S: Views and Experiences of employment among people with psychosis: a qualitative descriptive study

Background: Work is important for mental health but we are only just beginning to understand why so few people with psychosis in the UK work. Aims: To identify the opinions of a purposive sample of patients with psychosis on themes related to employment. Method: A thematic analysis of 15 semi-structured interviews with people with schizophrenia or bipolar affective disorder. Results: Participants identified a range of advantages to working but also expressed substantial doubts. Symptoms, medication and potential damage to health are the problems that people believe affect their ability to work. Most people would not tell their employers about their illness because they feared dis-crimination during the selection process, but believed it could help their chances of retaining a job if employers knew. A number reported a lack of encouragement to work from mental health professionals and not enough helpful employment services. Conclusions: Although most people want to work, given the pressures they face some may choose not to. Barriers that people face are both internal and external and these interact. BACKGROUND Unemployment is known to be harmful to the health of the general population (Bartley, 1994) as well as being an element of the social exclusion that those with severe mental illness (SMI) face. Health and social services in the UK have a responsibility to lessen this exclusion and reduce discrimination and a requirement to consider employment in the care plans of those with SMI (Department of Health, 1999). The economic cost of unemployment among the mentally ill is high, both to the state and the individuals concerned (Boardman, 2003a; Huxley & Thornicroft, 2003). There is a distinction between employment and work. Work is ‘essentially something you do for other people ’ whereas employment ‘is work you get paid for ’ (Boardman, 2003b). Among the long term disabled, people with SMI find it more difficult to get employment than those with physical disabilities and it is only thos