Predictors of Employment Outcome for People with Psychiatric Disabilities: A Review of the Literature since the Mid '80S

Abstract

It is generally accepted that work is therapeutic and is an important part of life, filling much of an individual's time, supplying a source of income, providing a source of identity, and contributing to the physiological and psychological well-being in societies (Chan et al., 1997; Dawis, 1987; Mowbray, Bybee, Harris & McCrohan, 1995; Osipow, 1968). While work serves an important function in the life of a person, impairments in vocational ability, which include choosing, getting, and keeping a job in the community, are considered to be a central feature of mental disorders (Massel et al., 1990). Results of surveys on employment rates of persons discharged from psychiatric hospitals show that the figures for full-time competitive employment range from 20 to 30% (Anthony, Cohen, & Vitals, 1978; Anthony & Jansen, 1984; Dion & Anthony, 1987; Goldstrom & Manderscheid, 1982; Wasylenki, Goering, Lancee, Ballantyne, & Farkas, 1985). For those who are more chronically ill, the figure drops to about 15% (Unger & Anthony, 1984). Clients with severe psychiatric disabilities seem to experience more problems in adjusting to work than clients with other disabilities (McCue & Katz, 1983). Vocational rehabilitation services for psychiatric patients have, therefore, become a focus of concern among mental health professionals. As Bond (1992) pointed out, vocational rehabilitation for persons with severe mental illness was not considered important by rehabilitation centers, even as late as the early 1980's. From the mid 80's onwards, there has been a growing interest in vocational rehabilitation for psychiatric patients rising from the increasing awareness of the low employment rates of people with severe mental illness and the development of supported employment (Mueser et al., 1997). The effort by mental health professionals to design and evaluate vocational rehabilitation programs for patients suffering from psychiatric disabilities is well documented. With the awareness that employment is a normalizing experience, helping patients with psychiatric disabilities to escape from the role of dependency, returning to normal functioning becomes more important than symptom control and reduced hospitalization (Drake, 1998; Mueser et al., 1997). Mental health service providers, therefore, strive to provide consumer-centered services, to offer community-based services, to implement shared decision making, and to enhance quality of life outcomes. All of these efforts make employment the cardinal outcome measure of psychiatric rehabilitation. Knowing and accepting that employment status, which refers to whether a person is gainfully employed in the labor market, is an important outcome indicator of psychiatric rehabilitation service is not the end of our effort. Two other related questions that have frequently been addressed by both researchers and clinicians are can we predict the employment status of psychiatric patients upon discharge? and if so, how? Identification of predictive variables would tremendously help the psychiatric rehabilitation process to facilitate the employment of their clients. Clinicians could use these predictive variables as a reference when designing programs. Similarly, rehabilitation planners and managers would also gain more information about evaluating the outcome and effectiveness of psychiatric rehabilitation programs. Early Studies and Reviews Since the 1960's, there have been numerous studies on the prediction of vocational outcome for individuals with psychiatric disabilities. In a study by Hall, Smith and Shimuknas (1966), it was found that the degree of residual mental illness, marital status, and level of skill were most closely related to the post-hospital employment status of people suffering from mental illness. In another study by Griffiths (1977), work success in the community among people with mental illness is found to be unrelated to intelligence, personality, age and chronicity. …

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