Personal experiences of people with serious mental illness when seeking, obtaining and maintaining competitive employment in Queensland, Australia.

BACKGROUND: High non-participation in the labour force and unemployment remain challenging for adults with serious mental illness. OBJECTIVES: This study examined the personal experiences of people with serious mental illness when seeking, obtaining and maintaining competitive employment. The aim was to increase understanding of personal experiences of employment and how these experiences can be used to inform the assistance provided in support of clients' competitive employment goals. METHODS: Qualitative data from a two-year period were thematically analysed from one participating site in a multi-site trial of employment services integrated with public funded community mental health treatment and care. RESULTS: Both positive and negative themes arose. Positive themes included: Aspirations for a better life, receiving feedback on good job performance, employment displacing preoccupation with illness, and employment improving self-esteem and reducing financial stress. Negative themes included stigma experiences, stress, and health difficulties. Both positive and negative experiences did not depend on type of employment service assistance nor key client characteristics such as age, sex, and diagnostic category. CONCLUSIONS: Despite its many benefits, employment can also increase the risk of negative personal experiences. These findings suggest that employment service providers could do more to assist people who commence employment, to reduce the risk of negative personal experiences and to enhance the benefits of competitive employment.

A multi-site randomised controlled trial of evidence-based supported employment for adults with severe and persistent mental illness.

BACKGROUND/AIM: The Individual Placement and Support (IPS) approach is an evidence-based form of supported employment for people with severe and persistent mental illness. This approach is not yet widely available in Australia even though there is mounting evidence of its generalisability outside the USA. One previous Australian randomised controlled trial found that IPS is effective for young people with first episode psychosis. The aim of the current trial was to assess the effectiveness of evidence-based supported employment when implemented for Australian adult consumers of public mental health services by utilising existing service systems. METHODS: A four-site randomised control trial design (n = 208) was conducted in Brisbane (two sites), Townsville and Cairns. The intervention consisted of an IPS supported employment service hosted by a community mental health team. The control condition was delivered at each site by mental health teams referring consumers to other disability employment services in the local area. RESULTS: At 12 months, those in the IPS condition had 2.4 times greater odds of commencing employment than those in the control condition (42.5% vs. 23.5%). The conditions did not differ on secondary employment outcomes including job duration, hours worked, or job diversity. Attrition was higher than expected in both conditions with 28.4% completing the baseline interview but taking no further part in the study. CONCLUSION: The results support previous international findings that IPS-supported employment is more effective than non-integrated supported employment. IPS can be successfully implemented this way in Australia, but with a loss of effect strength compared to previous USA trials.

Treatment priority for suicide ideation and behaviours at an Australian emergency department.

AIM: To investigate the treatment priority given to self-harmers presenting to a hospital emergency department (ED) in Queensland, Australia, over the period 2005-2010. METHODS: The main outcome measure of this study was the treatment priority given to persons presenting with suicide ideation and communication (SIC) or self-harming behaviour. Treatment priority was measured using the Australasian Triage Scale, which ranks patients from 1 (in need of immediate treatment) to 5 (assessment and treatment to start within 120 min). Ordered logistic regression was used to assess the broad demographic and treatment-related factors associated with more urgent triage categories and to investigate which methods of non-fatal suicidal behaviour (NFSB) were prioritised as most urgent. RESULTS: Most cases of NFSB were between 15 and 34 years. A larger proportion of persons presenting for SIC were aged 35 to 44 years. Over 50% of male presentations and 38% of female presentations were for SIC. Those cases prioritised as being more urgent had significantly greater odds of being older, presented after an act of self-harm rather than SIC, and had used multiple methods of NFSB. These individuals also had greater odds of being male and having made past presentations for SIC or NFSB. Among males, those presenting after ingestion of drugs had the greatest odds of receiving immediate attention compared to SIC. "Cutters" were considered as the least "urgent" subjects, and had a greatest risk of waiting 60 to 120 min for treatment compared to suicide ideators. Among females, those presenting with chemicals, poisons and gases had the greatest odds of receiving immediate attention compared to SIC. Females who presenting after cutting themselves had lower odds of receiving immediate treatment than those who presented with SIC. CONCLUSION: ED staff seems to judge the urgency of cases based on demographic factors such as age and gender, as well as method of NFSB.

Significant relationship between lifetime alcohol use disorders and suicide attempts in an Australian schizophrenia sample.

OBJECTIVE: Suicide and attempted suicide are common in individuals with schizophrenia, and evidence exists for a link between substance use disorders and suicidality in this disorder. However, alcohol has not been consistently implicated. We examined the relationship between substance use disorders and suicide attempts in schizophrenia. METHODS: We recruited a schizophrenia sample in Australia (n = 821) for genetic analyses. We analysed demographic and clinical variables, including substance use disorders, and their relationship to suicide attempts using generalised equation modelling. RESULTS: A significant association was identified between lifetime alcohol abuse/dependence and suicide attempts (OR = 1.66; 95% CI, 1.23 to 2.24; p = 0.001) after adjustment for potential confounders, but not between cannabis abuse/dependence and suicide attempts, nor between other illicit drug abuse/dependence and suicide attempts. Polysubstance abuse/dependence was also not implicated. CONCLUSIONS: These results suggest that the presence of alcohol abuse/dependence may be a risk factor for suicide attempts in individuals with schizophrenia, independent of comorbid substance abuse/dependence.

Reliability and validity of a measure of role functioning among people with psychiatric disabilities.

AIM: The aim was to investigate the reliability and validity of the Socially Valued Role Classification Scale (SRCS), a domain-specific measure of role functioning designed for use with community residents with psychiatric disabilities. Test-retest reliability, concurrent validity, face validity, consumer and clinician acceptability and utility were examined. METHODS: Sixty community residents with schizophrenia or schizoaffective disorder participated in this study where the SRCS was administered by telephone. RESULTS: Test-retest reliability showed good or very good agreement for subscale scores (intraclass correlations (ICCs): 0.78-0.89) and for items capturing amount of participation in domain-specific activities (ICC: 0.67-1.00). Greater variation was observed for items capturing assistance required with activities (κ: 0.40-0.75), and standard of activities performed (κ: 0.43-1.00). Concurrent validity was supported by moderate to very good associations in the directions expected. Face validity, user acceptability and utility in telephone interviews were adequate. CONCLUSIONS: These findings add to previous psychometric evidence and support the continued development of the SRCS for use in community mental health settings. The SRCS has promising utility for occupational therapists involved in psychiatric rehabilitation outcome measurement.

The reliability of an education-related self-efficacy scale for people with psychiatric disabilities.

We investigated the reliability of the Education-related Self Efficacy Scale (ESS-40), a measure of self-efficacy at a core task level designed for people with psychiatric disabilities. Sixty community residents with schizophrenia or schizoaffective disorder participated. The ESS-40 was administered twice via telephone interview. Short cycle test-retest reliability was very good for the total score and most items. The measure demonstrated signs of a coherent internal structure, adequate face validity, good client acceptability, and promising utility. The reliability evidence supports its use in community mental health services and in psychiatric rehabilitation settings. Sensitivity and predictive validity require further investigation.

A brief measure of vocational activity and community participation: development and reliability of the Activity and Participation Questionnaire.

OBJECTIVES: Social and economic marginalization are significant problems for many people living with mental illness. Clinicians and policy-makers have increased their focus on these aspects of recovery. Current outcome measures, however, do not support this focus, and detailed functional measures are not suitable for routine clinical use. This report describes the development and test-retest reliability of the Activity and Participation Questionnaire (APQ6); a self-report measure of vocational activity and social participation for routine use in community mental health services. METHOD: The APQ6 was developed from concepts of the Australian Bureau of Statistics Labour Force Surveys and Census. Field testing and consumer consultation were undertaken in New South Wales (NSW) mental health rehabilitation services. Test-retest reliability trials were conducted simultaneously by research teams in NSW and Queensland. RESULTS: Pairs of short-cycle test-retest reliability interviews were obtained from 129 mental health service consumers. Consumer feedback and test-retest reliability results at question and item levels indicate good construct validity. The measure has utility as both a telephone and a personal interview in community mental health settings. CONCLUSIONS: The reported psychometric properties support the proposed use of the APQ6 as a recovery-orientated measure focusing on vocational activity and community participation. The APQ6 is being introduced for routine use by NSW mental health services.

Reliability of a scale of work-related self-efficacy for people with psychiatric disabilities.

Work-related self-efficacy at a core task level fits with the social cognitive career theory explaining the career development of people with severe mental illness. The aim of this study was to further investigate the psychometric properties of the 'Work-related Self-Efficacy Scale' for use with people with psychiatric disabilities. Sixty individuals with schizophrenia or schizoaffective disorder participated in repeated telephone interviews conducted 2-5 days apart. Short-cycle test-retest reliability and internal structure were assessed. Face validity, consumer and clinician acceptability and utility were examined qualitatively. Short-cycle test-retest reliability was found to be very good at item and total score levels. The internal structure was consistent with previous investigations. Although face validity, acceptability and utility were adequate, use of face-to-face interviews is preferred over telephone interviews. The construct validity evidence supports wider use for research purposes in community mental health service, supported employment and other psychiatric rehabilitation settings.