Improving Employment Outcomes for Persons With Severe Mental Illnesses

Anthony F. Lehman · Richard W. Goldberg · Lisa B. Dixon · Scot W. McNary · Leticia T. Postrado · Ann L. Hackman +1 more

377 citations0/0 files storedArchives of General Psychiatry

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Disability Education and Employment Schizophrenia research and treatment Employment and Welfare Studies

Abstract

BACKGROUND: Unemployment remains a major consequence of schizophrenia and other severe mental illnesses. This study assesses the effectiveness of the Individual Placement and Support model of supportive employment relative to usual psychosocial rehabilitation services for improving employment among inner-city patients with these disorders. METHODS: Two hundred nineteen outpatients with severe mental illnesses, 75% with chronic psychoses, from an inner-city catchment area were randomly assigned to either the Individual Placement and Support program or a comparison psychosocial rehabilitation program. Participants completed a battery of assessments at study enrollment and every 6 months for 2 years. Employment data, including details about each job, were collected weekly. RESULTS: Individual Placement and Support program participants were more likely than the comparison patients to work (42% vs 11%; P<.001; odds ratio, 5.58) and to be employed competitively (27% vs 7%; P<.001; odds ratio, 5.58). Employment effects were associated with significant differences in cumulative hours worked (t(211) = -5.0, P =.00000003) and wages earned (t = -5.5, P =.00000003). Among those who achieved employment, however, there were no group differences in time to first job or in number or length of jobs held. Also, both groups experienced difficulties with job retention. CONCLUSIONS: As hypothesized, the Individual Placement and Support program was more effective than the psychosocial rehabilitation program in helping patients achieve employment goals. Achieving job retention remains a challenge with both interventions.

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References

1997An update on supported employment for people with severe mental illness 1999A Randomized Clinical Trial of Supported Employment for Inner-city Patients With Severe Mental Disorders

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2009The Intricate Link Between Violence and Mental Disorder 2004Components of a modern mental health service: a pragmatic balance of community and hospital care 2005Cognitive Training and Supported Employment for Persons With Severe Mental Illness: One-Year Results From a Randomized Controlled Trial 2012Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US 2004The Hartford Study of Supported Employment for Persons With Severe Mental Illness.2003Vocational Rehabilitation in Schizophrenia and Other Psychotic Disorders 2003Cognitive and Symptom Predictors of Work Outcomes for Clients With Schizophrenia in Supported Employment 2013Supported Employment: Assessing the Evidence

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