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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
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
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.
The emerging theory
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.
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