A Standardized Assessment of the Work Behaviour of Psychiatric Patients

¹ Senior Lecturer in Clinical Psychology, Department of Psychological Medicine Welsh National School of Medicine, Heath Park, Cardiff, CF4 4XW

This paper describes the development of a standardized work report intended for use in assessing the behaviour of psychiatric patients in hospital workshops and clerical units. The report was developed to satisfy a number of aims, e.g. the provision of a comprehensive assessment which would identify patients' assets and difficulties, the standardization of assessment, the development of a quantitative measure which could be used to assess an individual's progress over time, and to compare individuals and groups.

The standardized work report was developed from a previous version described by Cheadle, Cushing, Drew and Morgan (1967). The previous 16 item report was, however, extended by the addition of a further 9 items. The final version was developed on the basis of a consensus of opinion by industrial supervisors and occupational therapists at the Maudsley Hospital Rehabilitation Unit.

A number of studies have investigated several aspects of the scale's usefulness. Inter-rater reliability is certainly satisfactory for group studies, though some caution is necessary in the use of the report with individuals. All correlations between judges were highly significant, and one study failed to demonstrate differences in the level of scoring between different raters. Assessments of reliability and `level' need to be repeated, however, in situations where the report is used. There was some suggestion that rater agreement improves with practice and the opportunity to discuss assessments. The retest reliability of the scale over two weeks was considered to be satisfactory.

The report is valid to the extent that it has been shown to differentiate between a group of patients who returned to gainful employment after discharge and others who became chronically unemployed. In predicting work success after discharge, the rate of misclassification was low. The report misclassified one out of 15 `failures', and two out of 13 ` successes'. A principal components analysis indicated five main dimensions of behaviour within the work report. These were tentatively identified as (1) task competence, (2) attitude to supervision and authority, (3) relationships with other patients, (4) work enthusiasm or motivation, and (5) patient confidence and initiative. The total report could now be scored in terms of the item clusters—in addition to analyses based on specific items and total score. The report has also been used to study the self-assessments of patients, and their accuracy when compared with staff ratings. The accuracy of patient assessments, and their tendency to under-or over-estimate, is related to the kind of work which they are doing, intelligence, a general tendency to `optimism' or to deny abnormal behaviours, and the length of contact with the psychiatric services.

The work satisfaction of patients was found to be unrelated to assessments of their work behaviour provided by unit staff, but was significantly associated with patients' own assessments of their behaviour.