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Sustaining employment in a social firm: use of the Work Environment Impact Scale v2.0 to explore views of employees with psychiatric disabilities Anne Williams,1 Ellie Fossey 2 and Carol Harvey 3

Key words: Psychiatric disability, employment, Model of Human Occupation.

1 Lecturer, School

of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia. 2 Senior Lecturer, School of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia. 3 Associate Professor, Department of Psychiatry, The University of Melbourne, Carlton, Victoria, Australia. Corresponding author: Anne Williams, Lecturer, School of Occupational Therapy, La Trobe University, Kingsbury Drive, Bundoora, Victoria 3086, Australia. Email: a.e.williams@latrobe.edu.au Reference: Williams A, Fossey E, Harvey C (2010) Sustaining employment in a social firm: use of the Work Environment Impact Scale v2.0 to explore views of employees with psychiatric disabilities. British Journal of Occupational Therapy, 73(11), 531-539. DOI: 10.4276/030802210X12892992239279 © The College of Occupational Therapists Ltd. Submitted: 20 December 2009. Accepted: 18 May 2010.

Evidence suggests that people with psychiatric disabilities find it difficult to get and keep jobs, with workplace characteristics contributing to difficulties staying in employment. This qualitative study aimed to understand the views of employees with a psychiatric disability about working in an Australian social firm designed to provide an inclusive and supportive work environment. Method: Seven participants who had sustained jobs for 6 months or longer in the social firm, a contract cleaning business, were interviewed using the Work Environment Impact Scale (Version 2.0). Interviews were audiotaped, transcribed and analysed inductively using thematic and narrative analysis. Findings: Participants’ views of the work environment included that the regular structure and achievable tasks, the supportive and cooperative team and the benefits of the job made working in the social firm enjoyable and the right job for now. The findings suggest that participants’ decisions to stay in their jobs were influenced by the social firm environment, which supported their wellbeing, and by their individual illness and occupational narratives. Conclusion: The WEISv2.0 was effective in gaining participants’ views on wide-ranging features of their workplaces. Further research is recommended to expand the evidence base concerning workplace features that support employees with psychiatric disabilities to sustain their jobs.

Introduction Engaging in productive occupations, in particular paid employment, is central in adult life, so it is not surprising that many people with psychiatric disability want to work (McQuilken et al 2003, Mental Health Council of Australia 2006). Supporting people with psychiatric disabilities to secure worthwhile and sustainable employment is a traditional role and continues to be an important area of occupational therapy (Strong and Rebeiro 2003, Ross 2007, Waghorn et al 2009). Evidence suggests that employment circumstances for people with psychiatric disabilities are not positive, even in developed countries. The unemployment rate for this population has been reported as 70-80% in Australia (Waghorn et al 2009); the United Kingdom (UK) (Boardman et al 2003) and in recipients of standard vocational rehabilitation in the United States (US) (Bond et al 2008). Sustaining employment is also challenging. On average, people with psychiatric disabilities who obtained employment following vocational rehabilitation worked for less than 6 months a year (Bond et al 2008, Waghorn et al 2009). These are dire statistics given that ‘enabling people to retain or gain employment

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has a profound effect on more life domains than any other medical or social intervention’ (Boardman et al 2003, p467). Diverse vocational services have evolved internationally to make work, with its benefits of economic participation and social inclusion, a reality for more people with psychiatric disabilities (Corbiére and Lecomte 2009). Two service models that share the goal of securing ongoing jobs on equal pay for people with psychiatric disabilities alongside other co-workers are supported employment (SE) and social firms, also known as affirmative businesses (Warner and Mandiberg 2006). Much international research demonstrates the success of SE in securing jobs when compared with traditional train-then-place vocational services, leading to its adoption as an evidence-based practice (Bond et al 2008, Waghorn et al 2009). However, this success is often tempered by short tenure or unsatisfactory job endings (Drake and Bond 2008). In comparison, little research has been undertaken in social firms, so their vocational outcomes are unknown (Schneider 2005). This study examines the experience of people with psychiatric disabilities who work within a social firm.

Literature review Sustained employment Several reviews of literature and evidence from predominantly North American trials of SE identify the difficulty of sustaining employment (Kirsh et al 2005, Bond et al 2008, Corbiére and Lecomte 2009, Waghorn et al 2009). For example, in their review of 11 randomised controlled trials of SE, Bond et al (2008) found that participants were employed on average for 24.2 weeks per year, while in one SE study 57% of jobs ended because they were time limited or the participant resigned or was fired (Lucca et al 2004). Long-term follow-up of SE programmes has found that some participants sustain jobs for longer periods, although having several jobs amidst periods of unemployment is common; for example, Salyers et al (2004) reported that 33 SE programme participants had an average of 3.1 jobs (range 1 to 7) over 10 years and had stayed on average 32 months in their most recent jobs. Qualitative research undertaken in a broad range of vocational services internationally has enhanced understanding of factors influencing sustained employment. Factors reported by employees experiencing psychiatric disability as contributing to their staying in their jobs included a supportive social environment in the form of friendly, inclusive and respectful relationships with coworkers, supervisors or customers (Kirsh 2000, Killeen and O’Day 2004, Auerbach and Richardson 2005, Huff et al 2008) and an employer’s willingness and ability to provide job accommodations, such as restructuring duties or flexibility with work schedules (Kirsh 2000, Secker and Membrey 2003, Lucca et al 2004). Individual beliefs and values held by participants, including their self-ratings of

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work readiness (Lucca et al 2004) and belief in capacity for work (Killeen and O’Day 2004), and the match of the job to individual needs for interest, enjoyment and feelings of competence (Huff et al 2008) also helped participants to sustain their jobs. In sum, evidence suggests that the social environment at work, the nature of the work and workers’ responses all contribute to how long jobs are sustained.

Social firms Social firms are competitive businesses with both economic and social goals: to be commercially viable and to provide inclusive employment for disadvantaged or disabled employees alongside other employees in work environments that support wellbeing (Jeffery 2005, Warner and Mandiberg 2006). Social firms make support available for all employees, rather than add-on workplace accommodations or external supports, as occurs in supported employment. Social firms developed in Europe in the 1960s as part of a broader social enterprise movement, expanding to countries including the UK, Japan and Canada (Warner and Mandiberg 2006). While the UK has more than 150 social firms (Social Firms UK 2007), few exist in Australia. Established in 2004, Social Firms Australia has supported the development of social firms in which 25-50% of employees have a disability; all employees have the same opportunities, are paid statutory minimum wages and can access supportive modifications designed into the workplace; and 50% or more of income comes from the business (Social Firms Australia and Social Ventures Australia 2005). Other studies have noted that supportive workplaces contribute to employment success from the perspective of people with psychiatric disabilities (for example, Shankar and Collyer 2003, Svanberg et al 2010); however, there is a need for further research to understand those job factors and service ingredients that contribute to better vocational outcomes (Kirsh et al 2005).

Model of Human Occupation Literature that identifies factors having an impact on sustained employment does not yet include a theoretical structure for understanding the relationships between these factors. This study employs an occupational therapy theoretical framework, the Model of Human Occupation (MOHO) (Kielhofner 2008a), because it provides a conceptual structure for understanding how people choose, organise and perform occupations including work. This model emphasises the importance of how personal characteristics (that is, interests, values, personal causation, roles, habits and skills) interact with environmental factors (for example, characteristics of jobs and workplace environments) for choosing and sustaining employment (Baron and Littleton 1999, Mentrup et al 1999). MOHO has been used to guide vocational programme development for people with psychiatric disability (Braveman et al 2008). Further, the application of MOHO to work-related occupational therapy is well supported by evidence (Braveman 1999, Lee and Kielhofner 2009) and several assessments based on MOHO


Anne Williams, Ellie Fossey and Carol Harvey

have been developed, validated and used in the study of work-related services (Lee and Kielhofner 2009). This study used MOHO as a conceptual framework and used the MOHO-based Work Environment Impact Scale (WEIS v2.0) (Moore-Corner et al 1998) to collect data about the views of people experiencing psychiatric disability regarding their employment in a social firm.

Research aims This study aimed to identify the views of people with psychiatric disabilities about their employment in a social firm, and to identify factors within the social firm workplace that contribute to these employees sustaining employment. Finally, it aimed to identify how these factors are interrelated.

Method Research design A qualitative research design informed by a constructivist inquiry paradigm was chosen, because the aim was to understand employees’ individual and shared perspectives of their work environment. The research methodology was further guided by naturalistic inquiry principles outlined by Lincoln and Guba (1985). These included being attuned to the broader context; recognising the need for flexibility and reflexivity; choosing a semi-structured interview to explore participants’ views and experiences; analysing data inductively in successive cycles; negotiating findings by discussing them with participants; and making individual complexities and multiple realities evident in the findings.

cleaners at SHINE for between 11 months and 6 years, all reporting that working at SHINE was their longest job in the past 5 years. The majority also reported involvement with the mental health system for more than 10 years. All worked regular shifts, mostly on alternate afternoons, working a total of 6-13.5 hours per week. Each employee received fortnightly pay at above the statutory minimum wage for cleaners and a disability support pension adjusted according to their earnings. A typical shift involved working with a co-worker to vacuum and clean bathrooms and offices at up to three different worksites. All participants described working relationships with the manager, co-workers, supervisors and SHINE business clients as part of their jobs. Further participant details are summarised in Table 1.

Data collection Individual interviews were conducted by the first author using the WEISv2.0 (Moore-Corner et al 1998) as a semistructured interview guide. The WEISv2.0 is a MOHO-based interview, designed specifically to explore a worker’s perception of the work environment (Kielhofner et al 2008a) through questions about physical and social workplace factors that may have a positive or negative impact on the worker. The interview format allows the interviewer to adapt the interview to the client so that it ‘flows naturally and encourages honest, thorough responses’ (Moore-Corner et al 1998, p13). The WEISv2.0 has evidence of construct validity, discriminative capacity and minimal rater bias (Kielhofner et al 1998). In this study, the interviews averaged 50 minutes in length (range 25-67 minutes) and were audiotaped with participants’ permission.

Setting and participants Ethics approval was obtained from the Faculty of Health Sciences’ Human Ethics Committee, La Trobe University (FHEC07/168), and the social firm’s governing body. Pseudonyms are used here for organisations and people involved to protect confidentiality. The setting chosen was an Australian social firm, which had been operating for several years and therefore provided a source of employees with the experience of sustained employment. SHINE (pseudonym) is a suburban commercial cleaning company providing services to public and private businesses and employing approximately 18 cleaners, several supervisors and a manager. All employees who met the following criteria were invited to participate: adults experiencing psychiatric disability; comfortable conversing in English; and employed for 6 months or longer in the social firm. Six months was chosen as the minimum duration of employment since tenure of 6 months is considered an enduring job (Bond et al 2008). Seven employees were recruited through an initial invitation presented at a SHINE staff meeting, followed by individual meetings to explain the study and seek their written informed consent. The participants were five men and two women, aged between 38 and 60 years, and had been employed as

Data analysis The analysis process involved sequential transformation: moving back and forth between understanding, interpreting and retelling individual stories and exploring content and themes within the group of participants (Gibbs 2007). Interviews were transcribed verbatim by the first author. Initial coding commenced after the first two interviews were transcribed, following principles outlined by Charmaz (2006). Reflective notes were then written to help focus subsequent interviews. Thematic analysis was used to focus codes; to compare the coded data through constant comparison; and to outline the properties of codes, so as to develop themes across the interviews (Lincoln and Guba 1985, Charmaz 2006, Gibbs 2007). Iterative phases of analysis also included narrative analysis, involving writing individual stories to understand and preserve the complexity of individual occupational experiences (Molineux and Rickard 2003). Strategies to enhance the first author’s interpretive rigour included reflexivity and peer review through supervision and conference presentation; seeking participants’ feedback; member checking; and including verbatim quotes in the findings to preference participants’ own voices and increase authenticity (Fossey et al 2002).

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Table 1. Summary of participants’ information Number of participants Personal information Gender Male..........................................................................................5......... Female.......................................................................................2......... Age (years) 35-44 .......................................................................................3......... 45-54 .......................................................................................3......... 55-64 .......................................................................................1......... Birthplace Australia....................................................................................6......... Outside Australia........................................................................1......... Partner Single (including separated and widowed)..................................6......... Partnered...................................................................................1......... Employment information Length of employment at SHINE 6 months to 1 year.....................................................................2......... 1-2 years ...................................................................................2......... 2-3 years...................................................................................2......... More than 3 years......................................................................1......... Employment status Permanent part time ..................................................................6......... Casual part time ........................................................................1......... Average hours worked per week in last month 6-8 hours ..................................................................................4......... 12-13.5 hours ...........................................................................3......... Current job gives me the hours I want to work Yes ............................................................................................6......... No.............................................................................................1......... Current job matches the type of work I want to do Yes ............................................................................................5......... No.............................................................................................2......... Health information Sought help/had contact with mental health system Less than 2 years .......................................................................1......... 5-10 years .................................................................................1......... More than 10 years....................................................................5......... Hospitalisation due to mental health issues in the past 5 years None .........................................................................................5......... Once..........................................................................................1......... Twice.........................................................................................1......... Main mental health issue Depression.................................................................................4......... Schizophrenia ............................................................................2......... Anxiety ......................................................................................1.........

Findings Three core and eight secondary themes were identified (see Table 2), which describe participants’ experience of the SHINE work environment. These themes, which are presented below, interlinked with participants’ narratives about sustaining their jobs.

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Table 2. Core themes from thematic analysis Doing this job with ease and enjoyment: ‘You’re used to it and you know what to do.’ – I’m used to it. – I know I can do the job. Working in this team: ‘It’s a good team to work in.’ – It’s very supportive. – I get feedback that I’m doing a good job. – We get on well. Thinking about working here: ‘It’s doing positive things in my life.’ – I feel better from having something to do and somewhere to go. – The benefits of this job are a bonus. – This job is ‘right for now’.

Doing this job with ease and enjoyment: ‘You’re used to it and you know what to do’ The participants viewed working at SHINE as a regular, easily maintained and satisfying pattern in their lives. They described doing their duties capably and finding work achievable and enjoyable.

I’m used to it Regular work schedules, tasks and locations, together with opportunities for negotiating changes to these, enabled the participants to develop routines for working and still maintaining other valued activities, such as seeing family or managing health. This was important to Scott: When I have days off I go for a walk, I do my exercises and all that sort of thing, try to eat well, take my medication obviously, to stay well.

Regular work hours were an important source of satisfaction for Judy: Look, I’m used to working in the afternoon now, I’m used to it … so during the day I can do things during the day and then I go into work in the afternoon, which is quite good actually.

Peter also appreciated a regular work schedule: I’m always on time. It doesn’t bother me catching transport and that, I’m used to it.

While regular duties helped to make performing the job easy for Toni: I always do the vacuuming. Yeah, I find it better to do it that way, rather than swapping, changing all the time. Otherwise I get too confused.

Terry, Chris and Nick had all cleaned in the same offices for the duration of their employment and felt comfortable in these familiar worksites; this familiarity was particularly emphasised by Terry, who described the workplace as ‘my second home’. Flexibility added to the ease of their jobs: two participants reported renegotiating schedules so they could engage in other regular activities, such as sport or attending a club. Judy valued flexibility with work location:


Anne Williams, Ellie Fossey and Carol Harvey

They’re pretty flexible actually, cause I was so happy when they said to me ‘You’ve got a placement in [suburb]’, which is great! … I could walk here to work and I don’t have to take it if I don’t want to.

Nah, nothing’s wrong with concentration and all that. I’ve got support from [manager], if I want to get something or ask him a question, that’s what he’s here for he reckons … I really count on him you know.’

This flexibility meant that the participants viewed their jobs as relatively low stress, an advantage for those concerned that stress would affect their wellbeing.

Other relationships at work were also supportive, but more individual. For example, Chris had a supportive relationship with a co-worker that involved ‘catching up’ during breaks and Terry felt highly supported by the business clients whom he saw on each shift: ‘People care for me over there … when I come everyone says hello.’

I know I can do the job Regular duties with opportunities for training, responsibility and autonomy meant that the participants viewed themselves as experienced and capable of performing their duties well. As Nick noted: He (supervisor) doesn’t have to say nothing to me, not even once. He knows I know my job.

Peter shared this view: I’m doing my job, I’m not lazy, don’t want to leave nothing there missing or not cleaned or something like that. I always do a thorough job.

Completing training courses in cleaning was a key factor in developing the participants’ sense of expertise: I’ve been a cleaner much longer than he (co-worker) has, he hasn’t had the experience that I’ve had. And he hasn’t done the course that I’ve done, the cleaning course, so I know all the theory side of it … (Scott).

Some participants also described taking on responsibility, such as supporting newer employees, locking up worksites, or checking that the work was complete, as described by Chris: Sometimes I have to run around and check things though, cause occasionally they [other workers] might miss a bin or something.

The combination of regularity, flexibility and feeling capable meant that participants viewed their jobs as easy and enjoyable, even when being a cleaner was not their preferred type of work: … it’s not like, ‘Oh, not this again’, you know, at home, you’re thinking, ‘Oh that can be done another day’ [cleaning]. But I enjoy, sort of it’s funny isn’t it though, maybe because you know, you go there every day that’s your … , you enjoy it too, you enjoy it (Judy).

Working in this team: ‘It’s a good team to work in’ The participants viewed interactions with the manager, supervisors, co-workers and SHINE clients as friendly and supportive, making them feel at ease, included and valued.

It’s very supportive Relationships with the manager stood out as being a key source of support for all participants. Managerial support ranged from practical assistance, such as ‘making sure you’ve got the right chemicals and stuff and the jobs going along smooth’ (Toni), to a deeper sense of care for their personal wellbeing, such as described by Peter:

I get feedback that I’m doing a good job The participants described receiving feedback from the manager, supervisors or clients frequently and in ways that felt genuine. Feedback was informally given during conversations at work, but also formally such as when supervisors conducted worksite inspections. Feedback added to participants’ perceptions that they worked for a quality company, reinforced their belief in their capabilities and contributed to job satisfaction. In response to a question about what was most satisfying about his job, Scott noted: About the job? To make sure it all comes up well and you do get compliments from the [business] clients, that’s the one good thing, that’s really good when you get that, cause it’s feedback.

Getting feedback was a point of difference for Toni to other jobs: It’s a lot easier going, the work for SHINE than it is in a regular job … The bosses, the supervisors, they’re not there looking over your shoulder all the time, seeing if you’re doing it. Just in their approach: they point something out to you, they do it in the right manner … It’s a good team, the whole SHINE, bosses and supervisors, it’s a good team to work for.

We get on well The participants described the relationships at work with co-workers as cooperative and friendly. The social atmosphere in this job was preferred by Nick, who described relationships with previous co-workers as competitive: ‘That’s his backyard, his job, he guards it.’ Another participant preferred her current job to a previous job where she ‘felt a bit out of place’. The participants gave examples of helping one another in their day-to-day working relationships. For instance, Toni noted: There is another lady I work with, she’s a good, a good team worker, yeah. No we help each other, like I do one job, like the vacuuming and the mopping and she might get the dusting.

Teaching co-workers was satisfying for Scott: I feel better that I can show someone, teach someone something I know, that’s really good.

Relationships with people working in offices were also good: I think it’s relaxed and friendly, cause like most of the people there say hello and stuff. A lot of them don’t mind when I’m vacuuming (Chris).

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Cooperative work relationships did not necessarily extend into friendships outside work, beyond saying hello to one another, as explained by Peter: ‘If I bump into someone I say hello. I have a little chat with them. That’s about it.’ The participants were generally satisfied that they had friendly relationships at work and were not seeking further external contact with their co-workers.

This job is ‘right for now’

Thinking about working here: ‘It’s doing positive things in my life’

Although some entertained the possibility of doing something different in the future, all participants planned to sustain their employment at SHINE. For example, while Judy imagined that she might someday do other work, she was fully satisfied with her work at SHINE:

The participants described how work enhanced their present lives and fulfilled their desire to participate in meaningful occupation.

I feel better from having something to do and somewhere to go The participants connected working at SHINE with feeling better, keeping healthy and preventing boredom: … Well I think it is doing positive things in my life, very positive things, try and keep healthy, keep the mind healthy, keep the body healthy, and just try and relax about things, that’s where I have my problems, stress, all that sort of area, … I relax a lot more now (Scott). Not just the money, I enjoy it cause you get out and about and you’re doing something with your life, you’re not sitting down and thinking all day and that. You go to work, you feel good, you come home, you feel happy (Peter).

As Terry poignantly described, work ‘put me back to my life’ and without it ‘maybe I’m worse and worse and no good for nothing’. Further, for Toni, sustaining working in a stressful life represented independence, self-respect and the belief that ‘there’s hope for me yet’.

The benefits of this job are a bonus The participants viewed their pay and conditions as a bonus and saw them as better than jobs available to them in ‘regular’ employment. Receiving wages to supplement the disability support pension (DSP) provided income to pay bills, buy goods or support family. As Terry said, ‘I have some money from pension, some from company and I’m very happy, help me a lot.’ Earning an income was also important to how participants felt about themselves, as explained by Toni: ‘Just being on a pension like, it’s not really good for you, you know, your self-esteem, self-respect, it’s not very good … ’ Job security was another much valued benefit of working at SHINE. Permanency brought entitlements that were important to Scott: ‘Annual leave and all that sort of thing, superannuation, all the kick backs, all the fringe benefits, which is good.’ The employment conditions also included an entitlement to extended unpaid sick leave, providing an extra level of security that compared favourably to other jobs in which job security was far from assured. As Judy explained: … if I’m sick or something, or something happens, they know about it, let them know about it, and my job will be there when I come back, which is very good, good to know.

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The participants talked about being satisfied with their employment, as explained by Nick: I like it here … and I’ve proved it, been here 3 years. Now for me to be here 3 years, there’s something good. Normally a job, if I don’t like it, I wouldn’t last 3 years. I’d last about a month, 2 months, then I’m going … see the difference? (Nick).

I wouldn’t mind, you know, office work or something, but that’s, that’s not for now … because I’ve got the job and I get paid for it, that’s fine.

Moreover, the participants tended to view their current employment as just right in light of past employment experiences that had been difficult. For instance, Judy described being ‘put off’ her last job and Nick explained that he had resigned from a prior cleaning job because there was ‘too much pressure, it was too hard … here’s friendly. At [past workplace] it’s like you’re in a contest’. Additionally, participants were motivated to sustain their current part-time employment because they anticipated barriers to increasing their hours or changing to a different type of job, as illustrated by the following comments: Now the thing is, you can’t go over 30 hours (a fortnight). Let’s suppose, say you do like 30 hours minimum, 30 goes 31, 33, 34, 35 hours, something like that. No you can’t. Your pension, you will lose it (Nick). I would like to work as a trades assistant or something like that, but this is what I’m doing at the moment. You know how life changes, you do one thing, next year you’re doing something else. But really I haven’t got the schooling for an apprenticeship or anything like that … (Scott). Full time work’s sort of out of the question at the moment, it’s just the medication I’m on, it knocks me out (Chris).

For others, satisfaction with the present extended to hopes for a long-term future with SHINE: I feel myself staying for a long time, for as long as this job ever lasts, I mean if they ever shut it down, that’s the only time I would leave from it, cause I find this job very good, very supportive, all the workers and everyone (Peter).

Discussion This study explored how employees with psychiatric disabilities view working in a social firm and what factors in this workplace contributed to employees staying in their employment. The participants perceived rewards, interactions with others, work schedules and task demands at SHINE positively. The participants sustained their


Anne Williams, Ellie Fossey and Carol Harvey

Fig. 1. Influences on participants choosing to sustain employment at SHINE.

employment because they perceived that their jobs were different to other jobs: SHINE offered secure employment; supportive and inclusive work relationships; and regular schedules and tasks that participants believed they could complete well, leading to high levels of job satisfaction. Further, they perceived that working at SHINE benefited their emotional and physical wellbeing, specifically contributing positively to their health, economic circumstances and occupational life-course. The participants’ reasons for staying in their jobs can be further understood using MOHO (Kielhofner 2008a). The participants described a work environment that afforded socially supportive supervisor, co-worker and client interactions. This pivotal role of workplace support and feedback is reported elsewhere (Secker and Membrey 2003, Henry and Lucca 2004). The social environment also offered achievable occupational forms as a result of the work schedule, task and time demands and opportunities to adopt an individual worker role style in terms of degrees of autonomy and responsibility. These workplace features were experienced regularly and contributed to participants developing work-related habits and consolidating their worker role, as explained by the concept of habituation (Kielhofner 2008b). Further, regular work schedules and task demands were a necessary and ongoing foundation for participants’ job satisfaction, to which flexibility, challenge and variety could be added. Flexibility in work hours and duties and part-time hours have previously been identified as important in sustaining employment (Salyers et al 2004, Becker et al 2007). Finally, the participants’ volitional choices (Kielhofner 2008c) were strongly influenced by the SHINE environment: holding a secure job gave participants a highly valued role of being a worker, while getting frequent feedback and undertaking training enhanced their self-efficacy and job satisfaction. Thus, several participants sustained their jobs at SHINE despite cleaning not being their preferred type of work, the job benefits seeming to outweigh its drawbacks (Honey 2004). Thus it appears possible to achieve satisfying and sustainable employment when a

job promotes feelings of competence and offers a balance of challenge and variety, as previously suggested by Huff et al (2008). Overall then, working at SHINE enabled participants to craft a new occupational life (Kielhofner et al 2008b). The supportive work environment was not, however, the only influence on the participants sustaining their employment. As well as viewing SHINE as a supportive place to work, the participants’ decisions to stay in their jobs were influenced by their views of their past and future. Kielhofner et al (2008b, p110) stated that ‘people conduct and draw meaning from life by locating themselves in unfolding narratives that integrate, past, present, and future selves’. Fig. 1 depicts how participants employed at SHINE viewed their work as supporting them in the present and as part of their unfolding narrative, influenced by their past and future health and security concerns. The participants looked back to prior experiences of illness, unemployment and stressful jobs. These experiences created a press to stay in the current job where participants felt well and secure. Despite wanting a different type of job, more hours or to retire in the future, when they looked forward they perceived multiple barriers to achieving these goals, including fear of relapse and disability support pension restrictions. This concurs with international research that has identified many barriers to the employment of people with psychiatric disability, including the episodic nature of mental illhealth, financial disincentives and systemic barriers in health and income support systems (Boardman et al 2003, Henry and Lucca 2004, Salyers et al 2004). Each participant perceived health and security presses uniquely within his or her story. For example, working had a central meaning of supporting recovery as a result of being well and looking back to illness for Terry, whereas for Chris working meant renewing and sustaining satisfying occupation through a secure job in the present, compared with an occupationally insecure past and future. In comparison, working for Nick had a central meaning of progressing

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towards a preferred occupational future, albeit that the press of health and security concerns limited the attainment of this future. Thus, the findings suggest that when the goal is sustaining employment, two factors require attention. The first is to attend to the specific match between the work environment and an employee’s need for regularity, flexibility challenge and support. Occupational therapists with their expertise in human occupation and person-environmentoccupation interactions (Kielhofner 2004) are well placed to make these assessments and to use this expertise to work with social firms and other employers in designing and evaluating workplace supports that foster sustainable employment for people with psychiatric disabilities (Strong and Rebeiro 2003). The second factor highlighted is that it is necessary to understand the employment-related motivations of people with psychiatric disabilities within the context of their occupational narratives and illness experience to gain a deeper appreciation of the decisions they make about staying in jobs. Attending to these personal narratives will also help orient occupational therapists, case managers in mental health services and vocational service providers towards providing support and advocacy to address the barriers, such as inflexible benefit systems and a dearth of supported education and training opportunities, that limit their clients’ career development.

straightforward to administer, easy for participants to understand and time efficient. Thus, further use of the WEISv2.0 in this context appears warranted.

Study limitations and recommendations for further research

Acknowledgements This article is based on a paper submitted in partial fulfilment of the requirements for the degree of Master of Occupational Therapy by the first author. We thank the participants in this study who willingly shared their views, and the social firm and Social Firms Australia for their support. Conflict of interest: None

Seven participants shared their views of the workplace environment from one social firm in Australia, each through one qualitative interview. Thus participants’ views represent a slice in time of their employment experiences; a longitudinal design may better capture the variability in participants’ views about their employment, including at times of leaving or changing jobs. Further, as a naturalistic inquiry, the study was designed to generate findings that take account of its specific context, so that they are not necessarily transferable to other populations or contexts (Lincoln and Guba 1985). So, while SHINE’s contract cleaning requires teamwork across different sites and geographical locations with varying work hours, employees may experience social firms with other job arrangements somewhat differently. Thus, further research is warranted in social firms, and other workplaces, to identify workplace features that are consistently supportive of people experiencing psychiatric disability in finding meaningful and sustainable employment. Focusing on employees’ views also necessarily excluded other information about their work performance and interactions with fellow workers. The addition of observation of participants in their workplaces, and multiple interviews with participants and supervisors, may have enabled these factors to be explored in greater depth. However, the semi-structured interview format of the WEISv2.0 (Moore-Corner et al 1998) was effective in gaining participants’ views on wide-ranging features of their workplace,

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Conclusion This study explored how employees with psychiatric disabilities viewed working in an Australian social firm. This workplace was socially supportive and accommodating, and enabled sustained employment from the perspective of those interviewed. These findings provide evidence that social firms can create supportive employment environments for people with psychiatric disabilities. The study also demonstrated that MOHO provided a useful theoretical framework and practice tool (the WEISv2.0) to understand how factors in the work environment supported participants’ job tenure. Further application of MOHO constructs and assessments in the arena of psychiatric disability and employment in research and practice appears warranted. Given current interest in social inclusion and employment for people with psychiatric disabilities, it is timely for occupational therapists to use this knowledge base to improve the opportunities of people with psychiatric disabilities to access sustainable employment.

Key findings ■

According to participants, the social firm provided a supportive and accommodating workplace that enabled employees with psychiatric disabilities to sustain employment.

Participants’ views were effectively explored using the WEISv2.0. What the study has added

Creating a supportive work environment and understanding employees’ past and future occupational and illness narratives may facilitate employees with psychiatric disabilities to stay in their jobs.

References Auerbach E, Richardson P (2005) The long-term work experiences of persons with severe and persistent mental illness. Psychiatric Rehabilitation Journal, 28(3), 267-73. Baron K, Littleton M (1999) The Model of Human Occupation: a return to work case study. Work, 12(1), 37-46. Becker D, Whitely R, Bailey E, Drake R (2007) Long-term employment trajectories among participants with severe mental illness in supported employment. Psychiatric Services, 58(7), 922-28.


Anne Williams, Ellie Fossey and Carol Harvey

Boardman J, Grove B, Perkins R, Shepherd G (2003) Work and employment for people with psychiatric disabilities. British Journal of Psychiatry, 182(6), 467-68. Bond G, Drake R, Becker D (2008) An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31(4), 280-90. Braveman B (1999) The Model of Human Occupation and prediction of return to work: a review of related empirical research. Work, 12(1), 13-23. Braveman B, Kielhofner G, Bélanger R (2008) Program development. In: G Kielhofner. Model of Human Occupation: theory and application. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 442-65. Charmaz K (2006) Constructing grounded theory: a practical guide through qualitative analysis. London: Sage. Corbiére M, Lecomte T (2009) Vocational services offered to people with severe mental illness. Journal of Mental Health, 18(1), 38-50. Drake R, Bond G (2008) The future of supported employment for people with severe mental illness. Psychiatric Rehabilitation Journal, 31(4), 367-76. Fossey E, Harvey C, McDermott F, Davidson L (2002) Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry, 36(6), 717-32. Gibbs G (2007) Analyzing qualitative data. London: Sage. Henry A, Lucca A (2004) Facilitators and barriers to employment: the perspectives of people with psychiatric disabilities and employment service providers. Work, 22(3), 169-82. Honey A (2004) Benefits and drawbacks of employment: perspectives of people with mental illness. Qualitative Health Research, 14(3), 381-95. Huff S, Rapp C, Campbell S (2008) ‘Every day is not always jell-o’: a qualitative study of factors affecting job tenure. Psychiatric Rehabilitation Journal, 31(3), 211-18. Jeffery S (2005) Social firms: developing business, economic viability, stakeholder value and worker inclusion. International Congress Series, 1282, 1153-57. Kielhofner G (2004) Conceptual foundations of occupational therapy. 3rd ed. Philadelphia: FA Davis. Kielhofner G (2008a) Model of Human Occupation: theory and application. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins. Kielhofner G (2008b) Habituation: patterns of daily occupation. In: G Kielhofner. Model of Human Occupation: theory and application. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 51-67. Kielhofner G (2008c) Volition. In: G Kielhofner. Model of Human Occupation: theory and application. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 32-50. Kielhofner G, Forsyth K, Clay C, Ekbladh E, Haglund L, Hemmingsson H, Keponen R, Olson L (2008a) Talking with clients: assessments that collect information through interviews. In: G Kielhofner. Model of Human Occupation: theory and application. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 262-87. Kielhofner G, Borell L, Holzmueller R, Jonsson H, Josephsson S, Keponen R, Melton J, Munger K, Nygård L (2008b) Crafting occupational life. In: G Kielhofner. Model of Human Occupation: theory and application. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 110-25. Kielhofner G, Lai J, Olson L, Haglund L, Ekbadh E, Hedlund M (1998) Psychometric properties of the Work Environment Impact Scale: a cross-cultural study. Work, 12(1), 71-77. Killeen M, O’Day B (2004) Challenging expectations: how individuals with psychiatric disabilities find and keep work. Psychiatric Rehabilitation Journal, 28(2), 157-63.

Kirsh B (2000) Work, workers, and workplaces: a qualitative analysis of narratives of mental health consumers. Journal of Rehabilitation, 66(4), 24-30. Kirsh B, Cockburn L, Gewurtz R (2005) Best practice in occupational therapy: program characteristics that influence vocational outcomes for people with serious mental illnesses. Canadian Journal of Occupational Therapy, 72(5), 265-79. Lee J, Kielhofner G (2009) Vocational intervention based on the Model of Human Occupation: a review of evidence. Scandinavian Journal of Occupational Therapy, Published online July 2009, DOI: 10.1080/11038120903082260 Lincoln Y, Guba G (1985) Naturalistic inquiry. Newbury Park, CA: Sage. Lucca A, Henry A, Banks S, Simon L, Page S (2004) Evaluation of an individual placement and support model (IPS) program. Psychiatric Rehabilitation Journal, 27(3), 251-57. McQuilken M, Zahniser J, Novak J, Starks R, Olmos A, Bond G (2003) The work project survey: consumer perspectives on work. Journal of Vocational Rehabilitation, 18(1), 59-68. Mental Health Council of Australia (2006) Time for service: solving Australia’s mental health crisis. Australian Capital Territory: Mental Health Council of Australia. Mentrup C, Niehaus A, Kielhofner G (1999) Applying the model of human occupation in work-focused rehabilitation: a case illustration. Work, 12(1), 61-70 Molineux M, Rickard W (2003) Storied approaches to understanding occupation. Journal of Occupational Science, 10(1), 52-60. Moore-Corner R, Kielhofner G, Olsen L (1998) A user’s guide to Work Environment Impact Scale (WEIS) Version 2.0. Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago. Ross J (2007) Occupational therapy and vocational rehabilitation. Chichester: John Wiley. Salyers M, Becker D, Drake R, Torrey W, Wyzik P (2004) A ten-year follow-up of a supported employment program. Psychiatric Services, 55(3), 302-08. Schneider J (2005) Getting back to work: what do we know about what works? In: B Grove, J Secker, P Seebohm, eds. New thinking about mental health and employment. Oxon: Radcliffe Publishing, 37-49. Secker J, Membrey H (2003) Promoting mental health through employment and developing healthy workplaces: the potential of natural supports at work. Health Education Research, 18(2), 207-15. Shankar J, Collyer F (2003) Vocational rehabilitation of people with mental illness: the need for a broader approach. Australian e-Journal for the Advancement of Mental Health, 2(2), 1-13. Available at: www.cinahl.com/ cgi-bin/refsvc?jid=2719&accno=2005082363 Accessed on 09.03.09. Social Firms Australia, Social Ventures Australia (2005) Social firms information kit. Melbourne: Social Firms Australia. Social Firms UK (2007) 2007 Annual report. Available at: http://resources.social firms.co.uk/files/2007%20Annual%20Report.pdf Accessed on 19.06.09. Strong S, Rebeiro K (2003) Creating supportive work environments for people with mental illness. In: L Letts, P Rigby, D Stewart, eds. Using environments to enable occupational performance. Thorofare, NJ: Slack, 137-54. Svanberg J, Gumley A, Wilson A (2010) How do social firms contribute to recovery from mental illness? A qualitative study. Clinical Psychology and Psychotherapy, Published online February 2010, DOI: 10.1002/cpp.681 Waghorn G, Lloyd C, Clune A (2009) Reviewing the theory and practice of occupational therapy in mental health rehabilitation. British Journal of Occupational Therapy, 72(7), 314-23. Warner R, Mandiberg J (2006) An update on affirmative businesses or social firms for people with mental illness. Psychiatric Services, 57(10), 1488-92.

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