stuck in the mud

Stuck in the mud

Experiences of access to employment in northeastern Ontario for persons with serious mental illness.

1 Karen Rebeiro Gruhl, Laurentian University June 2010

Objectives for today To share how people with SMI are doing in

the area of employment in NEO To offer an explanation of why consumers

are stuck in the mud regarding employment, and how this happens

To share community based solutions and next steps

2 Karen Rebeiro Gruhl, Laurentian University 2010

quan

ProvidersPersons with

SMIDecision makers

Case Study

QUAL

Com

mu

nity

Based

Partn

ers

Com

mu

nity

Based

Partn

ers


Final participant sample

Setting Sudbury Manitoulin District Cochrane-Timiskaming District Totals

Sampling Sub-group Urban Rural Urban Rural

Persons with SMI 3 2 5 10 20

Providers 13 0 3 2 18

Decision makers 5 3 8

Totals 21 2 11 12 46


Data Collection techniques

QUALitative Quantitative

Interviews: Individual Focus groups

Field notes Conceptual notes Methods notes

Pertinent documents Brochures (local) Community socio-

demographic data (LHIN) (Regional)

Policy (Provincial )

Primary data source: Participant demographic questionnaire SMI, PR, DM Empirically driven

variables Secondary data source:

(MCSS) Empirical and study

generated variables Regional and local

contexts5 Karen Rebeiro Gruhl, Laurentian

University 2010

Data analysis Inductive analysis of QUAL data

Iterative, inductive back and forth process between field notes, transcript data, documents, analytic memos

Deductive analysis of quan data Theory driven, drawn from empirical literature

Within and between case analyses Yielded a unifying conceptualization of access

to employment for people with SMI in northeastern Ontario


Quantitative resultsDoes place matter?

Primary dataSecondary data


Primary data source findings

Participant Employment success Reported employment

Rurality & Employment NEO

# Reporting employment

Prior work experience

North South Urban Rural

Yes No Yes No

Sudbury Manitoulin

2/5 5/5 2 4 4 4 8

Cochrane Timiskaming

6/15 15/15 6

Totals Participant Sample

8/20 20/20 6 2 4 4 4 8


Secondary data tables: Northeastern Ontario

Employment success Recipients on ES

Adult ODSP Recipients with SMI

Total # ODSP Recipients with SMI

# Reporting earned income

% Reporting Earnings

Total # reported earnings URBAN

% Total # reported earnings RURAL

%

Sudbury Manitoulin

2515 2198.7%

43 91.5 4 8.51

Cochrane Timiskaming

1597 1398.7%

19 76 6 24

Totals NEO 4112 3588.7%

62 86.1 10 13.8


Quan samplen=4112

Cochrane Timiskaming n=1597

Sudbury Manitoulin n=2515

Northeastern Ontario

# employed139

219 358 (8.7%)

# Met 13 week target20

47 67 (18.7%)

Tenure: How longare people working?

< 1-6 month11

25 36 (53%)

6 -12 month9

22 31 (47%)

>12 months0

0 0

Reported earnings How much are people making?

0.01 – 750.0072%

750.01 – 2000.0023.8%

>2000.004.2%

Self-sufficiency Are people leaving income support systems?*Income precludes or in excess

1 Year period 3.0%

6 year period 8.1%


Does place matter? People with SMI in NEO are not faring well in

employment 8.7% reported employment earnings Earn < $750.00 Few reaching the target of 13 weeks (2%) No one is sustaining employment > 1 year Few exit income support systems

Urban Individuals are doing better than rural cohorts WHY?


Qualitative results

Stuck in the mudRaising the bar and the expectations

“People with mental illnesses are stuck (SM02)…We are stuck in the mud” (CT02).


INFLUENCE OF THE DOMINANT DISCOURSE

SYSTEMIC AND LOCAL TENSIONS

THE NEED TO RAISE THE BAR AND THE

EXPECTATIONS

Ideological and interest-based tensions

Painting everybody with the same brush

Northern and Rural Tensions

Jurisdictional Tensions

s

Funding Tensions

Organizational Tensions

SE

TT

LIN

G F

OR

LE

SS

BUILD COMMUNITY CAPACITY

BUILD CONSUMER CAPACITY

CHANGE THE THINKING ABOUT CAPACITY





EXPECTATIONS





s

Funding Tensions


SE

TT

LIN

G F

OR

LE

SS





•Rise in unemployment rates from 5.5% to 10.5% during study period.•Few employment specialists to cover a large geography.•Few service providers willing to provide vocational services in rural or remote areas•Service providers must travel large distance•Few designated vocational workers on mental health teams, and if so, dedicate <25%•Service providers do not collaborate due to limited resources, and distance

SYSTEMIC AND LOCAL

TENSIONS



Funding Tensions


Figure 8: Systemic and local tensions contributing to being stuck in the mud





EXPECTATIONS





s

Funding Tensions


SE

TT

LIN

G F

OR

LE

SS





Building community capacity Fostering best

practice employment services

Fostering collaboration and integration of services for persons with SMI

Creating opportunity for employment through creative community and cross sectoral partnerships


Building consumer capacity Widely promoting

the benefits of work for all

Greater focus on education and training

Providing a variety of evidence based supports as long as needed


Changing the THINKING about capacity Inclusive thinking

about mental “health” care

Shifting the paradigm beyond illness to include social determinants of health

Making employment more of a priority within mental health systems in NEO


Town Hall forums & Next steps Employment

Advisory Building community

capacity: Train vocational

service providers & mental health providers in IPS ES

Advocacy for implementing best practice models and ways to collaborate

Sponsor a workshop23 Karen Rebeiro Gruhl, Laurentian

University 2010

Building consumer capacity

Karen Rebeiro Gruhl, Laurentian University 2010

24

Advocacy for supported education and access to training dollars to bridge the education-work gap

Actively promoting work, education and other rights of citizenship within mental health care continuum

Changing the thinking about capacity

Karen Rebeiro Gruhl, Laurentian University 2010

25

Influence the discourse by demonstrating successful outcomes

Raise the profile of employment for persons with SMI with local employers and decision makers within our communities

Celebrate employers who make a difference

Questions?

26

stuck in the mud

Documents

laurentian university

transcript data

primary datasecondary

primary data source

secondary data tables

northeastern ontario

employment successrecipients

area of employment