Stuck in the mud

1. Stuck in the mud Experiences of access to employment in northeastern Ontario for persons with serious mental illness. Karen Rebeiro Gruhl, Laurentian University June 2010

2. 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 Karen Rebeiro Gruhl, Laurentian University 2010

3. Research design Case Study Setting Sudbury Manitoulin Cochrane Timiskaming Community Based Partners Sample Decision makers Providers Persons with SMI QUAL Data quan Analysis Theme analysis Karen Rebeiro Gruhl, Laurentian University 2010

4. Final participant sample Karen Rebeiro Gruhl, Laurentian University 2010

5. 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 contexts Karen Rebeiro Gruhl, Laurentian University 2010

6. 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 Karen Rebeiro Gruhl, Laurentian University 2010

7. Quantitative resultsDoes place matter? Primary data Secondary data Karen Rebeiro Gruhl, Laurentian University 2010

8. Karen Rebeiro Gruhl, Laurentian University 2010

9. Primary data source findings Karen Rebeiro Gruhl, Laurentian University 2010

10. Secondary data tables: Northeastern Ontario Karen Rebeiro Gruhl, Laurentian University 2010

11. Karen Rebeiro Gruhl, Laurentian University 2010

12. 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? Karen Rebeiro Gruhl, Laurentian University 2010

13. Qualitative results “People with mental illnesses are stuck (SM02)…We are stuck in the mud” (CT02). Stuck in the mud Raising the bar and the expectations Karen Rebeiro Gruhl, Laurentian University 2010

14. STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE Ideological and interest-based tensions SETTLING FOR LESS Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s SYSTEMIC AND LOCAL TENSIONS Funding Tensions Organizational Tensions BUILD COMMUNITY CAPACITY THE NEED TO RAISE THE BAR AND THE EXPECTATIONS BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY Karen Rebeiro Gruhl, Laurentian University 2010

15. STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE Ideological and interest-based tensions SETTLING FOR LESS Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s SYSTEMIC AND LOCAL TENSIONS Funding Tensions Organizational Tensions BUILD COMMUNITY CAPACITY THE NEED TO RAISE THE BAR AND THE EXPECTATIONS BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY Karen Rebeiro Gruhl, Laurentian University 2010

16. STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE Ideological and interest-based tensions SETTLING FOR LESS Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s SYSTEMIC AND LOCAL TENSIONS Funding Tensions Organizational Tensions BUILD COMMUNITY CAPACITY THE NEED TO RAISE THE BAR AND THE EXPECTATIONS BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY Karen Rebeiro Gruhl, Laurentian University 2010

17. Figure 8: Systemic and local tensions contributing to being stuck in the mud • 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 Northern and Rural Tensions Jurisdictional Tensions SYSTEMIC AND LOCAL TENSIONS Funding Tensions Organizational Tensions Karen Rebeiro Gruhl, Laurentian University 2010

18. BUILD COMMUNITY CAPACITY BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE Ideological and interest-based tensions SETTLING FOR LESS Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s SYSTEMIC AND LOCAL TENSIONS Funding Tensions Organizational Tensions THE NEED TO RAISE THE BAR AND THE EXPECTATIONS Karen Rebeiro Gruhl, Laurentian University 2010

19. STUCK IN THE MUD INFLUENCE OF THE DOMINANT DISCOURSE Ideological and interest-based tensions SETTLING FOR LESS Painting everybody with the same brush Northern and Rural Tensions Jurisdictional Tensions s SYSTEMIC AND LOCAL TENSIONS Funding Tensions Organizational Tensions BUILD COMMUNITY CAPACITY THE NEED TO RAISE THE BAR AND THE EXPECTATIONS BUILD CONSUMER CAPACITY CHANGE THE THINKING ABOUT CAPACITY Karen Rebeiro Gruhl, Laurentian University 2010

20. 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 Karen Rebeiro Gruhl, Laurentian University 2010

21. 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 Karen Rebeiro Gruhl, Laurentian University 2010

22. 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 Karen Rebeiro Gruhl, Laurentian University 2010

23. 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 workshop Karen Rebeiro Gruhl, Laurentian University 2010

24. Building consumer capacity • 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 Karen Rebeiro Gruhl, Laurentian University 2010

25. Changing the thinking about capacity • 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 Karen Rebeiro Gruhl, Laurentian University 2010

26. Questions?