Fostering Identity-Enhancing Work Experiences for Mentally Ill Individuals in a Sheltered Workshop: A Case Study

Introduction

According to the Federal Statistical Office (2023), 18% of the Swiss population is affected by mental health conditions. Such conditions can hinder an individual's ability to engage in regular work activities. Individuals with mental health conditions face major challenges in managing their health while meeting organizational expectations for performance and work engagement (Elraz, 2018). Although these conditions can affect employees’ cognitive and behavioral abilities, such as concentration or social interaction skills (Follmer & Jones, 2017), their capabilities and skills are also frequently underestimated (Boardman et al., 2003). This reflects a broader pattern of stigmatization toward individuals with mental illnesses, which encompasses stereotypes (i.e., widely held beliefs about such individuals), prejudice (i.e., personal endorsement of these stereotypes accompanied by negative emotional responses), and discrimination (i.e., behavioral manifestations of prejudice) (Corrigan, 2005). Stigma can manifest in both public forms and self-stigma (Corrigan, 2005).

Mental health problems account for more than 50% of disability pensions granted in Switzerland (Federal Social Insurance Office, 2023). The Federal Social Insurance Office (2023) offers various programs designed to support the reintegration of individuals with mental illness into the labor market, including vocational training initiatives, supported employment opportunities, and sheltered workshops.

Although sheltered workshops aim to facilitate reintegration, scholars argue that these segregated settings do not effectively contribute to positive outcomes for individuals with mental illness. The criticisms of segregated environments include cost inefficiency, poor employment outcomes, and the failure to meet the economic needs of participants, as those in segregated environments tend to earn less than those in integrated settings (Cimera, 2011; Cimera et al., 2012; Suijkerbuijk et al., 2017; Taylor et al., 2021, 2023). Furthermore, research has demonstrated that individuals in segregated settings experience lower levels of quality of life, self-determination, autonomy, self-esteem, and job satisfaction compared to those in integrated settings (Beyer et al., 2010; Griffin et al., 1996; Taylor et al., 2023; Wehmeyer & Bolding, 2001). This is reflected in the assessment of the participants: A significant majority of adults with an intellectual disability who recently began attending workshops would prefer employment outside of workshops in the regular, so-called first labor market (Migliore et al., 2007).

Despite these findings suggesting that sheltered workshops may not represent the optimal rehabilitation approach, the implications can vary across different local contexts. Notably, Switzerland presents a significant challenge for individuals with mental health conditions seeking entry into the first labor market due to high educational standards, few entry-level jobs and no prevailing hire and fire policy (Hoffmann & Richter, 2020). To evaluate supported vocational programs in Switzerland, Hoffmann et al. (2012) initiated a program at the Center of Psychiatric Rehabilitation at the University of Bern, demonstrating that individuals with mental illness, despite showing no differences in symptoms and quality of life, achieved significantly better work outcomes than those in sheltered employment. Nevertheless, the implementation of such programs is constrained by key structural barriers. First, the Federal Social Insurance Office requires that individuals demonstrate at least 50% of the functional work capacity of a non-disabled person to qualify for reintegration programs (Hoffmann & Richter, 2020). Second, employer reluctance to hire individuals with psychiatric disabilities remains a persistent obstacle (Baer et al., 2017).

As a result, despite their limitations and ongoing criticism, sheltered workshops continue to represent a common form of vocational integration for people with mental health conditions in Switzerland. To serve a genuinely rehabilitative function, sheltered programs should fulfill specific requirements that go beyond merely maintaining daily structure, encompassing a broader range of psychosocial functions important for individuals with psychiatric disabilities, such as opportunities for social interaction, meaningful activity, personal involvement, support, a sense of achievement and identity as well as access to meaningful work (Boardman et al., 2003). The latter can broadly be defined as work that is “personally significant and worthwhile” (Lysova et al., 2019, p. 374). However, in practice, there are currently no binding standards or regulatory guidelines at the national level to ensure that these rehabilitative goals are systematically pursued within sheltered employment settings, as the implementation and regulation of sheltered workshops fall under the responsibility of the individual cantons. The canton where this study was conducted has established specific criteria, primarily concerning infrastructure, staff qualifications, and certain fundamental rights of the supported individuals (Department of Education, Culture and Sport Canton Aargau, 2023). Nevertheless, these criteria do not sufficiently challenge the design and qualitative aspects of the workshops themselves. To inform the development of comprehensive guidelines, it is therefore essential to incorporate the perspectives and needs of individuals with mental health conditions who participate in sheltered employment.

To better understand how sheltered workshops can be tailored to meet the needs of people with mental illnesses, insights from related research may be drawn upon. The factors that contribute to the satisfaction of individuals with disabilities are often similar to those that affect non-disabled workers (Akkerman et al., 2014). These individuals desire to become part of a community and establish connections with others (Leufstadius et al., 2008; Lysaght et al., 2009). Furthermore, they seek support from colleagues and managers (Flores et al., 2011; Lukas et al., 2018; Ybema et al., 2020) and value aspects of their work such as autonomy, participation, opportunities for growth and satisfaction with their responsibilities (Akkerman et al., 2014; Flores et al., 2011; Leufstadius et al., 2008; Lukas et al., 2018; Lysaght et al., 2009; Ybema et al., 2020). However, compared to non-disabled employees, people with disabilities – especially in non-competitive employment – often face additional challenges in establishing their sense of identity and in making meaningful contributions to society (Netto et al., 2016; Voermans et al., 2021). As Liljeholm and Bejerholm (2019) argue, rehabilitation programs for adults with mental illness are often clinically oriented, with a focus on enhancing function and alleviating symptoms. However, the recovery perspective emphasizing the development of meaningful life roles and personal identities is frequently undervalued. In this regard, establishing a positive work identity has been shown to be of critical importance from a recovery perspective of individuals with mental illness (Blank et al., 2014). The concept of work identity refers to a work-based self-concept, composed of a combination of organizational, occupational and other identities that shape the roles adopted by the individual and the corresponding ways in which they behave when performing their work (Walsh & Gordon, 2008, p. 47). However, sheltered workshops can also pose risks to identity development, as they are often perceived as “not real work,” potentially leading to feelings of shame and social stigma (Sebrechts, 2023). This raises the critical question of how a positive work identity can nonetheless be fostered within sheltered workshop settings.

Research conducted in sheltered workshops has indicated that some factors, such as opportunities for skill development, perceived autonomy and prospects for growth, may be particularly important for employees in sheltered workshops (Akkerman et al., 2014; Flores et al., 2011; Lukas et al., 2018). As Panzano et al. (((2002) have indicated, motivational work characteristics such as using a variety of skills, completing whole tasks, having tasks seen as significant, having autonomy and getting feedback from the job are equally important for people with mental health conditions as for the general population. These factors contribute to a sense of competence and pride among workshop participants, which is connected to their sense of identity (Lysaght et al., 2009). However, previous research in sheltered workshops has primarily focused on disabilities other than mental health issues, particularly intellectual disabilities (Kocman & Weber, 2018; Nevala et al., 2019; Taylor et al., 2021, 2023). There is limited information available regarding the experiences of individuals with mental health issues in sheltered workshops. It is possible that the experiences of participants with mental health conditions in sheltered workshops may differ from those of other disability subgroups due to the distinct characteristics and needs across disability subgroups (Boman et al., 2015; Elraz, 2018). For example, people with severe mental health conditions often face greater social exclusion than those with physical disabilities (Richter & Hoffmann, 2019) and their abilities are often underestimated (Boardman et al., 2003). Against this background, the present study examines the work identity of individuals with mental health conditions as a potential resource for recovery within the context of sheltered workshops. The aim is to derive recommendations for designing employment settings that promote recovery-oriented outcomes. This leads to the following research question: What work experiences and conditions in sheltered workshops contribute to a positive work identity of individuals with mental health conditions? Previous studies involving individuals with mental health conditions working at sheltered workshops focused on analyzing their experiences using questionnaires and scales (Lukas et al., 2018; Ybema et al., 2020). We aimed to gather more detailed and richer information about participants’ experiences by conducting a case study involving group discussions.

Methods

Participants and Data Collection

The data in this study are based on two group discussions involving ten individuals conducted by the two authors. All participants are employed at a sheltered workshop operated by a Swiss foundation that offers various work and residential programs, as well as day centers and job coaching services. All participants have a mental disorder in accordance with ICD-10 criteria and receive disability benefits from the Federal Social Insurance Office. Participants were aged between 18 and 64 years, with 20% women and 80% men. Participants have all completed an apprenticeship, some in the first labor market, others in a sheltered setting. The participants included individuals who have been employed at the sheltered workshop for three or more years after having failed attempts in the first labor market. Other participants are currently in an initial build-up program, starting with day center activities and now transitioning to workshop employment. Half of the participants are employed in an area that handles industrial orders, engaging in tasks such as filling and packaging for large Swiss companies. The other half works in food production, manufacturing baked goods and pasta sold at Swiss supermarkets.

Recruitment took place on site through the sheltered workshop supervisor, who informed employees about the upcoming group discussions and explained that participation was voluntary. Interested individuals could directly express their willingness to take part and were then invited to the discussion. There were no exclusion criteria and no incentives for this study. Participants were informed that the purpose of the group discussion was to explore what they like and dislike about their current employment to gain insight into their experiences and perspectives. The group discussions were conducted in Swiss German and translated into English by the researchers for the purposes of this paper.

Group discussions were selected as a data collection method due to their efficacy in fostering interactive data generation through group interactions, thereby offering valuable insights into the social norms and dynamics within specific settings (Braun & Clarke, 2013). A semi-structured question guide was developed to investigate the day-to-day work experiences of individuals at the sheltered workshop, as well as their attitudes and valuations of different aspects of work. The details of the question guide are presented in Table 1. The group discussions were conducted jointly by both authors at the participants’ workplace and lasted between 50 to 58 min. Ethical approval was obtained from the FHNW School of Applied Psychology Ethics Committee (approval number: EAaFE230308). The participants provided informed verbal consent for the audio recording and publication of data. The foundation provided written consent for data collection, analysis, and publication. To protect the anonymity of the participants, actual names have been replaced by pseudonyms.

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Table 1.

Semi-Structured Question Guide.

What do you value about your employer? What do you particularly like? If you meet with friends and family, what do you tell them about work? If someone asks you to come work in this sheltered workshop, what advice would you give this person? What speaks for it? What speaks against it? If you compare this workplace with others, what aspects make you think, “Ah, that's more favorable here” or on the contrary “that could be improved here"? What do you wish could be done better in your current work situation? Before the working day begins, what are you looking forward to? What is particularly fun? What brings a smile to your face? When you think about your work, what makes you particularly proud? How do you feel working here? How is the mood? How are you perceived? How do you get along with each other or with the group leaders? Would you think it would be nice if you could show the outside world a bit more about what you do?

Results

The analysis is divided into four main themes and seven subthemes that outline the work experiences and conditions that contribute to developing a positive work identity among sheltered workshop participants with a mental health condition.

Discussion

The aim of this research was to examine the work experiences and conditions in sheltered workshops, that contribute to a positive work identity for individuals with mental health problems. Three aspects were identified: (1) cultivating an egalitarian work environment that emphasizes the absence of stigma and actively promotes equality; (2) enhancing motivational work design characteristics, with a focus on skill development and autonomy; and (3) providing meaningful work through products with societal impact. A fourth theme concerning the compensation was mentioned but did not emerge as central to participants’ work identity.

Given the stigma that people with mental health conditions often face in the workplace (Baldwin & Marcus, 2006), a stigma-free culture is central for participants. As previous research has shown, disability stigma is negatively correlated with job satisfaction (Kim, 2022) and plays a significant role in shaping a positive work identity. As Elraz (2018, p. 726) states “[…] the area of mental health and work represents an interface in which the nature of the illness and the social stigma that surrounds it can result in particular manifestation of identities at work”. It is notable that, in addition to the absence of stigma, actively promoting equality not only among the participants themselves but also among regular employees and supervisors fosters a positive sense of normalcy for the participants. This extends previous research emphasizing the importance of community and social connections (e.g., Leufstadius et al., 2008; Lysaght et al., 2009) by highlighting that it is not only the sense of community among participants that matters but also the creation of an inclusive environment characterized by equal and respectful relationships between participants, reintegration professionals, and supervisors. In their review on how stigma influences employment, van Beukering et al. (2022) pointed out that the attitudes and behaviors of healthcare and support professionals may act as significant barriers or facilitators for individuals with mental health conditions yet noted that this area remains underresearched. Building on this, our study contributes by emphasizing the importance of fostering inclusive climates not only among participants but also involving healthcare professionals from two key perspectives. First, given that individuals with mental health conditions often internalize the messages conveyed by healthcare and support professionals, these actors play a profound role in shaping their work identity (Netto et al., 2016). Second, considering that in conventional workplaces employees generally interact on an equal footing, it is reasonable to implement analogous principles in sheltered workshops.

The second aspect highlighted in the study is motivational work design characteristics. Providing individuals with mental illness opportunities to autonomously develop their skills can enhance personal confidence and self-esteem, thereby strengthening their positive work identity (Deng et al., 2023). These findings align with previous research emphasizing the importance of development opportunities and job autonomy in sheltered workshops (Akkerman et al., 2014; Flores et al., 2011; Lukas et al., 2018). Soeker et al. (2018) report that individuals working in sheltered workshops frequently experience a sense of stagnation and perceive limited opportunities for skills development. This is particularly concerning given that the capacities and skills of individuals with mental illnesses are often underestimated (Boardman et al., 2003). For instance, Lukas et al. (2018) identified the lowest job satisfaction scores in sheltered workshops regarding opportunities for autonomous participation and career progression. Similarly, Ybema et al. (2020), in a weekly diary study, concluded that creating a good match between the job and the individual's abilities is crucial not only for productivity but also for well-being in sheltered workshops. This study adds to these findings by illustrating the critical role of reinforcing motivational work design characteristics to foster an identity-enhancing work experience. Notably, a meta-analysis by Humphrey et al. (2007) identified autonomy and skill variety as two of the three most critical factors contributing to a sense of meaningful work. This underscores our findings, emphasizing that these factors are especially relevant for people with disabilities in non-competitive employment, who often face challenges in making meaningful societal contributions and establishing their sense of identity (Netto et al., 2016; Voermans et al., 2021).

Additionally, Humphrey et al. (2007) found that task significance was the third crucial factor for work meaningfulness. The present study also emphasizes the importance of the nature of the work itself for enhancing identity-enhancing work experiences. Not only is the mere engagement in tasks and the establishment of a routine crucial, as also highlighted by Leufstadius et al. (2008), but it is also vital that participants perceive their work as fulfilling and as making a meaningful contribution to society. This aligns with findings from studies such as those conducted by Goldberg et al. (2002), Hvalsøe & Josephsson (2003) and Leufstadius et al. (2008), which indicate that occupations deemed most satisfying for mentally ill individuals, are those perceived as necessary and socially impactful. Especially in view of the function of sheltered workshops in facilitating the transition to the first labor market, it is imperative to establish roles that align with these demands by placing greater emphasis on practical, real-world activities in contrast to tasks such as arts and crafts. Notably, the present results suggest that manufacturing recognizable products was a strategy used by participants to steer conversations away from the sheltered workshop and towards the products themselves. This approach is similar to observations by Sebrechts (2023), who reported that participants sometimes removed workshop logos or wore clothing from previous jobs to counter the stigma linked to sheltered employment.

In addition to the stigma associated with sheltered workshops, low financial compensation represents another potential disadvantage, possibly undermining the perceived prestige of such work and negatively affecting work identity (Hassler, 2017). However, in the present study, compensation did not emerge as a central aspect of participants’ work experience. This finding aligns with results from Netto et al. (2016), where individuals with mental illness indicated that they would engage in vocational activities even in the absence of financial incentives. Instead, individuals emphasized the importance of being able to use their talents and skills, which they saw as essential for building an authentic self and for engaging in meaningful activities. Therefore, if sheltered workshops cannot offer adequate compensation, they should, at the very least, meet participants’ expectations for motivational and meaningful work. Given their rehabilitative and recovery-oriented potential particularly through fostering a positive work identity, they should be purposefully designed to support these aims. Currently, however, there are no clear structural guidelines in place.

Based on our findings, we propose three practical steps to improve sheltered workshops and, more broadly, to enhance the work experiences of individuals with mental illness in competitive employment settings: 1) Promote an inclusive, stigma-free work environment encouraging equal interaction between participants and staff (Shore et al., 2018). This includes treating participants as colleagues, using first names (which is not a common practice in all Swiss workplaces), sharing breaks, socializing together, promoting open dialogue, and actively involving everyone in decision-making. 2) Enhance motivational work design characteristics by focusing on skill development and autonomy (Hackman & Oldham, 1976). Given that the abilities of individuals with mental illness are often underestimated (Boardman et al., 2003), we recommend mandatory development discussions and targeted measures such as skill training (Follmer & Jones, 2017) to build competence relevant for transition into the first labor market. 3) Provide meaningful, realistic work activities that mirror the demands of the first labor market, rather than low-stakes tasks like arts and crafts (Lysova et al., 2019).

The study's methodology presents several noteworthy limitations. The findings of this study are based on a small sample of individuals employed at a sheltered workshop in Switzerland and thus may not be generalizable to other populations or contexts. There may be potential data bias since participants in this study chose to participate so they might have different experiences compared to those who declined participation. While the study identified various factors contributing to a positive work identity for mentally ill individuals, it did not delve deeply into the mechanisms through which these factors operate or their specific effects on participants. Future research should explore concrete interventions and their impacts, as well as thoroughly investigate the underlying mechanisms driving positive work identities in sheltered workshops. Due to the anonymity of participants, concrete diagnoses cannot be reported; however, future research should examine how different mental health conditions shape experiences in sheltered workshops. Lastly, our findings should be interpreted in light of the fact that supported employment programs generally yield better outcomes and should therefore be prioritized and expanded (Hoffmann & Richter, 2020). Sheltered workshops should only be utilized when participation in supported programs is not feasible, and in such cases, they should adhere to guidelines that promote recovery and support long-term labor market reintegration, as proposed in this study.

Conclusion

In conclusion, the present study proposes that sheltered workshops should be purposefully designed to cultivate positive work identity as an integral component of a comprehensive recovery process, as articulated by Liljeholm and Bejerholm (2019). Presently, Switzerland lacks clearly defined criteria for the development of sheltered workshops. By incorporating the perspectives of individuals with mental illness who participate in sheltered workshops, this study provides insight on essential design features. The participants underscored the significance of an inclusive, stigma-free environment that engages all staff members, not solely participants, in addition to opportunities for autonomous work, skill development, and meaningful contributions to society. While supported employment remains the preferred and most effective pathway, when it is not possible, sheltered workshops should implement these recommendations to provide not only rehabilitative work that enhances work identity but also realistic opportunities for skill development and progression toward competitive employment.