Content uploaded by Mogammad Shaheed Soeker
Author content
All content in this area was uploaded by Mogammad Shaheed Soeker on May 12, 2019
Content may be subject to copyright.
AUTHOR COPY
Work 62 (2019) 221–231
DOI:10.3233/WOR-192857
IOS Press
221
The experiences and perceptions
of individuals diagnosed with
schizophrenia regarding the challenges
they experience to employment and coping
strategies used in the open labor market
in Cape Town, South Africa
Mogammad Shaheed Soeker∗, Tamarin Truter, Nicole Van Wilgen, Polly Khumalo,
Heather Smith and Simone Bezuidenhout
University of the Western Cape South Africa, Cape Town, South Africa
Received 15 December 2017
Accepted 23 June 2018
Abstract.
BACKGROUND: There is limited research available regarding the coping skills of individuals living with schizophrenia
and the strategies used in the open labor market, particularly from a South African context.
OBJECTIVE: The aim of the study was to explore and describe the barriers, facilitators and coping strategies that individuals
with schizophrenia use when returning to the open labor market after participating in a vocational rehabilitation program to
improve work skills.
PARTICIPANTS: Four individuals diagnosed with schizophrenia and two key informants (occupational therapists) partici-
pated in the study.
METHODS: The research study was positioned within the interpretive paradigm, specifically utilizing an exploratory and
descriptive design. Semi-structured interviews were used in order to gather data from the participants.
RESULTS: Theme one reflects the barriers related to returning to work (i.e. society’s acceptance of an individual’s work
potential). The second theme relates to the enabling factors related to returning to work (i.e. the usefulness of work prepa-
ration programs to enhance open labor market employability). Theme three relates to the coping skills that individuals with
schizophrenia utilize (i.e. holistic support enhances participation in the worker role).
CONCLUSION: In conclusion, the findings indicate individuals with schizophrenia experience barriers that prevent them
from being able to adapt to their work environments. However, with the support of the occupational therapist, family, and
employer, together with improvements to the vocational rehabilitation program, these barriers may be alleviated, and there
could be an improvement in the reintegration of individuals with schizophrenia into the open labor market. The findings
suggest that the disclosure of an individual’s medical diagnosis, in order to facilitate the return to work of an individual
diagnosed with schizophrenia, could be viewed as a barrier and a facilitator.
Keywords: Open labor market, schizophrenia, coping skills and strategies, rehabilitation
∗Address for correspondence: Mogammad Shaheed Soeker,
University of the Western Cape South Africa, Cape Town, South
Africa. E-mail: msoeker@uwc.ac.za.
1051-9815/19/$35.00 © 2019 – IOS Press and the authors. All rights reserved
AUTHOR COPY
222 M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work
1. Introduction
The research study aims to identify the effec-
tiveness of vocational rehabilitation on work
opportunities with regard to individuals diagnosed
with schizophrenia, and identifying their reintegra-
tion success into the open labor market. The global
average unemployment rate of individuals with a
mental illness, according to the World Health Orga-
nization [1], is approximately 90%, in contrast to
that of individuals with sensorial or physical disabil-
ities, which is approximately 50%. Again, expressed
differently, only 10% of persons with a serious
psychiatric background are employed globally. Due
to these high levels of unemployment, individuals
with psychiatric illnesses can experience economic
poverty and are deprived of social networking within
their communities. According to Bevan et al. [2],
a substantial proportion of working age individuals
with a history of schizophrenia are able and eager to
work. However, this group of individuals has one of
the highest unemployment rates, despite repeatedly
expressing the need for vocational training, place-
ment, and dependable support services. According
to Taskila, Steadman, Gulliford, Thomas, Elston, &
Bevan [3] there is a strong need for research to look
at factors that advance relationship-building among
colleagues. There is also a need to view research,
particularly from the lived experiences of individu-
als with schizophrenia, about the manner in which
they adapt to the worker role [4]. Currently there is
a void in the literature that focuses on the adaptation
and coping strategies used by individuals living with
schizophrenia, particularly when being employed in
the open labor market. It is therefore essential to
gain an understanding of the strategies individuals
with schizophrenia use to adapt to work in the open
labor market. This information would be beneficial
in developing vocational rehabilitation programs that
aim to enhance the transition of individuals living
with schizophrenia to employment in the open labor
market.
2. Literature review
2.1. Incidence of schizophrenia and stigma
Schizophrenia is the ninth leading cause of dis-
ability worldwide. It is viewed as one of the most
severe mental disorders. The average onset age of
schizophrenia in South Africa is between 25 and 35
years of age for males and females [5]. Having a
family history of mental disorders in close or distant
relatives increases the risk of developing schizophre-
nia. It has been highlighted that 10% to 13%
of individuals diagnosed with schizophrenia com-
mit suicide. According to Dickerson, Sommerville,
Origoni, Ringel, & Parente [6], many individuals with
schizophrenia experience discrimination because of
their mental illness. A large number of individuals
with schizophrenia are of the opinion that people view
them in a critical manner because of their diagnosis
and many schizophrenics avoid sharing this infor-
mation with other people. People with schizophrenia
have stated that they have heard offensive statements
and remarks made about psychiatric disorders [6].
It could therefore be argued that a lack of pub-
lic awareness about schizophrenia could negatively
affect the ability of a person living with the diagnosis
of schizophrenia to find employment.
2.2. The importance of work as a meaningful
occupation for individuals with mental
illness
According to the World Health Organization [7],
the link between work and one’s mental health is sig-
nificantly evident. Health professionals highlight that
a working environment improves one’s mental health
in relation to personal identity, self-esteem, and social
participation, and, for most individuals, relates to a
desire or goal to obtain some form of employment or
return to the industry in which they had previously
worked. Lovvik et al. [8], highlights the relationship
between employment and an increased anxiety due
to the possible experience of not being proficient
enough, not being able to cope with stressors, and
not being able to reach role expectations within the
work setting. Khalema & Shankar [9], agree and state
that these stressors are triggers and decrease mental
health. Although the World Health Organization [7],
identifies the aspect of job stress to have a signifi-
cant impact on one’s health and wellbeing, they too
identify that employment also improves one’s mental
health. The World Health Organization [7], continues
to highlight the importance of further exploring the
effects of unemployment on mental health. This rela-
tionship was not explored in detail, although a link
between unemployment and degeneration in mental
health was highlighted.
AUTHOR COPY
M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work 223
2.3. Barriers that prevent returning to work by
individuals with brain injury
According to Zaprutko et al. [10], individuals
living with a diagnosis of schizophrenia are often
afraid to seek employment. This anxiety brings about
a higher prevalence of individuals who are able to
work but are currently unemployed. In addition, this
fear often negatively affects motivation and drive
to engage in work occupations. According to the
World Health Organization [7], three factors are
highlighted to help individuals return to work. The
first is to return to work within a short time frame
of being out of work or injured. The second is to
be aware of and acknowledge the job requirements
before making a decision on returning to a work
environment. The third factor looks at providing an
opportunity to start part-time work initially before
going into full-time work, allowing flexibility and
less job stress. Collin [11], further argues that factors
contributing to returning to work include one’s
behavior in wanting to develop oneself willingly,
as well as finding meaning within the work one is
doing. Developing coping skills to compensate for
the difficulties experienced helps clients in returning
to work if they have a supportive environment [12].
Communication between the person returning to
work and the supervisor from the vocational rehabil-
itation program is an influencing factor on the effec-
tiveness of the program in enabling an individual’s
ability to return to work [9]. Personalized interven-
tion that occurs immediately after the diagnosis of a
condition facilitates a high rate of return to work for
individuals with schizophrenia. The latter study also
highlighted that the outcome of one’s ability to return
to work is highly influenced by experienced symp-
toms. Brichford [13] indicated that, with the utilsation
of interviews, he was able to gain insight into how
individuals living with a diagnosis of schizophrenia
adapt to the workplace, and found that the positive
symptoms of schizophrenia, which include halluci-
nations and delusions, can be addressed and resolved
through the use of medication; while the negative
symptoms of schizophrenia, such as concentration
and motivation, remain affected. Due to the fact that
the negative symptoms are not addressed through
medication, the individual’s ability to adapt to the
workplace is still affected. In some cases individ-
uals have had to change their work environment.
According to Taskilaa et al. [3] other barriers that pre-
vent individuals from maintaining their worker roles
include disability benefits that demotivate the indi-
vidual with regard to seeking employment, high costs
related to vocational intervention, and a lack of coor-
dination of services between health professionals.
The proposed research study explores the coping
skills and strategies that individuals with schizophre-
nia use when returning to work in the open labor
market after receiving vocational rehabilitation.
3. Aim
The aim of the study was to explore the barriers,
facilitators, and coping skills that individuals with
schizophrenia use when returning to work in the open
labor market after participating in a vocational reha-
bilitation program.
4. Research design
Qualitative researchers study topics in natural
settings, interpreting phenomena in terms of the sig-
nificance people bring to them [14]. The current
study was positioned in the interpretive paradigm
specifically using an exploratory research design.
Explorative research can be identified as the explo-
ration of new phenomena in order to develop an
understanding of people or events. In the current
study an exploratory design enabled the researcher to
obtain detailed information about the coping strate-
gies used by people diagnosed with schizophrenia.
5. Population and sampling
Three participants were purposively sampled from
the statistical records of the Occupational Therapy
departments of psychiatric hospitals in the Western
Cape, South Africa. Purposive sampling was used
because the researcher wanted to explore the specific
experiences of individuals living with the diagnosis
of schizophrenia and who successfully transitioned
to open labor market employment after rehabilita-
tion. This sampling strategy is important because the
majority of individuals living with schizophrenia in
the South African context are dependent on a gov-
ernment disability grant. The participants took part
in a vocational rehabilitation program of 6 weeks in
duration that was focused on improving work skills.
The inclusion and exclusion criteria are set out in
(Appendix A).
AUTHOR COPY
224 M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work
5.1. Data collection
The researchers were occupational therapists who
conducted three semi-structured interviews with each
of the four participants, including the key informants
(See Appendix B). The researchers had no prior
contact with the participants. The names of the par-
ticipants were obtained from the statistical records of
one psychiatric hospital that has a work integration
program. The clinicians at the hospital contacted the
participants and informed them about the study, and
then the participants were given the opportunity to
contact the researchers themselves. When the partic-
ipants contacted the researchers, the requirements of
the study were described in more detail. The study
participants received no financial compensation for
participating in the study. The researchers used a
semi-structured interview guide to ask the partici-
pants questions relevant to the study (See Appendix
C). The data gathering took place at the key informant
participant’s place of work and at a psychiatric hos-
pital where treatment/intervention was received. The
researchers prepared the interviewee for the interview
by building a relationship and explaining the study
beforehand to help the participant feel more relaxed
and comfortable. Interviews were conducted with the
four research participants and key informants until
data saturation was achieved.
6. Data analysis and trustworthiness
The researchers used the data analysis method
described by Tesch [15]. Data analysis has eight core
steps in order for it to be analised effectively. First, the
researcher carefully reads through the transcripts and
writes thoughts in the margins. Second, it is noted
that there are stand out-points referred to as codes.
When that task is completed for all the documents,
the researchers make a list of topics, also known as
sub-categories. Step three, these topics are grouped
into columns identified by their themes. Step four is to
abbreviate the topics as categories and then the cate-
gories are written next to the appropriate segments of
the text. For steps five through eight, the researchers
decide on the most descriptive wording to become the
categories’ names for the topics. Grouping the topics
decreases the list and amount of sub-categories. The
last step of data analysis is to recode existing data.
Strategies such as credibility, transferability,
dependability and confirmability are used in order to
ensure the trustworthiness of the data [16]. Credibility
is ensured by the dense description of the lived expe-
rience of the research participants. Credibility is also
enhanced by triangulation. Triangulation is ensured
by the use of more than one source of collecting data;
for example within this study, participants living with
a diagnosis of schizophrenia and the key informants.
Transferability is ensured by the detailed description
of the research methods, contexts, and the lived expe-
rience of the participants. Dependability is ensured by
means of dense descriptions, peer examination, and
triangulation. The study is documented in such a man-
ner that the readers are able to follow an audit trail.
Confirmability is ensured by the process of reflexivity
whereby the researcher’s own biases or assumptions
are made apparent by means of a reflexive journal.
The study was approved by the Institutional
Review Board of the [name of the university], the
ethics number being BM/16/3/2
7. Findings
7.1. Theme One: Society’s acceptance of one’s
work potential
The theme of “Society’s acceptance of one’s work
potential” was of great significance to the participants
because they perceived society to lack an understand-
ing about their condition. This theme will be further
described in the following categories.
7.1.1. Category: The ideal working environment
The category of “Ideal working environment”
came about when the participants and the key infor-
mants described the ideal working environment for a
person diagnosed with schizophrenia. A key infor-
mant described the ideal work environment for
individuals diagnosed with schizophrenia:
“The type of work we doing here is, is is of-, is very
often not conducive for people with schizophre-
nia. Number one because ... it’s, it’s only factory
work, so it’s very repetitive and, and we’ve got
a large population of people with schizophrenia
who do come from the, the higher functions... .
Our setup is too big and too noisy, and too...
distracting”(B1)
AUTHOR COPY
M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work 225
7.1.2. Type of work influencing work experience
This subcategory emerged when the participants
expressed how each experienced different types of
work, and furthermore, how these different types of
work affected each of them.
“It’s nice to be there on the job ... I, I, I’ma
little bit ... .I’m not sick now, so I can work. But
the work is ... a little bit difficult because we lift
heavy stuff there”(A1)
7.1.3. Understanding the effects of job
satisfaction
Participants indicated clearly that, when in a
specific job they might or might not desire, job sat-
isfaction can make a large difference to the working
environment. A participant said:
“I cannot say no I am happy just because I work
hard everyday ... but there is no reward at the
end of the day”(A2)
7.1.4. Category: Fear of losing one’s work
The category of “fear of losing one’s work” is
emphasized due to the expression of concern from
both the participants and the key informants about
how society views people with mental illnesses, espe-
cially people diagnosed with schizophrenia.
“I didn’t tell the bosses that I am sick ... I don’t
know what they’re going to think if I tell them.
Maybe I’ll lose the job, they’ll think if I tell them.
Maybe I’ll lose the job, they’ll think that no, I
cannot afford to work there, in their job. So I’m
scared to tell them”(A1)
7.1.5. The influence of Stigma
Fear was clearly expressed by the participants in
regard to stigmatization. While not all participants
experienced it directly, there was a definite fear of
experiencing stigmatization and prejudice.
“Because if you coming out from (name of hospi-
tal), all people they think that you are mad... .
You sick, they think you’re sick if you coming
here from (name of the hospital), you can’t do
anything”(A1)
7.1.6. Ambivalence of the disclosure of mental
health status
The participants had various feelings with regard
to disclosure, some positive and others negative. The
positive thoughts were emphasized when disclosure
of the condition enabled the participants to not fear
society and to increase co-workers understanding of
the medical condition in the workplace.
“My co-workers, they know my history, they know
where I’m from, but that doesn’t affect our rela-
tionship, our working relationship.”(A3)
7.2. Theme Two: The usefulness of work
preparation programs to enhance open
labor market employability
The prior theme expressed the important role that
a well-structured work preparation program has in
enabling individuals diagnosed with schizophrenia to
work in the open labor market. This theme will be
further described in the following categories.
7.2.1. Category: Return to work
The key informants identified aspects of the work
preparation programs that assist the participants in
returning to work in the open labor market.
“We equip you with the skills to find work, and
to perform better at work, right, to look for work
(B2)
7.2.2. Transferring of work skills in vocational
rehabilitation
Specific skills such as anger management and how
to prevent relapse were emphasized by the key infor-
mants. The participants identified the program as
being beneficial when returning to work.
“Conflict management, anger management,
stress management, right, relationships,
because relationships and communication is
around ... not just the work environment but the
home environment”(B2)
AUTHOR COPY
226 M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work
7.2.3. Category: Vocational rehabilitation
program is essential in preparation for
re-entry into the open labor market
The participants highlighted that rehabilitation
emphasized the vocational rehabilitation aspect to
prepare for returning to work and providing the skills
to function independently.
“Voc. rehab, rehabilitation, has helped me in a
great, great sense, you know, to be in a work area”
(A3)
7.2.4. Type of therapies within vocational
rehabilitation
This subcategory emerged when key informants
emphasized the specific types of therapy used within
vocational rehabilitation to aid clients in the develop-
ment of skills for re-entering the open labor market.
“By putting him in a situation, discussing
it ... what would you do if this happens, and then
after putting him in the role play situation where
he has to practice ... how he’s going to handle
the situation”(B1)
7.3. Theme Three: Holistic support enhances
participation in the worker role
This theme presents the participants’ views of
stakeholder support when transitioning into the open
labor market. The theme will be further described in
the following categories.
7.3.1. Category: Therapeutic support enhances
personal & work skills development
In this category, the key informants expressed the
importance of providing support to the individual liv-
ing with a diagnosis of schizophrenia by means of
multi- disciplinary intervention in the community.
“Making contact especially with the OT’sinthe
community ... . understanding what services are
available, right and if services aren’t available in
terms of OT services, looking what the other MDT
services that you can offer to the client”(B2)
7.3.2. The effect of medication on an
individual’s ability to function
This subcategory explores the usefulness of medi-
cation on the participants’ functioning capabilities.
The participants shared the importance of taking
medication to enhance functioning on a daily level.
“There’s tablets which, tablets which I... helps
me to just lower the stress. I’m taking those
tablets”(A1)
“Ya the medication does help”(A2)
7.3.3. True insight as an enabler for functioning
This subcategory explores both participants’ and
the key informants’ views regarding the acceptance
of the diagnosis, understanding what it means to
have the diagnosis, and implications from having
schizophrenia.
“You think maybe you doing the right thing, you
feel like you are on your mind, you see there is
nothing wrong with what you are doing, people
can see, maybe a friend or your family can see it”
(A2)
7.3.4. Category: Stakeholder support and the
influence it has on coping
This category explores both the key informants’
and the participants’ views of the support currently
received or required. This support may come from the
participant’s family, employer, or vocational rehabil-
itation program.
“What are the support systems that are in
place ... you know, how can they access support,
you know so, so again it’s about what are the skills
that the patients ... need, what are the things that
they struggle with right, what will make it easier
for them in the workplace”(B2)
7.3.5. Required support from stakeholders and
the effects on the participants’ lives
This subcategory of required support is described
by the participants’ point of view of the support that
is not received. They described feeling that support
is needed from individuals in the workplace in order
to cope in the open labor market. This support is not
readily available. One participant said:
AUTHOR COPY
M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work 227
“I think in a situation like this it will need some
like, who, who like some that has got experi-
ence like this, such stuff, someone professional,
someone who can be able to ... listen to your
complaints, someone who can listen to your prob-
lems”(A2)
8. Discussion
8.1. Barriers to return to work
The participants’ work environment could be
either an enabler or a barrier in facilitating or
hindering the successful return to work of indi-
viduals living with the diagnosis of schizophrenia.
The category of “The ideal working environment”
in the current study reveals the participants indi-
cate a non-supportive work environment could be
a barrier that does not facilitate returning to the
worker role or maintaining employment in the open
labor market. Satisfaction with the worker role is
dependent on feelings about work and the work-
ing environment. Steadman [17] and Soeker [18],
state that a supportive working environment can
enable people to remain in work because they
feel they are accepted and they can ask for help
and support when needed. Similarly, supportive
employment is seen as a strategy for individuals
with physical conditions or mental health condi-
tions to return to work and to maintain employment
[4, 18].
According to Ross et al. [19], a hostile work envi-
ronment can be considered a barrier and ultimately
can prevent an individual from effectively returning
to work. Taskilaa et al. [3] reinforce the conclusion
that a lack of confidence of the treating health pro-
fessional or the employer of the individual diagnosed
with schizophrenia will negatively affect the motiva-
tion to return to work.
Redmond [20], states that an individual’s work
experience is evaluated by the amount of satisfac-
tion or dissatisfaction with regard to the type of work
and the physical work environment. “Fear of losing
one’s work” stems from the misunderstanding and
the judgment of society to mental illness. The par-
ticipants indicated that they become defined by their
mental illness and they are seen as lesser humans
rather than who they are. The participants are emo-
tionally and psychologically affected but they are of
the opinion that they never lost confidence in their
own abilities. Read, Haslam, Sayce, & Davies, [21],
state that negative judgments and attitudes towards
those who have a mental illness are very well docu-
mented.
8.2. Facilitators to return to work
Theme two, “The usefulness of work prepa-
ration programs to enhance open labor market
employability,” describes some of the facilitators
that enabled the participants to return to work.
D´
esiron, De Rijk, Van Hoof, & Donceel, [18],
identify vocational rehabilitation as a treatment
modality that reflects a range of return to work out-
comes including voluntary employment, sheltered
employment, and open labor employment. The key
informants identified work preparation and skills
development as key factors for successful reinte-
gration into the open labor market. D´
esiron et al.
[22] reinforce the finding of the current study and
highlight that during vocational rehabilitation, the
rehabilitation therapist works with the individual on
a client-centered basis to develop, improve, and/or
restore skills in order to engage and participate in
work occupations. The category of “Return to work”
identifies the importance of client-centered practice,
making sure the individual is an active participant in
the vocational rehabilitation process. Stergiou-Kita
[23], states client preferences are important factors in
the decision-making process. The occupational ther-
apist should engage directly with the client and take
into consideration the client’s desired outcome. The
participants indicated that support and reassurance
from family and the employer are beneficial for return
to work.
8.3. Coping skills used by the participants in the
open labor market
The theme of “Holistic support enhances par-
ticipation in the worker role” describes some of
the coping strategies identified by the participants.
Therapeutic support in the form of use of medication
is regarded as important to the participants. One of
the participants went as far as stating that he does
not experience any lingering symptoms when taking
his medication. This is interesting because, accord-
ing to Bevan et al. [2], the negative symptoms may
continue to linger after the positive symptoms have
subsided. The effectiveness of antipsychotic drugs
has been proven for people with psychopathological
symptoms by reducing rates of re-hospitalization and
relapse. Non-adherence to a medication routine is a
AUTHOR COPY
228 M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work
common cause of impairment, risk of suicide, longer
time of remission, relapse, loss of work, violence,
arrest, dangerous behavior, alcohol and substance
use, poorer prognosis, and low satisfaction with life
[24]. A study conducted in Japan by Shimada, Nishi,
Yoshida, Tanaka & Kombayashi [25] indicates indi-
vidualised occupational therapy with adherence to
outpatient treatment and medication were associated
with reducing the rehospitalisation of patients with
diagnosis of schizophrenia.
Some of the participants in our study indicated
that to disclose status about their diagnosis could
either enable adapting in the workplace or could
be a barrier to return to work. According to a sys-
tematic review conducted by Brohan et al. [26],
the disclosure of a mental illness places job appli-
cants at a disadvantage in securing employment when
compared to applicants with a physical disability
or no disability. Therefore, individuals with mental
health conditions need to be careful when disclos-
ing their status to employers. However, individuals
with disability (including mental health illnesses)
are protected by policies such as the South African
Employment Equity Act [27] and advocacy against
the discrimination of people with disability (PWD),
particularly regarding employment practices.
9. Limitations of the study
One major limitation is the fact that only male
participants took part in this study. Another major
limitation is due to the stigma related to schizophre-
nia, particularly amongst people living with the
diagnosis of schizophrenia who are employed, it was
very difficult to recruit a larger number of participants
for the current study.
10. Conclusion
Both the participants and the key informants
emphasized the stigma experienced by the partici-
pants. Disclosing mental health status is one of the
major barriers and increases the anxiety of the partic-
ipants when returning to work. The study findings
suggest that the participants are ambivalent about
disclosure of their medical diagnosis in order to
facilitate return to work as an individual diagnosed
with schizophrenia. Disclosure is seen as a bar-
rier and/or as a facilitator. Some of the participants
indicated that a stronger support system in the work-
place could be established by disclosing the mental
state of the individual. The current study identified
some of the barriers preventing individuals living
with a diagnosis of schizophrenia from adapting to
the work environment; however, we also identified
some of the facilitating factors including the sup-
port of the occupational therapist, the family, and
the employer, as well as the provision of good qual-
ity vocational rehabilitation programs. These factors
may improve reintegration of individuals diagnosed
with schizophrenia into jobs in the open labor market.
Conflict of interest
None to report.
References
[1] WorldHealth Organization. Addressing non-communicable
diseases and mental health: Major challenges to sustainable
development in the 21st century. 2009; Retrieved from
http://www.who.int/nmh/publications/discussion paper en.
pdf [Accessed on 16 October 2016]
[2] Bevan S, Gulliford J, Steadman K, Taskila T, Thomas R,
Moise A. Workingwith schizophrenia: Pathways to employ-
ment, recovery & inclusion (1st ed.). Lancaster: The Work
Foundation (2013) Retrievedfrom http://www.thework
foundation.com/downloadpublication/report/330 working
with schizophrenia.pdf [Accessed on 16 October 2016]
[3] Taskila T, Steadman K, Gulliford J, Thomas R, Elston R,
Bevan S. Working with schizophrenia: Experts’ views on
barriers and pathways to employment and job retention.
Journal of Vocational Rehabilitation. 2014;41:29-44.
[4] Pa´
nczak A, Pietkiewicz I. Work activity in the process of
recovery–an interpretive phenomenological analysis of the
experiences of people with a schizophrenia spectrum diag-
nosis. Psychiatr Pol. 2016;50(4):805-26.
[5] Mosotho L, Louw D, Calitz F. Schizophrenia among
Sesotho speakers in South Africa. African Journal of Psy-
chiatry. 2001;14:50-55.
[6] Dickerson F, Sommerville J, Origoni A, Ringel N,
Parente F. Experiences of Stigma among Outpatients
With Schizophrenia. Schizophrenia Bulletin. 2002;28(1):
143-55.
[7] World Health Organization. Mental health and work:
Impact, issues and good practices. Mental Health policy
and Service Development, 2000; 1-61. Retrieved from
http://www.who.int/nmh/publications/discussion paper en.
pdf [Accessed on 16 October 2016].
[8] Lovvik C, Overland S, Hysing M. Association between ill-
ness perceptions and return-to-work expectations in workers
with common mental health symptoms. Journal of Occupa-
tional Rehabilitation. 2014;24:160-70.
[9] Khalema N, Shankar J. Perspectives on employment inte-
gration, mental illness and disability, and workplace health.
Advances in Public Health. 2014;1(1):1-7.
AUTHOR COPY
M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work 229
[10] Zaprutko T, Kus K, Bilobryvka R, Rakhman L, Goder R,
Michalak M, Poglodzinski A, Nowakowska E. Schizophre-
nia and employment: Evaluation from professional point of
view. Psychiatry. 2015;86:569-79.
[11] Collin K. Work-related identity in individual and social
learning at work. Journal of Workplace Learning. 2009;
21(1):23-35.
[12] Tan B. Profile of cognitive problems in schizophrenia and
implications for vocational functioning. Australian Occu-
pational Therapy Journal. 2009;56:220-8.
[13] Brichford C. Schizophrenia and the Workplace. (2012)
Retrieved from http://www.everydayhealth.com/schizophr
enia/working-with-schizophrenia.aspx
[14] Denzin N. The sage handbook of qualitative research, (3rd
edition)United states of America: Sage publications; 2005.
[15] Tesch R. Qualitative research: Analysis types and software
tools (pp. 9-19). Great Britain, Bedford: LSL Press Ltd;
1990.
[16] Krefting L. Rigour in qualitative research. The assessment
of trustworthiness. American Journal of Occupational ther-
apy. 1991;45(3):214-22.
[17] Steadman (2015) Working with Schizophrenia: Employ-
ment, recovery and inclusion in Germany (Doctoral
dissertation). Retrieved from http://www.theworkfounda
tion.com/DownloadPublication/Report/384 Schizophrenia
Germany.pdf [Accessed on 16 October 2015]
[18] Soeker MS. A pilot study on the operationalization of the
Model of Occupational Self Efficacy: A model for the rein-
tegration of persons with brain injuries to their worker roles.
Work. 2016;53:523-34.
[19] Ross LA, Saint-Amour D, Leavitt VM, Molholm S,
Javitt DC, Foxe JJ. Impaired multisensory processing
in schizophrenia: Deficits in the visual enhancement of
speech comprehension under noisy environmental condi-
tions. Schizophrenia Research. 2007;97(1-3):173-83.
[20] Redmond BF. Job Design History and Overview. In:
Dumnich, J.L. (ed.) Work Attitudes and Job Motivation.
(2015) [Online] Available from: https://wikispaces.psu.
edu/display/PSYCH484/10.+Job+Design [Accessed on 16
October 2016].
[21] Read J, Haslam N, Sayce L, Davies E. Prejudice and
schizophrenia: A review of the mental illness is an ill-
ness like any other approach. Prejudice and Schizophrenia.
2006;114:303-18.
[22] D´
esiron H, De Rijk A, Van Hoof E, Donceel P. Occupational
therapy and return to work: A systematic literature review.
BMC Public Health. 2011;11(1).
[23] Stergiou-Kita M. Implementing Clinical Practice Guide-
lines in occupational therapy practice: Recommendations
from the research evidence. Australian Occupational Ther-
apy Journal. 2010;57(2):76-87.
[24] Acosta F, Hernandez J, Pereira J, Herrera J, Rodriguez C.
Medication adherence in schizophrenia. World Journal of
Psychiatry. 2012;2(5):74-82.
[25] Shimadaa T, Nishia A, Yoshidaa T, Tanakac S, Kobayash
M. Factors Influencing Rehospitalisation of Patients with
Schizophrenia in Japan: A 1-year Longitudinal Study. Hong
Kong Journal. 2016;28:7-14.
[26] Brohan E, Henderson C, Wheat K, Malcolm E, Clement
S, Barley EA, Thornicroft G. Systematic review of beliefs,
behaviors and influencing factors associated with disclo-
sure of a mental health problem in the workplace. BMC
Psychiatry. 2012;12(1):11.
[27] Employment Equity Act, No. 55 of 1998. [Online] Avail-
able: http://www.labour.gov.za
AUTHOR COPY
230 M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work
Appendix A
Table One Demographics of the participants
Participants Gender Education Age Work experience Diagnosis Rehabilitation
A1 Male Grade 11 35 Fast Food Schizophrenia OT (vocational rehabilitation)
A2 Male Grade 09 30 No work experience Schizophrenia OT (Vocational rehabilitation)
A3 Male Grade 10 40 Assistant Plumber Schizophrenia OT (Vocational rehabilitation)
A4 Male Grade 10 35 General Assistant Schizophrenia OT (Vocational rehabilitation)
Key informants
B1 Female BSc (OT) 38 Senior OT: 5 years of working
in vocational rehabilitation
B2 Female B Sc (OT) 55 Senior OT: 10 years of
working in vocational
rehabilitation
Appendix B
Inclusion and Exclusion criteria
Participants
Below are the inclusion criteria used for this study:
•Individuals between the ages of 18 and 55 years
old
•Individuals with schizophrenia whose condition
is stable
•Individuals who have returned to work in the
open labour market for at least 1 month after
completing vocational rehabilitation.
•Individuals who can communicate in English or
Afrikaans
•Male and female participants
Below are the exclusion criterion used for this
study:
•Individuals who are actively experiencing symp-
toms i.e. psychosis related to schizophrenia
Key informants
Below are the inclusion criteria pertaining to the
Occupational Therapists used for this study:
– The individual must be a qualified Occupational
Therapist, and have practised for at least two
years.
Appendix C
Interview guide (semi-structured) - Participants
Interview questions:
1. Could you describe to me how you cope in
your work environment?
Probe: Describe what you do when you are in a
stressful situation?
Describe how your rehabilitation has helped you
to cope within your work place?
2. What factors within your working environ-
ment make it difficult for you to cope?
Probe: What are the obstacles that make your job
unpleasant?
3. Can you describe the support that you have
when you feel that you are struggling to cope
within your work environment?
Probe: How do you make use of these supports?
What type of support assists you within your work-
place and at home?
Do you feel you receive the support you need to
cope within your workplace and at home?
4. Now that you have completed rehabilitation
and returned to work, can you describe how your
Identity as a worker has been affected?
AUTHOR COPY
M.S. Soeker et al. / The experiences of individuals with Schizophrenia about returning to work 231
Probe: Please describe how it has been affected?
Please describe your confidence in terms of over-
coming the challenges in your job?
Please describe your view of seeking another job
in the corporate sector?
5. Can you think of any ways that the rehabil-
itation program in which you participated could
be improved so that others attending it would be
able to adapt better to working in the corporate
sector?
Probe: Can you describe how the rehabilitation you
received helped you to cope better within your work
environment?
Key Informant Interview guide (semi-structured)
This interview is directed to the key informant (OT
at the clinic) in order to determine what rehabilitation
is done and how the OT feels about working with
schizophrenic clients whose aim is to return to work.
Interview questions:
1. Could you describe to me how you facilitate a
session for clients with schizophrenia who intend
to work?
Probe: Describe how you determine what needs
to be focussed on for your clients in order to RTW?
Describe how your rehabilitation differs from client
to client?
2. Does your rehabilitation program/session
simulate the individual’s work environment?
Probe: do your session (s) work from the client’s
point of view?
3. What are the different coping skills or
strategies that are incorporated within the reha-
bilitation program?
Probe: How does it help the client to adapt to the
work environment?
4. How does working with the negative symp-
toms of schizophrenia differ from that of another
diagnosis and would you say it has an influence on
their work performance?
Probe: can you explain why if schizophrenia
affects an individual’s work performance?
Would it be a recommendation for an individual
suffering from schizophrenia to return to the same
field of employment or job?
5. Can you think of any ways that the rehabili-
tation program that you run could be improved
or expanded so that more individuals with
schizophrenia will seek help?
Probe: Outpatient programs, rehabilitation within
the workplace?
