The meaning and experience of stress among supported employment clients with mental health problems

Abstract

Many clinicians are concerned that competitive work may cause excessive stress for people with severe mental health problems. Individual Placement and Support (IPS) is acknowledged as the most effective model of supported employment for this population. The manner in which IPS clients define and experience employment-related stress is poorly understood. This qualitative study aims to explore how people with mental health problems receiving IPS services define and experience employment-related stress. We purposively sampled and interviewed 16 clients of an IPS programme, who had been competitively employed for more than 1 month. Data were collected between September 2014 and July 2015 in Montreal, Canada. Transcripts of semi-structured interviews were analysed using grounded theory methodology. IPS clients often defined stress similar to its common understanding: the result of experiencing prolonged or/and cumulative strains, or of an incongruence between efforts and rewards, hopes and reality. Stress experienced in this way could exacerbate psychiatric symptoms, especially depression or psychotic symptoms. However, when maintained at a more manageable level, stress stimulated learning and improved planning of tasks. Participants described different coping mechanisms, such as sharing their experiences and difficulties with others, focusing on problem resolution and avoidance. The first two of these helped IPS clients remain at work and bolstered their confidence. Work-related stress has potentially positive as well as negative consequences for IPS clients. In order to maximise the potential beneficial effects of stress, employment specialists can help clients anticipate potential stressors and plan how they might cope with them. Further research on the most effective ways of helping clients cope with stress is needed.

Stakeholder Perspectives on IPS for Employment: A Scoping Review

“…Studies targeting solely clients of IPS accounted for most of the articles retrieved ( n = 15, 57.7%) (Alverson et al, 1995; Areberg et al, 2013; Becker et al, 2007, Besse et al, 2017, 2018; Boycott et al, 2015; Coombes et al, 2016; Gammelgaard et al, 2017; Huff et al, 2008; Johnson et al, 2009; Koletsi et al, 2009; Lexen et al, 2013a, 2013b; Liu et al, 2007; Nygren et al, 2016). An additional four articles focused on clients among other stakeholders (15.4%).…”

“…We documented the qualitative methodologies applied in the retrieved studies based on the authors’ verbatim descriptions of the methodological approaches they used; in other words, we did not apply our own methodological labels to what was described in the studies, but rather relied on the face value of the authors labels. Eight studies stated they used a grounded theory approach ( n = 8, 30.8%; Becker et al, 2007; Besse et al, 2017, 2018; Coombes et al, 2016; Glover & Frounfelker, 2011, 2013; Lexen et al, 2016; Liu et al, 2007). Seven studies stated they used content analysis ( n = 7, 26.9%; Areberg et al, 2013; Glover & Frounfelker, 2013; Hasson et al, 2011; Kostick et al, 2010; Nunes et al, 2011; Nygren et al, 2016; Salyers et al, 2008; Whitley et al, 2010), which included purely inductive content analysis, deductive content analysis, and directed content analysis approach.…”

“…Furthermore, 2 studies that were not written by occupational therapists mentioned “occupational therapy” (Crain et al, 2009; Johnson et al, 2009). From these 11 studies in total, 6 were conducted in Sweden ( n = 6, 54.5%; Areberg et al, 2013; Bejerholm et al, 2011; Hasson et al, 2011; Lexen et al, 2013a, 2013b; Nygren et al, 2016), 2 in Canada ( n = 2, 18.2%; Besse et al, 2018; Nunes et al, 2011), and the rest were from other countries.…”

“…Coping was facilitated when clients had self-awareness such as realizing that sometimes professional help is not enough, recognizing the risk of relapse, and being aware of one’s own limits. Self-awareness helped clients explain their limitations to the ES (Areberg et al, 2013) and to cope with work-related stress (Besse et al, 2017, 2018).…”

“…Most IPS research has been conducted with quantitative study designs which have been systematically reviewed in the literature (e.g., Modini et al, 2016). There has been an attempt to better understand the IPS model and its impact using qualitative research designs (e.g., Besse et al, 2018; Hasson et al, 2011; Lexen et al, 2016). Yet despite the existence of qualitative research studies on IPS, to our knowledge, limited effort has been made to systematically review and synthesize this evidence.…”