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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
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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
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quan
ProvidersPersons with
SMIDecision makers
Case Study
QUAL
Com
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nity
Based
Partn
ers
Com
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nity
Based
Partn
ers
3 Karen Rebeiro Gruhl, Laurentian University 2010
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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
4 Karen Rebeiro Gruhl, Laurentian University 2010
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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
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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
6 Karen Rebeiro Gruhl, Laurentian University 2010
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Quantitative resultsDoes place matter?
Primary dataSecondary data
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8 Karen Rebeiro Gruhl, Laurentian University 2010
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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
9 Karen Rebeiro Gruhl, Laurentian University 2010
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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
10 Karen Rebeiro Gruhl, Laurentian University 2010
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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%
11 Karen Rebeiro Gruhl, Laurentian University 2010
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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?
12 Karen Rebeiro Gruhl, Laurentian University 2010
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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).
13 Karen Rebeiro Gruhl, Laurentian University 2010
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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
14 Karen Rebeiro Gruhl, Laurentian University 2010
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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
15 Karen Rebeiro Gruhl, Laurentian University 2010
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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
16 Karen Rebeiro Gruhl, Laurentian University 2010
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•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
Northern and Rural Tensions
Jurisdictional Tensions
Funding Tensions
Organizational Tensions
Figure 8: Systemic and local tensions contributing to being stuck in the mud
17 Karen Rebeiro Gruhl, Laurentian University 2010
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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
18 Karen Rebeiro Gruhl, Laurentian University 2010
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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
19 Karen Rebeiro Gruhl, Laurentian University 2010
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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
20 Karen Rebeiro Gruhl, Laurentian University 2010
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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
21 Karen Rebeiro Gruhl, Laurentian University 2010
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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
22 Karen Rebeiro Gruhl, Laurentian University 2010
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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
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Building consumer capacity
Karen Rebeiro Gruhl, Laurentian University 2010
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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
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Changing the thinking about capacity
Karen Rebeiro Gruhl, Laurentian University 2010
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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
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Questions?
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