the potential of developing a work identity during the transition to work is important for changing current attitudes towards a personal recovery perspective and succeeding in integration of MH and vocational services. Consequently, simultaneous determination of work, occupational, environmental, and clinical factors, and providing guidance on how to support young adults' status and changes toward working lives [51,52], offering real workplace support instead of prevocational rehabilitation in sheltered settings, and collaboration with employers is critical [11]. MH services ought to integrate recommended evidence-based practices like supported employment [53], and supported education for young adults who want to study [54].…”

“…Moreover, the intervention group had a higher sense of empowerment, fewer symptoms, and higher levels of community integration [20,21]. Qualitative research points in the same direction [11,22,23]. An integration of mental health and vocational rehabilitation services that lead to work may increase the chance of recovery [17,24].…”

“…Nevertheless, work is a usual goal for most persons with MH problems [4,5], and has an essential meaning for personal recovery [6][7][8][9]. Most interventions focus on the treatment of MH disease and symptoms [10], and not on promotion of resources and abilities [11]. Less than 23% of persons with long-lasting MH problems in Sweden report engaging in regular work [12].…”

“…Social interaction can be seen as the primary opportunity to get feedback on oneself and how others perceive us [28,30]. The social environment of professionals from MH and vocational services [11], contributes with a social space [15] which offers opportunities for daily social interaction to develop and change one's identity [27]. This work role identification deals with both the environment's response to, and personal perception of, external and internal factors.…”

Mental health literacy among vocational rehabilitation professionals and their perception of employers in the return-to-work process

“…In Sweden, individuals in the RTW process encounter diverse groups of vocational rehabilitation professionals (labelled as 'professionals' for the remainder of this article) who have different perspectives and regulations to follow (Bejerholm, Areberg, Hofgren, Sandlund, & Rinaldi, 2015;Burstrom, Nylen, Clayton, & Whitehead, 2011). However, the mental health literacy of these professionals is often lacking, and this has consequences on RTW support, which may become deficient, delayed, or none existent (De Vries, Hees, Koeter, Lagerveld, & Schene, 2014;Lexén, Emmelin, & Bejerholm, 2016;Porter, Lexén, Johanson, & Bejerholm, 2018). Mental health literacy is defined in this study as the beliefs and knowledge of mental health problems which consequently affect the prevention, recognition and management of these mental health problems.…”