Narrative development and supported employment of persons with severe mental illness
Introduction. Supported Employment (SE) is widely recognized as the most effective vocational program in psychiatric rehabilitation, resulting in employment rates of 40 to 60%. However, little is known about the link between positive work outcomes and subjective aspects of recovery, such as those found in narratives. Objective. The present study investigated the prospective relationship between narrative development at the start of vocational rehabilitation and positive work outcomes. Method. Using a sample of 38 people with Severe Mental Illness (SMI) participating in Supported Employment, the authors employed a time-limited, mixed-method longitudinal design to examine the relationship between baseline self-experience, as measured using a quantitative measure of narrative development, and employment outcomes (competitively employed or not employed; hours worked per week) eight months later. The authors also explored whether narratives evolved over the course of the study. Results. The results showed that 57.9% of participants were competitively employed at the end of the study. Narrative development was unrelated to work outcome for those with competitive employment. Unemployed participants provided more developed narratives than workers with respect to emotional connectedness, social worth and overall development of narratives. In addition, higher emotional connectedness at the start of SE was predictive of fewer hours worked eight months later, controlling for executive functioning, negative symptoms and self-esteem. Finally, while workers showed no changes in narratives over time, those without work demonstrated increased agency over the eight months of participation in SE. Conclusions. The results demonstrated that narrative recovery is not related to the ability of persons with SMI to find work or to work more hours. The relationship between work outcomes and narratives warrants further study.
Severe Mental Illness psychosis schizophrenia Supported Employment narratives self-experience recovery clinical psychology