The internalized stigma, self-efficacy, occupational competence and employment outcome among persons with severe mental illness under one-to-one peer support services in Taiwan.

Abstract

Background: In non-Western countries, the provision of services by peer support workers (PSWs) for individuals with severe mental illness (SMI) has increased in recent years. However, the psychological and employment outcomes for both PSWs and service users remain underexplored.

Methods: In 2018 and 2019, a 28-hour PSW training curriculum was conducted at a community rehabilitation center in eastern Taiwan. Following the training, PSWs provided one-on-one support services to service users for 1 to 1.5 h per week over eight internship sessions, with a case-load ratio of 1:2 to 1:3. Internalized stigma, self-efficacy, and occupational competence were assessed using the Internalized Stigma of Mental Illness Scale-Chinese (ISMI-C), General Self-Efficacy Scale-Chinese (GSS-C), and Traditional Chinese-Occupational Self-Assessment Scale (TC-OSA). Employment and work training data were also collected.

Results: A total of 11 PSWs and 31 service users participated in the program, with a mean age of 48.9 ± 8.8 years. More than half were female (n = 18, 58.1%), the majority lived in halfway houses (n = 27, 87.1%), and most were diagnosed with schizophrenia (n = 29, 93.1%). By the end of the program, PSWs showed a significant improvement in the TC-OSA my environment subscale score (89.1 ± 16.0 vs. 92.2 ± 13.7, df = 28, t = 1.25, p = 0.22). Among the 29 service users who completed the program, weekly income significantly increased (USD 25.7 ± 32.7 vs. USD 47.9 ± 42.6, df = 28, Z = 3.02, p < 0.01). However, no significant changes were observed in other measured outcomes for either PSWs or service users.

Conclusions: Participation in the program enhanced PSWs' ability to manage environmental challenges, while service users experienced an improvement in income following one-on-one peer support services. Future large-scale studies are needed to validate these findings. Training programs for PSWs in Taiwan could emphasize sharing experiences of overcoming stigma to enhance self-competence in community life.

Clinical trial registration: Not applicable.