Changes in the nature and intensity of stress following employment among people with severe mental illness receiving individual placement and support services: an exploratory qualitative study

Abstract

Background: Most people with severe mental illness (SMI) want to work. Individual placement and support (IPS) programs have proven effective in helping them obtain and keep competitive jobs. Yet, practitioners often fear that competitive jobs might be too stressful.Aims: To explore how the nature and intensity of stress experienced by IPS clients changed after the transition from looking for work to being employed.Methods: Semi-structured interviews explored the experiences of 16 clients of an IPS program who had recently been competitively employed. Grounded theory was used to structure the analysis.Results: Most participants reported that their stress level decreased once they found work. Stress following work was associated with fear of failure, pressure to perform and uncertainty. The support that people perceived in their return-to-work project, and where they were on their recovery journey, modulated their perception of stress. Many cited IPS as a source of support.Conclusions: Competitive work changed the nature of stress and was mostly associated with a decrease in stress level. Adjunctive interventions aiming to buffer self-stigma or help participants use more adaptive coping mechanisms may merit investigation.