Empowerment promotion through competitive employment for people with psychiatric disabilities

Abstract

BACKGROUND:

Despite ample research about empowerment or supported employment in the mental health field, research about people with psychiatric disabilities in competitive employment and its impact on personal empowerment using standardized measurements needs to be expanded.

OBJECTIVE:

This study examined if competitive employment contributes to a positive impact on personal empowerment among 55 people with psychiatric disabilities who participate in community based mental health organizations.

METHODS:

The current sample was created from a larger study with the purpose of obtaining a homogenous set of participants based on the employment status criteria. Participants filled out the Portuguese version of the empowerment scale and hierarchical regression analysis was used to study if participants’ employment status was a predictor of personal empowerment.

RESULTS:

The conducted analyses demonstrated that competitive employment was related to higher levels of empowerment, and that the empowerment dimension of power-based interpersonal relationships was significantly associated with being at work.

CONCLUSIONS:

Our results suggest that addressing consumers’ working needs through supported employment services has the potential to enhance consumers’ personal empowerment and improve community life.

Keywords

Empowerment empowerment scale competitive employment supported employment

1 Introduction

Empowerment plays a central role in the transformative change brought about by community mental health programs (Nelson, Kloos, & Ornelas, 2014), contributing to people with psychiatric disabilities being considered equal citizens in society. In this proposal, empowerment is conceived as the power to choose where to work, which is enabled by access to community resources that allow those choices (Bond & Drake, 2014; Jorge-Monteiro & Ornelas, 2016). Competitive employment allows people with psychiatric disabilities to enjoy the same benefits that other people do, such as: income, the use of skills and talents, fulfilling of personal goals, and having valued roles in society (Ornelas, Duarte, & Jorge-Monteiro, 2014). In our study, employment is characterized by working in the competitive labor market and bringing about the same economic or social benefits that other employees enjoy, such as: job wages, training grants or enhanced community life and relationships (Waghorn, Saha, & McGrath, 2014; Wehman, 2012).

The empowerment process model (Cattaneo & Chapman, 2010) explains that power is not only gained through a person’s social interactions in which people exercise power, but also through the interaction of a person with a system. In this interaction social context will influence the process of empowerment, facilitating a person’s pursuit of meaningful and power oriented goals, and the gain of influence in social settings. Prior research (Jorge-Monteiro & Ornelas, 2016; Lloyd, King, & Moore, 2010) found a positive association between higher levels of personal empowerment and consumers who were taking advantage of supported employment (SE) programs in order to get and keep regular jobs in community contexts. Despite ample research about empowerment or SE in the mental health field, research about its impact on consumer’s empowerment using standardized measurements needs to be expanded. This leads us to examine if the social context of competitive employment will influence the personal empowerment of consumers with psychiatric disabilities. Participants in our study obtained work opportunities through SE services in which consumers’ choices regarding job types and level of support are observed (Drake, Bond, & Becker, 2012; Wehman, 2012). Research questions were formulated as follows: Does the employment status of consumers with psychiatric disabilities influence individuals’ outcomes of personal empowerment after controlling for the effects of age and symptom distress? Are there differences between consumers with psychiatric disabilities who are employed and not currently employed on the empowerment dimensions, such as activism and autonomy, esteem and power-based interpersonal relationships?

2 Method

The current research was part of a cross-sectional survey on mental health and community integration of people with psychiatric disabilities (Jorge-Monteiro & Ornelas, 2016). Data were collected from participants in five Portuguese non-profit, community mental health organizations (CMHO) with similar programs. Criteria for enrolment in the study were: age (≥18 years), personal history of psychiatric treatment or hospitalization and participation in the community mental health organization program (≥3 months). Written informed consent was provided by the participants, and the questionnaires were completed during individual face-to-face interviews. The study was approved by the ethical reviewers from the research funder and by the Boards at each CMHO that accepted to participate. Participants filled out questionnaires with demographic data and the Portuguese version of the Empowerment Scale (ES-P) that presented an overall good reliability (α= 0.80) (Jorge-Monteiro & Ornelas, 2014). ES was a consumer-constructed scale to measure empowerment and had an internal consistency of 0.82 (Rogers, Ralph, & Salzer, 2010). The ES-P includes 20 items, which respondents answered on a 4-point Likert scale (4, strongly agree). As part of the cross-sectional assessment, participants also indicated their employment status. The Colorado Symptom Index (CSI), a self-reported 14-item scale, was used to assess participants’ distress derived from their psychiatric disability (Conrad et al., 2001).

The current sample of 55 participants was created from a larger study in order to obtain a homogenous set of participants based on the employment status criterion. First, from a larger sample of 186 participants, every participant who had indicated that they were “currently employed” (n = 25) was extracted to the new dataset. “Currently employed”, was defined as being employed or in training in regular jobs, working 20 to 35 hours per week. Then, 30 participants that indicated that they were retired or unemployed were randomly selected from the remaining sample. For the main purpose of study, the employment status variable was transformed into “unemployed” = 0 (unemployed, retired or under social pension) or “employed” = 1 (with job wage or training grant). Chi-square tests were applied to verify significant differences in demographic data between the two groups. Hierarchical regression analysis was performed to analyse the contribution of competitive employment as a potential predictor of overall personal empowerment after controlling for the variable set of age and symptom distress that was entered first in the model followed by the employment variable itself. Three analyses of covariance were also conducted (p < 0.05) to assess the effect of competitive employment status on activism, esteem, and power relationships between the two groups of participants. The statistical software used was SPSS v. 21.

3 Results

Participants who were in competitive employment showed an empowerment mean±SD score of 2.94±0.32, and the other participants revealed an empowerment mean±SD score of 2.65±0.33. Background equivalence was observed between the two independent sub samples on age (t (53) = – 0.790, p = 0.518), sex (X² (1, N = 55) = 3.74; p = 0.071), educational degree (X² (2, N = 55) = 3.57; p = 0.168) and symptom distress (t (53) = 1.70, p = 0.095). Out of the total sample 25 participants (45.5 percent) who were in competitive employment had a mean±SD age of 41.76±8.4 years, and 10 of them were women (40 percent). A total of eight participants (32 percent) attended nine years of school, 36 percent of participants attended 12 years of school, and eight participants (32 percent) had attended university. In terms of diagnosis, 15 participants (60 percent) revealed having a schizophrenia diagnosis. Concerning hospitalizations 14 participants (56 percent) had experienced psychiatric hospitalization.

A multiple regression analysis was performed to examine whether people with psychiatric disabilities who were currently employed would have higher rates of personal empowerment. The overall model with all the predictors introduced accounted for a significant proportion of the variance in personal empowerment outcome (R² = 0.274, F (3, 51) = 6.415, p < 0.05). The hierarchical regression analysis indicated that employment predicts empowerment above and beyond the demographic and clinical variables (Table 1), ΔR² = 0.231, F (1, 51) = 9.038, p < 0.05. Being in the competitive employment was, therefore, significantly associated with higher rates of personal empowerment (B = 0.368, t (51) = 3.006, p < 0.05). Data satisfactorily supported our argument that consumers who are currently employed attain higher levels of empowerment. Separate analyses of covariance were conducted to ascertain if there were differences on outcomes of empowerment dimensions (activism, esteem and power) between consumers that were employed and those that were not. Mean scores of activism (3.26±0.45; 3.04±0.56), esteem (3.07±0.50; 2.76±0.62) and power (2.78±0.78; 2.23±0.60) were higher for currently employed participants, but after controlling for covariate effects (age and symptom distress), only power relationships remained significantly associated with employment status, F (1, 51) = 5.406, p < 0.05. Findings did not show significant effects of being employed on the activism or esteem dimensions between the two groups of participants, F (1, 51) = 2.578, p > 0.05 or F (1, 51) = 3. 386, p > 0.05.These findings provided partial support for our notion that empowerment dimensions are affected by employment status.

Table 1
Hierarchical regression of demographic, clinical and employment status variables as predictors of personal empowerment among 55 consumers with psychiatric disabilities

Model β SE R ² Δ R ²

Model 1 0.145* 0.112*

Age 0.317* 0.006

Symptom Distress − 0.124 0.054

Model 2 274* 0.231*

Age 0.307* 0.005

Symptom Distress − 0.044 0.052

Employment Status 0.368* 0.086

*p < 0.05

Model	β	SE	R ²	Δ R ²
Model 1			0.145*	0.112*
Age	0.317*	0.006
Symptom Distress	− 0.124	0.054
Model 2			274*	0.231*
Age	0.307*	0.005
Symptom Distress	− 0.044	0.052
Employment Status	0.368*	0.086
*p < 0.05

4 Discussion

Current analyses demonstrated that among people with psychiatric disabilities, participating as equal citizens in regular employment environments is positively associated with personal empowerment, above and beyond their demographic and clinical characteristics. Our results are sustained by prior research findings (Campbell, Bond, & Drake, 2011), that the psychiatric diagnosis doesn’t influence supported employment outcomes. People with psychiatric disabilities who engage in competitive employment have significantly higher empowerment scores than people receiving social security benefits, due to the participation in the community and having their needs fulfilled (Lloyd et al., 2010; Rogers et al., 2010). Taking advantage of employment is associated with enhanced income, symptom control, quality of life, self-esteem and social inclusion when compared with people that are unemployed or in sheltered work settings (Luciano et al., 2016; Waghorn et al., 2014). Our results go along with those presented above, suggesting that people with psychiatric disabilities engaged in daily meaningful community activities, integrated in competitive employment, enjoy the same benefits that other employees do, thus promoting personal empowerment. Parallel research accounts also refer to employment as a means of social inclusion, giving people the opportunity to participate as active citizens in society, offering personal and economics benefits, and having implications also for personal well-being, better functioning, social status and civil rights (Boardman, Grove, Perkins, & Shepherd, 2003; Eklund, Hansson, & Ahlqvist, 2004). Also, participants who were currently employed were more connected to daily activities and community life, had better quality of life and were more empowered than unemployed ones (Bejerholm & Björkman, 2011; Lloyd et al., 2010).

The benefits of accessing integrated employed reported above involve empowerment dimensions such as esteem, power, optimism and control, and community activism (Jorge-Monteiro & Ornelas, 2014; Rogers et al., 2010), but also with the empowerment definition since it comprises making decisions that exert control over one’s life, the ability to actively pursue one’s goals, and access to community resources that enable those choices (Dunn, Wewiorski, & Rogers, 2008; Eklund et al., 2004; Ornelas et al., 2014). This suggests that empowerment can result from the interactions between consumers and the social environment, such as the competitive labour market (Bejerholm & Björkman, 2011; Boardman et al., 2003; Cattaneo & Chapman, 2010; Waghorn et al., 2014).

In the present study, in comparing groups, neither the activism nor the esteem dimensions showed significant relationships with employment status. We argue that these outcomes result from the fact that both groups were involved in community based mental health organizations, and taking advantage of community organizations allowing them to equally improve their level of community participation. However, employment status showed a stronger relationship with overall empowerment and the power-based relations dimension. Published research found a significant relationship between number of hours worked as well as monthly income and empowerment (Jorge-Monteiro & Ornelas, 2016; Lloyd et al., 2010; Rogers et al., 2010). Moreover it was argued that income is often linked to the power dimension, in the sense that it plays a crucial role in interpersonal relationship balance by facilitating the increase of quality of life and control over the future, providing the personal feeling of empowerment.

Our study provides additional support regarding the value of competitive employment opportunities for people with psychiatric disabilities and how it may promote personal empowerment. Parallel qualitative studies reveal the important role that employment plays in consumers’ lives, identities, personal meaning, pride and facilitating the process of recovery (Dunn et al., 2008). Here we suggest that interaction with the competitive labour market is an empowering experience for people with psychiatric disabilities. Although our results corroborate this idea, we consider that it is important that future studies explore the relationship between employment status and empowerment from a controlled and longitudinal perspective.

5 Conclusion

Results of this study suggest that community mental health services should support consumers’ access to employment opportunities in natural community contexts, which is a way to enhance one’s personal empowerment. Therefore, this transformative community oriented practice can assist people with psychiatric disabilities to achieve a full live in the community as empowered citizens.

Conflict of interest

None to report.

Footnotes

Acknowledgments

The current research was supported through the Fundação para a Ciência e Tecnologia (FCT - PTDC/PSI-PCL/113301/2009 and BD/65518/2009).

References

Bejerholm, U., & Björkman, T. (2011). Empowerment in supported employment research and practice: Is it relevant?International Journal of Social Psychiatry, 57(6), 588–595. doi:10.1177/0020764010376606.

Boardman, J., Grove, B., Perkins, R., & Shepherd, G. (2003). Work and employment for people with psychiatric disabilities. The British Journal of Psychiatry, 182(6), 467–468. doi:10.1192/bj182.6.467.

Bond, G. R., & Drake, R. E. (2014). Making the case for IPS supported employment. Administration and Policy in Mental Health and Mental Health Services Research, 41(1), 69–73. doi:10.1007/s10488-012-0444-6.

Campbell, K., Bond, G. R., & Drake, R. E. (2011). Who benefits from supported employment: A meta-analytic study. Schizophrenia Bulletin, 37(2), 370–380. doi:10.1093/schbul/sbp066.

Cattaneo, L. B., & Chapman, A. R. (2010). The process of empowerment: A model for use in research and practice. American Psychologist, 65(7), 646–659.

Conrad, K. J., Yagelka, J. R., Matters, M. D., Rich, A. R., Williams, V., & Buchanan, M. (2001). Reliability and validity of a modified Colorado Symptom Index in a national homeless sample. Mental Health Services Research, 3(3), 141–153. doi:10.1023/a:1011571531303.

Drake, R. E., Bond, G. R., & Becker, D. R. (2012). Individual placement and support: An evidence-based approach to supported employment, New York, NY, US: Oxford University Press.

Dunn, E. C., Wewiorski, N. J., & Rogers, E. S. (2008). The meaning and importance of employment to people in recovery from serious mental illness: Results of a qualitative study. Psychiatric Rehabilitation Journal, 32(1), 59–62. doi:10.2975/32.1.2008.59.62.

Eklund, M., Hansson, L., & Ahlqvist, C. (2004). The Importance of Work as Compared to Other Forms of Daily Occupations for Wellbeing and Functioning among Persons with Long-Term Mental Illness. Community Mental Health Journal, 40(5), 465–477. doi:10.1023/B:COMH.0000040659.19844.c2.

10.

Jorge-Monteiro, M. F., & Ornelas, J. (2016). What’s wrong with the seed?’ A comparative examination of an empowering community-centered approach to recovery in community mental health. Community Mental Health Journal, 52(7), 821–833. doi:10.1007/s10597-016-0004-8.

11.

Jorge-Monteiro, M. F., & Ornelas, J. H. (2014). Properties of the Portuguese version of the Empowerment Scale with mental health organization users. International Journal of Mental Health Systems, 8.

12.

Lloyd, C., King, R., & Moore, L. (2010). Subjective and objective indicators of recovery in severe mental illness: A cross-sectional study. International Journal of Social Psychiatry, 56(3), 220–229. doi:10.1177/0020764009105703.

13.

Luciano, A., Metcalfe, J. D., Bond, G. R., Xie, H., Miller, A. L., Riley, J., …,& Drake, R. E. (2016). Hospitalization risk before and after employment among adults with schizophrenia, bipolar disorder, or major depression. Psychiatric Services, 67(10), 1131–1138. doi:10.1176/appi.ps.201500343.

14.

Nelson, G., Kloos, B., & Ornelas, J. (2014). Transformative change in community mental health: A community psychology framework. In Nelson

, Kloos

& Ornelas

(Eds.), Community Psychology and Community Mental Health: Towards Transformative Change (pp. 3–20). New York: Oxford university Press.

15.

Ornelas, J., Duarte, T., & Jorge-Monteiro, M. F. (2014). Transformative organizational change in community mental health. In Nelson

, Kloos

& Ornelas

(Eds.), Community psychology and community mental health: Towards transformative change. (pp. 253–277). New York, NY, US: Oxford University Press.

16.

Rogers, E. S., Ralph, R. O., & Salzer, M. S. (2010). Validating the Empowerment Scale with a multisite sample of consumers of mental health services. Psychiatric Services, 61(9), 933–936. doi:10.1176/appi.ps.61.9.933.

17.

Waghorn, G., Saha, S., & McGrath, J. J. (2014). Correlates of competitive versus noncompetitive employment among adults with psychotic disorders. Psychiatric Services, 65(4), 476–482. doi:10.1176/appi.ps.201300096.

18.

Wehman, P. (2012). Supported employment: What is it?Journal of Vocational Rehabilitation, 37(3), 139–142.