Activité professionnelle et processus de rétablissement Employment and Recovery Process

Résumé

Il est largement reconnu que l’exercice d’une activité professionnelle est un des facteurs contribuant le plus efficacement au rétablissement des personnes vivant avec des troubles mentaux sévères. En nous fondant sur une synthèse de la littérature pertinente dans ce domaine, nous nous attachons dans cet article à montrer que le lien étroit entre travail et rétablissement mérite d’être envisagé non seulement en partant du travail pour souligner ses apports au processus de rétablissement, mais également en partant d’une conception approfondie du rétablissement et de ce qu’il implique, pour contextualiser dans ce cadre les pratiques de soutien à l’emploi. Il est intéressant de remarquer la convergence entre les principes des pratiques axées sur le rétablissement et ceux qui orientent les pratiques de référence en matière de soutien à l’emploi. La spécification d’un changement de posture individuelle dans l’accompagnement pour promouvoir le rétablissement importe pour faire évoluer les pratiques d’accompagnement « vers » puis « dans » l’emploi. Nombre de travaux se sont attachés à identifier les façons par lesquelles le travail contribue au processus de rétablissement. Ces bénéfices du travail s’avèrent nombreux et de natures diverses. Ils ont fait l’objet d’études de synthèse qui identifient les principales dimensions en fonction desquelles nous présentons ces facteurs contribuant au rétablissement.

Mots-clés :

• handicap psychique,
• rétablissement,
• intégration professionnelle,
• soutien à l’emploi

Abstract

Objectives It is widely acknowledged and confirmed by research that there is a close relationship between work and recovery from a mental illness. The aim of this article is to discuss different aspects of the relationship between these two concepts.

Methods The discussion is based on a synthesis of the relevant literature in two domains: the benefits of employment for people living with a mental illness and their contributions to the recovery process, and the specification of the recovery paradigm and of the recovery-oriented practices.

Results The recovery paradigm may be characterized by some main shifts in the vision of people living with a mental illness and of their future, with consequences on how to support these people, and in particular how to conceive their vocational rehabilitation. One of the first shifts is that it is possible for a large majority of these people to recover, to return to active and social life, to consider a favourable future. This possibility, which gives rise to hope and a high expectation, should now be the priority objective of supporting practices, which implies a renewal of these practices. A second shift is that this possibility of recovery does not necessarily require a complete and prior reduction of the mental disorders. The recovery approach, by giving priority to commitment to an active and social life, supports vocational reintegration as a priority. This new approach to practices and services should be considered at two levels: in the design and organization of services, which must be redefined according to the primary objectives and the values of recovery, but also at the individual level, in the accompanying posture, which should be based on the values of recovery. In vocational rehabilitation, Individual Placement and Support (IPS) is recognized as an evidence-based practice and its principles are well defined. There is a striking convergence between the underlying principles of IPS programs and the principles of the recovery-oriented practices, but the shift in the accompanying individual posture is better specified by the recovery-oriented practice literature.

A number of research focuses on the different ways by which employment contribute to the recovery process. We rely on existing qualitative meta-synthesis of these studies, to present the factors contributing to the recovery process according to the relevant main dimensions.

Conclusion In the current French context of development of effective professional integration practices, based on the Place and train model, it is important to stress that these practices must be also recovery-oriented, which implies not only a new design of vocational services but also to adopt a new attitude for supporting people in the process of work integration.

Keywords:

• mental illness,
• psychiatric disability,
• recovery,
• work,
• supported employment