The Long-Term Impact of Employment on Mental Health Service Use and Costs for Persons With Severe Mental Illness

Dartmouth Psychiatric Research Center, Dartmouth Medical School, 2 Whipple Pl., Suite 202, Lebanon, NH 03766, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 09/2009; 60(8):1024-31. DOI: 10.1176/
Source: PubMed


Stable employment promotes recovery for persons with severe mental illness by enhancing income and quality of life, but its impact on mental health costs has been unclear. This study examined service cost over ten years among participants in a co-occurring disorders study.
Latent-class growth analysis of competitive employment identified trajectory groups. The authors calculated annual costs of outpatient services and institutional stays for 187 participants and examined group differences in ten-year utilization and cost.
A steady-work group (N=51) included individuals whose work hours increased rapidly and then stabilized to average 5,060 hours per person over ten years. A late-work group (N=57) and a no-work group (N=79) did not differ significantly in utilization or cost outcomes, so they were combined into a minimum-work group (N=136). More education, a bipolar disorder diagnosis (versus schizophrenia or schizoaffective disorder), work in the past year, and lower scores on the expanded Brief Psychiatric Rating Scale predicted membership in the steady-work group. These variables were controlled for in the outcomes analysis. Use of outpatient services for the steady-work group declined at a significantly greater rate than it did for the minimum-work group, while institutional (hospital, jail, or prison) stays declined for both groups without a significant difference. The average cost per participant for outpatient services and institutional stays for the minimum-work group exceeded that of the steady-work group by $166,350 over ten years.
Highly significant reductions in service use were associated with steady employment. Given supported employment's well-established contributions to recovery, evidence of long-term reductions in the cost of mental health services should lead policy makers and insurers to promote wider implementation.

Download full-text


Available from: Gregory J Mchugo, Jul 15, 2015
  • Source
    • "Our earlier review concluded that more evidence was needed concerning the potential to increase the power of IPS by combining it with adjunct interventions (Boycott et al., 2012). There is increasing evidence that on its own IPS results in significant cost offsets by increasing the proportion of clients who work (Bush et al., 2009;Kilian et al., 2011;Perkins et al., 2005;Schneider et al., 2009). In terms of both days worked and whether the individual had worked at least for 1 day, IPS generated improvements and was cost saving from the point of view of the health and social care systems (Knapp et al., 2013). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jan 2016
  • Source
    • "Employment was found to reduce utilization of government benefit programs and decrease the financial strain on mental health care systems (Baron, 2000; Bush, et al. 2009; Drake, McHugo, Becker, Anthony, & Clarke, 1996; Kouzis & Eaton, 2000). Employment was found to improve physical health, increase confidence, enhance competence, and increase opportunities to solve challenging work issues (Huff, Rapp, & Campbell, 2008; Corrigan, Larson, & Kuwabara, 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: In contrast to the institutional approach of years past, today most people with mental illness live in the community, and decide for themselves whether, and to what extent, to participate in treatment. Providers are now beginning to ask, How do I provide services that help people achieve their recovery goals? rather than, How do I get my patient to adhere to the prescribed treatment? Contributors to this volume describe the public health benefits that emerge when providers respect personal health care decisions even when the person making them has a serious mental illness. They also share evidence-based practices that enhance self-determination, such as creating an advance psychiatric directive, addressing clients information processing difficulties so they can better understand their treatment options, and motivational interviewing to support employment as part of a recovery plan. Rich examples of consumer-provider interactions illustrate how providers can instill hope and help activate the client s support
    Full-text · Chapter · May 2015
  • Source
    • "Another very recent small - scale study ( Schneider et al . , 2009 ) , based on experience in the United Kingdom , differed from Bush et al . ( 2009 ) in that the follow - up period was much shorter but all persons in the study were recipients of SE services . The paper examines baseline versus 12 - month follow - up costs of services used for 142 clients , comparing 32 who were already working pre - baseline and remained in the same job , 32 who obtained worked just prior to baseli"
    [Show abstract] [Hide abstract]
    ABSTRACT: The Office of the Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the Department of Health and Human Services (HHS) on policy development issues, and is responsible for major activities in the areas of legislative and budget development, strategic planning, policy research and evaluation, and economic analysis. ASPE develops or reviews issues from the viewpoint of the Secretary, providing a perspective that is broader in scope than the specific focus of the various operating agencies. ASPE also works closely with the HHS operating divisions. It assists these agencies in developing policies, and planning policy research, evaluation and data collection within broad HHS and administration initiatives. ASPE often serves a coordinating role for crosscutting policy and administrative activities. ASPE plans and conducts evaluations and research--both in-house and through support of projects by external researchers--of current and proposed programs and topics of particular interest to the Secretary, the Administration and the Congress.
    Full-text · Article · Mar 2014
Show more