By Rebecca A. Clay

Other Answers

The EIDP study also answered more specific questions:

Demographic factors. A Community Mental Health Journal article co-authored by UIC's Jane K. Burke-Miller, M.S., for instance, reports that certain demographic characteristics were associated with employment success.

Having any work history in the previous 5 years roughly tripled study participants' chances of getting a job, for instance. Other demographic characteristics lessened participants' chances of success. With every 10-year increment in participants' age, their chances of getting a job dropped by almost 20 percent. And those with less than a high school education were nearly 40 percent less likely to find jobs. The same characteristics also predicted who did—and didn't—work 40 hours or more a month.

Those findings have important implications for supported employment programs, the authors say. The positive effect of recent work history, for instance, supports the idea that individuals should start looking for jobs as quickly as possible. The other findings suggest the need for interventions tailored to older people and to younger people who need help completing secondary and post-secondary education.

Clinical factors. Clinical factors are another important variable, according to an article in the Journal of Nervous and Mental Disease co-authored by Lisa A. Razzano, Ph.D., of UIC.

Recent psychiatric hospitalizations, self-rated poor functioning, and negative psychiatric symptoms like low motivation and the monotonous voice, unvaried facial expression, and apathetic demeanor known as "flat affect" are all associated with failure to get jobs and to work at least 40 hours a month. Co-occurring medical conditions and substance abuse were also barriers to getting jobs.

These findings suggest the need to tailor supported employment programs to better fit the needs of various clinical subpopulations, say the study's authors.

Programs should also focus on helping people re-enter the workforce as soon as possible after hospitalizations. In addition, assistance with choosing appropriate jobs and designing workplace accommodations could help people get and keep jobs despite negative symptoms.

Specific services. Other articles focus not on the participants but on the services offered. A Psychiatric Services article co-authored by H. Stephen Leff, Ph.D., of the Human Services Research Institute in Cambridge, MA, examines the effect of two specific supported employment services: job development and job support. The researchers defined job development as contact with potential employers or networking with people who might have job information; they defined job support as counseling, support, and problem-solving.

The study's results were mixed. Study participants who received job development services were nearly five times more likely to get jobs than those who didn't, the researchers found. But while job support was associated with participants keeping their first jobs, the researchers questioned whether such services actually caused the improved retention rate.

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Site Studies

Some EIDP sites have published articles drawing on data from their own geographic locations.

In an article published in Schizophrenia Bulletin, for instance, Paul B. Gold, Ph.D., of the Medical University of South Carolina, and other researchers there and at the South Carolina Department of Mental Health, examined the question of whether supported employment works in rural areas where job opportunities are scarce and services are limited, fragmented, and geographically dispersed.

The answer was "yes." The researchers randomly assigned participants in a rural county to receive either integrated mental health and vocational services or traditional vocational and mental health services provided by two different agencies.

They found that outcomes in this rural area were comparable to outcomes in the large urban areas where supported employment has been studied the most. Sixty-four percent of participants receiving integrated services got competitive jobs, compared to just 26 percent of those receiving parallel services. They also earned more.

Although the participants made significant progress, however, they still didn't earn enough to achieve economic independence. The authors call for public policies to reduce barriers to higher education, promote career-oriented jobs for those with serious mental illnesses, and restore benefits eligibility to those who leave Federal insurance programs to work but later suffer setbacks in their recovery.

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Ongoing Data Analysis

Researchers will continue to analyze the EIDP data, said Dr. Cook. They want to study the effect employment has on people's quality of life, for instance. They also want to find ways to help people get higher-paying jobs with health insurance benefits, so it won't matter if they lose their disability benefits and access to Medicaid.

"There are many important questions we still want to address," said Dr. Cook. "After all, we devoted close to 10 years of our lives to the study."

For more information about the EIDP, visit the study's home page at www.psych.uic.edu. For information on mental illnesses, visit the SAMHSA Web site at www.samhsa.gov. 

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References

Burke-Miller, J.K., et al. "Demographic Characteristics and Employment Among People with Severe Mental Illness in a Multisite Study." Community Mental Health Journal, 2006. Published online.

Cook, J.A., et al. "Integration of Psychiatric and Vocational Services: A Multisite Randomized, Controlled Trial of Supported Employment." American Journal of Psychiatry, 2005. 162(10):1948-1956.

Cook, J.A., et al. "Results of a Multisite Randomized Trial of Supported Employment Interventions for Individuals with Severe Mental Illness." Archives of General Psychiatry, 2005. 62:505-512.

Gold, P.B., et al. "Randomized Trial of Supported Employment Integrated with Assertive Community Treatment for Rural Adults with Severe Mental Illness." Schizophrenia Bulletin, 2005. Published online.

Leff, H.S., et al. "Effects of Job Development and Job Support on Competitive Employment of Persons with Severe Mental Illness." Psychiatric Services, 2005. 56(10):1237-1244.

Razzano, L.A., et al. "Clinical Factors Associated with Employment among People with Severe Mental Illness: Findings from the Employment Intervention Demonstration Program." Journal of Nervous and Mental Disease, 2005. 193(11):705-713. 

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