First episode psychosis and employment: A review

South West London and St George's Mental Health NHS Trust, London, UK.
International Review of Psychiatry (Impact Factor: 1.8). 01/2010; 22(2):148-62. DOI: 10.3109/09540261003661825
Source: PubMed


Despite considerable growth in treatments, interventions, services and research of young people with a first episode of psychosis, little attention has been given to the priorities of these young people, in particular, gaining employment. A literature review was undertaken with the aim of investigating: 1) whether young people with a first episode of psychosis want to work, 2) what challenges they experience regarding work, 3) what is understood about employment outcomes, 4) what the most effective interventions to enable them to gain employment may be, and 5) what the associated costs may be. The review found that these young people appear to want to work yet face a range of psychological and social challenges to achieving this. Typically by the time they first come into contact with mental health services a proportion are already falling out of education and employment, and this decline continues with contact with services. However, there are specific interventions that can support them to gain employment. The Individual Placement and Support approach, adapted to include support to fulfil educational goals, has demonstrated that a mean of 69% of young people with a first episode of psychosis can gain education and employment compared to 35% of controls.

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Available from: Swaran Preet Singh, Sep 30, 2015
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    • "Some may have lost jobs while experiencing psychosis. No participants reported receiving supported employment, which might have increased employment outcomes further (Rinaldi et al., 2010 "
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    • "Some may have lost jobs while experiencing psychosis. No participants reported receiving supported employment, which might have increased employment outcomes further (Rinaldi et al., 2010 "
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    ABSTRACT: Background: Employment may be an important factor in helping patients with early psychosis to recover rapidly and to avoid involvement in disability and welfare programs. Methods: This study followed 351 patients with early psychoses, either primary psychoses or substance-induced psychoses, for two years to examine their patterns of competitive employment in relation to service use, psychosocial outcomes, and disability and welfare payments. Results: Workers differed from non-workers at baseline and over two years. At baseline, they had better educational and employment histories, were more likely to have substance-induced psychoses rather than primary psychoses, were less likely to have drug dependence, had fewer negative symptoms, and had better psychosocial adjustment. Over two years, baseline psychosocial differences persisted, and the workers used fewer medications, mental health services, and disability or welfare payments. Conclusions: Employment predicts less service use and fewer disability claims among early psychosis patients. Thus, greater attention to supported employment early in the course of illness may reduce federal insurance costs and disability payments.
    Schizophrenia Research 03/2013; 146(1-3). DOI:10.1016/j.schres.2013.02.012 · 3.92 Impact Factor
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    • "This is a significant finding, as it makes a novel contribution to the evidence base in early psychosis utilizing the methodological rigors of an RCT. This finding is consistent with the emerging literature in early psychosis (Rinaldi et al., 2010), and the broader literature examining supported employment among people diagnosed with severe mental illness (Burns et al., 2007). Study findings have important implications for the delivery of early psychosis services. "
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    ABSTRACT: Objective: The current study sought to examine demographic and clinical predictors of vocational recovery among young people with first-episode psychosis who participated in a randomized controlled trial (RCT) investigating the effectiveness of the supported employment model among this population. Method: Our original RCT compared Individual Placement and Support + treatment as usual (n = 20) with treatment as usual alone (n = 21) (Killackey, Jackson, & McGorry, 2008). A series of logistic regression analyses were conducted to assess the predictive power of demographic and clinical factors on the vocational recovery of young people with first-episode psychosis. Results: Vocational recovery (defined as securing a position in competitive employment or attending a course of education at any point during the 6-month follow-up period) was predicted by participating in the vocational intervention (OR = 14.17, p = .001), having never been married (compared to those married/de facto: OR = 6.56, p = .044), and the instrumental role functioning subscale from the Quality of Life scale (OR = 1.21, p = .037). When considered together, only treatment group remained significant: Participants randomized to the vocational intervention were 16.26 times more likely to obtain work or study during the follow-up period compared to participants randomized to treatment as usual. Conclusions and implications for practice: It is critical that vocational services are introduced as part of an evidence-based, multidisciplinary approach in routine clinical care at early psychosis services. Further replication of these findings is indicated with a larger sample, particularly with the addition of cognitive training interventions to further improve vocational outcomes for young people with first-episode psychosis.
    Psychiatric Rehabilitation Journal 12/2012; 35(6):421-427. DOI:10.1037/h0094574 · 1.16 Impact Factor
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