Workers with severe mental illness coping with clinical symptoms: Self-directed learning of work-health balance strategies.

Introduction: Most workers with a severe mental illness (SMI) experience brief job retention, usually under 6 months. Managing their clinical symptoms to maintain employment is a constant challenge. However, little is known about the personal initiatives these workers undertake to learn to manage their clinical symptoms at work. The study presented here documented, from an emic perspective, the self-directed learning of work-health balance strategies applied in the workplace.

Methods: The study was conducted with five adults with SMI employed in the competitive labour market and six support persons. Between March 2017 and May 2018, a dataset was constructed based on 21 semi-structured interviews, eight observation sessions, and photographs taken of 15 objects used by the workers to manage their clinical symptoms. The analysis was guided by Mendez's retrospective and current temporal analysis of social processes.

Results: The workers experienced four different self-directed learning patterns (preparation, post-crisis, active self-directed learning, and identity transformation) and used five types of strategies to facilitate work-health balance: preparation for work, reassurance, validation, assertiveness, and work-rest transitions.

Conclusion: These workers with SMI, all of whom had job retention of 2 years or more in competitive employment, learned and applied work-health balance strategies. Self-directed learning was enhanced by customised pharmacological treatment, mindfulness activities, active listening by support persons and psychotherapy specific to the mental illness.