One of the obvious impacts on psychosocial functioning by psychiatric
disability is in the domain of paid work or employment. Yet, despite this challenge
being placed before us as health professionals over fifty years ago by those
visionary men and women responsible for establishing services to help individuals
achieve their vocational goals, the challenge remains largely unfulfilled today. "Vocational
integration" as opposed to "vocational rehabilitation" has
been chosen as the title for this paper. It is felt that "integration" more
accurately reflects the process being outlined as opposed to "rehabilitation" which
implies a change or therapeutic intervention taking place primarily in the
client. It can be argued that changes within the service provider system, societal
attitudes and within work-related legislation are also needed to ensure the
successful placement in the workforce of those with psychiatric disabilities.
Furthermore, the vocational integration of persons with psychiatric disability
is a task shared by many service providers and practitioners from diverse professional
backgrounds demanding, in turn, trans-agency and trans-disciplinary collaboration
to ensure the necessary employment services are both available and effective. The
present study set to meet two main objectives: 1. To explore
factors supporting an individual within the employment arena in terms of achieving
his/her vocational goals. 2. To outline a theoretical framework
that describes and explains the wide variations in vocational success seen
between individuals with BD.
Factors that help people with BD achieve their vocational goals
This section aims to examine the various factors that helped people with BD
return to work. Again, these factors appeared to be inter-related and, as
previously, sub-themes were identified from the participants’ data
in order to provide a more detailed understanding of the role these factors
play in helping the process of vocational integration.
Factors which were related to the client • I was determined
to succeed • I was a good worker • I
had a professional qualification • I had faith
Factors related to the job or work place • I
gained a lot from having a job. For some participants the very fact of having
a job, especially one that was paid and well supported, gave satisfaction
and meaning to their lives and helped the participants keep the job. • The
nature or structure of the work helped me stay on task.
Factors related to support from the client’s family,
friends and professional people • I had good support from family
and friends • I had good support from professionals
and community support groups.
Factors related to my health • I was able to manage
my illness effectively. A participant talked about how she
coped at work when not feeling very well: "I’ve
had to be aware that days when I wasn’t quite on top
of things if somebody told me something I wrote it down.
I wrote down exactly what I had to do. • I
returned to work only when I was ready.
Factors related to support in the work place • I
had a good manager/boss • I had good support from work-mates • I
could take time off when unwell.
Factors related to people’s attitude • I have
not experienced any stigma
Findings from the data outlined above suggested that factors assisting people
with BD to integrate into paid work can be broadly divided into four categories:
i) personality factors, ii) social upbringing and attitudes, iii) available
support and iv) systemic factors including societal attitudes and government
policies. Mary and John belong to an older age group in this small selection
of six people. Vocationally they both achieved reasonably well despite having
had BD for over 20 years. Mary did not report any impairment in her daily functioning
when interviewed in 1998. One year later, a meeting with her daughter revealed
Mary’s ongoing mental well being. She established a new routine after
retirement, spending time with her granddaughter and her friends. John lived
with his wife and three boys. As with Mary, John did not report any functional
impairment. Review of the interview transcripts and the participants’ case
notes revealed that they were able to cope with their disorder while continuing
to practice professionally over the years due to the following reasons. • Both
Mary and John’s bipolar illness was effectively managed and did not cause
much disruption to their work. • Their mental health
needs were known, and accommodated by their employers.
• Both were determined to succeed in their career and
to continue to work. • Both participants spoke of the
great sympathy they received from management and workmates in their workplace
and from their husband/wife or children. • Both found
strength in the meaning, professional nature and structure of their work.
Because of their professional qualifications, work was readily available
to them. In addition, Mary developed a reputation of being a highly skilled
professional. Holidays also provided John with the opportunity to rest and
enabled him to spend time with his family and while working on his professional
The emerging theory
One of the main findings from the present study was the wide variability with
which individuals with BD are able to engage in paid work. Most research
participants saw the individual’s stage of recovery from his/her bipolar
disorder, and/or effective management of the disorder as pivotal in ensuring
vocational success. Specifically, reasonable control of the clinical symptomatology
associated with BD determined whether or not a person was ready to enter
the vocational integration process although it did not mean that a person
must wait until he/she was totally symptom free. Another important theme
emerging from the data to help explain the vocational outcome of people with
BD was the notion of "goodness of fit". Four key components emerged
from the data in this respect. These were: i) the individual; ii) support; iii) work
and iv) wider context components. For instance, a participant who
recovered from BD might still have a variety of functional
impairments such as a short attention span, lack of confidence
or inadequate organizational skills. These difficulties
did not have to result in disability, however, providing
the employer was willing to accommodate his/her employee’s
increased requirements and did not erect barriers to employment
by stigmatizing or even discriminating against that person.
What appeared to matter most was not only how well an individual coped
with his/her illness per se, but also how well an individual’s
disability due to BD was accommodated by his/her employers.
In other words, a person
who had very frequent hospital admissions might still be able to secure a paid
job if there existed "goodness of fit" between his/her absences
and leave entitlements and between his/her mood swings and the flexibility
and creativity required from the job. Furthermore, a participant’s
potential to return to work might be significantly enhanced through the provision
of a flexible work schedule with frequent, short breaks, temporarily simplifying
expected tasks and the provision of extra support for the person and his/her
workmates. In the long-term, if an individual was able to hold down meaningful
work for a significant length of time it could have a beneficial effect upon
that person’s recovery
from BD. In turn, the better the recovery from mental health problems the greater
the opportunities people with BD would have to improve their career prospects
resulting in a better outcome to the vocational integration process.
The vocational integration model comprises several interacting components.
The "Individual Component" relates primarily to a person’s
personality attributes, his/her determination to succeed vocationally and how
the re-occurring nature of the illness, the disturbances caused by the illness,
the adverse side effects of medication, stress in workplace and, finally, loss
of confidence is dealt with. The "Support Component" refers to
all positive, enabling supports a person with BD receives from a wide variety
of sources including family, social networks, professionals and community support
systems. The "Work Component" includes factors such as the meaning
and satisfaction of a job to the individual, a job’s flexibility and
structure along with the match between a job’s demands and a person’s
abilities and/or disabilities. Finally the "Wider Context Component" encompasses
such issues as societal attitudes, the consequences of government health and
disability policies, income support policies and the overall economic status
of the country. For any given individual, one particular component might play
a more significant role in determining his/her vocational outcome than the
others. Findings from the data suggested that the four components "interacted" with
each other to influence the overall success, or otherwise, of a person’s
employment outcome. The importance a particular component played also appeared
to depend upon an individual’s current stage of illness. The present
study proposes that being employed should not be viewed as the end of the rehabilitation
process in itself. Achieving an employment status can potentially act as a
catalyst to prompt the person concerned to further advance his/her career pursuits
and recovery from BD.
- Tse, S. and M. Yeats; What Helps People with Bipolar Affective Disorder
Succeed in Employment: A Grounded Theory Approach; Work; 2002; Vol. 19,
Reflection Exercise #9
The preceding section contained information
about creating a healthy work environment for bipolar clients. Write
three case study examples regarding how you might use the content of this section
in your practice.
Peer-Reviewed Journal Article References:
Houle, J., Radziszewski, S., Labelle, P., Coulombe, S., Menear, M., Roberge, P., Hudon, C., Lussier, M.-T., Gamache, C., Beaudin, A., Lavoie, B., Provencher, M. D., & Cloutier, G. (2019). Getting better my way: Feasibility study of a self-management support tool for people with mood and anxiety disorders. Psychiatric Rehabilitation Journal, 42(2), 158–168.
Manoli, R., Cervello, S., & Franck, N. (2021). Impact of insight and metacognition on vocational rehabilitation of individuals with severe mental illness: A systematic review. Psychiatric Rehabilitation Journal. Advance online publication.
Maru, M., Rogers, E. S., Nicolellis, D., Legere, L., Placencio-Castro, M., Magee, C., & Harbaugh, A. G. (2021). Vocational peer support for adults with psychiatric disabilities: Results of a randomized trial. Psychiatric Rehabilitation Journal. Advance online publication.
Millner, U. C., Rogers, E. S., Bloch, P., Costa, W., Pritchett, S., & Woods, T. (2015). Exploring the work lives of adults with serious mental illness from a vocational psychology perspective. Journal of Counseling Psychology, 62(4), 642–654.
Online Continuing Education QUESTION
What four components affect the establishment of a successful work environment
for a bipolar client? Record the letter of the correct answer