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Okoroji C, Ibison Y, Robotham D. Employment support for Black people with long-term health conditions: a systematic narrative review of UK studies. J Ment Health 2024; 33:274-281. [PMID: 36899443 DOI: 10.1080/09638237.2023.2182410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/02/2022] [Indexed: 03/12/2023]
Abstract
BACKGROUND Black people in the United Kingdom disproportionately acquire long-term health conditions and are marginalised from the labour market compared with other groups. These conditions interact and reinforce high rates of unemployment among Black people with long-term health conditions. AIMS To examine the efficacy, and experience, of employment support interventions in meeting the needs of Black service users in Britain. METHODS A systematic literature search was conducted focusing on peer-reviewed literature featuring samples drawn from the United Kingdom. RESULTS The literature search revealed a paucity of articles that include analysis of Black people's outcomes or experiences. Six articles met the selection criteria of the review, of which five focused on mental health impairments. No firm conclusions could be drawn from the systematic review; however, the evidence suggests that Black people are less likely than their White counterparts to secure competitive employment and that Individual Placement and Support (IPS) may be less effective for Black participants. CONCLUSIONS We argue for a greater focus on ethnic differences in employment support outcomes with an emphasis on how such services may remediate racial differences in employment outcomes. We conclude by foregrounding how structural racism may explain the dearth of empirical evidence in this review.
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Affiliation(s)
- Celestin Okoroji
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
- Black Thrive, London, UK
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Noteboom Y, van Nassau F, Bosma AR, van der Hijden EJE, Huysmans MA, Anema JR. A roadmap for sustainable implementation of vocational rehabilitation for people with mental disorders and its outcomes: a qualitative evaluation. Int J Ment Health Syst 2024; 18:7. [PMID: 38341601 DOI: 10.1186/s13033-023-00620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/11/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND People suffering from mental health disorders have lower work participation compared to people without mental challenges. To increase work participation within this group vocational rehabilitation interventions are often offered. Collaboration between the mental health care and social security sectors is needed to enable professionals to perform optimally when carrying out these interventions. Yet, regulatory and financial barriers often hinder sustainable implementation. To overcome these barriers an experimental roadmap for sustainable funding based on a shared savings strategy was piloted in four regions. The aim of the present qualitative study was to gain understanding of the uses of this roadmap and the factors that were important in the experiment's process. METHOD The roadmap consisted of five steps based upon insights from shared savings strategies and implementation science knowledge, and was initiated by a national steering board. The roadmap aimed to make sustainable funding agreements (based on shared savings) for the implementation of a vocational rehabilitation intervention. In four regions, stakeholders from the mental health care and social security services sector followed the roadmap. We conducted interviews (n = 16) with involved participants and project leaders of the experiment and collected 54 sets of field notes and documents to evaluate the roadmap process. A thematic analysis was used to analyse the data. RESULTS Regions perceived improved stakeholder collaboration around vocational rehabilitation after they were guided by the roadmap. Three regions made, or intended to make, agreements on collaboration and funding, yet not based on shared savings. Moreover, going through the roadmap took more time than anticipated. Stakeholder collaboration depended on factors like personal and organizational interests and collaboration conditions and values. Financial legislation and politics were regarded as barriers and personal motives were mentioned as a facilitator in this process. CONCLUSIONS Our study showed that the roadmap supported stakeholders to establish a more sustainable collaboration, even though no sustainable financial agreements were made yet. Although participants acknowledged the function of financial insights and the need for financial resources, the driver for collaboration was found to be more on improving clients' perspectives than on solving unfair financial distribution issues. This suggests modifying the focus of the roadmap from financial benefits to improving clients' perspectives.
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Affiliation(s)
- Yvonne Noteboom
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Femke van Nassau
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Astrid R Bosma
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Eric J E van der Hijden
- Faculteit Der Sociale Wetenschappen, Talma Institute Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Maaike A Huysmans
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Johannes R Anema
- Amsterdam UMC, Department of Public and Occupational Health, Room C379, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Marsden J, Anders P, Shaw C, Amasiatu C, Collate W, Eastwood B, Horgan P, Khetani M, Knight J, Knight S, Melaugh A, Clark H, Stannard J. Superiority and cost-effectiveness of Individual Placement and Support versus standard employment support for people with alcohol and drug dependence: a pragmatic, parallel-group, open-label, multicentre, randomised, controlled, phase 3 trial. EClinicalMedicine 2024; 68:102400. [PMID: 38299044 PMCID: PMC10828604 DOI: 10.1016/j.eclinm.2023.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
Background Individual Placement and Support (IPS) is a specialist intervention to help people attain employment in the open competitive labour market. IPS has been developed in severe mental illness and other disabilities, but it is of unknown effectiveness for people with alcohol and drug dependence. The Individual Placement and Support-Alcohol and Drug (IPS-AD) is the first superiority trial to evaluate effectiveness and cost-effectiveness. Methods IPS-AD was a pragmatic, parallel-group, multi-centre, randomised, controlled, phase 3 trial of standard employment support (treatment-as-usual [TAU]) versus IPS. IPS was offered as a single episode for up to 13 months. The study was done at seven community treatment centres for alcohol and drug dependence in England. Study participants were adults (18-65 years), who had been enrolled for at least 14 days in treatment for alcohol use disorder (AUD), opioid use disorder (OUD), or another drug use disorder (DUD; mostly cannabis and stimulants); were unemployed or economically inactive for at least six months; and wished to attain employment in the open competitive labour market. After random allocation to study interventions, the primary outcome was employment during 18-months of follow-up, analysed by mixed-effects logistic regression, using multiple imputation for the management of missing outcome data. There were two cost-effectiveness outcomes: a health outcome expressed as a quality adjusted life year (QALY) using £30,000 and £70,000 willingness-to-pay [WTP] thresholds; and additional days of employment, with a WTP threshold of £200 per day worked. The study was registered with ISRCTN (ISRCTN24159790) and is completed. Findings Between 8 May 2018 and 30 September 2019, 2781 potentially eligible patients were identified. 812 were excluded before screening, and 1720 participants were randomly allocated to TAU or IPS. In error, nine participants were randomised to study interventions on two occasions-so data for their first randomisation was analysed (modified intention-to-treat). A further 24 participants withdrew consent for all data to be used (full-analysis set therefore 1687 participants [70.1% male; mean age 40.8 years]; TAU, n = 844; IPS, n = 843 [AUD, n = 610; OUD, n = 837; DUD, n = 240]). Standard employment support was received by 559 [66.2%] of 844 participants in the TAU group. IPS was received by 804 [95.37%] of 843 participants in the IPS group. IPS was associated with an increase in attainment of employment compared with TAU (adjusted odds ratio [OR] 1.29; 95% CI 1.02-1.64; p-value 0.036). IPS was effective for the AUD and DUD groups (OR 1.48; 95% CI 1.14-1.92; p-value 0.004; OR 1.45, 95% CI 1.03-2.04, p-value 0.031, respectively), but not the OUD group. IPS returned an incremental QALY outcome gain of 0.01 (range 0.003-0.02) per participant with no evidence of cost-effectiveness at either WTP threshold-but QALY gains were cost-effective for the AUD and DUD groups at the £70,000 WTP threshold (probability 0.52 and 0.97, respectively). IPS was cost-effective for additional days of employment (probability 0.61), with effectiveness relating to the AUD group only (probability >0.99). Serious Adverse Events were reported by 39 participants (13 [1.5%] of 844 participants in the TAU group and 23 [2.7%] of 43 participants in the IPS group). There was a total of 25 deaths (1.5%; 9 in the TAU group and 16 in the IPS group)-none judged related to study interventions. Interpretation In this first superiority randomised controlled trial of IPS in alcohol and drug dependence, IPS helped more people attain employment in the open competitive labour market than standard employment support. IPS was cost-effective for a QALY health outcome (£70,000 WTP threshold) for the AUD and DUD groups, and for additional days of employment for the AUD group (£200 per day worked WTP threshold). Funding UK government Work and Health Unit.
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Affiliation(s)
- John Marsden
- Addictions Department, School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Paul Anders
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Claire Shaw
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Chioma Amasiatu
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Winnie Collate
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Brian Eastwood
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Patrick Horgan
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Meetal Khetani
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Jonathan Knight
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Sandy Knight
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Alexandra Melaugh
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Helen Clark
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
| | - Jez Stannard
- Department of Health and Social Care, Addiction and Inclusion, Office for Health Improvement and Disparities, United Kingdom
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Hug N, Imfeld L, Holinger B, Jäckel D, Huber CG, Nienaber A. Work-related participation impairments and support needs of patients in a Swiss psychiatric university hospital. Front Psychiatry 2024; 14:1232148. [PMID: 38239903 PMCID: PMC10794531 DOI: 10.3389/fpsyt.2023.1232148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024] Open
Abstract
Objective To assess work-related participation impairments and support needs of adult patients in inpatient and day-care treatment at a Swiss psychiatric university hospital. Methodology Cross-sectional survey on a department-dependent cut-off date in May and June 2022 using a standardized structured interview. Results Data were available for 93 patients (response rate 59%), of which 51% (n = 47) stated that they had a job or training place. Patients in first hospitalization and with a job or training place were approached significantly more often. Regardless of age and first hospitalization, 76% of the patients expressed a need for support, of which 92% expressed interest in job coaching. A total of 54% of the patients stated that they had received support from the treatment team. Conclusion From the patients' point of view, work and education were not addressed by the treatment team across the board and independently of patient characteristics. The need for support was insufficiently met. There is a considerable interest for support programs through job coaching, and this offers opportunities to promote the inclusion of patients in the regular labor market.
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Affiliation(s)
- Niki Hug
- Department of Education, Research and Practice Development, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
| | - Lukas Imfeld
- Department of Education, Research and Practice Development, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
| | - Benjamin Holinger
- Department of Education, Research and Practice Development, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
| | - Dorothea Jäckel
- Vivantes Klinikum am Urban, Charité Klinik für Psychiatrie, Berlin, Germany
| | - Christian G. Huber
- Department of Education, Research and Practice Development, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
| | - André Nienaber
- Department of Education, Research and Practice Development, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
- Zentralinstitut für Seelische Gesundheit (ZI) Mannheim, Mannheim, Germany
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Johanson S, Gregersen Oestergaard L, Bejerholm U, Nygren C, van Tulder M, Zingmark M. Cost-effectiveness of occupational therapy return-to-work interventions for people with mental health disorders: A systematic review. Scand J Occup Ther 2023; 30:1339-1356. [PMID: 37119175 DOI: 10.1080/11038128.2023.2200576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/03/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Return-to-work (RTW) resources for persons with mental health disorders are limited and costs are typically shared by several stakeholders in society. Occupational therapists (OT) provide RTW interventions for this target group, however, increased knowledge of health, and employment effects, as well as costs are needed to better inform decision makers in their prioritisations. AIMS/OBJECTIVES To identify and summarise evidence of cost-effectiveness of RTW interventions for persons with mental health disorders which OTs provide. MATERIALS AND METHODS A systematic search was applied and resulted in 358 articles. After screening, nine articles met inclusion criteria and were reviewed. Quality assessment was conducted using the economic evaluation tool by Joanna Briggs Institute. RESULTS Supported employment, Individual Placement and Support was cost-effective in several contexts while three studies showed larger effects and higher costs. An OT intervention added to treatment for major depression was indicated to be cost-beneficial and an advanced supported employment was cost-saving. The methodological quality varied considerably between studies. CONCLUSIONS AND SIGNIFICANCE The results of the included studies are promising, however, to further strengthen the economic perspective in OT RTW interventions, the need for conducting more and methodologically robust economic evaluations is crucial in future studies.
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Affiliation(s)
- Suzanne Johanson
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Health Sciences/Centre for Evidence Based Psychosocial Interventions (CEPI), Lund University, Lund, Sweden
| | - Lisa Gregersen Oestergaard
- DEFACTUM Central Denmark Region, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ulrika Bejerholm
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Health Sciences/Centre for Evidence Based Psychosocial Interventions (CEPI), Lund University, Lund, Sweden
| | - Carita Nygren
- Swedish Association of Occupational Therapists, Nacka, Sweden
| | - Maurits van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije University, Amsterdam, The Netherlands
| | - Magnus Zingmark
- Department of Health Sciences, Lund University, Lund, Sweden
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden
- Epidemiology and Public Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Burdorf A, Fernandes RCP, Robroek SJW. Health and inclusive labour force participation. Lancet 2023; 402:1382-1392. [PMID: 37838443 DOI: 10.1016/s0140-6736(23)00868-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 02/02/2023] [Accepted: 04/27/2023] [Indexed: 10/16/2023]
Abstract
The future of work is rapidly changing, with higher flexibility of the labour market and increasing informal employment in many countries worldwide. There is also an increased pressure to extend working careers until older age. We introduce the concept of working life expectancy as a useful metric, capturing the expected numer of years in paid employment across the working age individuals, in particular among different groups. We describe factors that determine working life expectancy. Macro-level factors focus on the socioeconomic and political context that influences labour force participation, primarily policies and legislation in specific countries. At the meso level, employment contracts and working conditions are important. The micro level shows that individual characteristics, such as education, gender, and age, influence working careers. There are three important groups with a disadvantaged position in the labour market-workers with chronic diseases, workers with impairing disabilities, and workers aged 50 years or more. Within each of these disadvantaged groups, macro-level, meso-level, and micro-level factors that influence entering and exiting paid employment are discussed. To assure that paid employment is available for everyone of working age and that work contributes to better health, specific challenges need to be addressed at the macro, meso, and micro levels. To reach inclusive labour force participation, national policies, company practices, and workplace improvements need to be aligned to ensure safe and healthy workplaces that contribute to the health and wellbeing of workers and their communities.
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Affiliation(s)
- Alex Burdorf
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - Rita C P Fernandes
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Bahia, Brazil
| | - Suzan J W Robroek
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
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Mavindidze E, Nhunzvi C, Van Niekerk L. Supported employment interventions for workplace mental health of persons with mental disabilities in low-to-middle income countries: A scoping review. PLoS One 2023; 18:e0291869. [PMID: 37733732 PMCID: PMC10513264 DOI: 10.1371/journal.pone.0291869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE To review the evidence of supported employment interventions in low-to-middle income countries, documents their impact for persons with mental disorders in the open labour market and well as support decision making for its wider implementation in the workplace. DESIGN The scoping review is conducted following guidelines in the Arksey and O'Malley (2005) Framework. DATA SOURCES AND ELIGIBILITY Eleven databases which are PubMed, Scopus, Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX, Open Grey and Sabinet were searched for articles published between January 2006 and January 2022. Both peer-reviewed articles and grey literature were eligible if they were on supported employment interventions in low-to-middle income countries. Only articles published in English were included. STUDY APPRAISAL AND SYNTHESIS Articles were screened at title, abstract and full article levels by two independent teams with the use of Rayyan software. Deductive thematic analysis was used to synthesize evidence on the supported employment interventions implemented in LMICs, capturing evidence of their outcomes for persons with mental disabilities securing competitive work. RESULTS The search yielded 7347 records and after screening by title and abstract, 188 studies were eligible for full article screening. Eight studies were included in this scoping review. Thematic descriptions of the findings were based on the availability of supported employment interventions within the context, the type of supported employment interventions as well as mental health and vocational outcomes in the workplace. CONCLUSIONS There is limited evidence of supported employment interventions in low-to-middle income countries despite the promising potential it has as an intervention to address mental health problems in the workplace and facilitate work participation by persons with mental disabilities.
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Affiliation(s)
- Edwin Mavindidze
- Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, Occupational Therapy Programme, Rehabilitation Sciences Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Clement Nhunzvi
- Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, Occupational Therapy Programme, Rehabilitation Sciences Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Lana Van Niekerk
- Faculty of Medicine and Health Sciences, Division of Occupational Therapy, Stellenbosch University, Cape Town, Western Cape, South Africa
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Drake RE, Bond GR. Individual placement and support: History, current status, and future directions. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e122. [PMID: 38867819 PMCID: PMC11114326 DOI: 10.1002/pcn5.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 06/14/2024]
Abstract
Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.
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Affiliation(s)
- Robert E. Drake
- Department of PsychiatryColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
- Westat CorporationRockvilleMarylandUSA
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Orme S, Zarkin GA, Luckey J, Dunlap LJ, Novak MD, Holtyn AF, Toegel F, Silverman K. Cost and cost-effectiveness of abstinence contingent wage supplements. Drug Alcohol Depend 2023; 244:109754. [PMID: 36638680 PMCID: PMC10207811 DOI: 10.1016/j.drugalcdep.2022.109754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substance use disorders are correlated with unemployment and poverty. However, few interventions aim to improve substance use, unemployment, and, distally, poverty. The Abstinence-Contingent Wage Supplement (ACWS) randomized controlled trial combined a therapeutic workplace with abstinence-contingent wage supplements to address substance use and unemployment. The ACWS study found that abstinence-contingent wage supplements increased the percentage of participants who had negative drug tests, who were employed, and who were above the poverty line during the intervention period. This study presents the cost of ACWS and calculates the cost-effectiveness of ACWS compared with usual care. METHODS To calculate the cost and cost-effectiveness of ACWS, we used activity-based costing methods to cost the intervention and calculated the costs from the provider and healthcare sector perspective. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves for negative drug tests and employment. RESULTS ACWS cost $11,310 per participant over the 12-month intervention period. Total intervention and healthcare costs per participant over the intervention period were $20,625 for usual care and $30,686 for ACWS. At the end of the intervention period an additional participant with a negative drug test cost $1437 while an additional participant employed cost $915. CONCLUSIONS ACWS increases drug abstinence and employment and may be cost-effective at the end of the 12-month intervention period if decision makers are willing to pay the incremental cost associated with the intervention.
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Affiliation(s)
- Stephen Orme
- RTI International, Research Triangle Park, NC, United States.
| | - Gary A Zarkin
- RTI International, Research Triangle Park, NC, United States
| | - Jackson Luckey
- RTI International, Research Triangle Park, NC, United States
| | - Laura J Dunlap
- RTI International, Research Triangle Park, NC, United States
| | - Matthew D Novak
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - August F Holtyn
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Forrest Toegel
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kenneth Silverman
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
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10
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Ma BH, Badji S, Petrie D, Llewellyn G, Chen G. Social interventions to support people with disability: A systematic review of economic evaluation studies. PLoS One 2023; 18:e0278930. [PMID: 36662789 PMCID: PMC9858707 DOI: 10.1371/journal.pone.0278930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/23/2022] [Indexed: 01/21/2023] Open
Abstract
Social interventions are essential in supporting the health and well-being of people with disability, but there is a critical need to prioritise resources for those that provide the best value for money. Economic evaluation is a widely used tool to assist priority setting when resources are scarce. However, the scope and consistency of economic evaluation evidence for disability social services are unclear, making it hard to compare across interventions to guide funding decisions. This systematic review aims to summarise the current evidence in the economic evaluation of social services for people with disability and to critically compare the methodologies used in conducting the economic evaluations with a focus on the outcomes and costs. We searched seven databases for relevant studies published from January 2005 to October 2021. Data were extracted on study characteristics such as costs, outcomes, perspectives, time horizons and intervention types. Overall, economic evaluation evidence of social services for people with disability was scarce. Twenty-four economic evaluations were included, with the majority conducting a cost-effectiveness analysis (n = 16). Most interventions focused on employment (n = 10), followed by community support and independent living (n = 6). Around 40% of the studies addressed people with mental illnesses (n = 10). The evidence was mixed on whether the interventions were cost-effective but the methods used were highly variable, which made comparisons across studies very difficult. More economic evidence on the value of interventions is needed as well as a more standardised and transparent approach for future research.
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Affiliation(s)
- Bernice Hua Ma
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
- Centre for Research Excellence in Disability and Health, Parkville, Victoria, Australia
| | - Samia Badji
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
- Centre for Research Excellence in Disability and Health, Parkville, Victoria, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
- Centre for Research Excellence in Disability and Health, Parkville, Victoria, Australia
| | - Gwynnyth Llewellyn
- Centre for Research Excellence in Disability and Health, Parkville, Victoria, Australia
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
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11
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Jordan N, Stroupe KT, Richman J, Pogoda TK, Cao L, Kertesz S, Kyriakides TC, Bond GR, Davis LL. Comparing Service Use and Costs of Individual Placement and Support With Usual Vocational Services for Veterans With PTSD. Psychiatr Serv 2022; 73:1109-1116. [PMID: 35538744 DOI: 10.1176/appi.ps.202100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Among veterans with posttraumatic stress disorder (PTSD), supported employment that utilizes the individual placement and support (IPS) model has resulted in consistently better employment and functional outcomes than usual vocational rehabilitation services. This study aimed to compare these two approaches in terms of health services use and associated costs. METHODS A secondary analysis of a multisite randomized controlled trial of 541 unemployed veterans with PTSD used archival data from electronic medical records to assess the use and costs of health services of IPS and usual care (i.e., a transitional work [TW] program) over 18 months. Comparisons were also made to an 18-month postintervention period. RESULTS The two study groups did not differ in number of inpatient days or in utilization or cost of high-intensity services. Annual per-person costs of health services were approximately 20% higher for IPS than for TW participants (mean difference=$4,910 per person per year, p<0.05) during the intervention period, largely driven by higher utilization and costs for vocational services in the IPS group (p<0.001). These costs declined postintervention to nonsignificant differences. The mean annual per-person vocational service cost was $6,388 for IPS and $2,549 for TW (mean difference=$3,839, p<0.001) during the intervention period. CONCLUSIONS In keeping with IPS’s intensive case management approach, veterans receiving IPS used more vocational services and had correspondingly higher costs than veterans receiving TW. The two groups did not differ in use or cost of other types of health services. Future research should examine whether higher short-term costs associated with IPS relative to usual care result in long-term cost savings or higher quality of life for persons with PTSD.
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Affiliation(s)
- Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Joshua Richman
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Terri K Pogoda
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Stefan Kertesz
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Tassos C Kyriakides
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Gary R Bond
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
| | - Lori L Davis
- Center of Innovation for Complex Chronic Healthcare, Hines U.S. Department of Veterans Affairs (VA) Hospital, Hines, Illinois (Jordan, Stroupe, Cao); Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago (Jordan); Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois (Stroupe); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, and Boston University School of Public Health, Boston (Pogoda); Birmingham VA Research Service (Richman), Birmingham VA Medical Center, Birmingham, Alabama (Kertesz); Department of Surgery (Richman), Department of Medicine (Kertesz), and Department of Psychiatry and Behavioral Neurobiology (Davis), University of Alabama School of Medicine, Birmingham; VA West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut (Kyriakides); Westat, Lebanon, New Hampshire (Bond); Research Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama (Davis)
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12
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Martinelli A, Bonetto C, Bonora F, Cristofalo D, Killaspy H, Ruggeri M. Supported employment for people with severe mental illness: a pilot study of an Italian social enterprise with a special ingredient. BMC Psychiatry 2022; 22:296. [PMID: 35473634 PMCID: PMC9040313 DOI: 10.1186/s12888-022-03881-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND People with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the 'social enterprise' (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users. METHODS This is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE-on average 5 years before the study recruitment, and at the study recruitment-year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,-year 2016; 1 year before the recruitment - year 2017; and at the recruitment-year 2018. An assessment at the recruitment time-year 2018, of SE users' satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time-year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done. RESULTS At the recruitment time - year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE-when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time - year 2016, to good ones at the recruitment time - year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement. CONCLUSIONS SE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI.
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Affiliation(s)
- Alessandra Martinelli
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy ,grid.419422.8Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni, 4, 25125 Brescia, BS Italy
| | - Chiara Bonetto
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Federica Bonora
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Doriana Cristofalo
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Helen Killaspy
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. .,Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy.
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13
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Zheng K, Stern BZ, Wafford QE, Kohli-Lynch CN. Trial-Based Economic Evaluations of Supported Employment for Adults with Severe Mental Illness: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:440-452. [PMID: 35037105 DOI: 10.1007/s10488-021-01174-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
To identify, appraise, and summarize outcomes reported in trial-based economic evaluations of Individual Placement and Support programs for adults with severe mental illness. Six databases were searched, including Medline, PsycINFO, CINAHL, Cochrane, Scopus, and EconLit. Inclusion criteria were trial-based, full economic evaluations comparing Individual Placement and Support programs to traditional vocational rehabilitation programs for adults 18 years and older with severe mental illness. Study quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement. Of the 476 articles identified in the database search, seven were included in the review. Studies conducted across Europe (n = 4) and Japan (n = 1) suggested that Individual Placement and Support may be a cost-effective alternative to traditional vocational rehabilitation programs. Two studies conducted in the United States demonstrated that Individual Placement and Support led to better vocational outcomes, but at neutral or higher costs than traditional vocational rehabilitation, depending on the benefit measure used. Trial-based economic evaluations of supported employment for adults with severe mental illness are limited and heterogeneous. The interpretation of economic outcomes warrants consideration of factors that may impact cost-effectiveness, such as geographical location. Future studies should evaluate whether the benefits of IPS outweigh additional costs for patients and other stakeholders.
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Affiliation(s)
- Katherine Zheng
- Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St, 20th Floor, Chicago, IL, 60611, USA.
| | - Brocha Z Stern
- Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St, 20th Floor, Chicago, IL, 60611, USA
| | - Q Eileen Wafford
- Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St, 20th Floor, Chicago, IL, 60611, USA
| | - Ciaran N Kohli-Lynch
- Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair St, 20th Floor, Chicago, IL, 60611, USA
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14
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Sanches SA, Feenstra TL, Swildens WE, van Busschbach JT, van Weeghel J, van Asselt TDI. Cost Effectiveness and Budget Impact of the Boston University Approach to Psychiatric Rehabilitation for Increasing the Social Participation of Individuals With Severe Mental Illnesses. Front Psychiatry 2022; 13:880482. [PMID: 35722578 PMCID: PMC9199888 DOI: 10.3389/fpsyt.2022.880482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. METHOD In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n = 90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. RESULTS Total costs per participant at 12-month follow-up were € 12,886 in BPR and € 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to €190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. CONCLUSIONS This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.
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Affiliation(s)
- Sarita A Sanches
- Altrecht Institute for Mental Health Care, Utrecht, Netherlands.,Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands.,Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg, Netherlands
| | - Talitha L Feenstra
- University of Groningen, University Medical Center, Department of Epidemiology, Groningen, Netherlands.,University of Groningen, Groningen Research Institute of Pharmacy, Groningen, Netherlands.,Center for Nutrition, Prevention, and Health Services Research, Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Wilma E Swildens
- Altrecht Institute for Mental Health Care, Utrecht, Netherlands.,Inholland University of Applied Sciences, Amsterdam, Netherlands
| | - Jooske T van Busschbach
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Rob Giel Research Center, Groningen, Netherlands.,Windesheim University of Applied Sciences, School of Human Movement and Education, Zwolle, Netherlands
| | - Jaap van Weeghel
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands.,Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Thea D I van Asselt
- University of Groningen, Groningen Research Institute of Pharmacy, Groningen, Netherlands.,University of Groningen, University Medical Center, Department of Health Sciences, Groningen, Netherlands
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15
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Park AL, Rinaldi M, Brinchmann B, Killackey E, Aars NAP, Mykletun A, McDaid D. Economic analyses of supported employment programmes for people with mental health conditions: A systematic review. Eur Psychiatry 2022; 65:e51. [PMID: 35983840 PMCID: PMC9491084 DOI: 10.1192/j.eurpsy.2022.2309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract
Background
Employment is intrinsic to recovery from mental health conditions, helping people live independently. Systematic reviews indicate supported employment (SE) focused on competitive employment, including individual placement and support (IPS), is effective in helping people with mental health conditions into work. Evidence is limited on cost-effectiveness. We comprehensively reviewed evidence on the economic case for SE/IPS programmes.
Methods
We searched PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, IBSS, Business Source Complete, and EconLit for economic and return on investment analyses of SE/IPS programmes for mental health conditions. Traditional vocational rehabilitation, sheltered work, and return to work initiatives after sickness absence of less than 1 year were excluded. Studies were independently screened by two reviewers. We assessed quality using the Consolidate Health Economic Evaluation Reporting Standards checklist. The protocol was preregistered with PROSPERO-CRD42020184359.
Results
From 40,015 references, 28 studies examined the economic case for IPS, four IPS augmented by another intervention, and 24 other forms of SE. Studies were very heterogenous, quality was variable. Of 41 studies with quality scores over 50%, 10 reported cost per quality-adjusted life year gained, (8 favourable to SE/IPS), 14 net monetary benefits (12 positive), 5 return on investment (4 positive), and 20 cost per employment outcome (14 favorable, 5 inconclusive, 1 negative). Totally, 24 of these 41 studies had monetary benefits that more than outweighed the additional costs of SE/IPS programmes.
Conclusions
There is a strong economic case for the implementation of SE/IPS programmes. The economic case is conservative as evidence on long-term impacts of programmes is limited.
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Weld-Blundell I, Shields M, Devine A, Dickinson H, Kavanagh A, Marck C. Vocational Interventions to Improve Employment Participation of People with Psychosocial Disability, Autism and/or Intellectual Disability: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212083. [PMID: 34831840 PMCID: PMC8618542 DOI: 10.3390/ijerph182212083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/16/2022]
Abstract
Objective: To systematically review interventions aimed at improving employment participation of people with psychosocial disability, autism, and intellectual disability. Methods: We searched MEDLINE, Embase, PsycINFO, Web of Science, Scopus, CINAHL, ERIC, and ERC for studies published from 2010 to July 2020. Randomized controlled trials (RCTs) of interventions aimed at increasing participation in open/competitive or non-competitive employment were eligible for inclusion. We included studies with adults with psychosocial disability autism and/or intellectual disability. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias II Tool. Data were qualitatively synthesized. Our review was registered with PROSPERO (CRD42020219192). Results: We included 26 RCTs: 23 targeted people with psychosocial disabilities (n = 2465), 3 included people with autism (n = 214), and none included people with intellectual disability. Risk of bias was high in 8 studies, moderate for 18, and low for none. There was evidence for a beneficial effect of Individual Placement and Support compared to control conditions in 10/11 studies. Among young adults with autism, there was some evidence for the benefit of Project SEARCH and ASD supports on open employment. Discussion: Gaps in the availability of high-quality evidence remain, undermining comparability and investment decisions in vocational interventions. Future studies should focus on improving quality and consistent measurement, especially for interventions targeting people with autism and/or intellectual disability.
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Affiliation(s)
- Isabelle Weld-Blundell
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
| | - Marissa Shields
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
| | - Alexandra Devine
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
- Correspondence:
| | - Helen Dickinson
- School of Business, University of New South Wales, Canberra 2610, Australia;
| | - Anne Kavanagh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
| | - Claudia Marck
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
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17
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Stroupe KT, Jordan N, Richman J, Bond GR, Pogoda TK, Cao L, Kertesz SG, Kyriakides TC, Davis LL. Cost-Effectiveness of Individual Placement and Support Compared to Transitional Work Program for Veterans with Post-traumatic Stress Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:429-439. [PMID: 34677786 DOI: 10.1007/s10488-021-01173-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) leads to significant disability, unemployment, and substantial healthcare costs. The cost-effectiveness of vocational rehabilitation (VR) interventions is important to consider when determining which services to offer. This study assesses the cost-effectiveness and return on investment of Individual Placement and Support (IPS) compared to transitional work (TW) programs. Employment outcomes from a multisite randomized trial comparing IPS to TW in military veterans with PTSD (n = 541) were linked to Veterans Health Administration (VHA) archival medical record databases to examine the comparative cost-effectiveness and return on investment. Effectiveness was defined as hours worked and income earned in competitive jobs. Costs for VR, mental health, and medical care and income earned from competitive sources were annualized and adjusted to 2019 US dollars. The annualized mean cost per person of outpatient (including vocational services) were $3970 higher for IPS compared to TW ($23,245 vs. $19,276, respectively; P = 0.004). When TW income was included in costs, mean grand total costs per person per year were similar between groups ($29,828 IPS vs. $26,772 TW; P = 0.17). The incremental cost-effectiveness analysis showed that while IPS is more costly, it is also more effective. The return on investment (excluding TW income) was 32.9% for IPS ($9762 mean income/$29,691 mean total costs) and 29.6% for TW ($7326 mean income/$24,781 mean total costs). IPS significantly improves employment outcomes for individuals with PTSD with negligible increase in healthcare costs and yields very good return on investment compared to non-IPS VR services.
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Affiliation(s)
- Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA. .,Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua Richman
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
| | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Building 9, Office 218, 150 South Huntington Avenue (152M), Boston, MA, 02130, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 South 5th Ave (151H), Hines, IL, 60141, USA
| | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA.,Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Tassos C Kyriakides
- West Haven Cooperative Studies Program Coordinating Center, VA Connecticut Health Care System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Lori L Davis
- Research and Development Service, Tuscaloosa VA Medical Center-Psychiatry, 3701 Loop Rd, Tuscaloosa, AL, 35404, USA.,Department of Psychiatry and Behavioral Neurobiology, University of Alabama School of Medicine, Birmingham, AL, USA
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Drake RE, Bond GR. Psychiatric Crisis Care and the More is Less Paradox. Community Ment Health J 2021; 57:1230-1236. [PMID: 33993362 PMCID: PMC8123092 DOI: 10.1007/s10597-021-00829-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/17/2021] [Indexed: 10/24/2022]
Abstract
Psychiatric crisis care in the U.S. exemplifies the "more is less paradox" of U.S. health care. We spend more for health care than any other high-income country, yet our outcomes are typically poor compared to these other countries (OECD in OECD health statistics. Retrieved from https://www.oced.org/health/health-data.html , 2020). We do this, in part, by emphasizing medical treatments for problems that are inherently social, rather than addressing social determinants of health. Medical interventions for socio-economic problems are usually expensive and ineffective. For mental health crisis care, adding unfunded, untested, medical interventions to the current mélange of poorly funded, disorganized arrangements will not help. Instead, the U.S. should address social determinants, emphasize research-based interventions, and emphasize prevention-proven strategies that decrease costs and improve outcomes.
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Affiliation(s)
- Robert E Drake
- Westat, IPS Employment Center, 85 Mechanic Street, Lebanon, NH, 03766, USA.
| | - Gary R Bond
- Westat, IPS Employment Center, 85 Mechanic Street, Lebanon, NH, 03766, USA
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19
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Hellström L, Kruse M, Christensen TN, Trap Wolf R, Eplov LF. Cost-effectiveness analysis of a supported employment intervention for people with mood and anxiety disorders in Denmark - the IPS-MA intervention. Nord J Psychiatry 2021; 75:389-396. [PMID: 33559510 DOI: 10.1080/08039488.2021.1877348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We aimed to investigate the cost-utility and cost-effectiveness of a modified Individual Placement and Support intervention for people with mood and anxiety disorders (IPS-MA). METHODS Costs were assessed from a societal perspective. Health care costs were derived from registers and combined with data on use of IPS-MA services, municipal social care, and labour market services. EQ-5D was used to compute QALY. Missing data were imputed in a sensitivity analysis. We also computed the cost per gain in hours worked. Incremental cost-effectiveness ratios (ICER) were computed and bootstrapped to obtain confidence intervals for QALY and gain in hours worked. RESULTS We found no difference in overall costs between groups. A significant saving was found in use of labour market services in the IPS-MA group. But the IPS-MA group had significantly lower wage earnings compared to the control group. The intervention group had a higher, though statistically in-significant, increase in QALYs than the control group. The ICER did not show statistically significant results, but there was a tendency, that IPS-MA could have a positive effect on health-related quality of life without any additional costs. However, participants in the IPS-MA group had a significantly lower gain in hours worked compared to the control group. CONCLUSIONS Despite a significant saving in use of labour market services, IPS-MA was not cost-effective. Participants in the IPS-MA group worked significantly fewer hours and earned significantly less than participants in the control group at 1-year follow-up.
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Affiliation(s)
- Lone Hellström
- CORE: Copenhagen Research Center for Mental Health, Mental health Centre Copenhagen, Hellerup, Denmark
| | - Marie Kruse
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | | | - Rasmus Trap Wolf
- CORE: Copenhagen Research Center for Mental Health, Mental health Centre Copenhagen, Hellerup, Denmark.,Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Lene Falgaard Eplov
- CORE: Copenhagen Research Center for Mental Health, Mental health Centre Copenhagen, Hellerup, Denmark
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20
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Doyle N, McDowall A. Diamond in the rough? An “empty review” of research into “neurodiversity” and a road map for developing the inclusion agenda. EQUALITY, DIVERSITY AND INCLUSION: AN INTERNATIONAL JOURNAL 2021. [DOI: 10.1108/edi-06-2020-0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe aims of the paper were to highlight the dearth of applied practitioner research concerning the expression of neurodiversity at work and develop an epistemological framework for a future research agenda.Design/methodology/approachA systematic empty review protocol was employed, with three a priori research questions, inquiring as to the extent of neurodiversity research within mainstream work psychology, psychology in general and lastly within cross-disciplinary academic research. The results of the final search were quality checked and categorized to illustrate where studies relevant to practice are currently located.FindingsThe academic literature was found to be lacking in contextualized, practical advice for employers or employees. The location and foci of extracted studies highlighted a growing science-practitioner gap.Research limitations/implicationsThe research focused on common neurominority conditions such as autism and dyslexia; it is acknowledged that the neurodiversity definition itself is broader and more anthropological in nature. A need for a comprehensive research agenda is articulated, and research questions and frameworks are proposed.Practical implicationsGuidance is given on applying disability accommodation to both individual and organizational targets.Social implicationsThe disability employment gap is unchanged since legislation was introduced. The neurodiversity concept is no longer new, and it is time for multi-disciplinary collaborations across science and practice to address the questions raised in this paper.Originality/valueThis paper offers an original analysis of the neurodiversity paradox, combining systematic inquiry with a narrative synthesis of the extant literature. The conceptual clarification offers clear directions for researchers and practitioners.
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21
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Anderson M, Pitchforth E, Asaria M, Brayne C, Casadei B, Charlesworth A, Coulter A, Franklin BD, Donaldson C, Drummond M, Dunnell K, Foster M, Hussey R, Johnson P, Johnston-Webber C, Knapp M, Lavery G, Longley M, Clark JM, Majeed A, McKee M, Newton JN, O'Neill C, Raine R, Richards M, Sheikh A, Smith P, Street A, Taylor D, Watt RG, Whyte M, Woods M, McGuire A, Mossialos E. LSE-Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19. Lancet 2021; 397:1915-1978. [PMID: 33965070 DOI: 10.1016/s0140-6736(21)00232-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 12/10/2020] [Accepted: 01/07/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Emma Pitchforth
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Barbara Casadei
- Radcliffe Department of Medicine, BHF Centre of Research Excellence, NIHR Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Anita Charlesworth
- The Health Foundation, London, UK; College of Social Sciences, Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Angela Coulter
- Green Templeton College, University of Oxford, Oxford, UK; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Bryony Dean Franklin
- UCL School of Pharmacy, University College London, London, UK; NIHR Imperial Patient Safety Translational Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Margaret Foster
- National Health Service Wales Shared Services Partnership, Cardiff, UK
| | | | | | | | - Martin Knapp
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Gavin Lavery
- Belfast Health and Social Care Trust, Belfast, UK
| | - Marcus Longley
- Welsh Institute for Health and Social Care, University of South Wales, Pontypridd, UK
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ciaran O'Neill
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Mike Richards
- Department of Health Policy, London School of Economics and Political Science, London, UK; The Health Foundation, London, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Peter Smith
- Centre for Health Economics, University of York, York, UK; Centre for Health Economics and Policy Innovation, Imperial College London, London, UK
| | - Andrew Street
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - David Taylor
- UCL School of Pharmacy, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Moira Whyte
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Michael Woods
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK.
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22
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Humensky JL, Turner LR, Dixon LB, Drake RE, Becker DR, Subotnik KL, Ventura J, Nuechterlein KH. Personnel time required for supported employment and education services for individuals in a recent-onset psychosis treatment program. Early Interv Psychiatry 2021; 15:402-405. [PMID: 32351048 PMCID: PMC7606755 DOI: 10.1111/eip.12971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
AIM Individual Placement and Support (IPS) improves vocational outcomes in first-episode psychosis patients, but policy makers need information on costs (and personnel time required) to conduct effective IPS. METHODS Using chart records of 42 clients in a first-episode psychosis study, we examined service time for specific activities over 18 months. RESULTS The IPS specialist averaged 92 (SD = 62) minutes per client per week: 39% of time was spent in direct client contact, 9% in meetings without the client, 14% in meetings with the treatment team, 14% in supervision and 24% on travel time. Time required was significantly higher when participants were seeking work/school placements, decreased over duration of enrolment and was similar for those using work vs school support. CONCLUSIONS IPS service time covers numerous activities, is reduced when not seeking work/school placements and required less time over enrolment duration. Financing structures should support the full range of IPS services.
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Affiliation(s)
- Jennifer L Humensky
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | - Luana R Turner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Lisa B Dixon
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.,New York State Psychiatric Institute, New York, New York, USA
| | | | | | - Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA.,Department of Psychology, University of California, Los Angeles, California, USA
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23
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Soutien en emploi : une nouvelle approche vers l’inclusion. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Christensen TN, Kruse M, Hellström L, Eplov LF. Cost-utility and cost-effectiveness of individual placement support and cognitive remediation in people with severe mental illness: Results from a randomized clinical trial. Eur Psychiatry 2020; 64:e3. [PMID: 33342450 PMCID: PMC8057485 DOI: 10.1192/j.eurpsy.2020.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Administrators and policymakers are increasingly interested in individual placement and support (IPS) as a way of helping people with severe mental illness (SMI) obtain employment or education. It is thus important to investigate the cost-effectiveness to secure that resources are being used properly. METHODS In a randomized clinical trial, 720 people diagnosed with SMI were allocated into three groups; (a) IPS, (b) IPS supplemented with cognitive remediation a social skills training (IPSE), and (c) Service as usual (SAU). Health care costs, municipal social care costs, and labor market service costs were extracted from nationwide registers and combined with data on use of IPS services. Cost-utility and cost-effectiveness analyses were conducted with two primary outcomes: quality-adjusted life years (QALY) and hours in employment. Incremental cost-effectiveness ratios (ICER) were computed for both QALY, using participant's responses to the EQ-5D questionnaire, and for hours in employment. RESULTS Both IPS and IPSE were less costly, and more effective than SAU. Overall, there was a statistically significant cost difference of €9,543 when comparing IPS with SAU and €7,288 when comparing IPSE with SAU. ICER's did generally not render statistically significant results. However, there was a tendency toward the IPS and IPSE interventions being dominant, that is, cheaper with greater effect in health-related quality of life and hours in employment or education compared to usual care. CONCLUSION Individual placement support with and without a supplement of cognitive remediation tends to be cost saving and more effective compared to SAU.
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Affiliation(s)
| | - Marie Kruse
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Lone Hellström
- Copenhagen Research Center for Mental Health - CORE, Copenhagen, Denmark
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25
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Abstract
employment is critically important in mental health care. Unemployment worsens mental health and gaining employment can improve mental health, even for people with the most serious mental illnesses. In this editorial, we argue for a new treatment paradigm in mental health that emphasises employment, because supported employment is an evidence-based intervention that can help the majority of people with mental health disability to succeed in integrated, competitive employment. Unlike most mental health treatments, employment engenders self-reliance and leads to other valued outcomes, including self-confidence, the respect of others, personal income and community integration. It is not only an effective short-term treatment but also one of the only interventions that lessen dependence on the mental health system over time.
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26
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Doyle N. Neurodiversity at work: a biopsychosocial model and the impact on working adults. Br Med Bull 2020; 135:108-125. [PMID: 32996572 PMCID: PMC7732033 DOI: 10.1093/bmb/ldaa021] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The term neurodiversity is defined and discussed from the perspectives of neuroscience, psychology and campaigners with lived experience, illustrating the development of aetiological theories for included neurodevelopmental disorders. The emerging discourse is discussed with relevance to adults, social inclusion, occupational performance and the legislative obligations of organizations. SOURCES OF DATA Literature is reviewed from medicine, psychiatry, psychology, sociology and popular press. No new data are presented in this article. AREAS OF AGREEMENT There is consensus regarding some neurodevelopmental conditions being classed as neurominorities, with a 'spiky profile' of executive functions difficulties juxtaposed against neurocognitive strengths as a defining characteristic. AREAS OF CONTROVERSY The developing nomenclature is debated and the application of disability status versus naturally occurring difference. Diagnosis and legal protections vary geographically, resulting in heretofore unclear guidance for practitioners and employers. GROWING POINTS The evolutionary critique of the medical model, recognizing and updating clinical approaches considering the emerging consensus and paradigmatic shift. AREAS TIMELY FOR DEVELOPING RESEARCH It is recommended that research addresses more functional, occupational concerns and includes the experiences of stakeholders in research development, moving away from diagnosis and deficit towards multi-disciplinary collaboration within a biopsychosocial model.
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Affiliation(s)
- Nancy Doyle
- Department of Organizational Psychology, Birkbeck University of London, London, UK
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27
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Rössler W, Kawohl W, Nordt C, Haker H, Rüsch N, Hengartner MP. 'Placement budgets' for supported employment: impact on employment rates in a multicentre randomised controlled trial. Br J Psychiatry 2020; 216:308-313. [PMID: 31256765 DOI: 10.1192/bjp.2019.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The most effective rehabilitation model for job (re-)entry of people with mental illness is supported employment. A barrier to introducing supported employment into standard care is its temporally unlimited provision, which conflicts with health and social legislation in many European countries. AIMS To test the impact of different 'placement budgets', i.e. a predefined maximum time budget for job seeking until take-up of competitive employment. METHOD Participants (116) were randomly assigned to 25 h, 40 h or 55 h placement budgets in an intent-to-treat analysis. We applied the individual placement and support model over 24 months, following participants for 36 months. Primary outcome was employment in the labour market for at least 3 months. RESULTS The proportion of participants obtaining competitive employment was 55.1% in the 25 h group, 37.8% in the 40 h group and 35.8% in the 55 h group. In a Cox regression analysis, time to employment was slightly lower in the 25 h group relative to the 40 h (hazard ratio 1.78, 95% CI 0.88-3.57, P = 0.107) and 55 h groups (hazard ratio 1.74, 95% CI 0.86-3.49, P = 0.122), but this was not statistically significant. The vast majority of all participants who found a job did so within the first 12 months (80.4%). CONCLUSION A restricted time budget for job finding and placement does not affect the rate of successful employment. In accordance with legislation, a restriction of care provision seems justified and enhances the chances of supported employment being introduced in statutory services.
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Affiliation(s)
- Wulf Rössler
- Professor, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil; and Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Wolfram Kawohl
- Senior Consultant, Psychiatrische Dienste Aargau AG, Klinik für Psychiatrie und Psychotherapie, Switzerland
| | - Carlos Nordt
- Senior Researcher, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Switzerland
| | - Helene Haker
- Senior Researcher, Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Nicolas Rüsch
- Professor, Section of Public Mental Health, University of Ulm, Germany
| | - Michael P Hengartner
- Senior Lecturer, Department of Applied Psychology, Zurich University of Applied Sciences, Switzerland
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28
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Cubillos L, Muñoz J, Caballero J, Mendoza M, Pulido A, Carpio K, Udutha AK, Botero C, Borrero E, Rodríguez D, Cutipe Y, Emeny R, Schifferdecker K, Torrey WC. Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru. Psychiatr Serv 2020; 71:378-384. [PMID: 31896339 DOI: 10.1176/appi.ps.201900306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalization and community-based care. This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru. The authors conducted a thematic analysis by using public records and semistructured interviews with stakeholders. The authors found evidence of supported employment programs for vulnerable populations, including people with disabilities, but found that the programs did not include people with severe mental illnesses. Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services: rigid labor markets, insufficient advocacy, public subsidies that create conflicting incentives, lack of deinstitutionalized models, and lack of reimbursement for evidence-based psychiatric rehabilitation interventions. Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programs to facilitate community integration and functional recovery. Because these countries have other supported employment programs for people with nonpsychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.
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Affiliation(s)
- Leonardo Cubillos
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Juliana Muñoz
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - July Caballero
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - María Mendoza
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Adriana Pulido
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Karen Carpio
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Anirudh K Udutha
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Catalina Botero
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Elizabeth Borrero
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Diana Rodríguez
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Yuri Cutipe
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Rebecca Emeny
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - Karen Schifferdecker
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
| | - William C Torrey
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Cubillos); Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park (Muñoz); Ministry of Health (Caballero, Mendoza, Cutipe) and National Institute of Mental Health (Caballero), Lima, Peru; Department of Public Health, Fundación Santa Fe de Bogotá, Bogotá, Colombia (Pulido, Botero, Borrero); Regional Office for Central and North America and the Caribbean, International Organization for Migration, San José, Costa Rica (Carpio); Department of Psychiatry (Udutha, Torrey) and the Dartmouth Institute for Health Policy and Clinical Practice (Emeny, Schifferdecker, Torrey), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Health and Social Protection, Bogotá, Colombia (Rodríguez)
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Abstract
Economics and mental health are intertwined. Apart from the accumulating evidence of the huge economic impacts of mental ill-health, and the growing recognition of the effects that economic circumstances can exert on mental health, governments and other budget-holders are putting increasing emphasis on economic data to support their decisions. Here we consider how economic evaluation (including cost-effectiveness analysis, cost-utility analysis and related techniques) can contribute evidence to inform the development of mental health policy strategies, and to identify some consequences at the treatment or care level that are of relevance to service providers and funding bodies. We provide an update and reflection on economic evidence relating to mental health using a lifespan perspective, analyzing costs and outcomes to shed light on a range of pressing issues. The past 30 years have witnessed a rapid growth in mental health economics, but major knowledge gaps remain. Across the lifespan, clearer evidence exists in the areas of perinatal depression identification-plus-treatment; risk-reduction of mental health problems in childhood and adolescence; scaling up treatment, particularly psychotherapy, for depression; community-based early intervention and employment support for psychosis; and cognitive stimulation and multicomponent carer interventions for dementia. From this discussion, we pull out the main challenges that are faced when trying to take evidence from research and translating it into policy or practice recommendations, and from there to actual implementation in terms of better treatment and care.
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Affiliation(s)
- Martin Knapp
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political ScienceLondonUK,School for Social Care Research, National Institute for Health ResearchUK
| | - Gloria Wong
- Department of Social Work and Social Administration, University of Hong KongHong Kong
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30
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Loughlin M, Bucci S, Brooks J, Berry K. Service users' and carers' experiences of engaging with early intervention services: A meta-synthesis review. Early Interv Psychiatry 2020; 14:26-36. [PMID: 30912274 DOI: 10.1111/eip.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 01/14/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
AIM The provision and implementation of early intervention for psychosis services (early intervention services [EIS]) has received increasing attention over recent years. Maximizing engagement with EIS is of clinical and economic importance, and exploring the experiences of those who access EIS is vital. Although research has been conducted exploring the experiences of engaging with EIS from both a service user and carer/family member point of view, these data have not been systematically collated to generate new understanding. The primary aim of this study is to review, critically appraise and synthesize qualitative findings relating to the experiences of service users and/or carers and family members engaging with EIS. METHODS Four databases were systematically searched. Studies were analysed using an inductive thematic analysis approach, within a critical realist epistemological framework. Studies were critically appraised using the critical appraisal skills programme tool. RESULTS Fourteen papers were identified for inclusion. Three main themes were identified: the importance of a personal relationship with an EIS staff member, the impact of this relationship and consideration of life after EIS. The importance of a strong relationship with EIS staff was the most prominent theme throughout the papers reviewed. CONCLUSIONS The quality of the therapeutic relationship with at least one EIS staff member was the single most important factor in determining whether the experience of accessing EIS was a positive or negative one. The majority of the studies reviewed were conducted in the United Kingdom or Australia. Therefore, more research across countries is needed to understand transferability of findings.
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Affiliation(s)
- Matthew Loughlin
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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31
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Weller A, Gleeson J, Alvarez-Jimenez M, McGorry P, Nelson B, Allott K, Bendall S, Bartholomeusz C, Koval P, Harrigan S, O'Donoghue B, Fornito A, Pantelis C, Paul Amminger G, Ratheesh A, Polari A, Wood SJ, van der El K, Ellinghaus C, Gates J, O'Connell J, Mueller M, Wunderink L, Killackey E. Can antipsychotic dose reduction lead to better functional recovery in first-episode psychosis? A randomized controlled-trial of antipsychotic dose reduction. The reduce trial: Study protocol. Early Interv Psychiatry 2019; 13:1345-1356. [PMID: 30488637 DOI: 10.1111/eip.12769] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/04/2018] [Accepted: 11/08/2018] [Indexed: 01/04/2023]
Abstract
UNLABELLED Antipsychotic medication has been the mainstay of treatment for psychotic illnesses for over 60 years. This has been associated with improvements in positive psychotic symptoms and a reduction in relapse rates. However, there has been little improvement in functional outcomes for people with psychosis. At the same time there is increasing evidence that medications contribute to life shortening metabolic and cardiovascular illnesses. There is also uncertainty as to the role played by antipsychotic medication in brain volume changes. AIM The primary aim of the study is, in a population of young people with first-episode psychosis, to compare functional outcomes between an antipsychotic dose reduction strategy with evidence-based intensive recovery treatment (EBIRT) group (DRS+) and an antipsychotic maintenance treatment with EBIRT group (AMTx+) at 24-months follow-up. METHODS Our single-blind randomized controlled trial, within a specialist early psychosis treatment setting, will test the whether the DRS+ group leads to better vocational and social recovery than, the AMTx+ group over a 2-year period in 180 remitted first-episode psychosis patients. Additionally, we will examine the effect of DRS+ vs AMTx+ on physical health, brain volume and cognitive functioning. This study will also determine whether the group receiving DRS+ will be no worse off in terms of psychotic relapses over 2 years follow-up. RESULTS This paper presents the protocol, rationale and hypotheses for this study which commenced recruitment in July 2017. CONCLUSION This study will provide evidence as to whether an antipsychotic dose-reduction recovery treatment leads to improved functioning and safer outcomes in first-episode psychosis patients. In addition, it will be the first-controlled experiment of the effect of exposure to antipsychotic maintenance treatment on brain volume changes in this population.
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Affiliation(s)
- Amber Weller
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Gleeson
- Australian Catholic University, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Allott
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Bendall
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cali Bartholomeusz
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Koval
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Susy Harrigan
- Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Health, Melbourne, Victoria, Australia
| | - Alex Fornito
- Monash Clinical and Imaging Neuroscience, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Melbourne, Victoria, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - G Paul Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Health, Melbourne, Victoria, Australia
| | - Andrea Polari
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Health, Melbourne, Victoria, Australia
| | - Stephen J Wood
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,School of Psychology, University of Birmingham, Edgbaston, UK
| | - Kristi van der El
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carli Ellinghaus
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse Gates
- Melbourne Health, Melbourne, Victoria, Australia
| | | | - Marianne Mueller
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lex Wunderink
- Friesland Mental Health Services, Leeuwarden, Netherlands
| | - Eóin Killackey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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32
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Ignatova D, Kamusheva M, Petrova G, Onchev G. Costs and outcomes for individuals with psychosis prior to hospital admission and following discharge in Bulgaria. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1353-1362. [PMID: 30929041 DOI: 10.1007/s00127-019-01700-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/22/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the cost of psychotic disorders in Bulgaria prior to hospital admission and following discharge from two perspectives: healthcare and societal; and to evaluate the association between the costs and the patient's characteristics. METHODS 96 individuals with psychosis experiencing psychotic exacerbation and their primary caregivers were evaluated upon the patients' hospital admission. The participants were followed up after 12 months. The costs were evaluated from healthcare and societal perspective using the Client's Sociodemographic and Service Receipt Inventory (CSSRI-EU). The psychopathology, functioning, quality of life and caregiver's burden were measured using standardized instruments. The mean differences in the costs and the associations with the clinical and socio-demographic characteristics of the patients were evaluated. RESULTS The healthcare costs increase from EUR 120.66 (SD = 163.85) at baseline to EUR 177.54 (SD = 136.98) at follow-up. The total cost from societal perspective are up to sixfold higher than the healthcare costs at both assessments [EUR 717.41 (SD = 402.33) and 880.40 (SD = 1592.00), respectively] and do not change significantly. A major shift in the subtypes of costs, and significant associations of the costs with the socio-demographic and clinical characteristics, were found. CONCLUSIONS Psychotic disorders and psychotic exacerbations have high societal costs. The underfunding of mental healthcare in Bulgaria is at the expense of high caregivers' and societal cost. The treatment of psychotic exacerbation is effective and investment in mental healthcare for the improvement of the psychopathology, social functioning, quality of life and the burden of informal care should be viewed as a sustainable investment.
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Affiliation(s)
- Desislava Ignatova
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Medical University Sofia, St. G. Sofiyski 1, 1431, Sofia, Bulgaria.
| | - Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University, Sofia, Bulgaria
| | - Georgi Onchev
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Medical University Sofia, St. G. Sofiyski 1, 1431, Sofia, Bulgaria
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33
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Sultan-Taïeb H, Villotti P, Berbiche D, Dewa CS, Desjardins É, Fraccaroli F, Zaniboni S, Mazaniello-Chézol M, Lecomte T, Durand MJ, Corbière M. Can social firms contribute to alleviating the economic burden of psychiatric disabilities for the public healthcare system? HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1311-1320. [PMID: 31149764 DOI: 10.1111/hsc.12775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/19/2019] [Accepted: 04/16/2019] [Indexed: 06/09/2023]
Abstract
In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Québec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job-seekers. Two complementary datasets were used: a self-report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ-5D-5L), the severity of psychiatric symptoms (18-item Brief Symptom Inventory) and self-declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision-making.
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Affiliation(s)
- Hélène Sultan-Taïeb
- Human Resources Department, School of Management, Université du Québec à Montréal (UQAM), Montréal, QC, Canada
| | - Patrizia Villotti
- Department of Education, Career Counselling, Université du Québec à Montréal (UQAM), Montréal, QC, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Djamal Berbiche
- Département des Sciences de la Santé Communautaire, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, QC, Canada
| | - Carolyn S Dewa
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA
| | - Émilie Desjardins
- Faculté des sciences humaines, Université du Québec à Montréal (UQAM), Montréal, QC, Canada
| | - Franco Fraccaroli
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Sara Zaniboni
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Maud Mazaniello-Chézol
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Tania Lecomte
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada
| | - Marie-José Durand
- École de réadaptation, Université de Sherbrooke, Longueuil, QC, Canada
| | - Marc Corbière
- Department of Education, Career Counselling, Université du Québec à Montréal (UQAM), Montréal, QC, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
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Sutton BS, Ottomanelli L, Njoh E, Barnett S, Goetz L. Economic evaluation of a supported employment program for veterans with spinal cord injury. Disabil Rehabil 2019; 42:1423-1429. [PMID: 31099272 DOI: 10.1080/09638288.2018.1527955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To estimate the net monetary benefit of an individual placement and support-based supported employment program for Veterans with spinal cord injuries.Design: Economic evaluation comparing a supported employment program to treatment as usual, using cost and quality-of-life data from a longitudinal study of Veterans with spinal cord injuries.Setting: Spinal cord injury centers in the Veterans Health Administration.Participants: Subjects (N = 213) who participated in a 24-month supported employment program at seven spinal cord injury centers. Supported employment participants were compared with a group of spinal cord injury Veterans who received treatment as usual in a prior study.Main outcome measures: Costs and quality-adjusted life years using the Veterans Rand-6 Dimension, estimated from the Veterans Rand 36-Item Health Survey.Results: The supported employment program was more effective at both 1- and 2-year periods compared with treatment as usual. Outpatient costs were significantly higher for supported employment, but inpatient costs were not significantly different from treatment as usual. When cost and effectiveness were compared jointly using net monetary benefit, a supported employment program following the core principles of Individual Placement and Supported employment was more effective but not cost-effective at standard willingness to pay thresholds. When we considered a sub-group of the supported employment participants who more closely resemble the treatment as usual group from a randomized trial, there was no significant difference in the cost-effectiveness of supported employment when compared to treatment as usual.Conclusions: With higher effectiveness and similar costs, supported employment for spinal cord injury Veterans has the potential to be cost-effective. Future studies need to randomize participants or carefully match participants based on observable patient characteristics to improve cost-effectiveness evaluations of this population.Implications for RehabilitationSupported employment as part of ongoing rehabilitation care helps individuals with spinal cord injury return to work and improve their quality of life.Many studies show that supported employment programs are cost effective for persons with mental disabilities, but there is only limited economic evaluation data on use of supported employment with persons with spinal cord injury.This study shows that supported employment integrated with ongoing rehabilitation care is more effective in restoring employment and health-related quality of life.
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Affiliation(s)
- Bryce S Sutton
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Lisa Ottomanelli
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA.,Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, FL, USA
| | - Eni Njoh
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Scott Barnett
- Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL, USA
| | - Lance Goetz
- Hunter Holmes McGuire VA Medical Center, Richmond, VI, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VI, USA
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35
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Evensen S, Wisløff T, Lystad JU, Bull H, Martinsen EW, Ueland T, Falkum E. Exploring the potential cost-effectiveness of a vocational rehabilitation program for individuals with schizophrenia in a high-income welfare society. BMC Psychiatry 2019; 19:140. [PMID: 31064371 PMCID: PMC6505225 DOI: 10.1186/s12888-019-2130-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past decades research has shown that employment has a positive impact on quality of life, global functioning and recovery in individuals with schizophrenia. However, access to vocational rehabilitation services for this group is limited and unemployment rates remain high. In this study we explore the potential cost-effectiveness of a novel vocational rehabilitation program (The Job Management Program - JUMP) earmarked for individuals with schizophrenia in Norway. METHODS The JUMP study was a vocational rehabilitation program augmented with either cognitive behaviour therapy or cognitive remediation. In addition to the JUMP protocol, we extracted treatment cost data from comprehensive and mandatory health and welfare registers. The costs over a two-year follow-up period were compared with the costs over the two-year period prior to inclusion in the study. We also compared the cost-effectiveness of JUMP with a treatment as usual group (TAU). RESULTS We identified significant reductions in inpatient services in the JUMP group, both for those who obtained employment and those who did not. Significant reductions were also found in the TAU group, but adjusted for baseline differences the total cost for JUMP participants were € 10,621 lower than in the TAU group during the follow-up period. CONCLUSION In addition to supporting individuals with schizophrenia obtain employment, JUMP appears to have reduced the reliance on mental health services, which should be of interest to stakeholders. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01139502 . Retrospectively registered on 6 February 2010.
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Affiliation(s)
- Stig Evensen
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Wisløff
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - June Ullevoldsæter Lystad
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Helen Bull
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Egil W. Martinsen
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik Falkum
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
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36
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van Dijk SDM, Veenstra MS, Bouman R, Peekel J, Veenstra DH, van Dalen PJ, van Asselt ADI, Boshuisen ML, van Alphen SPJ, van den Brink RHS, Oude Voshaar RC. Group schema-focused therapy enriched with psychomotor therapy versus treatment as usual for older adults with cluster B and/or C personality disorders: a randomized trial. BMC Psychiatry 2019; 19:26. [PMID: 30646879 PMCID: PMC6334382 DOI: 10.1186/s12888-018-2004-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several types of psychotherapy have been proven successful in the treatment of personality disorders in younger age groups, however studies among older patients are lacking. We developed a group schema-focused therapy (SFT) enriched with psychomotor therapy (PMT) for older adults with cluster B and/or C personality disorders. This paper describes the design of a randomized controlled trial (RCT). We will evaluate the (cost-)effectiveness of this therapy protocol in specialized mental health care. We hypothesize that our treatment program is cost-effective and superior to treatment as usual (TAU) in reducing psychological distress and improving quality of life in older adults treated to specialized mental healthcare. METHODS A multicenter RCT with a one-year follow-up comparing group schema-focused therapy enriched with psychomotor therapy (group SFT + PMT) and TAU for adults aged 60 years and older who suffer from either a cluster B and/or C personality disorder. The primary outcome is general psychological distress measured with the 53-item Brief Symptom Inventory. Secondary outcomes are the Schema Mode Inventory (118-item version) and the Young Schema Questionnaire. Cost-effectiveness analysis will be performed from a societal perspective with the EuroQol five dimensions questionnaire and structured cost-interviews. DISCUSSION This study will add to the knowledge of psychotherapy in later life. The study specifically contributes to the evidence on (cost-) effectiveness of group SFT enriched with PMT adapted to the needs of for older adults with cluster b and/or c personality. TRIAL REGISTRATION Netherlands Trial Register NTR 6621 . Registered on 20 August 2017.
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Affiliation(s)
- S. D. M. van Dijk
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - M. S. Veenstra
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - R. Bouman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - J. Peekel
- Mediant Geestelijke Gezondheidszorg, Enschede, The Netherlands
| | - D. H. Veenstra
- Van Andel Ouderenpsychiatrie (GGZ Friesland), Leeuwarden, The Netherlands
| | - P. J. van Dalen
- Dimence, Mental Health Organization, Deventer, The Netherlands
| | - A. D. I. van Asselt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M. L. Boshuisen
- Lentis, Mental Health Organization, Groningen, The Netherlands
| | | | - R. H. S. van den Brink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
| | - R. C. Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Post office box 30.001, 9700 RB Groningen, The Netherlands
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Ignatova D, Kamusheva M, Petrova G, Onchev G. Cost-effectiveness analysis of current treatment of individuals with acute exacerbation of schizophrenia in Bulgaria. BIOTECHNOL BIOTEC EQ 2019. [DOI: 10.1080/13102818.2018.1561209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Desislava Ignatova
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Georgi Onchev
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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Gmitroski T, Bradley C, Heinemann L, Liu G, Blanchard P, Beck C, Mathias S, Leon A, Barbic SP. Barriers and facilitators to employment for young adults with mental illness: a scoping review. BMJ Open 2018; 8:e024487. [PMID: 30567825 PMCID: PMC6303634 DOI: 10.1136/bmjopen-2018-024487] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The issue of gaining employment for those with mental illness is a growing global concern. For many in the young adult population, who are at a transitional age, employment is a central goal. In response, we conducted a scoping review to answer the question, 'What are the barriers and facilitators to employment for young adults with mental illness?' DESIGN We conducted a scoping review in accordance to the Arksey and O'Malley framework. We performed a thorough search of Medline, EMBASE, CINAHL, ABI/INFORM, PsycINFO and Cochrane. We included studies that considered young adults aged 15-29 years of age with a mental health diagnosis, who were seeking employment or were included in an employment intervention. RESULTS Our search resulted in 24 research articles that focused on employment for young adults with mental illness. Four main themes were extracted from the literature: (1) integrated health and social services, (2) age-exposure to employment supports, (3) self-awareness and autonomy and (4) sustained support over the career trajectory. CONCLUSIONS Our review suggests that consistent youth-centred employment interventions, in addition to usual mental health treatment, can facilitate young adults with mental illness to achieve their employment goals. Aligning the mental health and employment priorities of young adults may result in improved health and social outcomes for this population while promoting greater engagement of young adults in care.
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Affiliation(s)
- Taryn Gmitroski
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Christl Bradley
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Lyn Heinemann
- Canadian Mental Health Association, Vancouver, British Columbia, Canada
| | - Grace Liu
- Providence Health, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
| | - Paige Blanchard
- Providence Health, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
| | - Charlotte Beck
- UBC Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Mathias
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
- UBC Library, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adelena Leon
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Skye Pamela Barbic
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
- UBC Library, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, St Paul's Hospital, Vancouver, British Columbia, Canada
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Papakonstantinou D. Why should employers be interested in hiring people with mental illness? A review for occupational therapists. JOURNAL OF VOCATIONAL REHABILITATION 2018. [DOI: 10.3233/jvr-180967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Doxa Papakonstantinou
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54006, Thessaloniki, Greece. Tel.: +30 2310 891403; E-mail:
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Radhakrishnan M, McCrone P, Lafortune L, Everard L, Fowler D, Amos T, Freemantle N, Singh SP, Marshall M, Sharma V, Lavis A, Jones PB, Birchwood M. Cost-effectiveness of early intervention services for psychosis and fidelity to national policy implementation guidance. Early Interv Psychiatry 2018; 12:747-756. [PMID: 28857431 DOI: 10.1111/eip.12481] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/26/2017] [Accepted: 07/11/2017] [Indexed: 11/28/2022]
Abstract
AIM Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost-effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG). METHODS EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75-80%, 81-90% and 91-95%. Patient-level resource use and outcomes were measured 1 year following inception into the service; costs were calculated and combined with quality-adjusted life years (QALYs) gained. RESULTS At a threshold of £20 000 per QALY, the 81-90% fidelity group had a 56.3% likelihood of being the most cost-effective option followed by 75-80% fidelity at 35.8% and 91-95% fidelity group (7.9%). CONCLUSIONS The results from England suggest that striving to maximize fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources.
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Affiliation(s)
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Louise Lafortune
- Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Linda Everard
- The Early Intervention Service, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Sussex, UK
| | - Tim Amos
- Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Max Marshall
- School of Medicine, University of Manchester, Manchester, UK
| | - Vimal Sharma
- Early Intervention Service, Cheshire and Wirral NHS Foundation Trust & University of Chester, UK
| | - Anna Lavis
- Institute of Applied Health Research, University of Birmingham, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Max Birchwood
- School of Medicine, University of Manchester, Manchester, UK
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How do social security schemes and labor market policies support the return-to-work of cancer survivors? A review article. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Saha S, Bejerholm U, Gerdtham UG, Jarl J. Cost-effectiveness of supported employment adapted for people with affective disorders. Nord J Psychiatry 2018; 72:236-239. [PMID: 29316832 DOI: 10.1080/08039488.2017.1422801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The individual enabling and support (IES) model was effective in gaining competitive employment for people with affective disorders compared with traditional vocational rehabilitation (TVR) services in a randomized controlled trial in a Swedish setting. The object of this study is to perform a cost-effectiveness analysis of IES comparing to TVR. METHODS We considered the costs of intervention and productivity gain due to increased competitive employment. We estimated quality of life using EuroQol 5 Dimension (EQ-5D) and Manchester Short Assessment of Quality of Life (MANSA) scale. EQ-5D was translated into quality-adjusted life-years (QALY), using the UK, Danish, and Swedish tariffs. We performed the analysis from a societal perspective with a one-year timeframe. RESULTS The cost of IES was €7247 lower per person per year (2014 prices) compared to TVR. There were no significant differences in QALY improvement within or between groups. However, quality of life measured by the MANSA scale significantly improved over the study period in IES. LIMITATIONS Besides the small sample size, details on the intervention costs for both IES and TVR group were unavailable and had to be obtained from external sources. CONCLUSIONS Implementation of IES for people with affective disorders is most likely cost-saving and is potentially even dominating TVR, although a larger trial is required to establish this.
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Affiliation(s)
- Sanjib Saha
- a Health Economics Unit, Department of Clinical Science (Malmö) , Lund University , Lund , Sweden.,b Health Economics & Management , Institute of Economic Research, Lund University , Lund , Sweden
| | - Ulrika Bejerholm
- c Department of Health Sciences/Work and Mental Health, Medical Faculty , Lund University , Lund , Sweden
| | - Ulf-G Gerdtham
- a Health Economics Unit, Department of Clinical Science (Malmö) , Lund University , Lund , Sweden.,b Health Economics & Management , Institute of Economic Research, Lund University , Lund , Sweden.,d Department of Economics , Lund University , Lund , Sweden
| | - Johan Jarl
- a Health Economics Unit, Department of Clinical Science (Malmö) , Lund University , Lund , Sweden.,b Health Economics & Management , Institute of Economic Research, Lund University , Lund , Sweden
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Rössler W, Kawohl W, Nordt C, Haker H, Rüsch N, Hengartner MP. "Placement Budgets" for Supported Employment-Impact on Quality of Life in a Multicenter Randomized Controlled Trial. Front Psychiatry 2018; 9:462. [PMID: 30319467 PMCID: PMC6168924 DOI: 10.3389/fpsyt.2018.00462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Employment is an important aspect of psychiatric rehabilitation. The objective of this analysis was to explore how quality of life (QoL) may affect the outcome of supported employment and vice versa. Methods: A total of 116 participants with severe mental disorders were randomly assigned to either 25, 40, or 55 h placement budgets, which comprises job coaches' time resources to support a client in finding a job. The intervention followed the individual placement and support model and lasted up to 36 months. Primary outcome was employment in the first labor market for at least 3 months. QoL was assessed 7 times over the entire 36-months observation period using the WHO QoL Bref, which comprises the dimensions physical health, psychological, social relationships, and environment. Results: The three placement budgets did not differentially relate to QoL, but QoL environment showed a significant increase over time across all three groups. Baseline QoL environment weakly predicted subsequent obtainment of employment (F = 4.08, df = 1, p = 0.046, Cohen's d = 0.39). Controlling for baseline QoL, those participants who obtained a job, as compared to those who did not, showed persistent increases in QoL physical health (b = 0.39, p = 0.002, Cohen's d = 0.50) and QoL psychological (b = 0.40, p < 0.001, Cohen's d = 0.47). Conclusion: Obtaining employment in the first labor market improves patients' QoL. Supported employment is a valuable intervention that may benefit patients with severe mental disorder.
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Wolfram Kawohl
- Department for Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
| | - Carlos Nordt
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Helene Haker
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Günzburg, Germany
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.
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Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
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Yamaguchi S, Sato S, Horio N, Yoshida K, Shimodaira M, Taneda A, Ikebuchi E, Nishio M, Ito J. Cost-effectiveness of cognitive remediation and supported employment for people with mental illness: a randomized controlled trial. Psychol Med 2017; 47:53-65. [PMID: 27654902 DOI: 10.1017/s0033291716002063] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little is known about the economic benefits of cognitive remediation and supported employment (CR + SE). The present study aimed to investigate the cost-effectiveness of CR + SE compared with traditional vocational services (TVS). METHOD Individuals with mental illness and low cognitive function were recruited at six sites in Japan. A total of 111 participants were randomly allocated to the CR + SE group or the TVS group. Clinical and vocational outcomes were assessed at baseline and 12-month follow-up. Service utilization data were collected monthly. The data on outcomes and costs were combined to examine cost-effectiveness. RESULTS The data were obtained from a total of 92 participants. The CR + SE group resulted in better vocational and clinical outcomes (employment rate, 62.2%; work tenures, 78.6 days; cognitive improvement, 0.5) than the TVS group (19.1%, 24.9 days and 0.2). There was no significant difference in mean total costs between the groups (CR + SE group: $9823, s.d. = $6372, TVS group: $11 063, s.d. = $11 263) with and without adjustment for covariates. However, mean cost for medical services in the CR + SE group was significantly lower than that in the TVS group after adjusting covariates (Β = -$3979, 95% confidence interval -$7816 to -$143, p = 0.042). Cost-effectiveness acceptability curves for vocational outcomes illustrated the high probabilities (approximately 70%) of the CR + SE group being more cost-effective than TVS when society is not willing to pay additional costs. CONCLUSIONS CR + SE appears to be a cost-effective option for people with mental illness who have low cognitive functioning when compared with TVS.
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Affiliation(s)
- S Yamaguchi
- Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan
| | - S Sato
- Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan
| | - N Horio
- Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan
| | - K Yoshida
- Department of Social Welfare, Faculty of Human and Social Sciences,Showa Women's University,Setagaya,Tokyo,Japan
| | - M Shimodaira
- Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan
| | - A Taneda
- Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan
| | - E Ikebuchi
- Department of Psychiatry,School of Medicine, Teikyo University,Itabashi, Tokyo,Japan
| | - M Nishio
- School of Social Welfare, Tohoku Fukushi University,Sendai,Japan
| | - J Ito
- Department of Psychiatric Rehabilitation,National Institute of Mental Health, National Center of Neurology and Psychiatry,Kodaira,Japan
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Drake RE, Bond GR, Goldman HH, Hogan MF, Karakus M. Individual Placement And Support Services Boost Employment For People With Serious Mental Illnesses, But Funding Is Lacking. Health Aff (Millwood) 2016; 35:1098-105. [DOI: 10.1377/hlthaff.2016.0001] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robert E. Drake
- Robert E. Drake is a professor of health policy and clinical practice at the Dartmouth Institute, Geisel Medical School at Dartmouth, in Lebanon, New Hampshire
| | - Gary R. Bond
- Gary R. Bond is a professor of psychiatry at the Geisel Medical School at Dartmouth
| | - Howard H. Goldman
- Howard H. Goldman is a professor of psychiatry in the Department of Mental Health Policy Studies at the University of Maryland School of Medicine, in Baltimore
| | - Michael F. Hogan
- Michael F. Hogan is principal at Hogan Health Solutions, in Delmar, New York
| | - Mustafa Karakus
- Mustafa Karakus is a senior health economist at Westat, in Rockville, Maryland
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Luyten J, Naci H, Knapp M. Economic evaluation of mental health interventions: an introduction to cost-utility analysis. EVIDENCE-BASED MENTAL HEALTH 2016; 19:49-53. [PMID: 27075444 PMCID: PMC10699413 DOI: 10.1136/eb-2016-102354] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 11/04/2022]
Abstract
Finite resources need to be allocated over an ever-increasing range of competing health policies and interventions. Economic evaluation has been developed as a methodology to inform decision makers on the efficiency of particular resource allocations. In this paper we summarize cost-utility analysis, one of the most widely-used forms of economic evaluation in healthcare. We discuss its main elements, interpretation, limitations and relevance to the domain of mental health.
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Affiliation(s)
- Jeroen Luyten
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Huseyin Naci
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Evensen S, Wisløff T, Lystad JU, Bull H, Ueland T, Falkum E. Prevalence, Employment Rate, and Cost of Schizophrenia in a High-Income Welfare Society: A Population-Based Study Using Comprehensive Health and Welfare Registers. Schizophr Bull 2016; 42:476-83. [PMID: 26433216 PMCID: PMC4753607 DOI: 10.1093/schbul/sbv141] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Schizophrenia is associated with recurrent hospitalizations, need for long-term community support, poor social functioning, and low employment rates. Despite the wide- ranging financial and social burdens associated with the illness, there is great uncertainty regarding prevalence, employment rates, and the societal costs of schizophrenia. The current study investigates 12-month prevalence of patients treated for schizophrenia, employment rates, and cost of schizophrenia using a population-based top-down approach. Data were obtained from comprehensive and mandatory health and welfare registers in Norway. We identified a 12-month prevalence of 0.17% for the entire population. The employment rate among working-age individuals was 10.24%. The societal costs for the 12-month period were USD 890 million. The average cost per individual with schizophrenia was USD 106 thousand. Inpatient care and lost productivity due to high unemployment represented 33% and 29%, respectively, of the total costs. The use of mandatory health and welfare registers enabled a unique and informative analysis on true population-based datasets.
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Affiliation(s)
- Stig Evensen
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;
| | - Torbjørn Wisløff
- Department of Biostatistics, Epidemiology and Health Economics, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - June Ullevoldsæter Lystad
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Helen Bull
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik Falkum
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway;,Department of Clinical Medicine, University of Oslo, Oslo, Norway
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Schneider J, Akhtar A, Boycott N, Guo B, Latimer E, Cao Z, McMurran M. Individual placement and support versus individual placement and support enhanced with work-focused cognitive behaviour therapy: Feasibility study for a randomised controlled trial. Br J Occup Ther 2016. [DOI: 10.1177/0308022615619184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Employment is a key goal for many people with long-term mental health issues. Evidence-based individual placement and support is a widely advocated approach. This study explored whether individual placement and support outcomes could be enhanced with work-focused counselling. Method The study was designed as a pragmatic randomised controlled trial comparing the cost-effectiveness, in severe mental illness, of work-focused intervention (intervention) as an adjunct to individual placement and support compared to individual placement and support alone (control). Results The original sample (330) proved impossible to attain so the design was revised to a pilot study from which information on feasibility of a full trial could be drawn. Twenty-five individuals out of 74 found paid work but no difference was found in the mean number of hours in paid employment between the intervention and control groups. Conclusion Results demonstrate that delivering work-focused counselling in tandem with individual placement and support is feasible and acceptable to service users. The study observed that, even during a period of recession (2010–13), individuals with mental health problems succeeded in obtaining paid employment. Any additional benefit of counselling over individual placement and support alone could not be ascertained, due mainly to the high drop-out rate from this study.
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Affiliation(s)
- Justine Schneider
- Professor of Mental Health and Social Care, School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Athfah Akhtar
- Lecturer in Applied Psychology, Faculty of Business, Law and Social Sciences, Birmingham City University, Birmingham, UK
| | - Naomi Boycott
- Psychologist, Collaboration for Leadership in Applied Health Research and Care East Midlands, University of Nottingham, Nottingham, UK
| | - Boliang Guo
- Assistant Professor in Medical Statistics, Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - Eric Latimer
- Research Scientist, Douglas Mental Health University Institute, Montreal, Canada
- Professor, Department of Psychiatry, McGill University, Montreal, Canada
| | - Zhirong Cao
- Statistical Analyst, Douglas Mental Health University Institute, Montreal, Canada
| | - Mary McMurran
- Professor of Personality Disorder Research, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Abstract
It has been recognised that work is a positive factor for mental health since the days of Galen (2nd century CE). It was central to the theories and practice of William Tuke at the Retreat in York (founded 1796) and has continued in different forms as a therapy and/or a form of rehabilitation ever since. These forms can be usefully divided into four main categories: sheltered work, vocational training, transitional employment (or work experience) and supported employment. These broad categories have been adapted to different cultures and economic circumstances across the world. There are advantages and disadvantages to all forms, but the burgeoning research literature of the past 20 years does show that when it comes to finding people paid work in the open labour market, supported employment is markedly more successful than other methods.
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Affiliation(s)
- Bob Grove
- Senior Policy Adviser, Mental Health Europe, Brussels, email
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