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There is little knowledge of how organizational and social work environmental conditions impact workers' perceptions of occupational balance. The aim of the present study was to investigate organizational and social work environmental conditions as predictors of Swedish occupational therapists' perceptions of occupational balance.This prospective study collected data twice, with a one-year interval, and used a web survey. The present study included 1835 participants. Logistic regression analysis was used to analyze the work predictors of occupational balance.A reasonable workload, high control, and high reward predicted high occupational balance. Having no children living at home, a satisfactory financial situation, and being physically active also predicted high occupational balance.A reasonable workload, high control and high reward predicted occupational balance among the occupational therapists. All these factors may be of importance for a sustainable working life for occupational therapists.This knowledge can support occupational therapists in the development of interventions at the work place, with focus on the workload and the resources (control and reward), to promote employees' occupational balance.

BACKGROUND: Lack of mental health literacy among rehabilitation professionals and employers in the return-to-work of persons with mental health problems resulted in the development of a three-day group training program, the Support to Employers from rehabilitation Actors about Mental health (SEAM) intervention. OBJECTIVE: To evaluate the impact of SEAM on rehabilitation professionals’ knowledge and beliefs, attitudes, and supporting behaviors towards people with mental health problems and employers as part of the return-to-work process. METHODS: In this longitudinal study, 94 rehabilitation professionals were included. Data were collected prior to (T1), immediately after (T2) and 6 months after SEAM training (T3) using knowledge and attitude scales and a questionnaire on supporting behaviors. SEAM includes training in Mental Health First Aid, presentations and discussions on current research on work and mental health, and strategies and communication guidelines to use when meeting service users and employers as part of the return-to-work of persons with mental health problems. SEAM also includes a homepage with targeted employer information. Data were analyzed using non-parametric statistics. RESULTS: SEAM significantly increased rehabilitation professionals’ knowledge of mental health (T1-T2: z = –2.037, p = 0.042; T2-T3: z = –5.093, p = 0.001), and improved their attitudes towards persons with mental health problems (T1-T2: z = 4.984, p = 0.001). Professionals (50–60%) also estimated that they had increased their use of supporting strategies towards service users and employers. CONCLUSIONS: The study suggests that SEAM can increase mental health literacy among rehabilitation professionals and lead to a greater focus on service users’ resources and work ability, as well as on employers’ support needs.

BACKGROUND To the detriment of service users, stakeholders have not previously had the opportunity to influence the design of their healthcare or be involved in mental health and return-to-work (RTW) research. Co-design of digital RTW solutions is thus vital to create acceptable and engaging interventions that are useful for those receiving or providing them. mWorks is a digital RTW solution for people with common mental disorders. OBJECTIVE To describe stakeholder perceptions of a co-design process during prototype development of mWorks. METHODS A co-design approach was used in the development of mWorks. Eighty-one stakeholders participated in the iterative co-design process, including service users, RTW professionals, employers, digital design and system developers, the public, and researchers. Multiple data sources from seven iterations were analyzed with content analysis. RESULTS Stakeholders highlighted the importance of enabling service users to self-manage by delivering supplementary support to traditional services and a place to identify the surrounding RTW support network. This is reflected by the categories. Additional crucial aspects included development of strategies of empowerment (to aid against self-stigma and mental health issues), foster control, identify strengths, and formulate a positive self-narrative to disrupt negative mindsets. While testing the alpha and beta prototypes, stakeholders stressed that mWorks needs to be warm and welcoming, understandable and intuitive, offer clear guidance, and provide motivational and goal setting strategies. CONCLUSIONS : Stakeholder experience-based knowledge asserts that mWorks needs to empower service users by providing them with a personal support tool. To enhance RTW prospects, a digital tool should engage users in a meaningful manner while focusing on their strengths and available resources.

Background: Occupational therapists are an essential healthcare profession and play a vital rolein rehabilitating patients in the activities of daily life. Nevertheless, many occupational therapistsin Sweden are leaving the profession and this jeopardises occupational therapy services.Objective: To explore factors that cause occupational therapists to seriously consider leavingtheir profession.Material and methods: As part of a larger national study of Swedish occupational therapists’health and work environment, qualitative content analysis with a summative approach wasapplied to explore the reasons for considering leaving their profession among 1279 Swedishoccupational therapists.Results: Three themes emerged: (1) facing work environment deficiencies, (2) pursuing owndevelopment and (3) Personal factors and external constraints. The largest category, belongingto theme 1, was stress and high work pressure given 344 times as a reason to consider leavingthe profession.Conclusions and significance: This article provides new and important insights on the reasonswhy occupational therapists may seriously consider leaving their profession. The results are significant for managers and employing organizations to consider in order to prevent a shortageof occupational therapy services.

BackgroundFlexible assertive community treatment (FACT) is an innovative model for providing long-term treatment to people with severe mental illness. The model was developed in the Netherlands but is now used in other countries, including Norway, which has a geography different from the Netherlands, with many rural and remote areas. Implementation of innovations is context dependent. The FACT model's potential in rural and remote areas has not been studied. Therefore, we aimed to gain knowledge regarding the challenges and modifications of the model in rural and remote contexts and discuss how they can affect the model's potential in such areas. This knowledge can improve the understanding of how FACT or similar services can be adapted to function most optimally in such conditions. We sought to address the following questions: Which elements of the FACT model do team leaders of the rural FACT teams find particularly challenging due to the context, and what modifications have the teams made to the model?MethodsDigital interviews were conducted with five team leaders from five rural FACT teams in different parts of Norway. They were selected using purposive sampling to include team leaders from some of the most rural teams in Norway. The interviews were analyzed using thematic text analysis.ResultsThe following three themes described elements of the FACT model that were experienced particularly challenging in the rural and remote context: multidisciplinary shared caseload approach, intensive outreach and crisis management. The following eight themes described the modifications that the teams had made to the model: intermunicipal collaboration, context-adaptive planning, delegation of tasks to municipal services, part-time employment, different geographical locations of staff, use of digital tools, fewer FACT board meetings, and reduced caseload.ConclusionsRural and remote contexts challenge the FACT model's potential. However, modifications can be made, some of which can be considered innovative modifications that can increase the model's potential in such areas, while others might move the teams further away from the model.

BACKGROUND: Mental health problems are the main cause of sick leave in today's working age population. Employers are responsible for their employees' work environment and preventing work-related illnesses, but their knowledge regarding mental health problems is lacking. Employer beliefs and support strategies need further exploration. OBJECTIVE: To explore employers' beliefs, knowledge and strategies use in providing support to employees with mental health problems. METHODS: This grounded theory study comprised 24 interviews with employers in a variety of workplaces, and included women and men in large and small organizations in a Swedish context. RESULTS: Two categories related to the aims emerged: comprehending mental health problems is complex, and lacking established conditions to support work. The results show that employers seek to support employees with mental health problems but have low expectations and lack knowledge and strategies. Employers acknowledged experiences of inadequate support and collaboration from other actors in the return-to-work (RTW) process. CONCLUSIONS: To close the service gap and improve the RTW process, employers need to increase their mental health literacy. Other actors need to improve their understanding of employer situations and provide them with necessary support. (Less)

Occupational therapists with less than 10 years of work experience have been shown to be at higher risk of work-related stress. There is a need for further research on the level of job strain they perceive.To investigate the perceived level of job strain among Swedish occupational therapists with less than 10 years of work experience and differences between groups who have worked for 0-5 years and 6-10 years.In this cross-sectional study, a web-based survey was sent to 345 occupational therapists with less than 10 years of work experience, with 252 responding. Data was collected using the Swedish Demand-Control-Support Questionnaire and questions on job strain and sociodemographics.The participants scored 19.68 points on the control scale and 20.01 points on the support scale, indicating high levels of control and support, and 13.33 points on the demand scale (high demand ≤ 14 points). Twelve percent worked in high strain jobs. Most (75%) worked in low strain and active jobs.The participants reported low levels of job strain. However, to prevent mental health problems, employers need to identify those in active jobs to ensure that they have time to exercise control over their work situation.

Background Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes. Methods This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education). Results Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p Conclusion An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment. Trial registration NCT04083404 Registered 05 September 2019 (retrospectively registered).

BACKGROUND: Individuals with mental health problems often need support from vocational rehabilitation professionals in their return-To-work (RTW) process. Research has shown that this support can be deficient, with vocational rehabilitation professionals lacking relevant knowledge and an underlying belief in the individual's ability to resume a working life. More understanding is therefore needed of professionals' mental health literacy and their perception of and influence on employer roles in the RTW process. OBJECTIVE: To explore the mental health literacy of Swedish vocational rehabilitation professionals and their perception of employers in the RTW process. METHOD: Qualitative grounded theory study which included 22 interviews of vocational rehabilitation professionals working with individuals with mental health problems in their RTW process. RESULTS: Three categories emerged: holding a position of power in the RTW process, viewing and believing in individuals' work ability plays a central role, and recognizing the employer's role as a key factor for realizing employment. CONCLUSION: Increasing the mental health literacy of vocational rehabilitation professionals is crucial since they have a decisive role with both clients and employers in the RTW process. (Less)

BACKGROUND: Depression is among the major causes of disability with a negative impact on both daily life and work performance. Whilst depression is the primary cause of sick-leave and unemployment in today’s workplace there is a lack of knowledge of the needs of individuals with depression regarding their return-to-work (RTW) process. OBJECTIVE: To explore which factors are of critical importance for people suffering from depression and who also are unemployed in their RTW-process and to explore the impact of two vocational approaches on the service users’ experiences. The study included participants in two vocational rehabilitation approaches; Individual Enabling and Support (IES) and Traditional Vocational Rehabilitation (TVR). METHOD: Qualitative methods were applied to explore critical factors in the RTW-process. Individuals with affective disorders including depression and bipolar disorder were included. RESULTS Three themes emerged as critical factors; Experiencing hope and power, professionals’ positive attitudes, beliefs and behaviours, and employing a holistic perspective and integrating health and vocational service. CONCLUSION This study has demonstrated critical factors for the return-to-work process as experienced by persons with depression. To experience hope and power, to meet professionals that believe “you can work”, who use a person-centred and holistic service approach, are such factors necessary for gaining a real job. In particular, professionals in TVR need to embrace this understanding since their services were not experienced as including these elements.

Flexible Assertive Community Treatment (Flexible ACT) has been implemented in Sweden during recent years due to increasing interest in integrated services for people with severe mental illness. To date, few studies have been done on Flexible ACT effectiveness.The overall aim of this study was to explore the extent to which clients assigned to the Flexible ACT board for ACT intensive care were stabilized with improved everyday functioning, social outcomes, and changes in healthcare use.Ninety-three participants with psychosis, in need of ACT from six newly started Flexible ACT teams, were included. Data were collected using the Social Outcome Index scale (SIX), Practical and Social Functioning Scale, and a healthcare usage questionnaire.There was a significant positive change in everyday functioning and in the SIX-item 'friendship' at 18-months follow-up. A positive correlation was also found between everyday functioning and the SIX-item 'friendship' and a negative correlation between duration of ACT and everyday functioning. A significant increase in number of inpatient hospital days and psychiatric outpatient visits also occurred.Clients with psychosis who need ACT may benefit from Flexible ACT through improved social functioning. Being involved in meaningful activities and supported by others are key aspects of recovering from mental illness and are enhanced by Flexible ACT.

Despite the lack of scientific evidence for the effectiveness of Flexible Assertive Community Treatment (Flexible ACT), the model disseminates rapidly in the mental health services in a number of c ...

Purpose Stigma has been proposed to be one of the most serious obstacles to successful treatment, rehabilitation and inclusion in society of people with severe mental illness. An aspect of stigma which has been increasingly discussed is self-stigma, which refers to the internalization of negative stereotypes among people with severe mental illness. The aim of the present study was to investigate the effectiveness of a group-based anti self-stigma intervention, narrative enhancement and cognitive therapy (NECT) as an add-on to treatment as usual, with regard to changes in self-stigma, self-esteem, and subjective quality of life. Method After screening for eligibility 106 participants were included in a randomized controlled trial using a wait-list control group, of which 87 completed the study. Assessments were made at baseline, at termination of the intervention, and at a 6-month follow-up (intervention group only). Results The results showed that NECT was effective in reducing self-stigma and improving self-esteem compared to treatment as usual only. No differences were shown regarding subjective quality of life. Changes shown in the intervention group at termination of intervention were stable at the 6-month follow-up. A regression analysis showed that there was a positive relationship between exposure to the intervention and reduction of self-stigma. Conclusions The conclusion of the present study is that, using a sample size with adequate power, NECT seems to be an effective intervention with regard to diminishing self-stigma and improving self-esteem, and that these improvements were stable at a 6-month follow-up. There was a distinct relationship between number of sessions attended and improvements in self-stigma and self-esteem controlling for confounding factors. This puts attention to the importance of creating a group climate which facilitate and encourage participation through the various phases of the intervention.

Background: Research is needed on how to optimize the return-to-work process for persons with mental health problems.Objective: To develop a model that explains how employer and rehabilitation professional mental health literacy may influence strategies used in the return-to-work of persons with mental health problems.Methods: A grounded theory study design was used to collect and analyse interview data from 23 employers and 22 rehabilitation professionals.Results: The analysis resulted in four categories, illustrated in a conceptual process model: 1) seeing mental health problems through past experiences; 2) separating understandable and incomprehensible mental health problems; 3) balancing safeguarding one’s personal interest with providing adequate support; and 4) facing conflicts and uncertainty in employee/service user return-to-work. A positional map of employer/rehabilitation types was created based on level of negative attitudes and uncertainty in supporting employees/service users and the employer in relation to the level of comprehensive understanding of mental health problems.Conclusions: Professional mental health literacy needs to be increased. Interventions need to be developed that provide employers with targeted support and knowledge in mental health literacy. Education on how to prevent and detect common mental health problems in the workplace is needed. (Less)

BACKGROUND Although effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services. OBJECTIVE The aim of this study was to examine stakeholder groups’ perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave. METHODS A purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings. RESULTS The legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers’ concern of legislation incompatibility with innovative technology, and RTW professionals’ concern of the possibility that digital solutions may replace them to a certain extent. CONCLUSIONS This formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context.

BACKGROUND: Employment is central to recovery in schizophrenia, but little attention has been paid to its relationship with cognitive functioning. OBJECTIVE: This cross-sectional study adds to the knowledge base of relationships between cognitive functioning and gaining competitive employment, work hours per week, and monthly income among people with schizophrenia in vocational rehabilitation. It also examines which area of cognitive function may be decisive for gaining employment. METHODS: Thirty-nine vocational rehabilitation participants were administered a cognitive battery based on MATRICS Consensus Cognitive Battery. Socio-demographic, clinical, and vocational data were gathered and analyzed with nonparametric statistics. RESULTS: Individuals with competitive employment differed from those without competitive employment in attention and psychomotor speed, delayed verbal recall, immediate visual recall, and planning, reasoning, and problem-solving. Higher scores in immediate and delayed verbal recall and planning, reasoning, and problem-solving correlated with more work hours per week and higher income. Immediate visual recall was related to higher income. Higher scores in planning, reasoning, and problem-solving was an indicator of competitive employment (OR=1.48). CONCLUSIONS: Higher order cognitive functioning of planning, reasoning, and problem-solving may have a central role in gaining employment. The findings should be considered in compensation for or improving cognitive functions for vocational rehabilitation participants. (Less)

The goal of problem-based and team-based learning (PBL/TBL) is to maximize student engagement and encourage interactive learning. Combining these methods in course design is described as a win-win situation that optimizes student learning, professional development, and uses varied teaching approaches that fit well within health science. More research is needed in the effectiveness of such a hybrid approach.The aim of this study was to explore student experiences of a newly developed mental health course based on an integrated application of PBL and TBL in a university occupational therapy program in Sweden.In this grounded theory study data were collected through logbooks (n = 13) and supplemental open-ended interviews (n = 7) at the end of the course.The analysis resulted in two core categories: 1) learning is facilitated by a course design based on the integrated application of PBL and TBL, a current topic, and teachers who are perceived as engaging, and 2) a perceived safe setting facilitates learning and creates a good study environment. There were six related sub-categories.Combining elements of PBL and TBL may have a range of benefits in promoting student learning and professional development. Other aspects may also have a role to play.

Cognitive functioning may have implications for engagement in daily occupations among people with schizophrenia.This cross-sectional study explores relationships between time use assessed occupational engagement and cognitive functioning among persons with schizophrenia.Thirty-nine participants from four mental health care services in Sweden participated. The Profile of Occupational Engagement among persons with Severe mental illness (POES) and a cognitive test battery was used.Higher attention and psychomotor speed and higher scores in information processing speed, immediate and delayed verbal recall, and immediate and delayed visual recall were significantly correlated with higher scores in occupational engagement. Regression analyzes revealed that information processing speed and delayed visual recall best explained the variance in occupational engagement (RCognitive functioning has implications for occupational engagement, and thus the ability to perform daily occupations in a balanced rhythm within various social and physical environments.

Background: Despite the lack of evidence for effectiveness of the Flexible Assertive Community Treatment (Flexible ACT), the model is considered feasible and is well received by mental health professionals. No current studies have adequately examined mental health professional experiences of working with Flexible ACT. Aims: The aim of this study was to explore mental health professional experiences of working with the Flexible ACT model compared with standard care. Method: The study was guided by grounded theory and based on the interviews with 19 theoretically chosen mental health professionals in Swedish urban areas primarily working with consumers with psychosis, who had worked with the Flexible ACT model for at least 6 months. Results: The analysis resulted in the core category: “Flexible ACT and the shared caseload create a common action space” and three main categories: (1) “Flexible ACT fills the need for a systematic approach to crisis intervention”; (2) “Flexible ACT has advantages in the psychosocial working environment”; and (3) “Flexible ACT increases the quality of care”. Conclusions: Mental health professionals may benefit from working with the Flexible ACT model through decreased job-strain and stress, increased feeling of being in control over their work situation, and experiences of providing higher quality of care.

BACKGROUND: Rehabilitation professionals are increasingly interested in the vocational rehabilitation approach called Individual Placement and Support (IPS) for persons with serious mental illness. OBJECTIVE: Since employers play a crucial supporting role for the IPS service user in the workplace, the aim of this study was to explore the experiences and views of employers in Sweden who have participated in the IPS network and taken IPS service users into their workforce. METHODS: Grounded theory with situational analysis was used to analyze data from nine employers. RESULTS: The core category being socially committedwas identified. Six stages/categories illustrated the employer process, from taking on IPS service users to supporting them at work: 1) IPS is the keyhole, 2) being ready to open the door, 3) making a job offer, 4) removing barriers, 5) achieving the goal, and 6) pride mixed with negative feelings. CONCLUSION: The study results suggest that collaborative relationships with employers must be based on trust and professionalism, and that employers must be provided with adequate support. (Less)

Not all people with severe mental illness who attend Individual Placement and Support (IPS) gain and keep their jobs or work full time. Research has indicated a relationship between social disabilities and work performance in this group, and that support provided is often directed towards the social work environment. However, relationships between social skills performed in an authentic work setting and vocational outcomes have not been explored.To explore relationships between social communication and interaction skills and vocational outcomes among IPS service users in a Swedish context.Twenty-nine participants were appraised with the Assessment of Communication and Interaction Skills (ACIS-S) instrument, and their vocational data were registered. Correlations were estimated using Spearman's rho test with Bonferroni corrections at item level.Better communication and interaction skills were significantly correlated with increased working hours (rs = 0.64) and higher income (rs = 0.45). Increased working hours were related to assuming postures, asking questions, sharing information, and sustaining conversation in an appropriate manner.The results indicate that occupational therapists need to focus on social skills and accommodation of the social work environment in order to promote sustainable working careers among people with severe mental illness.

Objective: This multiple case study investigated support and process in the Individual Placement and Support (IPS) approach from individual client, longitudinal and Person-Environment-Occupation (PEO) model perspectives. Participants: Five IPS-participants, or cases, with severe mental illness (SMI) who worked a minimum of 4 hours a week entered the study. Methods: A multiple data collection method was used over a period of 12 months and included IPS-vocational profiles and plans as well as various instruments and questionnaires concerning socio-demographics, work performance, limitations, and accommodations. Both within- and across-case analyses were performed. Results: The IPS-process concerned job search support, job-matches (PEO-match), and adjustment of the PEO-match by providing accommodations by on- and off-worksite support. All participants had limitations concerning social interactions and handling symptoms/tolerating stress. Several accommodations were made for the same limitations, mostly directed towards the social environment. Prior work experience, disclosure, and not being in an acute phase of illness seemed important to the support provided. Conclusions: This study has visualised the support and process in IPS and provided a theoretical framework, the PEO-model, to detect limitations and provide IPS-support. The organization of IPS-support and methods of providing it to individuals may be important for job tenure and employment success.

Objective: People with severe mental illness are often successful in gaining work when participating in the evidence-based Individual Placement and Support (IPS) approach. Little evidence exists on how starting work is perceived by IPS participants. This qualitative study aimed to explore how IPS participants perceived working and the work environment to impact on their work performance. Methods: Nineteen participants starting work in mainstream work settings were interviewed. Questions from the Work Environment Impact Scale were used and data was analysed by content analysis. The participants strove to fit in by coping with environmental demands and adapting to their worker role. Results: Work was perceived as having a positive impact on their daily life, although starting work was perceived as a challenge and the mental illness affected work performance. Personal strategies were needed in order to cope. They perceived both supportive and demanding factors in their work environments, such as the employer's support and the social atmosphere among colleagues. Conclusion: The study showed that it is vital to focus on the individual's own strategies for adapting to the worker role when designing the support, as well as to develop collaborative relationships with employers and to optimize the match between the individual and the demands of the work environment.