Abstract
Occupational participation in a supported-employment is a rehabilitation strategy to improve both vocational and non-vocational domains of people with psychiatric disabilities, enabling them to access and/or re-enter employment. This study aims to identify the factors associated with unsatisfactory job-termination among the participants of supported-employment to inform future intervention. A cross-sectional survey was conducted on a group (with a diagnosis of schizophrenia) who participated in a supported-employment program in a large psychiatry institution in Malaysia. Within the first week of job termination, interviews were conducted with three subgroups independently - the participants, the employers and the hospital employment specialists, using the Job-Termination Interview. Factors linked to job-termination and job-accommodation were analysed using univariate and multivariate logistic regression.Key reasons for job termination were- poor job performance (n = 32; 47.1%), interpersonal issue (n = 31; 45.6%), medical illnesses (n = 30, 44.1%), incompatibilities between work-schedule and environment (n = 30; 44.1%), and job-dissatisfaction (n = 29, 42.6%). Key factor for sustaining job/ job-accommodation was “higher pay” (n = 4; 33.3%). Overall, an unsatisfactory trend of job terminations was observed where many (n = 53; 77.9%) quit their job without a ready job at hand. Unsatisfactory job-terminations were associated with three factors -(i). Enrolment in the Individual Placement-Support (IPS) (Adj. OR = 10.70, 95% CI 1.32-86.98, p = 0.012), (ii). Unstable medical issues (Adj. OR = 22.51, 95% CI 1.74-291.08, p = 0.003), (iii). Interpersonal issues (OR = 18.26, 95% CI: 2.24-149.15, p < 0.001).Most participants terminated their jobs in an unsatisfactory manner (77.9%). A high 63.2 percent quit their job without another ready-job at hand, while 14.7 percent were fired. Unsatisfactory job-endings were correlated to, poor job-performance, interpersonal problems and medical illnesses. Occupational re-entry intervention program must be tailored to the individual levels and needs, and be fully integrated within the clinical system to ensure job-person-environment fit, in order to improve job-experience and to lower unfavourable job terminations.
Highlights
Occupational participation in supported-employment for people living with psychiatric illnesses, has better evidence than conventional vocational rehabilitation intervention (Kinoshita et al, 2013; Marshall et al, 2014)
Supported-employment programs gained momentum as an occupational-rehabilitation strategy for people diagnosed with schizophrenia in Malaysia in the last decade
This study shows that a majority of the participants terminated their jobs in an unsatisfactory manner (77.9%): 63.2 percent quit without any other “ready job at hand”, with only 14.7 percent were fired
Summary
Occupational participation in supported-employment for people living with psychiatric illnesses, has better evidence than conventional vocational rehabilitation intervention (Kinoshita et al, 2013; Marshall et al, 2014). In Malaysia, the unemployment status among the people with schizophrenia remain high. Chee (2009) reported that among the first-episode schizophrenia, a high 50-75 percent unemployment rates. Supported-employment programs gained momentum as an occupational-rehabilitation strategy for people diagnosed with schizophrenia in Malaysia in the last decade. A cross sectional study undertaken in Hospital Permai (Johor, Malaysia) showed employment rate of 68.3 percent among program-users at 3-months follow-up (Wan et al, 2014); and the hospital’s 2014 internal survey found that 42.6 percent of job placement referrals could secure a job, with 28.5 percent has job terminated along the way. This study aims to explore reasons for job-termination, factors associated with unsatisfactory job-termination, and any needed job-accommodations among participants in a supported-employment program in a Malaysian setting
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