Supported Employment for Middle-Aged and Older People with Schizophrenia

Abstract

Many middle-aged and older people with severe mental illness are interested in working or volunteering. However, very few vocational rehabilitation programs target older clients with psychiatric illness. We examined employment outcomes among 50 middle-aged and older participants with schizophrenia or schizoaffective disorder in a 12-month randomized controlled trial comparing two work rehabilitation programs: Individual Placement and Support (IPS; a supported employment model) and conventional vocational rehabilitation (CVR). Compared with CVR, IPS resulted in statistically better work outcomes, including attainment of competitive employment, number of weeks worked, and wages earned. Cohen's d effect sizes for these variables were medium to large (.66-.81). Treatment group predicted future attainment of competitive work, but demographic and clinical variables (e.g., age, gender, ethnicity, education, illness duration, and medication dose) did not predict employment outcomes. Participants who obtained competitive employment reported improved quality of life over time compared to those who did not. These findings suggest that for middle-aged and older clients with schizophrenia, supported employment results in better work outcomes than does conventional vocational rehabilitation. Furthermore, age was not significantly associated with attainment of competitive work. Finally, the therapeutic value of work is reflected in improved quality of life.Across the age spectrum, rates of paid employment among people with schizophrenia are less than 15 percent (Anthony and Blanch, 1987). With the graying of the population, the number of middle-aged and older people with these disorders is growing rapidly (Palmer et al., 2002), and like their younger counterparts, most of them are unemployed. Older people with severe mental illness are frequently assumed to be incapable of returning to work and are not actively recruited to participate in work rehabilitation programs. However, just as healthy older people are working well past traditional retirement age, many older people with schizophrenia want to work (Auslander and Jeste, 2002).Middle-aged and older work rehabilitation clients may be different from younger clients in many ways. Older clients with schizophrenia may have less severe positive symptoms, lower rates of alcohol or substance abuse, and more lifetime work experience (e.g., Jeste et al., 2003). However, compared with younger workers, they may also face unique obstacles, including greater age-associated cognitive and sensory-motor deficits, increased medical comorbidity, slower processing speed, higher rates of side effects of medications such as NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript tardive dyskinesia, longer absences from the workforce, and ageist beliefs among employers (e.g., Jeste et al., 2003;Kurtz, 2005).Supported employment has emerged as an evidence-based practice in psychiatric rehabilitation, with a number of randomized controlled trials demonstrating its effect...

Client, Contextual and Program Elements Influencing Supported Employment: A Literature Review

“…In particular, clients who had a prior work history of one or more years were more likely to benefit from SE (Cook 2007;Cook and O'Day 2006;Danley et al 1992;McGurk and Mueser 2006a;McGurk et al 2003). Clients who worked more recently were also more likely to attain competitive employment (Regenold et al 1999;Twamley et al 2008). A study that combined data from 4 RCTs found that amongst IPS clients, work history was the only significant predictor for job acquisition.…”

Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research

“…The median follow-up period was 18 months (range = 12 to 120 months). The client population varied greatly across the cohorts, including people with co-occurring disorders (Bush et al, 2009;Xie et al, 2010;McHugo et al, 2012), people early in the course of illness (Drake et al, 2013), people with severe mental illness over 45 years of age (Twamley et al, 2008), and people with significant illness-related impairments in functioning (i.e., severe mental illness) (Mueser et al, 1997;Lam and Rosenheck, 2000;Torrey et al, 2000;Bond et al, 2001;Twamley et al, 2008;Burns et al, 2009;Xie et al, 2010;Kilian et al, 2012;Kukla et al, 2012;McHugo et al, 2012). Participants were recruited from community mental health centers in the US (Mueser et al, 1997;Torrey et al, 2000;Bond et al, 2001;Twamley et al, 2008;Bush et al, 2009;Xie et al, 2010;Kukla et al, 2012;McHugo et al, 2012) and abroad (Burns et al, 2009;Kilian et al, 2012), emergency departments (Drake et al, 2013), as well as emergency shelters, outdoors, and public or abandoned buildings (Lam and Rosenheck, 2000).…”

Health and well-being of homeless veterans participating in transitional and supported employment: Six-month outcomes

“…Clinical trials have shown IPS to be associated with higher CE rates, shorter time to entering CE, greater numbers of hours worked per week, and more weeks worked per year among individuals diagnosed with SMI [13,[16][17][18][19][20][21][22][23][24][25][26] and, most recently, among veterans with posttraumatic stress disorder (PTSD) [27]. The program is most effective when fidelity to the model is high [28][29][30].…”