Teaching fundamental workplace skills to persons with serious mental illness

Vocational Service Models and Approaches to Improve Job Tenure of People With Severe and Enduring Mental Illness: A Narrative Review

Employment is a valued occupation that offers a sense of meaning, identity, and belonging. For people with severe and enduring mental illness, employment has also been associated with personal recovery and decreased use of mental health services. However, this population continues to be underrepresented in the labor market. Sustainable employment is often challenging for people with severe and enduring mental illness, due to a combination of personal, organizational and systemic issues. While Individual Placement and Support is an evidence-based model of employment support known to improve job attainment for people with mental illness, job retention and sustained workforce participation continue to be challenges. This narrative literature review was undertaken to address the question: "What vocational service models and approaches improve job tenure for this population?" CinAHL, Medline, Embase, PsycINFO, and Cochrane Library were searched for the period 2005-2020, using key terms and subject headings, including "severe mental illness," "psychiatric disabilit^*," "job tenure," and "job retention." Several adjunct interventions may enhance job retention, including skills training, cognitive interventions, psychological interventions, and supported education, while social firms offer a different approach focused on creating new, sustainable job opportunities. Peer support and support from family and friends also appear to be important, and emerging evidence suggests that employment specialist practices, technology, self-management, and workplace accommodations may each also influence job tenure. Service providers could make more use of these non-clinical vocational approaches to improve employment retention for people with severe and enduring mental illness.

Psychosocial rehabilitation and chronic mental illness: international trends and South African issues

Psychosocial rehabilitation of persons with chronic mental illness has received increasing research attention over the past three decades. It is now widely accepted that pharmacotherapy alone is insufficient to treat persons with chronic mental illness. Additionally, there has been a paradigm shift towards the integration of evidence-based rehabilitation models and recovery models, which focus on collaborative approaches to care. This article reviews research findings relating to psychosocial rehabilitation interventions and models, and considers the implementation of psychosocial rehabilitation policies and practices in the South African healthcare context. Challenges to implementation and recommendations are presented.

Employment specialist competencies for supported employment programs

PURPOSE

Supported employment (SE) programs are evidence-based programs offered to people with severe mental illness to facilitate obtaining and keeping competitive work. However, significant variations in individuals' vocational success may be partly explained by differences in their employment specialists' competencies. Aim The main objectives of this study were to develop a questionnaire measuring the behaviors, attitudes and knowledge of employment specialists working in SE programs and to link specific competencies to vocational outcomes.

METHODS

A total of 153 employment specialists working in Canadian and Dutch supported employment programs completed the Behaviors, Attitudes, and Knowledge in Employment Specialists (BAKES) questionnaire and provided information about their clients' vocational outcomes.

RESULTS

Exploratory Factor Analyses results found 90 items over 12 subscales (e.g., Relationships with employers and supervisors). Regression analyses indicated that the two most useful subscales for predicting vocational success were: (1) Relationships with employers and supervisors, and (2) support and client-centered approach.

CONCLUSION

Employment specialists require specific competencies to help people with severe mental illness obtain and maintain competitive employment. Validating the BAKES will better define the broad range of competencies expected for this position, and this tool may facilitate training of employment specialists.

Course, outcomes, and psychosocial interventions for first-episode mania

OBJECTIVES

The course of bipolar disorder tends to worsen over time, highlighting the importance of early intervention. Despite the recognized need for adjunctive psychosocial treatments in first-episode mania, very few studies have evaluated psychological interventions for this period of significant risk. In this empirical review, we evaluate existing research on first-episode bipolar disorder, compare this body of research to parallel studies of first-episode schizophrenia, and identify strategies for future research.

METHODS

A comprehensive literature search of the MEDLINE and PsychINFO databases was conducted to identify studies of first-episode mania, as well as first-episode schizophrenia. Recovery and relapse rates were compared across studies.

RESULTS

In contrast to a number of studies of first-episode schizophrenia, the authors identified only seven independent programs assessing first-episode mania. Findings from these studies suggest that, while pharmacological treatment helps patients achieve recovery from acute episodes, it fails to bring patients to sustained remission. Early psychosocial intervention may be imperative in reducing residual symptoms, preventing recurrence of mood episodes, and improving psychosocial functioning. However, very few studies of psychosocial interventions for first-episode mania have been systematically studied.

CONCLUSIONS

Studies of first-episode mania indicate a gap between syndromal/symptomatic and functional recovery. Novel psychosocial interventions for first-episode mania may help bridge this gap, but require controlled study.

Additional interventions to enhance the effectiveness of individual placement and support: a rapid evidence assessment

Topic. Additional interventions used to enhance the effectiveness of individual placement and support (IPS). Aim. To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. Method. A rapid evidence assessment of the literature was conducted for studies where behavioural or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion. Conclusions. Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.

Relationships between occupational engagement and status of and satisfaction with sociodemographic factors in a group of people with schizophrenia

The present study is part of a larger project investigating occupational engagement and health in a group of people with schizophrenia. This study was aimed at extending this knowledge base with regard to occupational engagement and sociodemographic factors. Seventy-four outpatients participated in the study. The Profile of Occupational Engagement in People with Schizophrenia, the Lancashire Quality of Life Profile scale and a standardized questionnaire were used to gather data. Contrary to what was expected, occupational engagement was not associated with a certain type of schizophrenia, being younger or older, or gender. The results showed that a high level of occupational engagement was related to greater satisfaction with the participants' social and living situation, having a reliable alliance and a close friend, school-leaving age, living in a flat, and working or studying. Satisfaction with living independently, having had a recent experience of accomplishment, and working together explained 55% of the variance in occupational engagement. Occupational therapists should thus focus on and promote social engagement appropriate to the client's level of engagement, the client's opportunity and ability to work, his/her experience of accomplishment, and, most importantly, satisfaction with the home and living situation.

Neurocognition, social cognition, perceived social discomfort, and vocational outcomes in schizophrenia

Social cognition has been suggested to be an important mediating variable in the relationship between neurocognition and functional outcome. The present study tested this model in relation to work rehabilitation outcome and added self-reported social discomfort as a possible mediator. One hundred fifty-one participants with schizophrenia or schizoaffective disorder participated in a 26-week work therapy program. Neurocognition was constructed as a latent construct comprised of selected variables from our intake test battery representing executive functioning, verbal memory, attention and working memory, processing speed, and thought disorder. Social cognition at intake was the other latent construct comprised of variables representing affect recognition, theory of mind, self-reported egocentricity, and ratings of rapport. The 2 latent constructs received support from confirmatory factor analysis. Social discomfort on the job was based on their self-report on a weekly questionnaire. In addition, we constructed a composite rehabilitation outcome that was based on how many hours they worked, how well they worked, and how complex was the job that they were doing. Path analysis showed direct effects of neurocognition on rehabilitation outcome and indirect effects mediated by social cognition and social discomfort. This model proved to be a good fit to the data and far superior to another model where only social cognition was the mediating variable between neurocognition and rehabilitation outcome. Findings suggest that neurocognition affects social cognition and that poorer social cognition leads to social discomfort on the job, which in turn leads to poorer rehabilitation outcomes. Implications for rehabilitation interventions are discussed.

Factor structure of essential social skills to be salespersons in retail market: implications for psychiatric rehabilitation

This study continued the effort to apply social skills training to increase vocational outcomes of people with severe mental illness. We planned to identify factor structure of essential social skills necessary for mental health consumers who have a vocational preference to work as salesperson in retail market. Exploratory factor analysis of the results of a 26-item questionnaire survey suggested a five-factor solution: social skills when interacting with customers, problem-solving skills, knowledge and attitudes, flexibility, and skills for conflict prevention, which accounted for 65.1% of the total variance. With the factor solution, we developed a job-specific social skills training program (JSST) to help consumers who want to be salespersons. The structure and session design followed the basic format of a typical social skills training program. The way this JSST is to be used with the work-related social skills training model previously developed by the corresponding author to produce better vocational outcomes of consumers is suggested.

The Hartford Study of Supported Employment for Persons With Severe Mental Illness

The authors compared 3 approaches to vocational rehabilitation for severe mental illness (SMI): the individual placement and support (IPS) model of supported employment, a psychosocial rehabilitation (PSR) program, and standard services. Two hundred four unemployed clients (46% African American, 30% Latino) with SMI were randomly assigned to IPS, PSR, or standard services and followed for 2 years. Clients in IPS had significantly better employment outcomes than clients in PSR and standard services, including more competitive work (73.9% vs. 18.2% vs. 27.5%, respectively) and any paid work (73.9% vs. 34.8% vs. 53.6%, respectively). There were few differences in nonvocational outcomes between programs. IPS is a more effective model than PSR or standard brokered vocational services for improving employment outcomes in clients with SMI.

Social functioning and quality of life comparisons between obsessive-compulsive and schizophrenic disorders

Treatment of obsessive-compulsive disorder has focused almost exclusively on symptom reduction; however, deficits in social functioning and quality of life of individuals with this disorder may contribute more to their "burden," suffering, and disability. To gauge the significance of social dysfunction and quality of life of persons with obsessive-compulsive disorder (OCD), we made comparisons with a group of persons with schizophrenia matched for age and gender. Thirty-one patients with OCD participating in a partial hospital treatment program were compared with 68 schizophrenic outpatients participating in a day rehabilitation program. The Independent Living Skills Survey (ILSS) and Lehman Quality of Life Scale (QOL) were administered before and after treatment for both cohorts. QOL scores were significantly lower for the OCD patients both before and after treatment, but improved significantly during treatment. OCD and schizophrenic patients had similar scores on almost every domain of the ILSS at pretreatment. The OCD patients improved significantly on many of the domains of social and independent living skills as a result of treatment and acquired significantly greater skills by post-treatment than did their counterparts with schizophrenia; however, the performance of social and independent living skills by OCD patients remained less than satisfactory even in domains where they improved. In the areas of job and leisure skills, there were significant group-by-time interactions. We concluded that patients with severe OCD and patients with schizophrenia are equally socially impaired. However, OCD patients experience greater significant functional improvement with multimodal treatment.

Requirements for multidisciplinary teamwork in psychiatric rehabilitation

Psychiatric rehabilitation by its very nature is multidisciplinary because of the many competencies required for its implementation. In promoting optimal levels of recovery from schizophrenia and other disabling mental disorders, teams must combine the expert contributions of professionals and paraprofessionals who can individualize a comprehensive array of evidence-based services with competency, consistency, continuity, coordination, collaboration, and fidelity. The authors describe the properties and functions of the multidisciplinary team and key attributes of effective teams. The importance of teams' involving clients, their relatives, and other supporters in setting personally relevant life goals is emphasized. The authors provide examples of the challenges posed by the need to individualize services and of the ways in which barriers to communication and coordination can be overcome. The roles of the various team members are described, including leadership roles and the unique role of the psychiatrist, in the context of newly emerging, evidence-based treatments for psychiatric rehabilitation.