Seizure 1992; 1: 127-l 31
Employment
among young people with epilepsy
DEIRDRE CARROLL BRAINWAVE The Irish Epilepsy Association, Dublin, Ireland Correspondence
to Deirdre Carroll, Irish Epilepsy Association, 249 Crunilin Road, Dublin 12, Ireland
The study reports the findings of a follow-up review of 38 trainees who had completed social skills training programmes run by BRAINWAVE The Irish Epilepsy Association and FAS, the state training and employment authority, during the period 1986 to 1990. The social skills programmes were aimed at young, unqualified school leavers. A total of 101 young people completed the programmes, 45 of whom had epilepsy. Of those with epilepsy, 38 were interviewed about their current employment position. On completion of the programmes 58% had found a job or gone on to further training. At the time of interview 39% were in work or training. Fifty-eight per cent were still experiencing seizures (a seizure in the last 12 months). Fifty per cent of those interviewed felt that they were being actively discriminated against because of their epilepsy. Fifty-eight per cent had made contact with the National Rehabilitation Board, the state placement service for people with a disability, but only 36% of these were in training or employment at the time of interview. Sixty-six per cent of those interviewed had found the programmes helpful in terms of increasing their self-confidence and social skills. The study points to the need for more specialized training and job placement programmes for young people with epilepsy. Key words: young people; employment; social skills; training; epilepsy.
trainees
INTRODUCTION Many young people today are experiencing difficulty in finding suitable employment. However, the difficulties facing young people with epilepsy are even more extensive and more unfair. For the young person with epilepsy, especially where that young person continues to have seizures, no matter how occasional, the prospect of finding a job is reduced even further. It was with this group of young people in mind that BRAINWAVE The Irish Epilepsy Association in conjunction with FAS, the state training and employment authority, established a pilot social skills familiarization programme in 1986. Three other programmes followed. The programmes were unique in so far as young people with epilepsy were trained with those who did not have epilepsy. All of the trainees, however, would have experienced difficulties at school and would have been assessed as lacking the interpersonal and vocational skills necessary to be effective in the job market. During the 6 month training period the 1059-1311192/020127+05
$0800/O
were assisted to develop their
social
and communication skills and to sample basic skills in art, drama, home management, woodwork, decorating and leather-work. A total of 101 trainees completed the four training programmes, 45 of whom had epilepsy. The placement rate for trainees on completion of the four programmes is shown in Table 1. Although, the placement rate in jobs and training was higher for those without epilepsy than for those with epilepsy (72% versus 60%) the overall rate was encouraging.
Table 1: Placement of trainees on completion of the four training programmes
No. of trainees trainees with without Total no. epilepsy epilepsy trainees n (%) n (%) n (%)
No. of Type of
placement Job full-time Job part-time In training No placement No information
13 2 12 19 -
(29) (4) (27) (40) -
Total
45 (100%)
24 1 15 14 2
(43) (2) (27) (25) (i,
56 (100%)
37 3 27 32 2
(37) (3) (27) (31) (2)
101 (100%)
@ 1992 Baillkre Tindall
D. Carroll
128
The programmes were discontinued in 1990. In May 1991 it was decided to undertake a follow-up study of trainees who had completed the programmes. Although the original placement rate was good it was felt to be important to learn the longer term success and duration Owing to constraints on of placements. resources and time the study was confined to those trainees with epilepsy.
METHOD Forty-five trainees had been referred to the programme because of their epilepsy. Thirtyeight of these were contacted. In 34 cases the person him/herself was interviewed by the author and in four cases information was obtained from parents. An interview schedule was devised which covered areas such as: basic demographic data, job situation, job satisfaction, and views on the training programmes. The majority of former trainees were interviewed in their own homes and were very cooperative.
RESULTS Demographic
information
Twenty-two (58%) of the former trainees were male and 16 (42%) female. All but one lived in the greater Dublin area. The majority (27, 71%) were single, five (13%) were engaged, three (8%) were married and three (8%) were unmarried mothers. The majority (27, 71%) of former trainees were aged between 20 and 25 years old, with one as old as 30. The older participants had for the most part been on the first programme in 1986. All but five (13%) lived with their parents. For some the family home was of utmost importance in providing support. It could be argued that too much family support can promote over-dependence, which was certainly the case in some instances. However, it could also be argued that in times of high unemployment for young people few could afford to undertake independent living.
Employment In 1986 it was estimated that between 50000 and 100000 people in Britain were experiencing difficulties in finding or maintaining a job
because of their epilepsy’. There are no similar figures for Ireland, but it is unlikely that they would differ radically. While the ability to earn a living is important to all young people, for young people with epilepsy it assumes a special importance. For this reason it was of great interest to find out what the former trainees had been doing since they left the programmes. For some it would have been 5 years since they completed the programme, for others only a year. Table 2 compares the current employment position of the young people with the employment position on completion of the programme. Table 2: Current occupation of young person compared with occupation on completion of training programme Current occupation
Occupation on completion of training
Type of occupation
n (%)
n (%)
Job full-time Job part-time In training Unemployed
6 1 8 23
9 1 12 16
Total
38 (100)
(16) (3) (21) (60)
(24) (3) (31) (42)
38 (100)
The current employment position has deteriorated somewhat with only six (16%) in fulltime employment and eight (21%) in training. This is not totally unexpected given the high level of unemployment for unqualified school leavers. On completion of training programmes, there is great emphasis put on placing the trainee in jobs or on further training programmes. The length of time that the person spends in their newly found job or training is often neglected. Unqualified school leavers who find jobs tend to be concentrated in the marginal sectors and occupations where labour turnover is high. Many of these, subsequently, find themselves joining their unemployed counterparts amongst the long term jobless. It has been shown recently in a report on the youth labour market in Ireland that there are no significant long term effects of training on the chances of being in work for unqualified school leavers2. Only one of those employed had a skilled trade (painter). Those in work and training were generally content with what they were doing and had good relations with their employers and fellow workers. Attendance and work performance were also good confirming a trend noticed in other research on people with epilepsy in employment3. Of the 23 (61%) who
Employment
among young people with epilepsy
were unemployed, only 10 (43%) were actively seeking work. Twenty-two (58%) of those interviewed had been in contact with the Vocational Officers of the National Rehabilitation Board, the placement service for people with a disability. Only eight (36%) of these, however, were in work or training. When contacted, the officers were aware of the difficulties facing this group and were anxious to find suitable placements for them. However, in at least three cases they were having extreme difficulty in doing so.
Epilepsy and employment All those who were interviewed had been referred to the training programmes because of their epilepsy. Epilepsy was seen as a contributory factor to their poor school performance and lack of interpersonal skills. Not all of the former trainees wished to talk about their epilepsy and their feelings were respected. Twenty-two (58%) were still experiencing seizures and it was interesting to note that two of those with intractable epilepsy (one tonicclonic and one complex partial) were amongst the six in full time work. The young person’s epilepsy was felt to be a major factor for employers as the following examples show.
Tom, 28 years old, complex partial seizures Tom is in full time, temporary employment as a filing clerk/messenger. His position is reviewed every 3 months. Tom has been told by his superior that while his work rate is good, there is some concern about sending him out on messages owing to his epilepsy. He fears that this may affect his prospects of securing permanent employment. This is worrying Tom since he is engaged to be married..
John, 27 years old, tonic-clonic
seizures
John recently applied for a place on a state training scheme. This scheme involved the renovation of the local community hall one street away from John’s home. He fulfilled all the qualifications required but was turned down on medical grounds owing to his epilepsy. John has had no seizures for over 18 months.
129
He remains at home and is upset and depressed by this decision.
Frank, 30 years o/d, tonic-clonic
seizures
Frank was placed in a training centre on completion of the programme. He has daily tonicclonic seizures. After 7 months on the training programme, it was decided that it was too dangerous for Frank to remain at the centre because of the proximity of machinery. No alternative was found for Frank. Horticulture was suggested, but Frank has no interest whatsoever in horticulture. He has been at home ever since. It is not surprising given these attitudes that people with epilepsy do not want to disclose information about their condition. People are usually willing and indeed relieved to disclose that they are sufferers, if they can be assured that they will be treated fairly3. This was also the case with many of those interviewed.
Social contacts Many of the young people spent a large proportion of their time at home and their families were often the focus point of their social life. Feelings of isolation and loneliness were further encouraged for many by their being at home all day. Psychological problems are higher in people with epilepsy: the most common being anxiety and depression. This was evident in the cases of two of the young people interviewed for whom anger and depression were making personal and family relations difficult. It was of interest that one of the benefits the former trainees felt that they had obtained from the training course was in this whole area of social contact, meeting people and increasing their confidence. Eleven (19%) found that the courses were too basic or that they did not suit them personally, but it was encouraging to see that the majority 25 (65%) found them helpful in increasing self confidence, personal and job skills. Enquiries about other trainees were often made and the desire to meet up with them expressed. One young woman mentioned how much she liked the programme, not so much for the content, but for the friendships she made. A few had kept in contact with
D. Carroll
130
people they had met on the programmes, these were the exceptions.
CONCLUSION
but
AND DISCUSSION
The size and nature of the study make it difficult to draw firm conclusions on which future policy decisions can be made. Further studies of larger numbers of people both with epilepsy, as well as comparable groups without epilepsy are needed. Nonetheless, it is possible to discuss the limitations of available services which the study highlighted and to discuss the implications of the findings for the development of future services. The three main areas of concern which emerged from the study were (a) employment, (b) training and (c) counselling. Employment The high level of unemployment (61%) is worrying. Surveys in Britain and the United States also indicate high levels of unemployment for people with epilepsy, ranging from 25% to 42%‘. It is likely that high levels of youth unemployment will continue in Ireland for some time. This will demand a high level of activity on labour market programmes catering for young people. It is expected that government policy in the future will shift towards groups facing particular difficulties in the labour market, i.e. the long term unemployed and unqualified/early school leavers. It is hoped that measures will also target young people with a disability such as epilepsy. Those surveyed, who were in work, were managing well and were keen to prove themselves in their jobs. They had a high level of motivation and a good approach to people. However, those who were unemployed had to face, in addition to the usual difficulties facing all unqualified job seekers, the problem of employers’ attitudes towards epilepsy. The attitudes of the employer as well as the attitude of the person him/herself are of crucial importance in the search for work, and must be addressed4v5.
Training Placement in training programmes always a simple matter. Vocational
was not officers
were experiencing considerable difficulty in three cases in finding suitable training programmes for young people with epilepsy. It should be remembered that the ‘difficult to place’ are a diverse group, not all of them have frequent seizures, some have not sought employment for years, others have a career of unemployment. Vocational rehabilitation programmes would need to take this into account. The small group with more problematic seizure control were lacking social maturity and would require more specialized training facilities than were available. Some might never be able to undertake open employment and would need to be employed in a sheltered capacity. Counselling The feelings of depression and frustration expressed by some of those interviewed must also give rise to concern. Anger, resentment and loss of confidence were often present. These make personal relationships extremely difficult and can have the effect of accentuating further the prejudices which people come across amongst the public and employers. The psychological consequences of epilepsy have received greater attention in recent years6,7. Such features can cause many difficulties when it comes to finding work and should be a prominent target in programmes preparing young people for work. Not all young people with epilepsy require such help but a minority do and should be assisted to explore their feelings. The ability to cope with a disability could prove a more valuable skill than particular vocational skills. One important question to emerge must be how effective were the original training programmes? Does the high level of unemployment indicate a lack of success? The initial good placement rate was encouraging but decreased over time. This would seem to be a feature of training programmes where there are positive short term benefits but no significant long term ones. However, it must also be remembered that job placement is not the sole objective. Developing confidence, social and job skills are also basic objectives. The majority (66%) of the young people interviewed felt that the programmes had helped them learn such skills and to come to terms with their epilepsy. Those who expressed dissatisfaction with the programme (20%) had, perhaps, too high
Employment
among young people with epilepsy
expectations for such a short course or were inappropriately placed in the first place. The survey findings would seem to point to the need for a more comprehensive programme of training and development for young people with epilepsy, many of whom are not being catered for under the existing rehabilitation programmes. Specialist programmes have proved extremely effective in America during the last 10 years’. Successful as these programmes may be, they are, however, costly to run and would need to be adapted to the Irish experience. REFERENCES 1. Floyd, M. A review of published studies on epilepsy and employment In: Epilepsy and Employment (Ed. J. Oxley). London, Royal Society of Medicine, 1986.
131
2. Breen, Richard. Education
Employment
and
Training
Dublin, Economic and Social Research Institute, 1991: pp. 61-70. 3. McLellan, D.L. Epilepsy and employment. Journal of the Society of Occupational Medicine 1987; 37: 94-99. 4. John, Carol and McLellen, D.L. Employer’s attitude to epilepsy. British Journal of Industrial Medicine 1988; in
the
Youth
Labour
Market.
45:713-715.
Collings, John. A. Psychosocial well-being and epilepsy: an empirical study. Epilepsia 1990; 31 (4): 418-426. 6. Betts, T.A. Depression anxiety and epilepsy. In: Epilepsy and Psychiatry (Eds E.H. Reynolds and M.R. Trimble). Edinburgh, Churchill Livingstone, 1981: pp. 60-71. 7. Dam, M. and Dam, A.M. Is there an epileptic personality? In: Aspects of Epilepsy and Psychiatry (Eds M.R. Trimble and T.B. Bolwig). Chichester, John Wiley and Sons Ltd, 1986: pp. 9-18. 8. Hauser, W.A. and Hesdorffer, D.C. Epilepsy: Frequency Causes and Consequences. Maryland, Epilepsy Foundation of America, 1990: pp. 273-296. 5.
Employment
among young people with epilepsy
DEIRDRE CARROLL BRAINWAVE The Irish Epilepsy Association, Dublin, Ireland Correspondence
to Deirdre Carroll, Irish Epilepsy Association, 249 Crunilin Road, Dublin 12, Ireland
The study reports the findings of a follow-up review of 38 trainees who had completed social skills training programmes run by BRAINWAVE The Irish Epilepsy Association and FAS, the state training and employment authority, during the period 1986 to 1990. The social skills programmes were aimed at young, unqualified school leavers. A total of 101 young people completed the programmes, 45 of whom had epilepsy. Of those with epilepsy, 38 were interviewed about their current employment position. On completion of the programmes 58% had found a job or gone on to further training. At the time of interview 39% were in work or training. Fifty-eight per cent were still experiencing seizures (a seizure in the last 12 months). Fifty per cent of those interviewed felt that they were being actively discriminated against because of their epilepsy. Fifty-eight per cent had made contact with the National Rehabilitation Board, the state placement service for people with a disability, but only 36% of these were in training or employment at the time of interview. Sixty-six per cent of those interviewed had found the programmes helpful in terms of increasing their self-confidence and social skills. The study points to the need for more specialized training and job placement programmes for young people with epilepsy. Key words: young people; employment; social skills; training; epilepsy.
trainees
INTRODUCTION Many young people today are experiencing difficulty in finding suitable employment. However, the difficulties facing young people with epilepsy are even more extensive and more unfair. For the young person with epilepsy, especially where that young person continues to have seizures, no matter how occasional, the prospect of finding a job is reduced even further. It was with this group of young people in mind that BRAINWAVE The Irish Epilepsy Association in conjunction with FAS, the state training and employment authority, established a pilot social skills familiarization programme in 1986. Three other programmes followed. The programmes were unique in so far as young people with epilepsy were trained with those who did not have epilepsy. All of the trainees, however, would have experienced difficulties at school and would have been assessed as lacking the interpersonal and vocational skills necessary to be effective in the job market. During the 6 month training period the 1059-1311192/020127+05
$0800/O
were assisted to develop their
social
and communication skills and to sample basic skills in art, drama, home management, woodwork, decorating and leather-work. A total of 101 trainees completed the four training programmes, 45 of whom had epilepsy. The placement rate for trainees on completion of the four programmes is shown in Table 1. Although, the placement rate in jobs and training was higher for those without epilepsy than for those with epilepsy (72% versus 60%) the overall rate was encouraging.
Table 1: Placement of trainees on completion of the four training programmes
No. of trainees trainees with without Total no. epilepsy epilepsy trainees n (%) n (%) n (%)
No. of Type of
placement Job full-time Job part-time In training No placement No information
13 2 12 19 -
(29) (4) (27) (40) -
Total
45 (100%)
24 1 15 14 2
(43) (2) (27) (25) (i,
56 (100%)
37 3 27 32 2
(37) (3) (27) (31) (2)
101 (100%)
@ 1992 Baillkre Tindall
D. Carroll
128
The programmes were discontinued in 1990. In May 1991 it was decided to undertake a follow-up study of trainees who had completed the programmes. Although the original placement rate was good it was felt to be important to learn the longer term success and duration Owing to constraints on of placements. resources and time the study was confined to those trainees with epilepsy.
METHOD Forty-five trainees had been referred to the programme because of their epilepsy. Thirtyeight of these were contacted. In 34 cases the person him/herself was interviewed by the author and in four cases information was obtained from parents. An interview schedule was devised which covered areas such as: basic demographic data, job situation, job satisfaction, and views on the training programmes. The majority of former trainees were interviewed in their own homes and were very cooperative.
RESULTS Demographic
information
Twenty-two (58%) of the former trainees were male and 16 (42%) female. All but one lived in the greater Dublin area. The majority (27, 71%) were single, five (13%) were engaged, three (8%) were married and three (8%) were unmarried mothers. The majority (27, 71%) of former trainees were aged between 20 and 25 years old, with one as old as 30. The older participants had for the most part been on the first programme in 1986. All but five (13%) lived with their parents. For some the family home was of utmost importance in providing support. It could be argued that too much family support can promote over-dependence, which was certainly the case in some instances. However, it could also be argued that in times of high unemployment for young people few could afford to undertake independent living.
Employment In 1986 it was estimated that between 50000 and 100000 people in Britain were experiencing difficulties in finding or maintaining a job
because of their epilepsy’. There are no similar figures for Ireland, but it is unlikely that they would differ radically. While the ability to earn a living is important to all young people, for young people with epilepsy it assumes a special importance. For this reason it was of great interest to find out what the former trainees had been doing since they left the programmes. For some it would have been 5 years since they completed the programme, for others only a year. Table 2 compares the current employment position of the young people with the employment position on completion of the programme. Table 2: Current occupation of young person compared with occupation on completion of training programme Current occupation
Occupation on completion of training
Type of occupation
n (%)
n (%)
Job full-time Job part-time In training Unemployed
6 1 8 23
9 1 12 16
Total
38 (100)
(16) (3) (21) (60)
(24) (3) (31) (42)
38 (100)
The current employment position has deteriorated somewhat with only six (16%) in fulltime employment and eight (21%) in training. This is not totally unexpected given the high level of unemployment for unqualified school leavers. On completion of training programmes, there is great emphasis put on placing the trainee in jobs or on further training programmes. The length of time that the person spends in their newly found job or training is often neglected. Unqualified school leavers who find jobs tend to be concentrated in the marginal sectors and occupations where labour turnover is high. Many of these, subsequently, find themselves joining their unemployed counterparts amongst the long term jobless. It has been shown recently in a report on the youth labour market in Ireland that there are no significant long term effects of training on the chances of being in work for unqualified school leavers2. Only one of those employed had a skilled trade (painter). Those in work and training were generally content with what they were doing and had good relations with their employers and fellow workers. Attendance and work performance were also good confirming a trend noticed in other research on people with epilepsy in employment3. Of the 23 (61%) who
Employment
among young people with epilepsy
were unemployed, only 10 (43%) were actively seeking work. Twenty-two (58%) of those interviewed had been in contact with the Vocational Officers of the National Rehabilitation Board, the placement service for people with a disability. Only eight (36%) of these, however, were in work or training. When contacted, the officers were aware of the difficulties facing this group and were anxious to find suitable placements for them. However, in at least three cases they were having extreme difficulty in doing so.
Epilepsy and employment All those who were interviewed had been referred to the training programmes because of their epilepsy. Epilepsy was seen as a contributory factor to their poor school performance and lack of interpersonal skills. Not all of the former trainees wished to talk about their epilepsy and their feelings were respected. Twenty-two (58%) were still experiencing seizures and it was interesting to note that two of those with intractable epilepsy (one tonicclonic and one complex partial) were amongst the six in full time work. The young person’s epilepsy was felt to be a major factor for employers as the following examples show.
Tom, 28 years old, complex partial seizures Tom is in full time, temporary employment as a filing clerk/messenger. His position is reviewed every 3 months. Tom has been told by his superior that while his work rate is good, there is some concern about sending him out on messages owing to his epilepsy. He fears that this may affect his prospects of securing permanent employment. This is worrying Tom since he is engaged to be married..
John, 27 years old, tonic-clonic
seizures
John recently applied for a place on a state training scheme. This scheme involved the renovation of the local community hall one street away from John’s home. He fulfilled all the qualifications required but was turned down on medical grounds owing to his epilepsy. John has had no seizures for over 18 months.
129
He remains at home and is upset and depressed by this decision.
Frank, 30 years o/d, tonic-clonic
seizures
Frank was placed in a training centre on completion of the programme. He has daily tonicclonic seizures. After 7 months on the training programme, it was decided that it was too dangerous for Frank to remain at the centre because of the proximity of machinery. No alternative was found for Frank. Horticulture was suggested, but Frank has no interest whatsoever in horticulture. He has been at home ever since. It is not surprising given these attitudes that people with epilepsy do not want to disclose information about their condition. People are usually willing and indeed relieved to disclose that they are sufferers, if they can be assured that they will be treated fairly3. This was also the case with many of those interviewed.
Social contacts Many of the young people spent a large proportion of their time at home and their families were often the focus point of their social life. Feelings of isolation and loneliness were further encouraged for many by their being at home all day. Psychological problems are higher in people with epilepsy: the most common being anxiety and depression. This was evident in the cases of two of the young people interviewed for whom anger and depression were making personal and family relations difficult. It was of interest that one of the benefits the former trainees felt that they had obtained from the training course was in this whole area of social contact, meeting people and increasing their confidence. Eleven (19%) found that the courses were too basic or that they did not suit them personally, but it was encouraging to see that the majority 25 (65%) found them helpful in increasing self confidence, personal and job skills. Enquiries about other trainees were often made and the desire to meet up with them expressed. One young woman mentioned how much she liked the programme, not so much for the content, but for the friendships she made. A few had kept in contact with
D. Carroll
130
people they had met on the programmes, these were the exceptions.
CONCLUSION
but
AND DISCUSSION
The size and nature of the study make it difficult to draw firm conclusions on which future policy decisions can be made. Further studies of larger numbers of people both with epilepsy, as well as comparable groups without epilepsy are needed. Nonetheless, it is possible to discuss the limitations of available services which the study highlighted and to discuss the implications of the findings for the development of future services. The three main areas of concern which emerged from the study were (a) employment, (b) training and (c) counselling. Employment The high level of unemployment (61%) is worrying. Surveys in Britain and the United States also indicate high levels of unemployment for people with epilepsy, ranging from 25% to 42%‘. It is likely that high levels of youth unemployment will continue in Ireland for some time. This will demand a high level of activity on labour market programmes catering for young people. It is expected that government policy in the future will shift towards groups facing particular difficulties in the labour market, i.e. the long term unemployed and unqualified/early school leavers. It is hoped that measures will also target young people with a disability such as epilepsy. Those surveyed, who were in work, were managing well and were keen to prove themselves in their jobs. They had a high level of motivation and a good approach to people. However, those who were unemployed had to face, in addition to the usual difficulties facing all unqualified job seekers, the problem of employers’ attitudes towards epilepsy. The attitudes of the employer as well as the attitude of the person him/herself are of crucial importance in the search for work, and must be addressed4v5.
Training Placement in training programmes always a simple matter. Vocational
was not officers
were experiencing considerable difficulty in three cases in finding suitable training programmes for young people with epilepsy. It should be remembered that the ‘difficult to place’ are a diverse group, not all of them have frequent seizures, some have not sought employment for years, others have a career of unemployment. Vocational rehabilitation programmes would need to take this into account. The small group with more problematic seizure control were lacking social maturity and would require more specialized training facilities than were available. Some might never be able to undertake open employment and would need to be employed in a sheltered capacity. Counselling The feelings of depression and frustration expressed by some of those interviewed must also give rise to concern. Anger, resentment and loss of confidence were often present. These make personal relationships extremely difficult and can have the effect of accentuating further the prejudices which people come across amongst the public and employers. The psychological consequences of epilepsy have received greater attention in recent years6,7. Such features can cause many difficulties when it comes to finding work and should be a prominent target in programmes preparing young people for work. Not all young people with epilepsy require such help but a minority do and should be assisted to explore their feelings. The ability to cope with a disability could prove a more valuable skill than particular vocational skills. One important question to emerge must be how effective were the original training programmes? Does the high level of unemployment indicate a lack of success? The initial good placement rate was encouraging but decreased over time. This would seem to be a feature of training programmes where there are positive short term benefits but no significant long term ones. However, it must also be remembered that job placement is not the sole objective. Developing confidence, social and job skills are also basic objectives. The majority (66%) of the young people interviewed felt that the programmes had helped them learn such skills and to come to terms with their epilepsy. Those who expressed dissatisfaction with the programme (20%) had, perhaps, too high
Employment
among young people with epilepsy
expectations for such a short course or were inappropriately placed in the first place. The survey findings would seem to point to the need for a more comprehensive programme of training and development for young people with epilepsy, many of whom are not being catered for under the existing rehabilitation programmes. Specialist programmes have proved extremely effective in America during the last 10 years’. Successful as these programmes may be, they are, however, costly to run and would need to be adapted to the Irish experience. REFERENCES 1. Floyd, M. A review of published studies on epilepsy and employment In: Epilepsy and Employment (Ed. J. Oxley). London, Royal Society of Medicine, 1986.
131
2. Breen, Richard. Education
Employment
and
Training
Dublin, Economic and Social Research Institute, 1991: pp. 61-70. 3. McLellan, D.L. Epilepsy and employment. Journal of the Society of Occupational Medicine 1987; 37: 94-99. 4. John, Carol and McLellen, D.L. Employer’s attitude to epilepsy. British Journal of Industrial Medicine 1988; in
the
Youth
Labour
Market.
45:713-715.
Collings, John. A. Psychosocial well-being and epilepsy: an empirical study. Epilepsia 1990; 31 (4): 418-426. 6. Betts, T.A. Depression anxiety and epilepsy. In: Epilepsy and Psychiatry (Eds E.H. Reynolds and M.R. Trimble). Edinburgh, Churchill Livingstone, 1981: pp. 60-71. 7. Dam, M. and Dam, A.M. Is there an epileptic personality? In: Aspects of Epilepsy and Psychiatry (Eds M.R. Trimble and T.B. Bolwig). Chichester, John Wiley and Sons Ltd, 1986: pp. 9-18. 8. Hauser, W.A. and Hesdorffer, D.C. Epilepsy: Frequency Causes and Consequences. Maryland, Epilepsy Foundation of America, 1990: pp. 273-296. 5.
