How OT can help young people experiencing psychosis with their employment

Melissa Aguey-Zinsou, University of Sydney, Centre for Disability Research and Policy, Faculty of Medicine and Health and Australian Catholic University, North Sydney

Occupational therapists are experts in helping people engage in productive occupations, with paid work being one of the main productive roles in adult life.

As teenagers and young adults, people start laying the foundations for employment opportunities and career paths. This is also the period of life when the onset of psychosis is most common. For a young person who develops psychosis, education and early employment experiences can be disrupted.

Disruption of early productive roles can lead to long-term unemployment, even though paid work is a common goal for young people with psychosis. In fact, a nationwide survey found only 22.4 per cent of people with psychotic disorders were engaged in paid work (Waghorn et. al., 2012). This raises the question about what occupational therapists can do to support young people experiencing psychosis with employment.

Current research evidence shows that the most common interventions are Early Intervention and Individual Placement and Support. Most current employment interventions used with people experiencing psychosis focus on finding a paid job. But finding a paid job is only one part of being ’“employed”. Occupational therapists know that in addition to finding and getting a paid job, keeping the job is just as important and can be a real challenge for young people with psychosis. Despite occupational therapists doing great work in this area, their contributions are not prominent in published research evidence. There is a need to share the great work that is being done and to use meaningful, replicable measures of employment outcome to demonstrate the value of occupational therapy in supporting young people with their employment.

In addition, almost absent in intervention research are the perspectives of young people themselves. There are currently no published employment interventions codesigned with young people with psychosis. Occupational therapists, with their personcentred approach, start with the needs and aspirations of young people and tailor interventions to help them achieve their goals. They can collaborate with young people to co-produce services and research.

Current research gives useful background information about the prevalence, conditions and interdisciplinary approaches, but there is a need for specialised occupational therapy practice research evidence. The way forward is for occupational therapists to start with what they do know. The world of work is changing with casual, insecure work and the gig economy, where most young people will start their first jobs (MacDonald and Giazitzoglu, 2019). Being able to move between jobs is essential, and keeping the same job may not be possible or desirable. Occupational therapists need to be ready to support young people with switching jobs. Also, young people’s own networks are increasingly important. A national survey found that most people obtained work on their own or through personal networks, rather than with employment services (Waghorn et. al., 2012). Occupational therapists with their expertise in identifying enablers in the social environment can support young people to consider and strengthen social networks that may boost employment/career prospects.

Occupational therapists are uniquely placed to support young people experiencing psychosis with their employment. With their training in lifespan development, they understand that many young people want to pursue education to improve their future employment prospects. Occupational therapists appreciate the importance of career planning, job skills coaching and workplace accommodations to develop a satisfying working life. Their training in vocational rehabilitation gives them wide-ranging skills, from encouraging people to consider pursuing their goals for work through to helping people return to work after time out of the workforce.

Occupational therapists working together can advance practice and research in this area. Get in touch!

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