Originally published here.

Several factors impact work productivity in employees with a psychiatric condition. Objective: In the context of social firms (SFs) the goal of this study is to test a theoretical model to predict work productivity across time, while considering worker and workplace factors. Methods: 222 people with a psychiatric disability employed in SFs were enrolled in a longitudinal study (6 month follow up) and completed the baseline battery of questionnaires on health (severity of symptoms), individual (self-esteem as a worker) and organizational factors (organizational constraints and supervisory support), and their work productivity (also measured at follow-up). Path analysis was used to test the hypothetical model, assessing individual and organizational factors in the context of social firms that could facilitate or hamper work productivity in the immediate term (T1), as well as the stability of work productivity in the middle/long term (T2 or 6 month follow up). Results: Work productivity of people with a psychiatric disability was affected negatively by severity of the symptoms, organizational constraints, and positively by self- esteem as a worker at T1. The stability of work productivity was significant across time (T2). Supervisor support was only related to work productivity at 6 month follow-up. Conclusions: The results highlight the importance of the supportive workplaces for people with mental disorders that SFs provide, and the stability of work productivity across time. Supervisor support seems to have a delayed impact on work productivity. In future studies, researchers could determine how individual and organizational variables influence job tenure of employees with a psychiatric disability.

To successfully integrate people with mental disorders in the workplace, we need to better understand factors that lead to work productivity, given its link to job tenure. Supported employment programs are currently the only evidence-based practice to help people with a psychiatric condition obtain competitive employment. However, job tenure of people with psychiatric conditions in the competitive labor market is often brief. In contrast, SFs tend to report longer job tenure and therefore offer valuable contexts in which to examine the work productivity of workers with mental disorders [15, 58–60]. Furthermore, contemporary research (e.g., [61]) has moved beyond a single-factor model (i.e., individual characteristics) in understanding the employment of people with psychiatric disabilities, favoring a more complex model of interactions involving several factors (including environmental aspects). As such, the goal of this study was to contribute to the understanding the contributions of health, individual and organizational factors to predicting work productivity in SFs. Consistent with the literature [21, 23, 24, 32, 33], our results con- firm that health (i.e., severity of clinical symptoms), individual (i.e., self-esteem as a worker) and work-place factors (i.e., organizational constraints) predictwork productivity in SFs.

As for health variables, in their meta-analysis of predictors of employment outcomes (including work productivity) for people with a severe mental illness such as bipolar disorders, Tse, Chan, Ng, & Yatham [25] mentioned that the effect size for symptom sever- ity varied from small to moderate (0.16 in absolute value), demonstrating the more severe the symptoms, the poorer the work productivity. In our study this coefficient was higher (0.38 in absolute value), proba- bly due to the fact that most of our study’s participants had a severe mental illness and had struggled in the competitive labor market. With respect to worker’s self-esteem, this vari- able was a modest but significant predictor of work productivity. In their meta-analysis, Bowling et al. [28] showed that the organization-based self-esteem (i.e., employees’ beliefs about their own values and competencies as organizational members) yielded a corrected correlation of 0.34 with work performance; a similar coefficient to our study (0.26). Our results also corroborate Krupa et al.’s study [62] suggesting that SFs provide workers with psychiatric conditions opportunities to work in a commercial venture (as opposed to a rehabilitative program), and to acquire work experience and self-confidence. Regarding organizational variables, our results indicate that organizational constraints predict work productivity, but less than severity of symptoms. In contrast, Merrill et al.’s study [32] looking into pre- dicting work productivity loss, conducted with close to 20,000 workers (without a mental illness diagnosed), found that organizational constraints (e.g., too much to do, too little time) were the strongest predictors, above and beyond individual characteris- tics and health. In our study, because of the nature of the sample, the organizational constraints are secondary to explaining work productivity.

However, to promote work productivity for people with a severe mental illness, it is also important to adapt work envi- ronments to accommodate the needs of employees across a continuum of symptom severity [21]. In this vein, work accommodations often implemented in SFs could compensate for health problems or medication side-effects [38], and thus provide a balanced and enabling work environment, in which people with a severe mental illness can evolve [33]. As in Merrill’s study [32], the cross-sectional part of our design did not indicate that current supervisor support was a significant predictor of current work productivity. However, the fit of the adjusted model improves when current supervisory support is used to predict work productivity in the long-run (6 months after). It appears that supervisor support affects work productivity, but primarily over time. Possible expla- nations related to this finding includes: 1) there is a cumulative effect of supervisory support over time, or a delayed effect, 2) the worker and the supervisor get to know each other better in a medium/long period of time, and the support is adjusted to be better tailored to the worker’s needs, or 3) other potential variables involved in the relation between supervi- sory support and work productivity could explain this result (e.g., mediators such as work accommodations). These results suggest that the supervisor plays a critical role in work productivity and the effects of the supervisor contributions are more clearly seen over the long term. They support suggestions that to improve work productivity in employees with a psychiatric condition, supervisors require time to work with employees to support them in overcoming obstacles to their productivity [40]. In their qualitative study conducted in social firms implemented in France, De Pierrefeu et al. [63] showed that immediate supervisors support workers in overcoming potential obstacles regarding their work by different means, namely by teaching how to work independently, manage emotions and perceive new challenges.

This training can result in increased worker confidence and self-esteem, which is translated into increased work productivity, as suggested by results of our study. De Pierrefeu et al. [63] identified more than 155 supervisors’ competencies working in social firms, all together representing nine conceptual categories (e.g., ensure tailored assistance for each worker, be a help reference for the worker, show hope in the worker). The results of their qualitative study support our result suggesting a delayedeffect of supervisory support. This information could be useful, not only for key actors in organizations,such as immediate supervisors working in SFs but also, those involved in the competitive labor market. The present study has some limitations. First, the study was conducted in a specific organizational context, i.e. social firms, which were developed to employ people with a psychiatric and/or physical disability. Consequently, it is difficult to generalize the study’s results to other settings. Nonetheless, most of our results were comparable or similar to those of other studies conducted with employees with or without a disability and in a variety of workplaces around the world. Second, work productivity was assessed via self- report. It would have been interesting to also obtain the supervisor’s assessment of work productivity. The Endicott work productivity measure was appropriate in the context of our study since it assesses the impact of illness on productivity at work, and most of the tools for work productivity are self-report measures [64–67]. Third, the absence of cognitive variables, such as executive functions, in the theoretical model is a shortcoming since the meta-analysis of Tse et al. [25] highlighted the importance of considering cognitive deficits (verbal memory, executive functions) when predicting employment outcomes (e.g., work productivity). Considering a large proportion of SF workers with schizophrenia are more likely to have cognitive deficits, including these variables in future studies would not only help to better understand their impact on work pro- ductivity, but also how the work environment can compensate for such deficits. Indeed, there is evidence that supported employment programs that are enhanced by providing training for cognitive functioning can be more effective than those that do not provide it [68]. Fourth, in our theoretical model, we did not include self-esteem in general but we have instead chosen to evaluate a specific type of self-esteem, related to the organizational context. As Bowling et al. [28] emphasized, this type of self-esteem is likely to be more precise and more stable across time for workers having longer work experiences. In future studies, it would be of interest to evaluate the self- esteem as a worker when they begin working at an SF as well as over time to learn more about how self- esteem changes during employments and its eventual impact on work outcomes.

Fifth, a comparison between worker productivity in firms in the competitive labor market versus social firms as well as its predictors of work productivity in the two contexts would be of interest. As Suijker-buijk et al. [7] concluded in their Cochrane review on diverse vocational rehabilitation programs (e.g., supported employment programs, social firms) dedicated to people with a psychiatric condition, trials on the effectiveness of social enterprises and other voca- tional programs are lacking. Yet, these interventions are widely used across the world. Therefore, such tri- als are warranted, particularly for comparing work productivity and job tenure across types of employment programs and firms. Sixth, to better understand the influence of the supportive behavior at T1 on work productivity evaluated at T2, it would have been interesting to measure if specific supportive supervisor behaviors took place between T1 and T2 in order to disentangle this relationship.

In conclusion, growing evidence suggests that work-related factors and organizational constraints can affect productivity [32, 40, 41, 69]. A vast body of literature reports that psychiatric symptomatology is a strong predictor of work productivity [25]. More recently, work-specific self-esteem is of interest, particularly for people with a disability and who have been unemployed for a long period of time. In the particular context of SFs, in which people with a psychiatric disability are employees, our results confirm that health, individual and organizational variables influence work productivity over time. These findings suggest that SFs have similarities with organizations in the competitive labor market since the same fac-tors have an impact on work productivity. Implicitly, this suggests that entrepreneurship in SFs can be similar to organizations in the competitive labor market[36]. More studies are warranted to better understand not only how workers’ self-esteem and supervisory support interact overtime and their mutual influence on work productivity, but also how the type of entrepreneurship in SFs can influence the implementation of work accommodations to facilitate work productivity of employees with a psychiatric condition. Furthermore, these avenues of research could determine if the variables mentioned above can influence job tenure, a crucial issue for people with a psychiatric disability.

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