Family support, forming careers, and breaking the disability mindset: implications for addressing structural barriers to employment pathways in coordinated specialty care for first-episode psychosis

ABSTRACT

Pathways to employment are typically interrupted by first-episode psychosis (FEP) which strikes during the developmentally critical time of young adulthood. This paper reports on the key moments and messages that influenced the developing employment, education, or disability trajectories of young adults in the years following completion of Coordinated Specialty Care (CSC) for FEP. Nineteen semi-structured interviews were conducted with young adults with both lived experience of a FEP and a CSC program, from a critical case sample of 10 persons who were involved in an advocacy group. Results indicate that family support and expectations, disability narratives from mental health professionals, the realities of the modern labor market, and university disability support strongly influenced the pathway to employment, education, or disability, and that these were influenced by multiple structural realities such as family SES, disability policies, and treatment ideology, and the capacity of the labor market and universities. This paper concludes that CSC services should create a unified plan to address the structural barriers that challenge those from marginalized families, reevaluate traditional disability ideology in mental health treatment, and better support new pathways to secure employment and education for all young adults with FEP.

KEYWORDS:

• First-episode psychosis
• employment
• education
• disability
• NEET
• CSC

Acknowledgments

The author would like to acknowledge the bravery and contributions of the members of the Young Adult Leadership Council and the support of the EASA Center for Excellence at Portland State University including Tamara Sale and Dr. Ryan Melton. She also acknowledges the invaluable direction from members of her dissertation committee including Dr. Gunnar Almgren, Dr. Taryn Lindhorst, Dr. Greg Townley, & Dr. Bob Mugerauer.

Disclosure statement

No potential conflict of interest was reported by the author.