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Supported Employment Reaps Clinical and Social Benefits

Summary and Comment |
August 26, 2014

Supported Employment Reaps Clinical and Social Benefits

  1. Joel Yager, MD

Five-year results showed better outcomes for severely mentally ill patients with a supported employment program than with traditional vocational rehabilitation.

  1. Joel Yager, MD

Helping psychiatrically impaired patients achieve and maintain competitive employment can assist meaningful recovery and individual self-worth and reduce disability costs and psychiatric treatment expenses. Researchers have now reported 5-year follow-up results of a Swiss study randomizing 100 individuals with severe mental illnesses to supported employment or traditional vocational rehabilitation.

Participants had persistent impairments in role, social or independent living, and self-care; no recent substance disorder or disabling physical conditions; and significant underemployment at baseline (65% men, mean age, 34; mean hospitalizations, 1.7; moderate-serious symptoms on a standardized scale assessing function). Supported employment included individual placement and job coaching, biweekly coach contact, and monthly coach contact with work supervisors, treatment team, and others. Traditional vocational rehabilitation included prevocational training in sheltered workshops (6–12 months); employable participants then received training in competitive jobs (3–6 months).

At 5 years (data included 88% of randomized participants), supportive employment had significantly higher rates of competitive employment (≥2 weeks' work in a job paying at least minimum wage in the open labor market) than traditional vocational rehabilitation (obtained competitive employment, 65% vs. 33%; continual or almost continual competitive employment, 37% vs. 9%). Supported patients also had fewer psychiatric hospitalizations and hospital days. Supportive employment was associated with a better cost-benefit ratio, including partial independence from social benefits programs, generating more tax revenue, higher work earnings, and lower inpatient costs, despite somewhat higher program costs.

Comment

These largely encouraging results are consistent with studies in the U.S. and elsewhere showing sustained and significant benefits for supported employment programs. Helping patients with serious mental illness gain access to supported employment programs should be both a clinical and a social policy priority.

  • Disclosures for Joel Yager, MD at time of publication Grant /Research support AHRQ Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Prevention; Eating Disorders Review (Editor-in-Chief); International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry Leadership positions in professional societies American Psychiatric Association (Chair, Council of Quality Care)

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