Employment Participation through the Lens of People with Lived Experience of Mental Illness A Photovoice Study

Background.

  • Employment is a major life domain valued by society. It brings not only financial stability but also health benefits, including social connectedness, daily structure and routine, a sense of worth, higher self-esteem, and better mental well-being.
  • Most people with mental health challenges want to engage in meaningful work. However, they are at least three times more likely to be unemployed than people without the challenges.
  • In the US, approximately 80% of people receiving mental health services were unemployed. Texas is one of the states with the highest unemployment rates for people with mental illness.
  • Photovoice is a community-based participatory research (CBPR) method that involves giving study participants cameras to take photos about issues in the community. The participants of this photovoice study completed 3 rounds of photo assignments and photo discussion meetings, each round they shared further in-depth issues and experiences related to employment participation.

This webpage is developed to tell stories about employment participation based on the above mentioned photovoice study, representing the perspective of people with mental health diagnoses.

We hope to bring about increased awareness and better understanding about high unemployment rates among people with mental health challenges- one of the first steps to address this dire issue in our community.

Outline

  • Key Theme #1- Impact of mental health issues on employment
  • Key Theme #2- Practices that support employment while living with mental health challenges
  • Key Theme #3- Envisioning a better workplace
  • Get Involved

Key Theme #1

Impact of Mental Health Challenges on Employment

Anxiety: This (the clock) is anxiety going on. It just keeps going round and round. You’re rapid through thoughts and you can't stop it.
Depression: I do excessive sleeping as a form of avoidance. When I’m depressed, I curl up in my bed. My bed is my safe place.
Insomnia: That was at 3:25 in the morning. I have really bad insomnia… you know, not everyone is just lazy. Some people are exhausted because they can't go to sleep.
Communication/ information processing difficulty. Left: That's my puppy. I took a picture of her ears to represent my communication deficits. When I'm at work and hear people talking, I'm very literal. I think of the dictionary definition of what they're saying, and apparently that's not how the majority of humans communicate. Right: The masks represent the scary side (of employment) because people don’t often represent themselves honestly and accurately. They're telling you all the good stuff and you don't see all the dirty stuff that's underneath.... People will say something either when you're job hunting or on a job and I'm like, I don't know if they really mean what they just said. I sometimes feel like I'm speaking a completely different language. And so that's another hurdle.
Incarceration in the past: That is a birdcage, just reflecting I did my time in the federal prison… the background check came back and I'm told that I either have to separate or they have to move me to another… So definitely a barrier to me.
Lack of financial safety net and low pay. Left: This was supposed to be a picture of a financial institution and it indicates the lack of money. Most of us are driven to work because we'd like to have more financial security... I work myself into nervous breakdown and yet I still kept working and working because I support myself. There's no one who can help me and… so when I finally realize I can't keep that up [need a break from work to take care of mental illness], I find out there is no safety net... Right: Today we did some door dashing. This is a way to do for income... a way to get over the barrier by having something else as an income until you're able to get that job.
Frequent job change/ difficulty retaining a job: This was a bus stop. I didn't have a car during my darkest time. I would start a job, get through two or three days of training, and my anxiety is so bad that I would leave during lunch and wouldn't come back. I have a lot of memories at bus stops (leaving my new job).
"There is not much out there for me": That's my prison. That actually was my dog’s cage. I just folded it up (and took a picture of it) to represent being stuck, locked in place, and having trouble breaking out of the wrath that I've created for myself. All of that stuff comes up when I start looking for jobs and and there's not much out there... I graduated in 2013, back at the Workforce [the state's vocational rehabilitation program], looking for a job... all the things that public admin can do and I'm still unemployed.
Financial hardship & homelessness. Left: You're walking through this (road construction) and to me, that's life. Like you're just trying to navigate some type of barrier (of employment). It's all of those barriers that stop us from moving forward and make us have to reroute. So that's my life right there. I had to put back grapes (while grocery shopping) last week because I didn't have enough money. I said to my daughter, I'm sorry to have to put the grapes back. She's like, it's OK, mom. Right: This is my view most days and… I have a hard time thinking about… hitting employment. For a long time I didn't have any work. I didn't have anywhere to call home literally because I was homeless. I had no income, except for food stamps. So I donated blood for a long time.

Key Theme #2

Practices That Support Employment While Living with Mental Health Challenges

Hobbies: (top) painting, music, reading, (bottom) beading, collage
Maintaining good health: Eat healthy, sleep & rest, exercise (swimming, resistance band), and get blood work done.
Connecting with family, friends, peers, and pets
Spiritual practices
Stop rushing and be in the moment.
Give self permission to have fun.
Positive self-concept & self-growth. Left: That bridge… is a symbol of me crossing over. You know, I left my old life behind. I don't have to apologize for it. To me, that's also growth and moving forward and that bridge signifies what I keep looking ahead to and that's what keeps me calm because I gotta keep moving forward. So I just have to keep going. Right: That's me. Sometimes we have to look at ourselves in the mirror. And understand who we are and where we are in life. It's not always easy, but you have to know yourself before you can do anything… Well, that's just the foundation. And that's where you begin.
Employment related self-management. Top left: Treat yourself like 24 karat gold (self-care). Top right: This is the time that I have to leave everyday to get to work on time. So I have a clock usually 30 inches big throughout my house for my time management. Bottom left: That was a Zen dog that my sister gave me... (representing) mindfulness and meditation that help me with emotions. I like to do guided meditations. They help me go to sleep most of the time.

Key Theme #3

Envisioning a Better Workplace

(I wish every company has)... a safe place where we can talk about things... It's important to be able to work somewhere where you feel safe enough to where if you lose your composure, you're not gonna lose your livelihood. I feel almost like so threatened by that, that it keeps me from even wanting to move forward sometimes because I know that I can have a panic attack without anybody noticing it. And it scares me, even when I'm medicated... I think we need to be able to be in an environment where we can earn a living and also cry sometimes. I think it would be nice to work somewhere to be able to have a room where you can have a safe space where if you feel overly emotional about something you can just go and be safe. I think that would help a lot of people... I know a TV medical drama that actually did a Zen room that had plants and calming lights and music... that you could go in (when needed)...
That (water fountain) is a hidden gem in our office. Going out there and just listening to the waterfalls, I can let the world just go away. That's like my thoughts and... center myself and meditate and bring myself back to... where I need to be.

Get Involved

  • Please feel free to share this webpage to someone who may be interested in or benefit from the content of this page.
  • Visit the Prosumers website to learn more about lived experience and support their initiatives.
  • A community advisory group is formed and meets regularly to address employment needs for people with mental health issues. The majority of the group is made of people with lived experience. The group continues to recruit members who care about this issue in our community.
  • Complete this online survey to express your opinions about mental illness in the workplace- scan the QR code below or click this link.
Scan this QR code to complete an online survey on mental illness in the workplace.

Acknowledgements

Support for this work was made possible by--

  • A Community Engagement Small Project Grant (CESPG) Award from the Institute for the Integration of Medicine & Science (IIMS) at the University of Texas Health Science Center at San Antonio (UT Health San Antonio).
  • A Community Service Learning (CSL) Grant from the Center for Medical Humanities and Ethics at UT Health San Antonio.

The study protocols met the ethical requirements involving human subjects set forth by the Institutional Review Board (IRB) of the UT Health San Antonio.

Comments & Questions

Please direct your questions or comments to Chinyu Wu, PhD, OTR at wuc7@uthscsa.edu or Prosumers office at 800-577-3795.