FR :

Cet article a pour objectif de présenter un aperçu des réflexions menées par diverses institutions européennes et internationales sur l’emploi des personnes en situation de handicap psychique. En premier lieu, l’étude s’attache à rechercher s’il existe un consensus sur la façon d’appréhender le « handicap psychique ». Si la notion n’est pas explicitement consacrée par les différentes normes juridiques européennes et internationales, ces dernières reconnaissent que les personnes souffrant de troubles psychiques peuvent être considérées comme des personnes en situation de handicap. Pour autant, les dispositifs juridiques existants ne semblent pas toujours en mesure d’apporter des réponses adaptées à l’insertion et au maintien dans l’emploi de personnes en situation de handicap psychique. En second lieu, l’étude identifie donc les recommandations et les actions qui sont proposées par les différentes instances afin de remédier à ce constat. Ce recensement fait ainsi émerger une certaine porosité entre la prévention de la santé mentale et la question du handicap psychique.

EN :

Objectives The aim of this article is to present an overview of the reflections led by various European and international organizations on the employment of people with mental disorders.

Methods This study is based on data from websites of international organizations and interviews taken place with a disability specialist at the International Labour Organisation (ILO) and members of the European Commission.

Results Unlike the French law of 11 February 2005 which refers expressly to psychic disability, this notion is not explicitly dedicated by various European and international legal rules. However, these standards like the United Nations Convention on the Rights of Persons with Disabilities have adopted the contemporary model which presents disability as the result of an interaction between person and environment. Thus they acknowledge that disabled people include people suffering from mental disorders because in the person’s environment, a psychiatric impairment could lead to limitations of activities or restrictions of social participation that constitute a situation of disability of psychiatric origin. Therefore, the legal mechanisms often do not provide appropriate answers to the characteristics of psychiatric disability.

Besides, negative attitudes, stereotypes and discrimination towards people with a psychiatric disability are still observed in the workplace, in spite of intensified anti-discrimination legislation.

This study inventories the different proposals to remedy to substantial barriers to the employment of people with a psychiatric condition. In the European Union’s strategy for increasing the employment of these persons, particular consideration is given to put forward a series of key recommendations to improve practices of reasonable accommodation in the workplace. Nonetheless, it must be emphasized that it is necessary to conceive adequate measures in order to take into account the changeability and the unpredictability of mental disorders. Indeed, situations of psychiatric disability require flexibility and reactivity more than any other situation of disability. The discrimination experienced by people with a psychiatric disability is likely to continue as long as specific responses are not implemented. In this perspective, ILO highlights a number of best practices addressing the challenges of psychiatric disabled people’s employment. That is why a disability network was created to share knowledge. The great added value of this network is the opportunity to share best practices between companies, best practices between countries in order to increase the ability to include people with mental disorders. Focus is put on strategies to combat discrimination in employment, by raising awareness, exploring measures and good practices to improve mental health in the workplace.

Conclusion Finally, this study shows similar challenges in the prevention of the mental health and the issue of the psychiatric handicap, including to remedy to the insufficient attention paid to provide reasonable accommodation to persons with mental disorders.

FR :

Le Forum économique mondial estime que, d’ici 2030, les coûts mondiaux des troubles mentaux devraient atteindre six mille milliards de dollars ; environ deux tiers de ces coûts seront attribués à la perte de productivité liée à l’incapacité. Cet article bref, examine les facteurs liés aux coûts de la maladie mentale en milieu de travail, identifie certains des éléments du milieu de travail qui pourraient être ciblés pour réduire les coûts et examine des exemples de types d’interventions en milieu de travail qui peuvent réduire les coûts.

Il existe au moins deux approches principales pour réduire les coûts relatifs aux troubles mentaux en milieu de travail. La première vise à réduire la prévalence des troubles mentaux chez les travailleurs ainsi que l’incidence des absences maladie. La seconde approche est de permettre un plus grand accès aux traitements requis. Ensemble, ces approches permettraient de réduire les coûts de façon significative, notamment en créant un climat de soutien et de solidarité dans les milieux de travail.

EN :

Objectives The World Economic Forum estimated that, by 2030, global costs of mental disorders are projected to reach US$6.0 trillion; about two thirds of these costs will be attributed to lost productivity related to disability. This brief article discusses factors that are related to the costs of mental illness in the workplace, identifies some of the workplace elements which could be targeted to reduce costs and explores examples of types of workplace interventions that can reduce costs.

Methods We summarize the results of a Canadian research program using economic analyses to understand the costs of work disability related to mental disorders and cost-effective interventions.

Results There are at least two main approaches to decrease the costs of mental disorders in the workplace. The first approach could be to decrease the prevalence of mental disorders among workers or the incidence of sickness absences. A second approach would be to increase access to treatment by addressing barriers to treatment. Both can have significant impacts to decrease costs.

Conclusions Treatment can help workers experience mental disorders have higher productivity than they would have otherwise. By creating supportive workplace cultures through management training, organizations can potentially see a return through decreased sickness absences and higher productivity.

FR :

Le travail constitue un puissant vecteur d’intégration sociale pour les personnes souffrant de troubles de santé mentale, en plus de leur procurer des bénéfices thérapeutiques. Pourtant, celles-ci demeurent encore largement exclues du marché du travail. Les obstacles à leur pleine participation résident dans les préjugés dont elles sont victimes et la nécessité d’adapter le travail à leurs besoins et à leurs capacités. Au Canada, l’approche des droits fondamentaux et, en particulier, l’obligation d’accommodement raisonnable sont bien ancrées dans la jurisprudence depuis le milieu des années 1980. De nature constitutionnelle, cette obligation de portée étendue n’est limitée que par la preuve d’une contrainte excessive. Elle force ainsi les milieux de travail à prendre en compte la réalité des personnes handicapées, notamment celle des personnes souffrant de troubles mentaux. À partir d’une étude de la jurisprudence québécoise, cet article explore les potentialités de cette obligation d’accommodement afin de favoriser l’accès et le maintien en emploi des personnes souffrant de troubles mentaux. Selon cette étude, l’obligation d’accommodement impose une démarche novatrice qui tient compte de la situation particulière de la personne handicapée et qui implique la participation de toutes les parties prenantes. Par la mise en place de mesures visant la modification de l’environnement psychosocial du travail, elle ouvre la voie à des pratiques favorisant la prévention primaire des troubles de santé mentale, au bénéfice de tous.

EN :

Objectives Being able to work constitutes a powerful social integration vector for those suffering from mental health disorders, while also providing therapeutic benefits for them. Yet, despite some advances in this regard, such persons are still denied employment. The obstacles to their full workforce integration reside in the prejudices surrounding the disorders affecting them and the need to adapt tasks to their needs and abilities. The International Convention on the Rights of Persons with Disabilities, adopted by the United Nations in 2006, points out that disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinder their full and effective participation in society on the basis of equality with others. It stresses the importance of the right to work of persons with disabilities and, in particular, the implementation of reasonable accommodation for these persons in all workplaces. From this perspective, this article aims to explore the impacts of the legal obligation of accommodation.

Methods In Canada, the fundamental rights approach and, in particular, the obligation for reasonable accommodation with regard to handicapped workers, has been well established in case law since the mid 1980s. This obligation is of a constitutional nature and its extended range is limited only by the proof of undue hardship. It thus forcefully prompts labour markets to take into consideration the needs and capacities of disabled workers. Through a study of Quebec case law, this article looks at the potential of the duty to accommodate with regard to promoting access to and retention of employment among people with mental disorders.

Results The study found that the duty to accommodate imposes an innovative approach that takes into account the particular situation of the disabled person and involves the participation of all stakeholders. Accommodation allows employees to maintain an employment relationship despite repeated absences caused by illness, thus enabling them to do their work. Employers must provide adjustments relating to working time and allow gradual return when necessary. Moreover, the accommodation may involve changing the work itself or its psychosocial aspects.

Conclusion By implementing measures to change the psychosocial work environment, accommodation not only promotes access to and retention of employment among people with mental disorders, but also opens the way to first stage prevention for the benefit of all.

FR :

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.

EN :

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.

FR :

Cet article dresse un état des lieux de l’implication du fonctionnement cognitif dans le champ de l’insertion professionnelle et du maintien en emploi des personnes qui souffrent de troubles du spectre schizophrénique (TSS). L’objectif est de visualiser comment les déficits cognitifs s’articulent avec les autres dimensions du handicap rapportées dans la Classification internationale du fonctionnement, du handicap et de la santé (CIF), dans le domaine du travail. Les données de la littérature vont dans le sens du modèle de la CIF, à savoir un plus fort impact du fonctionnement cognitif sur les limitations d’activités (LA) plutôt que sur les restrictions de participation (RP). Ce sont en effet davantage les facteurs environnementaux et personnels qui prédisent la participation au travail. En conclusion, ce cadre théorique offre de nouvelles perspectives, notamment que la prise en compte de l’interaction entre les déficits cognitifs et les limitations d’activités peut venir étayer l’accompagnement vers et dans l’emploi des personnes souffrant de TSS.

EN :

Objectives Cognitive impairment can be a barrier to employment of people with a schizophrenia spectrum disorder (SSD). However, other factors have also been identified as potentially hindering work integration and job tenure. But the links between all these factors remain unknown. The objective of this article is to propound an integrative model, using the International Classification of Functioning (ICF), of how cognitive impairment associated with SSD is related to other factors involved in difficulties in work integration and job tenure.

Methods The description of the theoretical framework of the ICF enables to organize these factors in a comprehensive model. Then, a review of recent literature allows us to identify factors associated with employment of people with SSD, and to see the link between cognitive functioning and other factors.

Results Most of reviewed studies find moderate correlations or no correlation between cognitive impairments and work integration or job tenure. Stronger correlations were nevertheless found between cognitive factors and work behavior or performance. Considering other factors, like personal or environmental factors, and the framework of the ICF, a comprehensive view of the vocational rehabilitation for people with SSD is developed. Interactions between some personal (e.g. self-efficacy or self esteem) and environmental (e.g. job coach or layout of workstation) factors may influence the translation of cognitive difficulties into work participation restrictions.

Conclusion Vocational rehabilitation programs should further consider the complexity of interactions between cognitive, personal and environmental factors, and how they impact work functioning. As defined in ICF, activity limitations may represent an interesting mediator between cognitive variables and work functioning. Future research should be conducted to bring a better understanding of these patterns of interactions.

FR :

La dépression est une des causes d’absence maladie (ou arrêt maladie) les plus fréquentes en milieu organisationnel. Plusieurs études se sont intéressées aux facteurs individuels, organisationnels, et ceux relatifs aux interventions qui peuvent prédire le retour au travail des personnes ayant vécu une dépression. Toutefois, peu d’études s’intéressent à la prévention des rechutes de dépression à la suite d’un retour au travail, alors que plus de la moitié des personnes ayant vécu une première dépression est à risque de faire une rechute dans un délai assez court.

Objectif Cet article présente le protocole de recherche relatif à une intervention de groupe novatrice, d’orientation cognitive comportementale, en vue d’optimiser la santé mentale des employés lors de leur retour au travail et ainsi diminuer d’éventuelles rechutes. Nous visons aussi à présenter la faisabilité de cette approche.

Méthode L’étude consiste en un essai pilote randomisé avec groupe contrôle dont la moitié des participants (n = 25) suit l’intervention de groupe et l’autre moitié (n = 25) reçoit les services/interventions usuels. Les bases théoriques et empiriques soutenant l’intervention proposée ainsi qu’une description de l’intervention et des objectifs de l’étude sont ici présentées.

Résultats Nous décrirons succinctement les propos tenus par les participants des deux premières cohortes concernant leur appréciation à l’égard de l’intervention de groupe.

Conclusion Enfin, les retombées d’une telle intervention seront aussi évoquées.

EN :

Workplace depression is one of the major causes for sick leave and loss of productivity at work. Many studies have investigated factors predicting return to work for people with depression, including studies evaluating return to work programs and organizational factors. Yet, a paucity of studies have targeted the prevention of depressive relapses at work, even though more than half of those having had a depression will have a depressive relapse in the near future.

Objectives This article describes a research protocol involving a novel group intervention based on cognitive behavioural principles with the aim to optimize return to work and diminish risk of depressive relapses.

Method This pilot study follows a randomized controlled trial design, with half the participants (N=25) receiving the group intervention and the other half (N=25) receiving usual services. The theoretical and empirical underpinnings of the intervention are described, along with a detailed presentation of the intervention and of the study’s objectives. The group intervention consists of 8 sessions whereby Cognitive behavioural therapy (CBT) principles and techniques are applied to the following themes: (1) Coping with stress at work; (2) Recognizing and modifying my dysfunctional beliefs linked to work; (3) Overcoming obstacles linked to work functioning and maintaining work; (4) Negotiating needed work adjustments with the support of the immediate supervisor; (5) Finding my strengths and competencies related to work; (6) Accepting criticism and asserting myself appropriately at work; (7) Uncovering my best coping strategies for work.

Results Qualitative information pertaining to the first two cohorts’ participants’ subjective appreciation of the group experience revealed that the intervention was perceived as very useful by all, with group support, namely harmony and interpersonal support, as well as CBT strategies being mentioned specifically.

Conclusion Finally, the potential relevance of the group intervention will be brought forward.

FR :

La réhabilitation psychosociale est une pratique en plein essor en France au sein du monde médical, social ou politique. En témoigne l’émergence récente de structures sanitaires et médicosociales spécialisées dans l’insertion socioprofessionnelle des personnes en état de handicap psychique, et les publications de plus en plus nombreuses sur ce sujet.

Cet article a pour objectif de présenter les différents dispositifs mis en place au Centre de Réhabilitation Psychosociale (CRPS) de la Tour de Gassies, structure sanitaire orientée vers le rétablissement des personnes en situation de handicap psychique, dont l’une des particularités est de proposer des accompagnements axés sur l’insertion professionnelle.

Après un bref rappel sur le handicap psychique, qui rappelle la place centrale de la Classification Internationale du Fonctionnement comme modèle théorique organisant notre pratique, nous aborderons la question de l’insertion professionnelle comme levier vers le rétablissement, en étayant nos propos par deux vignettes cliniques.

Nos accompagnements reposent ainsi sur plusieurs principes essentiels : des actions orientées vers les facteurs personnels par le biais d’actions personnalisées et un travail d’interdisciplinarité ; des actions orientées vers les facteurs environnementaux au travers d’activités tournées vers l’extérieur et l’aspect transitoire de nos interventions. Ces différents éléments sont toutefois à resituer dans le contexte sanitaire français avec ses particularités et ses écueils.

EN :

Objectives Psychosocial rehabilitation, particularly work integration, is currently a public health preoccupation, as evidenced by recent publications on this topic and the development of new professional insertion program. This article aims to present a French health facility focused on psychosocial rehabilitation of persons in state of psychic disability, in order to highlight its specific programs of professional insertion.

Methods After a brief remind about the theoretical foundations of psychosocial rehabilitation, psychic disability and recovery, we present the means used by our healthcare facility, illustrating our remarks with 2 case studies.

Results Our rehabilitation programs demonstrate the need of a multidisciplinary in interventions, the need for multiplicity in proposals of activities, the importance of self-determination, of healthcare professionals in management of the public admitted in our healthcare facility, and the importance of fighting the stigma caused by mental disorders.

Conclusion Our programs need to be placed in the French context, in which persist stigmatization towards persons with psychiatric disorders, and huge barriers to employment.

FR :

La stigmatisation des personnes souffrant d’un trouble du spectre schizophrénique a pour origine l’existence d’un stéréotype associé à une catégorie sociale, ici la schizophrénie. L’objectif de cet article bref est de proposer une courte synthèse de la littérature récente ayant exploré le contenu du stéréotype associé à la schizophrénie, en anglais et en français, et de proposer des perspectives de recherche basées sur les évolutions récentes de ce domaine.

Le stéréotype associé à la maladie mentale en général est clairement négatif. Le modèle le plus répandu dans la littérature postule l’existence de quatre facteurs qui en constituent le contenu : attribution de la responsabilité de la maladie, dangerosité, faible pronostic, imprévisibilité et incompétence dans les rôles sociaux. Si le stéréotype peut varier selon les pays, il est clairement associé à la discrimination et au désir de mettre les personnes à distance socialement. Le stéréotype diffère également entre les maladies mentales. En comparaison aux troubles bipolaires ou à l’autisme, la schizophrénie concentre les aspects les plus négatifs du stéréotype associé à la maladie mentale, notamment en termes de dangerosité et de distance sociale.

L’étude du stéréotype, en pleine expansion, demande encore des études spécifiques et la mise à l’épreuve des modèles non validés, pourtant largement utilisés dans la littérature psychiatrique. L’importation des méthodes et des modèles de la psychologie sociale constitue une piste prometteuse. Ainsi, la production de données utilisables par tous les acteurs du terrain, usagers, familles et professionnels, implique la constitution d’équipes pluridisciplinaires dans les projets futurs.

EN :

Objectives Stigmatization of people suffering from schizophrenia spectrum disorder relies on the existence of a stereotype which is associated with a social category, here schizophrenia. The short report’s aim is to briefly synthesize the recent literature about the content of the stereotype associated with schizophrenia, and to suggest some perspectives for future studies, on the basis of recent advances in the domain.

Methods First, we present the theoretical concepts of stigma and stereotype. Second, we propose a brief synthesis of the recently published articles focusing on the content of schizophrenia stereotype in the general population, in English and in French.

Results The stereotype associated with mental illness is clearly negative. The most common model in the literature assumes 4 factors in the content of stereotype: attribution of responsibility in the condition, dangerousness, poor prognosis, unpredictability and incompetence in social roles. If the stereotype could vary among countries, it is clearly associated with desire for social distance and discrimination. The stereotype also varies among mental illnesses. Compared with bipolar disorders and autism, schizophrenia focuses the most negative aspects of mental illness stereotype, especially in terms of dangerousness and social distance.

Conclusion The study of stereotype, though rapidly growing, still raises questions about the validity of commonly used models in the psychiatric literature, and may benefit from further specific studies. Social psychology models and methods appear to be a promising perspective. The production of data, useful for users, families as well as for professionals may require multidisciplinarity for future projects.

FR :

Le processus de stigmatisation est un des principaux freins à l’emploi des personnes présentant des troubles psychiques. Sonder les représentations de l’employeur est un premier indicateur de la compréhension générale des processus psychologiques qui le guident dans le recrutement de ce type de public. La présente étude vise à identifier les représentations d’employeurs vis-à-vis du « trouble psychique » en général et au travail, et des prérequis pour l’embauche afin de comprendre les processus psychologiques qui conduisent à l’exclusion professionnelle des personnes en situation de handicap psychique.

Vingt-neuf entretiens semi-directifs ont été menés auprès d’employeurs d’organisations implantées sur le territoire français et soumises à l’obligation d’emploi de travailleurs handicapés (OETH). Les résultats montrent des représentations du trouble psychique très péjoratives axées sur la déviance sociale (non-conformité à la norme sociale) et le préjudice que ces personnes constitueraient pour la société tout entière à cause des perturbations de l’interaction sociale et du fardeau qu’induirait le trouble psychique pour l’entourage et particulièrement pour le milieu de travail. L’analyse des prérequis pour l’embauche de personnes en situation de handicap psychique montre à quel point ces représentations sont des freins au recrutement principalement liés à un manque d’adéquation perçue à l’emploi.

Des perspectives de recherche et d’actions visant l’apprentissage et le perfectionnement des pratiques de recrutement et d’intégration en milieu de travail sont proposées pour accompagner les acteurs des organisations dans ce type d’inclusion.

EN :

Introduction People with mental disorders face stigma and discriminatory hiring practices in the competitive labour market. This study on employers’ representations of mental disorders provides knowledge regarding the specifics of their negative perceptions for this population, which appears to be an important barrier to their inclusion in the workplace. Heilman’s lack of fit model (1983) enabled to show that recruiters seek to match the characteristics they perceive in candidates with those they deem necessary to succeed in the organization. A lack of fit between the two components—candidates and the selection criteria—would explain the non-selection of the applicant. This psychological process can be applied to the recruitment of people with psychiatric disabilities.

Objectives The goal of this study was to identify employers’ representations towards mental disorder in general and in the workplace particularly, as well as to determine the prerequisites for hiring this population. As such, this would allow to better understand the psychological processes involved in the exclusion of people with psychiatric disabilities.

Method In a qualitative study, 29 semi-structured interviews were conducted with employers and HR Department representatives of organizations in France that were under the French legal obligation to hire people with a disability (organizations having more than 20 employees). We used the free association technique to identify representational contents concerning mental disorder. Qualitative data on the essential prerequisites for recruitment were collected through open-ended questions. The data were processed by a categorical content analysis conducted independently by three researchers. The structure of the representation was identified by distinguishing the components of the central nucleus from those of the peripheral nucleus according to the two criteria of the method of Moliner (1994): the index of popularity of each element and the co-occurrence between each element of the representation.

Results Results revealed negative representations of people with mental disorders, focusing on social deviance and harm to society, believing that people with mental disorders would have non-standard skills and behaviours and would be socially disruptive and burdensome, particularly in the workplace. The analysis of the prerequisites for hiring persons with psychiatric disabilities showed how these representations towards mental disorders are barriers for their recruitment, mainly linked to a perceived lack of employment fit.

Conclusion Future avenues of research and actions are suggested. They are as follows: learning, education on mental disorders, training and specific techniques to reduce organizational stakeholders’ stereotypes and prejudice. Also, supporting stakeholders for the inclusion of people with mental disorders in the workplace appears fundamental, especially by improving recruitment and integration practises.

FR :

Les dispositifs d’aide à la réinsertion professionnelle des personnes souffrant de troubles psychiques sont peu étudiés en France bien que la littérature spécialisée souligne que ces dispositifs sont clés pour favoriser l’insertion en milieu ordinaire. Les objectifs de cette recherche étaient de décrire les rôles, tâches et compétences des conseillers d’insertion et des responsables d’unité de production qui accompagnent ce public vers le milieu ordinaire au sein des ESAT de transition Messidor. Une méthodologie qualitative a été retenue : 24 entretiens individuels et 7 groupes de discussion ont été menés auprès des deux types de professionnels de ces structures. Les résultats ont permis de définir la fonction de chaque accompagnant et une liste de 110 compétences pour les conseillers d’insertion et de 155 compétences pour les responsables de production. Ce binôme d’accompagnants complémentaires apporte un soutien à l’insertion en favorisant un changement de regard sur soi. Le conseiller d’insertion accompagne chaque travailleur à construire et réaliser un projet d’insertion, tout en assurant la liaison entre différents partenaires externes de la collectivité (ex. employeurs, équipe soignante). En parallèle, au quotidien, le responsable de production assure une formation dans un métier, propose des défis à relever, ce qui contribue à restaurer l’estime de soi professionnelle des personnes, facteur clé pour l’insertion en milieu ordinaire. Les implications cliniques de cette recherche concernent le recrutement, la formation et la supervision des personnels accompagnant vers l’emploi.

EN :

Objectives Some programs have been developed in France for helping people with a psychiatric disability to get competitive employment, especially prevocational programs such as transitional social firms. However, these programs have not been studied until now. Studies on supported employment programs (evidence-based practices) conducted in other countries demonstrated that variation of work outcomes is due, among other factors, to employment specialists’ competencies. These results highlight the need for describing more specifically the work of the two professionals, employment counselors and supervisors, working in transitional social firms in order to better understand their role, tasks and competencies. Therefore, the objective of this study aims at describing the roles, tasks and competencies of these two professionals working in transitional social firms, to better understand how they support people with psychiatric disability for eventually obtaining competitive employment.

Methods A qualitative method was used to describe roles, tasks and competencies of employment counselors and supervisors working in the transitional social firms of the Messidor’s association (7 regions). In sum, 24 individual interviews with employment counselors and supervisors of these social firms as well as 7 focus groups with the two types of professionals, were conducted.

Results This study allowed to define the work of the two professionals (role and tasks) and a list of 110 competencies for employment counselors as well as 155 competencies for supervisors working in these transitional social firms, emerged from qualitative analyses. This “double support” has been defined as a complementary approach helping workers to change their own perceptions, becoming more confident in their work abilities, and thus helping them to gain competitive employment. On the one hand, the employment counselor supports each worker in developing strategies and actions to reach competitive employment, and put in place “job development skills” to coordinate his role with key stakeholders (e.g. psychiatrist, employers) involved in the work integration of people with severe mental disorders. On the other hand, the supervisor is following each worker all day long, training and helping them to overcome potential difficulties regarding the work to do, and building confidence and self-esteem in the workers under their supervision, which are all key elements to gain competitive employment.

Conclusion Clinical implications are suggested regarding the recruitment of professionals working in transitional social firms, and thus improving work outcomes for people with a severe mental illness.

FR :

La dépression majeure est l’une des premières causes d’incapacité au travail dans le monde et a de nombreuses conséquences tant sur l’employé concerné qu’auprès des acteurs du milieu de travail.

Objectif Nous visons à documenter, selon la perspective des employeurs et des cadres des ressources humaines, les stratégies que ces acteurs préconisent dans leur organisation pour faciliter le retour au travail (RaT) d’employés en absence maladie due à une dépression.

Méthode Deux cent dix-neuf employeurs et cadres de ressources humaines (n = 219) ont accepté de répondre à une entrevue semi-structurée téléphonique. La question abordée dans cet article était : « Selon vous, quelles sont les stratégies les plus efficaces pour aider un employé ayant reçu un diagnostic de dépression à retourner au travail ? » La codification du verbatim a été effectuée à partir d’études empiriques et de théories existantes.

Résultats Trente-quatre (34) stratégies réparties sur six grands principes ont émergé : 1) Contact avec l’employé en absence maladie (10 stratégies) ; 2) Évaluation et planification du RaT sans précipitation (6) ; 3) Formation des gestionnaires et du collectif de travail à la problématique de la santé mentale au travail (4) ; 4) Concertation des acteurs clés du RaT (4) ; 5) RaT progressif avec aménagements (4) ; 6) Suivi de la santé de l’employé et de son travail (6).

Conclusion Ces principes articulés autour de 34 stratégies du RaT vont au-delà d’un processus étapiste de nature chronologique. Articulés dans un programme de RaT, ils devront être testés afin d’évaluer leurs retombées dans les organisations, notamment sur la gestion de l’incapacité au travail.

EN :

Major depression is one of the leading causes of work disability across the world. In Canada, the lifetime prevalence of depression varies from 10 to 12%. Depression impacts not only the employee who is often stigmatized and can lose his professional identity, but also has consequences on colleagues and supervisors in organizations. In the literature, four models are described from which employers and managers use in their organizations to make decisions regarding the work disability of employees on sick leave: biomedical, financial management, personnel management, and organizational development. These models can also be supported by economic, legal and ethical interests. Even though these models are essential to better understand the decision of employers and HR regarding work disability, information remains scarce regarding the concrete strategies used by these stakeholders to facilitate the return to work for employees on sick leave due to depression.

Objectives the aim of this paper is to document, considering employers’ and human resources’ perspectives, the best strategies to put in place to facilitate the return to work of employees on sick leave due to depression.

Method This study was part of a larger study carried out in Canada to assess factors influencing the return to work after a depression-related sick leave, taking into account the viewpoint of four types of stakeholders: employers/human resources, supervisors, unions and people diagnosed with depression. 219 employers (68.5%) and human resources directors (31.5%) from 82.6% organizations having more than 100 employees accepted to answer a telephone semi-structured interview. The question of interest in this study is: In your opinion, what are the best strategies to help an employee who has had a depression to return to work? Coding was influenced by empirical findings and theories related to psychosocial risk factors that the authors use in their respective disciplines as well as return to work principles/steps mentioned in the literature. The main objective was to keep all the strategies mentioned by participants, and analyzing them with major principles of return to work.

Results 24 return to work strategies spread on six principles emerged: 1) Contact with the employee during his sick leave (10 strategies); 2) Evaluate and plan the return to work without precipitating it (6); 3) Training for managers and colleagues regarding mental health in the workplace (4); 4) Concertation between key return to work stakeholders (4); 5) Progressive return to work with work accommodations (4); 6) Health and work follow-up regarding the employee (6).

Conclusion These six principles including 34 strategies are usually related to the timeframe process of the return to work, though they can be implemented sometimes in parallel. This possible overlap reinforces the idea to consider the return to work as sustainable in order to prevent potential relapses and improve the performance at work. Next steps will be to systematically implement these principles and strategies in organizations in order to evaluate their impact on return to work of employees on sick leave due to depression.