title: "Balancing on Skates on the Icy Surface of Work": a metasynthesis of work participation for persons with psychiatric disabilities.
abstract: OBJECTIVE
  To explore how persons with psychiatric disabilities experience facilitators of and barriers to participation in paid work in transitional, supported, and open employment settings, in order to provide guidance for efforts to attract and retain these persons in gainful employment as a key dimension of recovery and community life.
  
  
  METHODS
  A metasynthesis was conducted using 16 qualitative studies published between 1990 and 2011.
  
  
  RESULTS
  Ten themes, two phases, and an overarching metaphor were identified. The first five themes describe facilitators of and impediments to getting a job (getting off the bench): (1) fighting inertia; (2) taking control; (3) encouraging peers; (4) disruptions related to the illness; (5) lack of opportunities and supports. The next five themes represent facilitators of and impediments to working (skating on the ice); (6) going mainstream; (7) social cohesion; (8) clarity in role and responsibilities; (9) environmental factors; (10) managing self-disclosure. We chose as our overarching metaphor "Balancing on Skates on the Icy Surface of Work," as we view both iceskaters and workers with psychiatric disabilities as needing to achieve and maintain their balance while being "on the edge" between various extremities.
  
  
  CONCLUSIONS
  We have shown that, for persons with psychiatric disabilities to "get off the bench" and "onto the ice" of employment, they may need to be supported in finding and maintaining their balance in new situations through a combination of learning new skills and competencies (learning how to skate) while receiving in vivo assistance from empathic and knowledgeable supporters (being coached while on the ice).
authors: Department of Social Work, Volda University College, 6101, Volda, Norway, livkinn@me.com.
authors: Liv Grethe
authors: LG
authors: Kinn
authors: Helge
authors: H
authors: Holgersen
authors: Randi W
authors: RW
authors: Aas
authors: Larry
authors: L
authors: Davidson
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D004651:Employment; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation*; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D036301:Qualitative Research; D012050:Rehabilitation, Vocational; D014937:Work; D017132:Workplace
references: Psychiatr Rehabil J. 2004 Fall;28(2):157-63
references: 15605752
references: Psychiatr Rehabil J. 2007 Winter;30(3):175-81
references: 17269267
references: Work. 2009;33(4):413-25
references: 19923664
references: Can J Occup Ther. 2008 Dec;75(5):301-8
references: 19382512
references: BMJ. 2001 Jan 27;322(7280):204-8
references: 11159616
references: Curr Opin Psychiatry. 2008 Jul;21(4):362-9
references: 18520741
references: Soc Psychiatry Psychiatr Epidemiol. 2004 May;39(5):337-49
references: 15133589
references: Am J Occup Ther. 2003 May-Jun;57(3):262-72
references: 12785664
references: Community Ment Health J. 2004 Oct;40(5):465-77
references: 15529479
references: Int J Soc Psychiatry. 2005 Dec;51(4):302-16
references: 16400906
references: Psychiatr Rehabil J. 2003 Summer;27(1):3-9
references: 12967226
references: J Health Serv Res Policy. 2002 Oct;7(4):209-15
references: 12425780
references: Psychiatr Rehabil J. 2004 Summer;28(1):8-15
references: 15468631
references: Psychiatr Rehabil J. 2006 Summer;30(1):15-22
references: 16881241
references: Work. 2009;32(4):455-65
references: 19478416
references: Qual Health Res. 2003 Sep;13(7):893-904
references: 14502956
references: Work. 2003;20(3):267-76
references: 12775932
references: Work. 2004;22(3):169-82
references: 15156083
references: Psychiatr Rehabil J. 2004 Fall;28(2):150-6
references: 15605751
references: Psychiatr Rehabil J. 2008 Spring;31(4):313-7
references: 18407881
references: Psychiatr Rehabil J. 2008 Spring;31(4):280-90
references: 18407876
references: Soc Psychiatry Psychiatr Epidemiol. 2009 Nov;44(11):961-70
references: 19280083
references: Qual Health Res. 2009 Oct;19(10):1504-16
references: 19805812
references: J Adv Nurs. 2006 Feb;53(3):311-8
references: 16441536
references: Soc Sci Med. 2003 Feb;56(4):671-84
references: 12560003
references: Qual Health Res. 2004 Mar;14(3):381-95
references: 15011905
references: Psychiatr Rehabil J. 2005 Winter;28(3):267-73
references: 15690740
references: Qual Health Res. 2013 Sep;23(9):1285-92
references: 23964060
references: Can J Occup Ther. 2006 Feb;73(1):36-43
references: 16570840
references: Soc Psychiatry Psychiatr Epidemiol. 2009 May;44(5):349-60
references: 18979055
references: Psychiatr Rehabil J. 2003 Winter;26(3):232-9
references: 12653445
references: Psychiatr Rehabil J. 2009 Spring;32(4):261-8
references: 19346204
references: Can J Occup Ther. 2005 Dec;72(5):265-79
references: 16435587
references: Adm Policy Ment Health. 2010 Nov;37(6):509-19
references: 20229141
references: Disabil Rehabil. 2010;32(22):1833-46
references: 20350068
references: J Psychiatr Ment Health Nurs. 2005 Oct;12(5):565-73
references: 16164507
references: Can J Occup Ther. 2010 Dec;77(5):303-14
references: 21268512
references: Nurs Outlook. 2006 Jan-Feb;54(1):10-6
references: 16487774
references: Work. 2002;19(1):47-62
references: 12454350
references: Int Rev Psychiatry. 2010;22(2):163-72
references: 20504056
references: BMJ. 2001 May 5;322(7294):1115-7
references: 11337448