Improving Employment Outcomes for Persons With Severe Mental Illnesses

TLDR

Unemployment remains a major consequence of schizophrenia and other severe mental illnesses. The study evaluates whether the Individual Placement and Support model improves employment outcomes compared to standard psychosocial rehabilitation for inner‑city patients with severe mental illnesses. A randomized controlled trial with 219 inner‑city outpatients (75% chronic psychosis) assigned to IPS or standard psychosocial rehab, with assessments every six months over two years and weekly employment data collection, was conducted. Participants in the IPS program were significantly more likely to secure employment (42% vs 11%) and competitive employment (27% vs 7%), earned more cumulative hours and wages, yet both groups faced similar challenges with job retention and had no differences in time to first job or job duration.

Abstract

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.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.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.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.