Martinelli Alessandra, Bonetto Chiara, Bonora Federica, Cristofalo Doriana, Killaspy Helen, Ruggeri Mirella
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, BS, Italy.
BMC Psychiatry. 2022 Apr 26;22(1):296. doi: 10.1186/s12888-022-03881-8.
People with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the 'social enterprise' (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users.
This is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE-on average 5 years before the study recruitment, and at the study recruitment-year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,-year 2016; 1 year before the recruitment - year 2017; and at the recruitment-year 2018. An assessment at the recruitment time-year 2018, of SE users' satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time-year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done.
At the recruitment time - year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE-when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time - year 2016, to good ones at the recruitment time - year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement.
SE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI.
与普通人群相比，精神障碍患者失业的可能性要高得多。针对严重精神健康问题患者的就业干预措施有两种国际认可的、基于证据的模式，即个别安置支持和俱乐部模式。在意大利，一种常见的模式是“社会企业”（SE），这是一个由非营利组织运营的项目，旨在帮助残疾人士就业。尽管社会企业在意大利广泛存在且具有重要意义，但尚无关于意大利样本的研究。本文报告了对意大利维罗纳一家社会企业的心理社会和工作成果的试点评估。该研究旨在调查参与社会企业工作安置的严重精神疾病患者是否能随着时间推移实现个人康复并取得更好的成果，并与一组类似的使用者进行比较。
这是一项具有三个组成部分的试点描述性研究。纵向设计包括对33名有精神疾病残疾的社会企业成员在两个时间点的功能描述（他们加入社会企业时——平均在研究招募前5年，以及在研究招募时——2018年）；并在三个时间点重复收集这33名成员的工作细节：招募前2年——2016年；招募前1年——2017年；以及招募时——2018年。在2018年招募时，对社会企业使用者对工作安置、症状、功能和生活质量（QoL）的满意度进行评估。一项横断面研究将2018年招募时的33名社会企业成员与一组符合以下标准的匹配人群进行比较：居住在当地支持性住所、失业且不是社会企业成员。比较两组在精神病理学、功能和生活质量方面的评分。进行了描述性分析。
在2018年招募时，所有社会企业参与者的功能表现均显著优于他们加入社会企业时（平均就业5年）（p < 0.001）。与匹配组相比，社会企业成员在功能（p = 0.001）、精神病理学（p = 0.007）和生活质量（p = 0.034）方面表现明显更好。根据他们的社会企业成员身份，参与者包括学员（21.2%）和员工成员（78.8%）。与员工相比，学员的自主性、功能、生活质量较低，精神病理学更严重。在研究招募前的两年里，学员的自主性一直较差，而员工成员的自主性从2016年招募前两年的平均水平，变化到2018年招募时的良好水平。在这两年中，所有社会企业成员在所有三个领域设定的目标数量都在增加。所有社会企业参与者对工作安置的各个方面都表示高度满意。
提供量身定制的支持以帮助人们获得就业技能的社会企业可能是帮助严重精神疾病康复的有效组成部分。
