A qualitative study on advocacy for employment in mental health

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Ramos, Shirley
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Advocacy is an expectation in health delivery services including occupational therapy (OT) services. Advocacy in health care has been related to assisting vulnerable individuals in protecting them from social exclusion and accessing opportunities. Employment is one of the most valued roles among individuals diagnosed with depression (IDDs), yet unemployment rates are high. The disparity between unemployment rates and desire for IDDs to be employed makes it imperative to investigate advocacy in ameliorating the barriers to employment. Furthermore, advocacy practices need to be clearly defined as lack of clarity in advocacy roles and processes contribute to challenges with implementing advocacy. This qualitative study explores the perceptions of the advocate role and the advocacy process among IDDs and OTs regarding employment related goals. IDDs were interviewed individually and OTs participated in a focus group to explore their perceptions of the advocate role and how the advocacy process is carried out. The recovery model and Canadian Model of Occupational Performance Model & Engagement (CMOP-E) were used as practice models to inform the topic choice. Study results indicate significant differences in expectations of the advocate role and how the advocacy process is carried out. However, there were some similarities in perception, such as the relationship established the foundation of the advocacy process, the advocate role addresses both health and employment issues, and advocacy processes yields outcomes. IDDs and OTs agreed that the advocacy process facilitated change by considering the dynamic interaction between the person, the occupations the IDDs wished to engage in, and the individual’s environments, which is consistent with core elements of the CMOP-E. OTs’ perception of the advocate role was consistent with the core elements of the recovery model of enhancing individual autonomy, facilitating client empowerment, and increasing client responsibility. On the other hand, IDDs felt that the advocacy process was having the advocate speak to others on their behalf, which is not consistent with the core elements of the recovery model. A number of complex issues contributed to why IDDs relied significantly on their advocates, such as 1) mental health stigma 2) previous negative experiences, 3) poor self-esteem and 4) fears related to disclosure of their depression. This study contributes to the existing body of literature as this study describes the advocacy process and advocate role as perceived by IDDs and OTs. The study is unique in design that it is one of the only studies that explores the concept of advocacy from two different perspectives (health providers and health users). Future research is indicated to establish a consistent definition of advocacy and establish a framework for carrying out the advocacy process. A consistent definition and advocacy framework would provide OTs a frame of reference in implementing the advocacy process. Furthermore, advocacy processes at all levels should be integrated into OT scope of practices to further enhance the practice of advocacy.
advocacy, employment