Cognitive impairment as barrier to engagement in vocational services among veterans with severe mental illness

Abstract

Abstract-Vocational services (VS), particularly supported employment models, have clear advantages for assisting adults with severe mental illness (SMI) in returning to the workplace, but a majority of eligible individuals with SMI do not receive any type of VS. The reasons for nonparticipation in VS remain poorly understood, and the potential contribution of cognitive impairment as a barrier to entry has not been explored. The present study uses a pathways-to-care design to examine the specific contribution of cognitive functioning to entry into VS among veterans with SMI. We examined 179 veterans with both SMI and un-or underemployment who completed a work history, the Pathways To Care Inventory, and the Trail-Making Test, Part B. Analysis revealed that veterans with SMI and moderate to severe cognitive impairment took significantly longer to progress through pathways-to-care than those with SMI and mild or no cognitive impairment. These results suggest that identifying veterans with SMI and cognitive impairment early and providing them with integrated and adjunct services may help them navigate VS.

Veterans Health Administration vocational services for Operation Iraqi Freedom/Operation Enduring Freedom Veterans with mental health conditions

“…Interactions between TBI sequelae and psychological health conditions may contribute to a downward spiral affecting occupational functioning [18]. OIF/OEF Veterans with multiple mental health conditions, but particularly those who also have a history of TBI and associated cognitive impairments, may face more barriers to workforce participation and may be among those most likely to seek VHA vocational services [15].…”

“…However, PTSD may be an impediment to employment, even in programs emphasizing work readiness rather than competitive employment such as TWE; Resnick and Rosenheck found that Veterans with PTSD were 19 percent less likely to be employed at discharge from the program than Veterans without PTSD and concluded that supported employment, which is primarily targeted to individuals with severe mental illness, may need to be modified to meet the needs of Veterans with PTSD [14]. Cognitive impairment, common among individuals with mental health conditions, appears to make navigating the pathways to vocational services offered by VHA difficult [15]. Veterans with a psychiatric disorder and sequelae of TBI, typically seen in VHA polytrauma clinics, may be most likely to experience cognitive barriers to entering vocational services.…”

An Overview of Cognitive Remediation Therapy for People with Severe Mental Illness

“…Similarly, in bipolar disorder, cognitive deficits have been shown to be associated with reduced psychosocial function [11,12]. Cognitive impairment is an important determinant of poor engagement with vocational rehabilitation services [13] and failure to maintain job tenure [14]. Research into measures to improve cognition is therefore driven by the hope that such improvements might lead to better long-term economic as well as functional outcomes, along with greater opportunities for social inclusion.…”

Enhanced vocational rehabilitation for Veterans with mild traumatic brain injury and mental illness: Pilot study

“…[20]. It is notable that 7 Veterans (10%) were not interested in employment or vocational services, which may suggest that even if services were offered, there would be a significant minority who would not participate because of lack of interest in employment.…”

“…In fact, in a sample of more than 4,000 Army Veterans with a psychiatric diagnosis, such as depression, generalized anxiety disorder, or posttraumatic stress disorder (PTSD) and no history of mTBI, the incidence of postconcussive syndrome symptoms, including cognitive difficulties, was greater than it was for Veterans with a history of mTBI [19]. Veterans with cognitive impairment are at significantly greater risk for poor employment outcomes [10], and moderate cognitive impairment has been associated with poor engagement in vocational rehabilitation in a Veteran sample [20].…”