The psychosocial benefits of work for people with severe and enduring mental health problems

Abstract

Perceptions of the value of work for people with severe and enduring mental health problems have changed frequently over the last two decades. With the new social inclusion agenda manifest in the Disability Discrimination Act and in the NHS modernization agenda, work is once again in vogue. There is a need for a way of evaluating work which draws on its potential contribution to psychological well-being as well as its provision of a valued social role and which is less susceptible to fluctuations in health and social policy. Jahoda's work on the psychosocial functions of work provides such a framework and this study sets out to explore its utility among workers who are severely disabled by mental health problems. Twelve of the psychosocial functions of work were rated by 50 people attending two sheltered work placements according to how important they were perceived to be and the extent to which the functions were fulfilled through their attendance. Satisfaction of the psychosocial functions through work was compared with their satisfaction through other aspects of the respondents’ lives. All functions were perceived as important, but self-confidence/self-esteem was rated as more important than most of the others. Structure to the day, self-confidence and social contact were better satisfied through work than were decision making, practising old skills and having goals to aim for. In general, the results showed that the functions were fulfilled better by work than by other aspects of the respondents’ lives. The study supports the notion that work is of value in the rehabilitation of people with severe and enduring mental health problems and offers a possible framework for the further exploration of this theme, both within mental health services and the community at large.

Percepciones del valor del trabajo para personas con problemas de salud mental graves y duraderos han cambiado con frecuencia durante las últimas dos decadas. Con la nueva agenda de inclusión social manifiesta en la Disability Discrimination Act y en el agenda de modernización del National Health Service, el trabajo está otra vez en boga. Se necesita una manera de evaluar el trabajo que recurre a su posible contribución tanto a bienestar psicólogico como a su prestación de un valioso rol social, y que es menos sensible a las fluctuaciones del político social y de salud. El trabajo de Jahoda sobre las funciones psicosociales de trabajo nos proporciona un tal marco y este estudio intenta explorer su utilidad entre trabajadores gravamente descapacitados por problemas de salud mental. Cinquenta personas que asistían a dos centros de colocación vigilada dieron puntuaciones a doce de las funciones psicosociales de trabajo segun su importancia percibida y hasta qué punto las funciones fueron realizadas por su asistencia a los centros. Se comparó la satisfacción de las funciones psicosociales por mediación del trabajo con su satisfacción por otros aspectos de la vida de los participantes. Todas las funciones fueron percibidas como importantes, pero la confianza en si mismo y el autoestima recibieron una puntuación más alta que la mayoría de las otras. Estructura diaria, confianza en si misma y contacto social se satisficieron por el trabajo mejor que la toma de decisions, la practicá de habilidades viejas, y el tener metas por alcanzar. En general, los resultados demuestran que se realizaron las funciones mejor por el trabajo que por otros aspectos de la vida de los participantes. El estudio apoya la idea que el trabajo tiene valor en la rehabilitación de las personas con problemas de salud mental graves y duraderos y ofrece un posible marco para explorer más este tema tanto dentro de los servicios de salud mental como en la comunidad en general.

Keywords:

• therapeutic work
• severe and enduring mental health problems
• psychiatric rehabilitation
• psychosocial benefits
• trabajo terapeutico
• problemas de salud mental graves y duraderos
• rehabilitacion psiquiatrica
• beneficios psicosociales

We are grateful to the service users who took part in this study, and literature review, to Jan Brind, Helen Carlson and Deborah Madell for contributions to the data analysis and literature review, and to two anonymous reviewers for comments on a previous version of the paper.

Notes

Dr Anne Goodwin is Consultant Clinical Psychologist in Mental Health Rehabilitation with Nottinghamshire Healthcare NHS Trust. She works clinically with people with severe and enduring mental health problems and has special interests in the process of adaptation to the mental patient role and in support systems for care staff. Address: Nottinghamshire Healthcare NHS Trust, Millbrook Unit, Kings Mill Centre, Sutton-in-Ashfield, Notts. NG17 4JT, UK.

Dr Angela Kennedy is Consultant Clinical Psychologist working in secondary care adult mental health for County Durham and Darlington Priority Services NHS Trust. She has an interest in the effects of trauma on the development of severe and enduring mental health problems and the impact on staff of working with such difficulties. Address: Bede House, Shotley Bridge Hospital, Consett, Co, Durham DH8 0NB, UK.

The authors were previously employed by Newcastle Mental Health Trust where this work was undertaken.

Additional information

Notes on contributors

Anne M. Goodwin

Dr Anne Goodwin is Consultant Clinical Psychologist in Mental Health Rehabilitation with Nottinghamshire Healthcare NHS Trust. She works clinically with people with severe and enduring mental health problems and has special interests in the process of adaptation to the mental patient role and in support systems for care staff. Address: Nottinghamshire Healthcare NHS Trust, Millbrook Unit, Kings Mill Centre, Sutton-in-Ashfield, Notts. NG17 4JT, UK. Dr Angela Kennedy is Consultant Clinical Psychologist working in secondary care adult mental health for County Durham and Darlington Priority Services NHS Trust. She has an interest in the effects of trauma on the development of severe and enduring mental health problems and the impact on staff of working with such difficulties. Address: Bede House, Shotley Bridge Hospital, Consett, Co, Durham DH8 0NB, UK.