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. 2021 Aug 23;85(7):541–548. doi: 10.1177/03080226211039429

Working in disability employment: An interpretative phenomenological study of experiences of people with a diagnosis of schizophrenia

Namino Ottewell 1,✉
PMCID: PMC12033621  PMID: 40337136

Abstract

Aim

To understand how employees with schizophrenia in disability employment interpret their work experience.

Method

Nine people with schizophrenia were interviewed. Data were analysed with the interpretative phenomenological analysis.

Results

All participants regarded themselves as ‘persons with mental illness’. Some participants developed their mental illness identity by realising that working without accommodations is difficult. Although participants found working in the current company comfortable because the supervisors provided appropriate accommodations, they were dissatisfied with low salary. A proportion of the participants felt dissatisfaction with the menial work, which led to low levels of self-esteem as they viewed non-disability employment of higher value. In addition, the present study noted a difference between self-labelling and labelling by others; although participants regarded themselves as ‘persons with mental illness’, they felt reluctant to be viewed as such by others. Most of the participants wanted to work in non-disability employment in future for financial and personal reasons, such as to increase self-esteem.

Conclusion

It is imperative that benefits and other issues in disability employment for people with psychosocial disability relating to mental illness are explored more broadly in future research. Further, employers must create healthy workplaces, for all employees regardless of disability can benefit from it.

Keywords: Disability employment, mental illness, illness identity, schizophrenia, work accommodation, psychosocial disability

Background

A special employment quota for people with disabilities, known as ‘disability employment’, exists in Japan. This quota enables people with disabilities to receive work accommodations. Disability employment should be regarded as competitive rather than sheltered employment. Similar to Japan, various European countries, including Germany, France and Italy, have adopted a disability quota system. Although countries such as the United Kingdom and the United States do not employ a quota system, they use a legislative approach to prohibit discrimination against people with disabilities in job-related matters. A quota system may contribute to the individuals’ negative feelings because it may create the impression that people are employed because of the system and not because of their qualifications (Vornholt et al., 2018). However, surveys have shown that employees with disabilities are more likely to suffer various forms of discrimination in comparison to other employees in the United Kingdom despite the prohibition thereof (Fevre, 2017).

In Japan, as of 2020, the Act for Promotion of Employment of Persons with Disabilities prescribes that companies with 45.5 or more employees (part-time workers are counted as 0.5 persons) should comprise 2.2% of employees with disabilities, including mental illness. In principle, only people holding disability certificates are included in the statutory employment rate. Disability certificates come in three types, namely, physical disability certificate, intellectual disability certificate and mental illness certificate. When applying for a certificate, one should be medically diagnosed by a doctor. Afterwards, one applies for a certificate from the municipality of residence, and the municipality decides whether to issue a certificate. The benefits of having a certificate include tax reductions and ability to apply for work in disability employment.

Since 2004, in the companies with 45.5 or more employees, the number of employees with disabilities has been increasing with 253,000 and 535,000 employees in 2004 and 2018, respectively. In addition, the proportion that persons with mental illnesses occupy in relation to the number of employees with disabilities has been increasing from 0.7% in 2006 to 14% in 2019 (MoHLW, 2019a). Moreover, the ratio of people with mental illness has recently been the highest of all new applications and new employment of people with disabilities (2015–2018), which accounts for approximately 50% of the total (MoHLW, 2019b). Although these employees with mental illness are unlikely to experience acute symptoms in the workplace, they may experience psychosocial disability, namely, difficulties in performing everyday tasks because of their impairments.

While the label ‘persons with mentally illness’ and accepting it has positive effects such as one’s seeking treatment and it can also foster interpersonal understanding (Pasman, 2011), acceptance of the label also has many detrimental effects, including low levels of self-esteem and hope and high risks of suicidal behaviours (Yanos et al., 2010a, 2020). The existing research also described the work experience of people with mental illness, revealing that employment is regarded as a positive experience due to the merits, such as recovery of self-esteem and financial independence (Saunders and Nedelec, 2014). Working also aids in the recovery of those who suffer from mental illness (Leufstadius et al., 2009). Recovery includes not only clinical improvement but also a person’s rights to self-determination and inclusion in community life despite continuing to suffer from mental illness (Davidson and Roe, 2007). Crucial recovery factors include connection to supportive people and communities, being hopeful about the future and discovering meaning in life and responsibility (Leamy et al., 2011).

As previously mentioned, whereas the acceptance of the label ‘mental illness’ often affects individuals negatively, working experience is beneficial for them. In Japan, individuals with mental illness are required to hold mental illness certificates, a label for ‘persons with mental illness’, to work in disability employment. However, studies that investigated the influence of working on persons with such a label are lacking. Considering that many studies observed the negative impacts of the label ‘mentally illness’ (Yanos et al., 2010a, 2020), investigating the influence of working with the label on persons with mental illness is imperative. To bridge the research gap, the present study, therefore, aims to understand the interpretation of people with psychosocial disability relating to schizophrenia of work experience in disability employment.

Methods

Study design

An interpretative phenomenological study design was employed to explore personal experiences in depth. This design complements the interpretative endeavour of the study because humans are sense-making organisms. This type of study is idiographic in its commitment to examining the detailed experience of each participant (Smith and Osborn, 2015).

The present study employed an unstructured interview to collect in-depth data on the experience of people with mental illness from their perspectives. An unstructured interview is more flexible than a structured or semi-structured interview and provides direct experience with participants (Willson, 2014), which is suitable for the objective of the study.

Recruitment

The study recruited participants through three organisations, namely, Semui (a non-profit organisation which conducts surveys and interviews with people with disabilities with its 1900 registrants) and two private companies, which were introduced to the researcher by the staff of a public agency related to disability employment. In Semui’s recruitment, the participants, who saw advertisements for registration in magazines for people with disabilities and registered with Semui, were selected. The criteria for inclusion in the study were set as follows:

  1. Received a diagnosis of schizophrenia.

  2. Holding a certificate for mental illness.

  3. Working in disability employment for 6 months or more.

The criterion diagnosis of schizophrenia was selected among other forms of mental illnesses as people with schizophrenia occupy the highest proportion (31.2%) of workers with mental illness in Japan (MoHLW, 2019c).

The exclusion criteria were set as follows:

  1. Currently experiencing hallucination and/or delusion.

  2. Having dementia or cognitive impairment caused by brain injury.

  3. Having drug or alcohol-related dependence problems.

In the recruitment through Semui, an invitation email was sent to potential participants from the registry. People interested in participating were redirected to the person in charge at Semui. In the recruitment through the two companies, the supervisors provided the staff who met the inclusion criteria with a copy of the email, and staff willing to participate was instructed to inform the supervisors.

Participants

Nine individuals agreed to participate in the study, out of which seven were recruited through Semui, with the remaining two through the two companies. Characteristics of the participants are shown in Table 1. There are two types of broad working environments in disability employment: first, companies where the majority of employees have disability certificates, and second, companies where most employees do not have disability certificates and those who do are in the minority. All the participants were working in companies where most of the employees are certificate holders for physical or intellectual disability as well as mental illness. The participants were engaged in clerical, cooking, cleaning, sewing or web design work. They had a long history of illness and needed support or accommodations with regard to employment. Of concrete examples participants described as their mental health problems, hearing voices and delusion were most frequently mentioned.

Table 1.

Characteristics of participants.

Female Male
Gender 6 3
 Age (years)
 26–35 4 0
 36–45 1 3
 46–55 1 0
 Working hours
 Full-time 3 2
 Part-time 3 1
 Average length of use of mental health service 14.6 years
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Interview

All interviews were one-to-one and face-to-face. Interview schedule was as follows:

  1. Please tell me about your current work.

  2. Please tell me about the circumstances where you first received mental health care.

  3. Please tell me how you came to apply for a certificate for mental illness.

As per the norm in unstructured interviews, the number of pre-planned questions was as small as possible, and the participants were encouraged to express their views freely. The researcher asked follow-up questions depending on a participant’s responses, such as ‘What do you think about your current work?’ and ‘Could you tell me how you felt when you applied for a mental illness certificate?’ All the interviews, conducted by the author, were recorded with the participants’ agreement. The interviews lasted between 38 and 91 min; on average, 69 min.

Data analysis

Recorded interview data were transcribed verbatim. Data were analysed with interpretative phenomenological analysis (IPA) (Smith et al., 2009), which is a qualitative research approach for exploring how people make sense of their experiences. IPA has three characteristics, namely, (1) phenomenological, (2) interpretative and (3) idiographic approaches. IPA typically employs a small number (1–6 people) of relatively homogeneous samples (e.g. people who are diagnosed with the same illness) because this approach focuses on understanding particular phenomena in targeted contexts.

IPA does not have stand-alone integrity in terms of data analysis. However, Smith et al. provided an in-depth description of the analytical methods used by the creators of IPA (Smith et al., 2009). Thus, the present study used these methods (Figure 1). The phenomenological approach requires an understanding of participants’ experiences from their perspective. Accordingly, in the initial stage of analysis, the author immersed herself in recorded and transcribed data. This involved listening to and reading each participant’s data at least five times. The author also produced a detailed set of comments on the data to understand each participant’s perspective. IPA adopts an interpretative approach, the purpose of which is to move beyond a simple description of the data towards the analyst’s interpretation. The author included her interpretation and questions on the data when writing comments. The notes and comments also included findings on the similarities and differences between each case. This is in line with an idiographic approach, which requires a detailed examination of each case. The comments were reviewed and reflected on, and codes and themes were generated accordingly. The analytical methods for these approaches were based on Smith et al.’s (2009) work.

Figure 1.

Figure 1.

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Data analysis process.

To verify the validity of data analysis, two researchers reviewed whether superordinate themes are grounded on the transcribed data. Themes were revised or added anew where necessary by the author according to the researchers’ comments.

Results

The study identified five superordinate themes, namely, ‘disability/illness identity’, ‘external causes of illness/disability identity’, ‘internal causes of illness/disability identity’, ‘perceived benefits and issues with disability employment’ and ‘living with mental illness’, which will be described in detail below. Participants’ names have been altered to protect their privacy.

Disability/illness identity

The statements of participants demonstrated that they regarded themselves as ‘persons with mental illness/psychosocial disability’. The study uses the word ‘disability/illness identity’ to refer to the participants’ acceptance of the label ‘persons with mental illness’ (Yanos et al., 2010a). Participants’ statements also reflected their work identity, namely, the meanings attached to the self by the individual and others in a work domain (Miscenko and Day, 2015), which is noted throughout the description of the superordinate themes.

During the interview, the participants called themselves ‘syôgaisya’ in Japanese, which means ‘persons with disabilities’. This is probably because people with mental health issues are called ‘seishin syôgaisya’, which means ‘persons with psychosocial disability’ in Japanese. Despite this perception, they also regarded themselves as ‘persons with mental illness’. They used the words ‘syôgai’ (‘disability’) and ‘byôki’ (‘illness’) interchangeably. For instance, Momo uses these words interchangeably when relating how she joined the current company as follows.

‘This is the first time in my life that I disclosed my psychosocial disability when applying for a job. … I’d been working before (joining the current company) without telling anyone about my illness, but it didn’t last, as my illness often recurred. … Then, I thought it might be a good idea to work at a company where people understand my disability, so I applied’.

The participants’ disability/illness identity was also observed in the manner that they distinguished themselves from persons without disabilities/illnesses. For example, Masa describes one of the difficulties he has experienced in the workplace as follows:

‘It’s hard to get my bosses’ understanding of my illness and disability. Because they are disability/illness-free people (kenjyôsya) … I find it most difficult to tell my position of living with an illness to these people, who may never have had an illness.’

As Masa did, several participants also used the word ‘kenjyôsya’ to distinguish themselves from those without disabilities/illnesses. For the participants, ‘kenjyôsya’ pertains to people without disabilities/illnesses and/or not holding disability certificates.

External causes of illness/disability identity

External causes for participants’ development of their disability/illness identity include the following: psychiatric diagnosis, medication, disability certificate and work environment.

The majority of participants came to regard themselves as ‘persons with mental illness’ due to their psychiatric diagnosis. For several participants, the psychiatric label was a shock, while it was a relief for other participants as the label helped them to understand the causes for their symptoms and experiences. For several participants, the needs for psychiatric medication also played an important role in developing disability/illness identity. The participants’ logic is that they are ‘persons with mental illness’ because living without psychiatric medication, which is intended for persons with mental illness, is difficult for them.

The possession of disability certificates also exerted influence on the participants’ identity. Karen, for example, says ‘I think I must live as a person with disability as long as I have this certificate’. Although the certificate enables people to work in disability employment, it is important that the employers know their disability; thus, the certificate does not accord them confidentiality. This may also have contributed to participants’ illness identity.

For some participants, the special work environment in their company also influenced their identity. Their company environment is special in the sense that the majority of employees hold disability certificates and certain work accommodations are provided. For example, Karen opted to work in disability employment after finding difficulty in continuing to work in a company where she concealed her disability/illness. After joining the current company, she received the accommodations she requested. She states that she ‘was determined to live as a person with disability as I work in this company’. When asked whether she felt this determination before joining the current company, she answered, ‘I did, but not as much as I do now. Since I started working in disability employment, my determination (to live as a person with disability) became stronger’. She used the term kakugo (translated into the word determination in English), which is a strong Japanese word meaning ‘the determination to carry a burden on one’s shoulders regardless of how heavy it is’. The reason why she developed disability identity by working in disability employment is that she became aware of the fact that working without accommodations is difficult.

Internal causes of illness/disability identity

Internal causes, which pertain to the participants’ thoughts and perceptions, include two themes, namely, perception about their ability to work and perception about their health. These themes are related, that is, participants think that it is difficult to work without accommodations because of poor health caused by mental illness. Hana, for example, had previously worked in the parent company of the current company where she worked at the time of her interview. She was particularly busy in the parent company and frequently worked until midnight, which she believes led to poor health. Although she continued to work for several years in the parent company, she ended up taking a leave of absence for 6 months as her conditions deteriorated. She informed HR that continuing to work in the same department would be difficult. Thus, she was transferred accordingly to the current company. She currently works comfortably in the current company, receiving accommodations. She states that although she does not deny her desire to work again at the parent company, she imagines that ‘... if I returned to the parent company, I wouldn’t be able to stand the load of work and pressure, and my symptoms would appear again’.

Perceived benefits and issues with disability employment

In the participants’ workplaces, employees’ health was given the highest priority. In general, the participants were satisfied with their work environment as they received the necessary accommodations. The most common accommodations received were flexible/reduced working hours and modified work duties. The majority of the participants felt that their supervisors were understanding and supportive.

Several participants who worked in general employment (non-disability employment is termed general employment to distinguish it from disability employment in Japan) compared their experiences with the current employment. In their perceptions, receiving accommodations in general employment was difficult. For example, Nina says, ‘... it’s easier to continue to work in disability employment. The majority of staff is disability/illness-free in general employment, so they don’t understand my illness. I’ve been sacked before because I fell so ill at work (in general employment)’.

However, Kazu expresses dissatisfaction with the current work and its environment. Although he originally worked full-time in the current company, the supervisors decided to reduce his working hours to part-time (as an accommodation) after he fell mentally and physically ill. He currently works part-time and claims that the supervisors underestimate his work ability, saying ‘I think I can work full-time’. In addition, he is not allowed to work in the desired department because ‘there is no job for a person working only 3 hours a day like me in the department’. Kazu is considering transferring to another company.

Although many participants valued their current working environment, they felt dissatisfaction with the low salary. For instance, Hana says:

‘The salary is completely different (from general employment). It’s whether you’d (choose to work in general employment and) put up with poor health to some extent and prioritise your financial aspects or (choose to work in disability employment) to prioritise a healthy working life even if you’d reduce your standard of living. It’s up to you. The salary is the biggest problem (with working in disability employment)’.

In terms of work content, the participants described it as basic and less demanding. Assignment to relatively simple work was one of the accommodations for them because complicated work with heavy responsibility is deemed to induce stress and thus exacerbate their illness. Approximately half of the participants enjoyed work, whereas the others considered work extremely easy and wanted to engage in more complex and difficult work. Specifically, the latter participants wanted to engage in the same level of work in general employment. These participants, however, found themselves in a conflicting situation. Although they wanted the contents of work to be similar to that in general employment, they felt unable to work in general employment because no accommodations will be provided. Several participants felt that their current work was not decent, socially desirable work, with one of the reasons being the extreme easiness of the current work contents. Several participants viewed disability employment of low value, which led to low self-esteem.

Living with mental illness

Superordinate theme 5 has three sub-themes; ‘reluctance in living with mental illness’, ‘acceptance of living with mental illness’ and ‘reluctance in being viewed as a person with mental illness’. This superordinate theme includes aspects related to the future as well as the present.

Four participants wanted to completely recover from their illness (to be illness-free). However, they were uncertain about whether they will be able to recover. Two participants also wanted to recover and believed that they will do so in future. Compared with the four abovementioned participants, the two participants were younger (twenties) and displayed a stronger sense of self-care. A probable reason for their belief in recovery is that the duration of their illness is relatively short and because they adapted personal strategies for addressing their problems, including non-medical methods, by conducting in-depth research on their illness. In contrast, the four participants tended to believe what the doctors said, including their explanation about schizophrenia and opinions about recovery (some participants were told that they would not recover), and were less enthusiastic about discovering their illness in an independent manner. For the four participants, the long duration of their illness was one of the reasons for their uncertainty regarding recovery.

The remaining three participants, alternatively, accepted living with mental illness for the rest of their lives. Although they did not believe that they would recover, their symptoms, which were severe and hindered them from working, have been rendered manageable with medication. They did not necessarily want to be illness-free but hoped that other people would learn from their experiences.

However, the majority of participants, including those who have accepted living with mental illness, felt uncomfortable with being viewed as ‘persons with mental illness’ by others. They were ashamed of their illness and did not want other people to be aware of such a status. The participants anticipated that people would become condescending towards them upon the revelation of mental illness.

This superordinate theme also includes the participants’ thoughts about their future regarding work. Five participants wanted to work in general employment (again) in future. In addition to financial reasons (increased income), they stated other reasons such as high levels of confidence and self-esteem, trust and respect from others. Ken, for example, wanted to work in general employment for the following reasons:

‘I want to be confident in myself. I will have high level of social trust if I can work in general employment. If I can work in general employment … my self-esteem will increase’.

This statement suggests that his current work is related to low levels of confidence and self-esteem compared with his (hypothetical) future work in general employment.

Three other participants wanted to work in general employment (again), but were uncertain about such a possibility because of age (they admitted that they are not very young), persistent problems, such as delusion, or inexperience of working in general employment. Similar to the five abovementioned participants, the three participants cited internal reasons in addition to financial ones regarding their desire to work in general employment. Momo, for instance, states, ‘I want to show to kenjyôsya (disability/illness-free people) that even a person with disability like me can work hard’.

The participants’ statements suggest that general employment is more desirable and socially reliable, which in turn suggest that disability employment can lead to low levels of recognition of themselves. The reason for this notion may be because work is relatively simple and salary is low in disability employment. Given their awareness of prejudice against persons with mental illness, another possibility is that the participants may find difficulty in feeling proud of themselves for engaging in work for ‘persons with mental illness’.

Discussion

Benefits of work accommodations in disability employment

The majority of participants worked comfortably, receiving accommodations. This is one of the positive aspects in disability employment. In other words, the label ‘persons with mental illness’ rendered it possible for participants to work in a health-first environment, where employees’ health was prioritised. The existing research pointed to a relationship between receiving work accommodations and longer job tenure (Chow et al., 2014), whereas shorter job tenure is one of the issues for people with mental illness (NIVR, 2017). Research has demonstrated that health-oriented leadership positively influences the psychological health of subordinates (e.g. low levels of depression and stress), regardless of whether subordinates have disabilities (Stuber et al., 2020). This signifies that a leader’s consideration of and engagement with employees’ health benefits all employees, not just those with disabilities.

Issues with disability employment

The participants expressed dissatisfaction towards the low salary. In disability employment, the average salary is lower than that in general employment. The average monthly wage of full-time workers with mental illness is 189,000 yen (MoHLW, 2019c), which is significantly lower than the average monthly wage of full-time workers at 306,200 yen (MoHLW, 2019d). The participants recognised the low salary as an aspect to be borne with working in disability employment.

The study also revealed that the work environment (i.e. disability-only employment where certain accommodations are provided) could lead to finding difficulty in working without accommodations, which developed their illness identity. This may be regarded as one of the less favourable aspects in disability employment, considering the detrimental effects of accepting the label ‘persons with mental illness’ (Yanos et al., 2010a, 2020). However, employees with disabilities in general employment may experience different issues, including the difficulties in receiving accommodations.

Recovery, social model of disability and labelling

Recent studies demonstrated the importance of constructing a positive identity in which individuals refuse adopting pejorative images of mental illness and embrace living with illness experiences (Elraz, 2018), for recovery (Leamy et al., 2011). If the work environment can contribute to identity formation, as this study showed, then it should be improved to enable employees with mental illness construct a positive identity. For example, programmes that aim to eliminate the stigma on mental illness can be implemented at work, which have proven to be effective for improving the knowledge and supportive behaviour of other employees (Hanisch et al., 2016).

The findings also suggest that the current employment could lead to less favourable results in several participants, such as low levels of confidence and self-esteem. Self-stigma, the internalised negative views of mental illness (Corrigan and Rao, 2012), has proven to be related to low levels of self-esteem (Livingston and Boyd, 2010) and also lower levels of improvement in vocational functioning (Yanos et al., 2010b). The participants may have internalised negative views of disability employment and given themselves low evaluations, which is an aspect of the social model of disability (Goering, 2015). Although working is beneficial for people with mental illness in various ways, such as association with higher quality of life (Connell et al., 2012), the findings illustrate that working in disability employment can hinder such benefits.

The study also observed a difference between the influence of self-labelling, which is individuals’ perception that their experiences are part of their mental illness (Thoits, 1985) and that of others’ labelling. The participants regarded themselves as persons with mental illness. Some participants valued this label because it enabled them to understand their issues and to receive support. The label worked as a positive ‘badge’ for them (Shakespeare, 2014). However, some participants did not want to suffer the stigma attached to this label. They disliked what Shakespeare called ‘identity spread’ (p. 95), where people’s individuality can be ignored, and thus their illness label becomes the most prominent feature of their life. Their disliking reflected stigma against mental illness, particularly schizophrenia, which is more stigmatised than other mental illnesses (Griffiths et al., 2006). The shame that some participants felt suggests that their awareness of stigma led to self-stigma.

In this study, although some participants wanted to recover, they were unsure about recovery because their doctors had told them that they would not recover. A systematic review found that mental health service users felt hopeless when they were told that their condition was permanent. Offering realistic messages of hope, which has proven to yield a more constructive experience for service users, is preferable when disclosing a diagnosis to service users (Perkins et al., 2018).

Recommendations for practice

It is imperative to assign appropriate work to employees with mental illness. Some participants suffered negative psychological effects because of inappropriately easy work. Notably, the problem is that the work was too easy for them because work that is simple does not necessarily affect every person with mental illness negatively. While research shows the importance of providing meaningful work to people with mental illness (Provencher et al., 2002), meaningful work is not the same for every person. Therefore, it is not recommended that all employees with mental illness are provided with the same accommodations. Rather, each employee’s values and interests must be considered when assigning work to them.

If some individuals with mental illness want to engage in complex tasks but find it difficult to do so consistently, job sharing may be a possible solution. This particular work accommodation for employees with mental illness allows them to perceive their work as less stressful (NIVR, 2003). Job sharing may also provide a more flexible accommodation to address episodic mental illness by allowing the choice of full-time or part-time work, depending on individuals’ symptom levels.

It is also essential to eliminate stigma towards mental illness to ensure that people with mental illness do not suffer disadvantages when disclosing psychiatric diagnoses and accordingly receive proper accommodations at work, be it in disability or non-disability employment. Research has shown that face-to-face contact has a significant effect on changing stigma towards mental illness (Corrigan et al., 2012). Employers can offer employee education programmes that are effective to reduce stigma (Dobson et al., 2019).

Strengths and limitations of the study and recommendations for further research

This study showed that work environment and content can affect employees’ identity and self-esteem, which requires further investigation to enhance the understanding on the influence of the work environment and content on people with mental illness. This study also showed the importance of examining the benefits and issues in disability employment from participants’ perspectives. This study’s limitation is that because the sample is small, its findings cannot be generalised. Therefore, it is recommended that a larger sample be employed in future research. Further, this study’s participants worked in a disability-only environment. Because there are many employees with mental illness who work in general employment, future research needs to examine such employees’ experiences to determine similarities and differences between different environments.

Conclusion

Working in disability employment has both benefits and problems for people with schizophrenia, including the ease of receiving accommodations, low salaries and low self-esteem. Employers must create a healthy working environment for people with disabilities, which should encompass working to eliminate stigma against disabilities in the workplace and providing flexible accommodations. Notably, this will benefit all employees and not only those with disabilities.

Key findings

  • Working in disability employment has both benefits and issues, including receiving needed accommodations and low salary.

  • Work environments and content can affect identity and self-esteem of people with schizophrenia negatively.

What the study has added

This study contributes to understanding the meaning of work experience in disability employment and the influence of work environment on employees with mental illness.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: This work was supported by the Japan Society for the Promotion of Science, Ministry of Education, Culture, Sports, Science and Technology (KAKENHI Grant Number 19K13903).

Research ethics: The research study was conducted after receiving ethics approval from the institution to which the author belonged (IKEN-20191; granted in August 2019).

Patient and public involvement statement: Participants were included in the conduct of the research.

Consent: All the participants provided written informed consent to be interviewed for this study.

ORCID iD

Namino Ottewell https://orcid.org/0000-0002-8580-7377

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