Background to the Research

• The ITO was founded in 1963 to provide a range of work programmes, care and vocational training for people who have mental health problems. It also sought to assist people in their rehabilitation and return to employment, and participation in the community.
  

Research Approach

• This report outlines findings from a three year study carried out to evaluate the effectiveness of ITO. The study assessed change in a cohort of new trainees in three ITO Units in Belfast, Antrim and Foyle. Participants were assessed prior to entering ITO; during a brief induction period; 6 months after the beginning of their placement and 1 year after placement. Assessment took the form of structured and semi-structured interviews.
  

Main Findings

Profile of the Sample

• Of the initial sample of 51 participants, 32 were male and 19 were female, the mean age was 37.1 years.
• Of the initial sample 32 were single, 11 were married, 3 were cohabiting, 3 were divorced and 1 was bereaved.
• In the initial sample, the majority of single people (47% of the sample) lived in the family home with their parents, whilst those who were married/cohabiting (27.5% of the sample) all lived with their partners.
• In the initial sample, the majority (52.9%) had either never been employed or had not worked during the 5 years leading up to their ITO placement. A further 11.8% had not worked during the last 3 years, however almost a third of the sample had worked during the last 2 years, and half of these had worked in the year leading up to the placement.
• In the initial sample, 20 had been given a primary diagnosis of schizophrenia, 6 with other psychosis, 11 with affective disorder - mostly depression, 5 with substance abuse and 9 with 'other' illness - including anxiety disorders, Post Traumatic Stress Disorder and neurosis.
• Only 7 of the initial sample had never been admitted to hospital, 11 had been once and 29 had been more than once.
• Of the 51 initial participants, 27 left after 6 months and a further 7 before the year had elapsed, leaving a final sample of 17.
• Data were available for 29 of the 34 leavers and showed that 20 left for negative reasons and 9 for positive reasons.
• Of the 20 that left for negative reasons, the most frequent reason given was that of poor attendance and motivation (nearly 35% ). The next most popular reason for leaving was mental health reasons (just over 24%).
• A relatively high proportion of female trainees left ITO (79% compared with 59% among males).
• Participants with depression were more likely than those in other diagnostic groups to leave, and mainly for negative reasons.
• Trainees who lived alone, and who experienced a degree of social isolation, were relatively more likely to leave ITO.
• The 9 who left for positive reasons such as entering further education, job training programmes or employment, tended to be younger, were employed relatively recently before their illness, and suffered from disorders other than schizophrenia or major depression.

The Effectiveness of ITO

• Of the final sample of 17 participants, 88.2% showed a significant improvement in the level of symptoms of mental illness during the first year of their placement.
• Participants developed wider social networks and improved perceptions of social integration, which in turn was linked to improvements in symptom levels.
• The improvement in levels of symptoms was accompanied by a decrease in the number of participants admitted to hospital and in the number of inpatient days during the first year of ITO.
• Almost all trainee interviews referred to how valuable social contact with both staff and fellow trainees had been. A small number noted that the opportunity for work and the possibility of progress to placement and employment offered a return to social status and value.
• Participation in ITO was not significantly connected to either improved self-esteem or change in causal health beliefs. Although interview data suggested trainees for whom work was important did experience a rise in self-esteem.
• Trainees' expectations of ITO varied, the most common themes were opportunities to work and return to employment; increased routine and structure and therapeutic support. Views of ITO were on the whole positive and criticisms constructive.

Recommendations

• Recent developments in assessing trainee characteristics and matching services to trainee needs and aspirations should be continued and refined. It may be possible to provide different forms of support to participants with different types of mental illness.
• Further research should be carried out to discover whether the higher leaving rate for women is a feature of ITO in general and, if this is the case, attention should be given to changing the culture of ITO.
• The introduction of workshops with the aim of improving trainees' social competence, communication skills, and self confidence should be considered.
• Thought should be given to increasing the number of younger trainees, and to the provision of activities and patterns of work which younger people would be attracted to.
• Present initiatives in developing relationships with referrers which allow more detailed recording of trainees' past histories should be consolidated.
• Emphasis on opportunities for realistic skill training and acquisition of qualifications should continue.