On the Cusp: Pathways to Employment, Education, and Disability in First-Episode Psychosis (FEP)
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Poverty is a persistent problem in serious mental illness (SMI) with adult unemployment rates consistently hovering around 80%. A psychiatric paradigm shift toward early intervention for first-episode psychosis (FEP) has shown promise in supporting employment and education in early stages of treatment, but with mixed outcomes. Theories implicate existing low SES and its associated structural barriers, social drift into disability following onset in early adulthood, and disability status with its accompanying label and stigma, in the maintenance of poverty for this population. Utilizing life course theory and considering that the developmental period before disability is established is a particularly critical intervention point for poverty prevention among this group, it is an urgent research priority to learn how young adults with FEP negotiate employment and/or education and how interventions can facilitate this process. This dissertation explored the ways in which employment, education, or disability trajectories form during the early stages of living with a FEP. Utilizing a standpoint epistemological lens, which seeks to highlight the position of the marginalized, 19 interviews were conducted with a critical case sample of young adults with lived experience of a FEP and early intervention programs to explore the key moments, messages, and structural influences that determined their trajectories towards employment, education, or disability. Results indicate that the initial life disruption from a FEP in young adulthood leads to a suspension of gainful activity, followed by a period of forward progress through overcoming their early experiences with hospitalization and medication regimes, and adjusting their self-concept after the label of psychosis. Mental health professionals sent different messages about disability or capability depending on treatment ideology, while families provided varying levels of support and encouragement based on their own SES and subsequent values. Finally, young adults who were successful in entering the labor market did so by moving into direct career pathways instead of looking for work in the secondary labor market, utilized university disability centers, and found support and direction through their involvement with the council. These conclusions have significant implications for early intervention programs, including targeting early-onset FEP, shifting employment focus to the primary labor market, promoting adjunctive peer-based support, and challenging the professional mental health discourse about disability. Implications for research include the need to better understand the pathways of FEP young adults who are not in education, employment, or training (NEET) and who face additional barriers to accessing employment programs and the labor market.