This is a preliminary qualitative study, using a basic interpretive approach, to investigate the work experiences of people with mental illness in Malaysia. Six females and four males (aged 30-70) from a residential home for the mentally ill participated in semi-structured interviews. Three inter-relating themes emerged, namely the experience of self at work, perception of work, and experience of others at work. All participants reported problems in either work or family relationships; most of which interfered with their work. In addition, findings suggest that the participants’ self experience may be related to the extent of one’s illness integration, experience of psychosis, attitude towards illness, locus of control, and self-efficacy. Limitations and implications of the study are also discussed. Key Words: Work Experience, Mental Illness, Mental
Health, and Qualitative Research
Work is a major part of people’s lives, as most of our prime adult years (between ages of 25-50 years) are spent in the workplace. Besides enabling one to enjoy a higher standard of living, work is also a source of social support (Rüesch, Graf, Meyer, Rössler,
& Hell, 2004). These benefits, however, may not be available to everyone, especially those with mental health problems. Four national surveys conducted from 1989 to 1998 in the United States revealed that the employment rate of people with disabling mental disorders, like schizophrenia, was between 22 and 40 percent, as compared to people without mental illness (76 to 87 percent; Mechanic, Bilder, & McAlpine, 2002).
In Malaysia, a 1996 study revealed that the mentally ill represented about 11 percent of the population (Hidden Casualties, 2000), which is likely an underestimation by now. This is of concern because essentially, these 2.3 million people (Malaysian
Science and Technology Information Centre, 1996) impact the overall productivity and economy of the nation. Mubarak (2005) found that 68 percent of 258 schizophrenic patients were unemployed, whereas Mubarak, Baba, Low, and Quah (2003) revealed a 58 percent unemployment rate in its sample of 174 schizophrenic patients. Extrapolating from these studies, about 1.5 million Malaysians with mental illness are unemployed, thus representing a great loss to the nation’s economy.
The odds of securing a professional job (i.e., jobs requiring high education levels in managerial, administrative, executive, or professional specialty fields) are against mentally ill people (Mechanic et al., 2002). Rather, most of them are found to hold semiskilled jobs, such as food service, general labour, bench work and janitorial work
(McCrohan, Mowbray, Bybee, & Harris, 1994).
Those who manage to secure employment face barriers like others doubting their capabilities (Killeen & O’Day, 2004), stigma and discrimination (Alverson, Becker, &
Drake, 1995; Auerbach & Richardson, 2005; Jamaiyah, 2000; Peckman & Muller, 1999;
Provencher, Gregg, Mead, & Mueser, 2002; Secker, Membrey, Grove, & Seebohm,
163 The Qualitative Report January 2011
2003), difficult workplace interactions (Auerbach & Richardson; Cunningham, Wolbert,
& Brockmeier, 2000), slowness (Peckman & Muller), concentration difficulties
(Peckman & Muller; Provencher et al.; Secker et al.), medication side effects (Alverson et al.; Auerbach & Richardson; Peckman & Muller; Secker et al.), and low confidence levels (Provencher et al.; Secker et al.). Other challenges include long working hours, inflexible work schedules, daunting job tasks (Secker et al.), as well as job stress and low pay (Auerbach & Richardson).
However, people with mental illness also report positive work experiences, such as good workplace relationships (Auerbach & Richardson, 2005; Bedell, Draving,
Parrish, Gervey, & Guastadisegni, 1998). Work is also a source of personal competence, autonomy, growth, and self-esteem (Auerbach & Richardson; Krupa, 2004; McCrohan et al., 1994). Apart from that, participants who had more frequent workplace interactions enjoyed higher wages (Banks, Charleston, Grossi, & Mank, 2001). Furthermore, supportive work environments help lengthen a mentally ill person’s job tenure (Kirsh,
2000), which is shown to be significantly shorter than the average person without mental illness (Xie, Dain, Becker, & Drake, 1997).
Regarding the coping strategies of people with mental illness, Auerbach and
Richardson (2005) elaborated on their participants’ perseverance in developing problemsolving skills and learning how to manage their psychiatric symptoms. While some sought social support (Krupa, 2004; Secker et al., 2003), others relied on positive mindsets, relaxation, and substances like nicotine and alcohol to cope with work and their illness (Cunningham et al., 2000).
It should be noted that most of the past studies were conducted in the United
States, which has social welfare programs (Frank & Glied, 2006) and federal vocational services for the mentally ill (Cook, 2006; Rimmerman & Botuck, 1995), such as workshops, transitional employment and supported employment programs. Furthermore, there are laws to ensure equal employment opportunity and to prevent discrimination against people with mental illness, such as the American with Disabilities Act (Starnes,
1999). In stark contrast, there are only 15 or more day-care centres that provide occupational therapy for people with mental illness in Malaysia (Deva, 2004), half of which are managed by NGOs and receive little funds (Haque, 2005). Industrial rehabilitation and sheltered workshops are provided (Deva). However, research reveals no transitional or supported employment programs so far. Malaysians with mental illness are also denied social welfare services (Malaysian Mental Health Association, 2003).
While there is a Mental Health Act (Malaysia, Legal Research Board, 2002, Act 615) that details psychiatric services for the mentally ill, there is no legal provision to ensure equal employment opportunities for them. Likewise, although the National Mental Health
Policy encourages employers to hire people with mental illness (Ministry of Health
Malaysia, 1997, as cited in Mubarak, 2005), the actual implementation is unknown.
In light of these differences, this study sought to explore the work experience of people with mental illness in Malaysia, as they are likely to experience working life much differently than those in the United States. Using a basic qualitative research design, the aim of this study was to understand how they construe the meaning of their work, the challenges they face, and the ways they cope with those challenges. Findings were expected to have implications at both the micro level (in promoting greater empathy for
Su-Lyn Boo, Jaymee Loong, and Wai-Sheng Ng 164 the mentally ill) as well as at the macro level (in providing useful information for socioeconomic policy making).