Pachoud B, Corbière M
UFR d'études psychanalytiques, université Paris-Diderot, bâtiment Olympe-de-Gouges, 8, rue Albert-Einstein, case 7058, 75205 Paris cedex 13, France.
École de réadaptation, université de Sherbrooke, campus Longueuil, 150, place Charles LeMoyne, Longueuil J4K 0A8, Québec, Canada.
Encephale. 2014 Jun;40 Suppl 2:S33-44. doi: 10.1016/j.encep.2014.04.001. Epub 2014 Jun 11.
Sustained work integration for people with a severe mental illness or handicap psychique in French (e.g., schizophrenia) is an important issue in our society today. Indeed, work is not only an essential factor in people's social integration but is also a stepping-stone toward recovery for this clientele. Well-defined programs and services related to work integration were developed and studied over the last three decades. Although the work integration of people with severe mental illness has been studied extensively in the Anglo-Saxon literature, the impact of these studies on the traditional beliefs and services in France remains uncertain. In terms of the scope of the studies so far, there has been an initial interest lasting over many years to uncover individual characteristics of people with severe mental illness which would best predict job tenure. Since, studies have been increasingly investigating various supports in order to facilitate the work integration process. These supports can be illustrated as direct supports or accommodations offered in the workplace, as needed, particularly when people with severe mental illness choose to disclose their mental disorder in the workplace. This awareness of the impact of the workplace environment on the work integration of people with a severe mental illness increases the need to find solutions and develop environmentally sensitive clinical strategies to overcome difficulties during the work integration. To illustrate this thematic, in this special issue, we have gathered together studies conducted in different countries but who share the focus on work integration of people with a severe mental illness. To reflect the advancement in this domain, this special issue is divided in three parts. The first part consists of the presentation of different types of vocational programs: supported employment programs, social firms, and hybrid models. Supported employment programs are very well documented in the specialised literature and are recognized as an evidence-based practice across the world to help people get competitive employment. Social firms is an another alternative model for facilitating the work integration of people with severe mental illness but has to date scarcely been studied empirically. Other hybrid vocational programs implemented in Québec (Canada) and France and inspired by supported employment programs and social firms' principles, are also described. The second part of this special issue is related to the presentation of two adjunct clinical interventions for helping people with a severe mental illness in their work integration, and more particularly for increasing job tenure: cognitive remediation and group cognitive behavioral therapy. Cognitive remediation was developed to reduce the impact of cognitive deficits, such as memory or attention, in people with a severe mental illness whereas group cognitive behavioral therapy was developed to change the dysfunctional beliefs and behaviours that might hinder job tenure in people receiving supported employment services. Finally, the third part of this special issue presents two papers on the influence of the workplace, of stakeholders from the organization (e.g., employers, supervisors) and of the work environment on the work integration of people with severe mental illness. The first paper discusses disclosure of the mental illness in the workplace and its positive and negative consequences such as receiving work accommodations and experiencing stigma, respectively. In the last paper, psychological processes during the hiring process are presented to better understand the elements related to discrimination and stigma during the work integration of people with severe mental illness.
对于患有严重精神疾病或精神障碍(如精神分裂症)的人来说,持续的工作融入在当今法国社会是一个重要问题。事实上,工作不仅是人们社会融入的关键因素,也是这类人群康复的重要一步。在过去三十年里,人们制定并研究了与工作融入相关的明确计划和服务。尽管在盎格鲁 - 撒克逊文献中对患有严重精神疾病者的工作融入进行了广泛研究,但这些研究对法国传统观念和服务的影响仍不明确。就目前研究的范围而言,多年来人们最初关注的是揭示严重精神疾病患者的个体特征,以便最好地预测其工作任期。此后,研究越来越多地调查各种支持措施,以促进工作融入过程。这些支持措施可以表现为根据需要在工作场所提供的直接支持或便利条件,特别是当患有严重精神疾病的人选择在工作场所披露其精神障碍时。意识到工作场所环境对严重精神疾病患者工作融入的影响,增加了寻找解决方案和制定对环境敏感的临床策略以克服工作融入困难的必要性。为了阐述这一主题,在本期特刊中,我们汇集了在不同国家开展的研究,这些研究都聚焦于严重精神疾病患者的工作融入。为了反映该领域的进展,本期特刊分为三个部分。第一部分介绍了不同类型的职业项目:支持性就业项目、社会企业和混合模式。支持性就业项目在专业文献中有详细记载,并且在全球被公认为是一种基于证据的实践,可帮助人们获得有竞争力的就业机会。社会企业是促进严重精神疾病患者工作融入的另一种替代模式,但迄今为止几乎没有进行实证研究。还介绍了在魁北克(加拿大)和法国实施的、受支持性就业项目和社会企业原则启发的其他混合职业项目。本期特刊的第二部分介绍了两种辅助临床干预措施,以帮助患有严重精神疾病的人融入工作,特别是延长工作任期:认知康复和团体认知行为疗法。认知康复旨在减少严重精神疾病患者认知缺陷(如记忆或注意力)的影响,而团体认知行为疗法旨在改变可能阻碍接受支持性就业服务的人工作任期的功能失调信念和行为。最后,本期特刊的第三部分发表了两篇论文,探讨工作场所、组织中的利益相关者(如雇主、主管)以及工作环境对严重精神疾病患者工作融入的影响。第一篇论文讨论了在工作场所披露精神疾病及其分别带来的积极和消极后果,如获得工作便利和遭受污名化。在最后一篇论文中,介绍了招聘过程中的心理过程,以便更好地理解严重精神疾病患者工作融入过程中与歧视和污名化相关的因素。