Background
Methods
Study design and population
Data collection
Data analysis
Results
Kenya Practitioners Study
Socio-demographic characteristics of study participants
Perspectives on the ability to work of persons with mental disorders
Perceived barriers to employment of persons with mental disorders
Mental illness
When you are given some of the drugs you sleep and you cannot function so that one causes another issue of utilizing both mental health facility and looking for employment among people who are mentally sick. (Health Care Provider 3_Psychatrist)
Dysfunctional health system
Our public mental health hospitals are few and people avoid them because there are so many patients within public hospitals and the resources are less staff who are overwhelmed; so they may not offer friendly services and have little time for the patients… (FGD _Psychologist)
I think access to medication is a problem but is no longer such a big problem…the bigger barrier is lack of purchasing power which leads to inability to buy medications and adherence to treatment. (Healthcare provider 9_Psychologist)
I think poor health care utilization is related to finance because health care insurance does not cover mental illness… Insurance companies are still discriminative of persons with mental illness. (Healthcare provider 3_Psychiatrist)
Social stigma
So, the society feels like you are not one of us and therefore you are not accepted among us, it’s like you are an outcast. So, because of that definitely one is stigmatized, and you cannot be allowed even to work in our[midst]… even the government itself does not allow many of these people, it does not employ them. (Healthcare provider 1_Psychologist)
So, I think the biggest barrier really in addition to money is the stigma around mental health. …. you don’t even have to be psychotic, having something as simple as anxiety, depression can get you fired and you are never getting a job again. (Healthcare provider 10_Psychologist)
Low socioeconomic status
Those who are poor let’s say those who are quite poor most probably you are not going to get even that employment, and then that means probably you will become poorer. But those who are a little bit wealthy, I think they have better services, they are given better services even in the hospitals because they are able to access the best psychiatrist for example and they get proper medication. And I think also those who are wealthy also kind of look at it as an illness, it’s not just like, it’s not something that people don’t understand what it is. (Healthcare provider 1_Psychologist)
Lack of government and policy commitment
We are fighting for health from all angles and that is a big challenge not only for mental health sector. Budgetary allocation for health itself is bare minimum now start thinking mental health… (Healthcare provider 5_Psychiatrist)
….they don’t have insurance they don’t have the money then they don’t come for clinic they don’t come for follow up and yeah so they are at a disadvantage. (Healthcare provider 5_Psychiatrist)
Perceived facilitators of employment for persons with mental disorders
Information of stigma reduction
If stigma is reduced and even employers are able to understand about mental illness that when they are stable they are able to work; when they are sick, they get treatment, I think that could help. If employers are understanding[about] of mental conditions, that would enable them to recover. (Healthcare provider 9_Psychologist)
Improved health care
Health institutions and professionalism are also key; so that people can access care and also in a non-judgmental manner….we have very few facilities around which deal with mental health like for example now we have only Mathare, so we need more of those kind of facilities. We need also even rehabilitation centres… (Healthcare provider 1_Psychologist).
Policy advocacy on employment
And because they don’t know what to do with you they would rather not employ you so that is further stigmatization they are experiencing. But the international companies and institutions I think they kind of understand this kind of condition. Like for example I have dealt with a number of international kind of institutions and there are a number of the patients they brought me or clients who have been in war-torn areas where there is a lot of fighting and majority of them have post-traumatic stress disorder. So when they come they actually bring them for help and without the intention of sacking them after treatment. But then the local companies sometimes are very shallow understanding about even how to deal with these people. (Healthcare provider 1_Psychologist)
Government commitment to health care and social welfare
…first of all, the government needs to see mental illness as something that needs to be addressed by coming up with a mental health policy and integrating into it ways of implementation. I think that can improve a lot, can improve first of all inpatient facilities so that people would stop stigmatizing against Mathare, so in terms of employing people, getting enough beds, getting drugs and also subsidizing the medication. (Healthcare provider 6_Social worker)
I think government has a very, very big role I mean for a long, long time health has been neglected in low-resource or developing countries context; however, you want to call it. The fact that the budget is great on security and less on primary education or health in itself very telling and we need to come up with institutional mechanisms to address poverty and socioeconomic disadvantages. (Healthcare provider 9_Psychologist)
…what I have noticed is that there are more of those who are self-employed than those who are formally employed are basically again what we’ve seen that securing employment is not easy for them so majority just choose to have some private business or something somewhere just to employ themselves, yes. (Healthcare provider 1_Psychologist)
I think they have social protection factors like being educated, being employable because of that educational training or skill that they have, often times is high level of management positions so there is already some success and some sort of problems that they have learnt and they are managing to the relationships or inciting in stress through psychotherapy and kind of psychopharmacologies is not very difficult. (Healthcare provider 9_Psychologist)
Nigerian Practitioners Study
Socio-demographic characteristics of study participants
Variable | Category | Distributiona |
---|---|---|
Sex | Female | 28 (35.4) |
Male | 51 (64.6) | |
Missing | 1 | |
Age (years) | 37.9; 37; 27–64 | |
Profession | Psychiatrist | 43 (53.8) |
Occupational health physician | 11 (13.8) | |
Community health physician | 19 (23.8) | |
Other | 7 (8.8) | |
Fellowship status | Completed residency | 31 (38.8) |
Currently doing residency | 45 (56.3) | |
Not applicable | 4 (5.0) | |
Years of practice | Years in continuous | 8.7; 7; 3–27 |
Less than 10 years | 49 (61.3) | |
More than 10 years | 30 (37.5) | |
Missing | 1 |
Perspectives on ability to work of persons with mental disorders
Variable | Category | Distribution N (%) |
---|---|---|
Do you have persons with mental disorders at your workplace? | No | 4 (5.0) |
Yes | 61 (76.3) | |
I do not know | 15 (18.8) | |
Do you think persons with mental disorders can work? | No | 3 (3.8) |
Yes | 75 (96.2) | |
Missing | 2 | |
Do you think persons with mental disorders pose a risk at work? | Always | 1 (1.3) |
Never | 6 (7.5) | |
Sometimes | 73 (91.3) | |
Are there things you can do to enhance jobs for persons with mental disorders? | No | 11 (13.8) |
Yes | 69 (86.3) | |
What are things you can do to enhance job opportunities for persons with mental disorders? | Public education to reduce stigma of mental illness | 16 (25.0) |
Early intervention and rehabilitation | 25 (39.1) | |
Demonstrating ability to work of persons with mental disorders | 4 (6.3) | |
Supportive work environment | 6 (9.4) | |
Policy advocacy and affirmative action | 4 (6.3) | |
Education of employers | 3 (4.7) | |
Others | 6 (9.4) | |
Missing | 16 | |
Under what conditions should persons with mental illness be allowed to work? | Under supervision | 20 (27.8) |
When clinically stable | 19 (26.4) | |
When on treatment or medication | 12 (16.7) | |
Unsupervised like others | 8 (11.1) | |
In sheltered work settings | 1 (1.4) | |
When they want and have the capacity to do the job | 6 (8.3) | |
Others | 6 (8.3) | |
Missing | 8 |
Perceived barriers and facilitators to employment of persons with mental disorders
Variable | Category | Distribution N (%) |
---|---|---|
Do you have pre-employment assessment at work? | No | 71 (88.8) |
Yes | 9 (11.3) | |
How often has pre-employment assessment affected opportunities at your workplace? | Never | 8 (10.7) |
Not applicable | 58 (77.3) | |
Sometimes | 9 (12.0) | |
Missing | 5 | |
Is there workplace accommodation at your workplace? | No | 68 (85.0) |
Yes | 12 (15.0) | |
What factors can enhance the job opportunities for persons with a mental disorder? | Public education to reduce stigma of mental illness | 21 (27.3) |
Early diagnosis and treatment | 18 (23.4) | |
Improved health care for persons with mental disorders | 6 (7.8) | |
Supportive work environment | 8 (10.4) | |
Family support | 2 (2.6) | |
Policy advocacy and affirmative action | 9 (11.7) | |
Formal education and training for persons with mental disorders | 7 (9.1) | |
Other | 6 (7.8) | |
Missing | 3 | |
Why is there no accommodation for persons with a mental disorder at your workplace? | I don’t know | 9 (20.5) |
No pre-employment assessment | 1 (2.3) | |
No provisions by employer/management | 9 (20.5) | |
Lack of awareness of its usefulness | 5 (11.4) | |
Non-disclosure of mental illness at employment | 2 (4.5) | |
Financial constraints | 3 (6.8) | |
Neglect of mental illness | 5 (11.4) | |
Other | 10 (22.7) | |
Missing | 36 |