What strategies improve employment outcomes in individuals with a psychiatric diagnosis?

From the Guidelines

To improve employment outcomes in individuals with a psychiatric diagnosis, a multifaceted approach involving both clinical and vocational interventions is recommended, with a focus on optimizing medical treatment, providing evidence-based psychotherapy, and implementing supported employment programs, as outlined in the most recent guidelines 1.

Key Components of the Approach

• Optimizing medical treatment to ensure symptoms are well-controlled, which may include medications like selective serotonin reuptake inhibitors (SSRIs) for depression and anxiety, stimulants for ADHD, or antipsychotics for schizophrenia, with careful consideration of potential side effects and comorbidities 1.
• Combining medication management with evidence-based psychotherapy, such as cognitive behavioral therapy (CBT), typically delivered in 12-16 weekly sessions, to address functional limitations and environmental barriers in the workplace 1.
• Implementing supported employment programs like Individual Placement and Support (IPS), which provides job coaching, on-the-job support, and long-term follow-up, rather than extended pre-employment training, to facilitate job retention and career advancement 1.

Additional Considerations

• Providing reasonable workplace accommodations, such as flexible scheduling, modified work environments, assistive technology, or adjusted job responsibilities, to create a more inclusive workplace and address stigma through education for employers and coworkers 1.
• Addressing cognitive and adaptive strengths and weaknesses, especially at transition to adulthood, through assessment and counseling, to provide evidence of need for supports and services and prevent overestimation of abilities 1.
• Implementing remediating and compensating measures for problem areas, such as structure and daily routine, to facilitate optimal overall functioning and reduce stress 1.

Prioritizing Morbidity, Mortality, and Quality of Life

• The approach prioritizes reducing morbidity and mortality related to physical health in individuals with psychiatric diagnoses, by addressing factors such as obesity, diabetes, hyperlipidemia, and disparities in access to preventive health care and treatment for physical conditions 1.
• The approach also prioritizes improving quality of life, by providing evidence-based treatments, supporting employment and education, and promoting social inclusion and participation 1.

From the Research

Strategies to Improve Employment Outcomes

Several strategies have been identified to improve employment outcomes in individuals with a psychiatric diagnosis, including:

• Individual Placement and Support (IPS) model of supported employment, which has been shown to be effective in improving competitive employment outcomes compared to traditional vocational rehabilitation 2, 3, 4, 5
• Supported employment, which has been found to be more effective than prevocational training, transitional employment, and psychiatric care only in obtaining competitive employment 3
• Augmented supported employment, which has been shown to be more effective than supported employment alone in obtaining and maintaining competitive employment 3
• Focus on rapid job search and no required prevocational skills training, which is a key principle of the IPS model 5
• Integration of vocational and clinical services, which is also a key principle of the IPS model 5
• Attention to client preferences about desired work and disclosure of mental illness to prospective employers, which is an important aspect of the IPS model 5

Key Principles of Supported Employment

The key principles of supported employment, as defined by the IPS model, include:

• Inclusion of all clients who want to work
• Integration of vocational and clinical services
• Focus on competitive employment
• Rapid job search and no required prevocational skills training
• Job development by the employment specialist
• Attention to client preferences about desired work and disclosure of mental illness to prospective employers
• Benefits counseling
• Follow-along supports after a job is obtained 5

Effectiveness of Supported Employment

Supported employment has been shown to be effective in improving employment outcomes for individuals with severe mental illness, with studies demonstrating that it is more than twice as likely to lead to competitive employment compared to traditional vocational rehabilitation 4. Additionally, supported employment has been found to be effective in varying economic conditions and across international settings 4. The effectiveness of supported employment is also supported by studies that have found it to be effective in improving mental health outcomes, including reducing symptoms and improving quality of life 6.