Abstract
BACKGROUND: Despite the importance of inclusive employment, described in Goal 8 of the Sustainable Development Goals (SDGs), employment of persons with psychiatric disabilities in Africa is lower than among the general population.
OBJECTIVE: The aim of this scoping review is to explore evidence related to the barriers to and facilitators of employment of persons with psychiatric disabilities in Africa.
METHODS: A literature search was conducted using six relevant electronic databases of articles published between 1990 and 2017.
RESULTS: Eight studies were identified and analysed regarding barriers and facilitators of employment of persons with psychiatric disabilities. The dynamic adaptation of the bio-psycho-social model was used as an analytical framework. Identified barriers include ill health, (anticipated) psychiatric illness, social stigma and discrimination, negative attitudes among employers and the lack of social support and government welfare. Facilitators of employment include stability of mental illness, heightened self-esteem, a personal decision to work despite stigma, competitive and supported employment, reduction in social barriers/stigma and workplace accommodations.
CONCLUSION: Employment of persons with psychiatric disabilities is essential, yet there is dearth of scientific evidence to identify contextual models that might be useful in African countries and other low-and middle countries (LMICs). This gap in information would benefit from further research to improve the employment rates of persons with psychiatric disabilities in Africa.
| Original language | English |
|---|---|
| Article number | 1463658 |
| Pages (from-to) | 1-18 |
| Number of pages | 18 |
| Journal | Global Health Action |
| Volume | 11 |
| Issue number | 1 |
| Early online date | 15 May 2018 |
| DOIs | |
| Publication status | Published - 15 May 2018 |
Funding
This study also recorded three models or sources of employment for people with psychiatric disabilities, namely self-employment [30], cooperative groups [32] and supported employment [34]. Self-employment through farming was noted as a major form of employment for individuals with psychiatric illness [30]. This is supported by the literature and is particularly useful in LMICs where formal employment is relatively scarce [2]. However, finance may be a limitation to self-employment as shown in this study [30] and the work by Heymann and colleagues [2]. Cooperative income-generation groups were observed to facilitate employment because they allowed individuals to work without fear of discrimination among people who understand them [32]. This assessment is corroborated by the use of sheltered workshops [50] and employment farms [39], which have been found to be useful in vocational rehabilitation for people with mental illness. Supported employment that fosters competitive employment for people with psychiatric disabilities was also identified as a useful employment model in resource-poor settings [34]. Individual placement and support has been demonstrated to be very effective in HICs [12,51], but its applicability in African countries and other LMICs is still limited by finances and lack of government support [2], which has also been noted in HICS [13]. This work was supported by funding received by the first author from the Erasmus Mundus Joint Doctorate (EMJD) Fellowship-TransGlobal Health Consortium 2013-0039. We also acknowledge the support of Ralph de Vries of VU Medical Library in the search of articles included in the study and of Professor David Ndetei for reviewing the initial draft. This work was supported by funding received by the first author from the Erasmus Mundus Joint Doctorate (EMJD) Fellowship-Trans Global Health Consortium 2013-0039.
Keywords
- low- and middle-income countries
- personal decision
- Psychiatric disability
- social stigma
- supported employment
