Employing People With Severe Mental Illness: Previous Work History Predicts Likelihood Of Getting A Job, UK

Main Category: Mental Health
Also Included In: Psychology / Psychiatry;  Schizophrenia
Article Date: 29 Feb 2008 - 1:00 PDT

email to a friend   printer friendly   opinions  

People with severe mental illness, such as schizophrenia, who have worked before, have fewer of their social needs met, and better relationships with their vocational workers are more likely to get a job and work for longer.

Illness remission, and faster uptake of vocational services, are also associated with working more, according to a new study published in the March 2008 issue of the British Journal of Psychiatry.

A randomized controlled trial was carried out in 6 European centres - London, Ulm-Gunzburg, Rimini, Zurich, Groningen and Sofia. It compared the individual placement and support (IPS) model of supported employment with the usual high-quality vocational rehabilitation based on the 'train and place' model.

312 patients were recruited into the study if they had psychotic illness, were aged between 18 and the local retirement age, had been ill for at least 2 years, were living in the community, had not been employed in the preceding year, and wanted to work.

Patients were followed up for 18 months, with interviews at the start of the study and then at 6, 12 and 18 months. 80.3% of the sample had schizophrenia and 60.5% were male.

It was found that the IPS services were more effective than the vocational services, with 85 IPS patients (54.5%) working for at least 1 day compared with 43 (27.6%) vocational service patients.

IPS patients worked for nearly 4 times as many hours over the 18-month follow-up period. Of those who worked, the duration of the longest-held job was twice as long for IPS patients (214 days) as for vocational service patients (108 days).

Previous work history was the only factor that predicted all aspects of employment. Those who had worked for at least 1 month in the previous 5 years were more than twice as likely to get work as those who had not. They obtained their first job more quickly, and were likely to work for more hours.

This confirms the findings of previous research. In contrast with previous studies, however, no link was found between age and employment outcomes. Nor did this study find that people with schizophrenia had worse employment outcomes that those with affective disorders, such as depression.

This is the first study to have assessed the effect of patients being in remission and found that previous work experience, and being in remission, clearly had more impact than any other patient factor. Remission did not predict whether a person would get a job, however.

A good therapeutic relationship with either the IPS worker or named vocational worker was associated with working for at least 1 day.

Having more of their social needs met at the beginning of the study made patients less likely to get a job. Being more satisfied with social and intimate relationships seems to have given them less incentive to look for work.

Similarly, having one or more service need met (need for information, transport, access to telephone and benefits) also doubled the likelihood of a patient withdrawing from the vocational service.

Satisfaction with personal or neighbourhood safety had a similar impact on job tenure, with those feeling less safe being more likely to hold on to their job for longer.

Reference

Predictors of employment for people with severe mental illness: results of an international six-centre randomised controlled trial.
Catty J, Lissouba P, White S, Becker T, Drake RE, Fioritti A, Knapp M, Lauber C, Rossler W, Tomov T, van Busschbach J, Wiersma D and Burn T, on behalf of the EQOLISE Group
British Journal of Psychiatry, 192, 224-231.

Royal College of Psychiatrists

• Additional
• References
• Citations