Schizophrenia is one of the most debilitating mental disorders. For a significant portion of individuals who suffer from this disorder, onset occurs in young adulthood, arresting important social and educational development that is necessary for future successful labor force participation. The purpose of this paper is to contribute to the literature about clients enrolled in first episode psychosis programs and psychosocial outcomes by examining the factors associated with paid employment among young adults who have experienced their first psychotic episodes. In this paper, we consider the association of socioeconomic factors to employment. Our results suggest that in addition to treatment, socioeconomic factors such as receipt of public disability benefits and educational attainment are associated with employment status. These results can help to inform future directions for the enhancement of psychosocial programs in FEP models to promote paid employment. 1. Introduction Schizophrenia is one of the most debilitating mental disorders. For a significant portion of individuals who suffer from this disorder, onset occurs in young adulthood, arresting important social and educational development that is necessary for future successful labor force participation. As a result, schizophrenia is often associated with an eventual downward spiral ending in poverty and isolation[1]. To avert this dismal future, the focus on the first psychotic episode (FEP) is becoming a priority for mental health care globally (e.g., Johannessen et al. [2]). There is also growing evidence surrounding the low employment rates of people with FEP. Employment rate estimates range from 13 to 55% [3–5]. Reviews of the literature [3, 6] note that there are a number of factors associated with employment along a number of dimensions [7–9]. Along with cognitive impairment and symptoms, educational attainment, family socioeconomic status, social benefit structures, and labour market conditions also potentially affect employment of young adults with first episode psychosis [3]. There appears to be a complex mix of both individual and environmental factors linked to successful labour market participation. Although it is a multifaceted challenge, there is increasing evidence for the effectiveness of interventions such as Individual Placement and Support (IPS) programs and the interventions of vocational specialists for this population [4, 6, 10–13]. As such, the International First Episode Vocational Recovery (iFEVR) Group [14] released a consensus statement advocating for the “right to
References
[1]
W. L？ffler and H. H？fner, “Ecological pattern of first admitted schizophrenics in two German cities over 25 years,” Social Science and Medicine, vol. 49, no. 1, pp. 93–108, 1999.
[2]
J. O. Johannessen, T. H. McGlashan, T. K. Larsen et al., “Early detection strategies for untreated first-episode psychosis,” Schizophrenia Research, vol. 51, no. 1, pp. 39–46, 2001.
[3]
S. Marwaha and S. Johnson, “Schizophrenia and employment: a review,” Social Psychiatry and Psychiatric Epidemiology, vol. 39, no. 5, pp. 337–349, 2004.
[4]
M. Rinaldi, K. McNeil, M. Firn, M. Koletsi, R. Perkins, and S. P. Singh, “What are the benefits of evidence-based supported employment for patients with first-episode psychosis?” Psychiatric Bulletin, vol. 28, no. 8, pp. 281–284, 2004.
[5]
B. S. Major, M. F. Hinton, A. Flint, A. Chalmers-Brown, K. McLoughlin, and S. Johnson, “Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study,” Social Psychiatry and Psychiatric Epidemiology, vol. 45, no. 1, pp. 1–8, 2010.
[6]
M. Rinaldi, E. Killackey, J. Smith, G. Shepherd, S. P. Singh, and T. Craig, “First episode psychosis and employment: a review,” International Review of Psychiatry, vol. 22, no. 2, pp. 148–162, 2010.
[7]
A. D. Henry and A. M. Lucca, “Facilitators and barriers to employment: the perspectives of people with psychiatric disabilities and employment service providers,” Work, vol. 22, no. 3, pp. 169–182, 2004.
[8]
K. T. Mueser, R. E. Clark, M. Haines et al., “The Hartford study of supported employment for persons with severe mental illness,” Journal of Consulting and Clinical Psychology, vol. 72, no. 3, pp. 479–490, 2004.
[9]
S. R. McGurk and K. T. Mueser, “Cognitive functioning, symptoms, and work in supported employment: a review and heuristic model,” Schizophrenia Research, vol. 70, no. 2-3, pp. 147–173, 2004.
[10]
E. J. Killackey, H. J. Jackson, J. Gleeson, I. B. Hickie, and P. D. McGorry, “Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first-episode psychosis: employing cautious optimism,” Australian and New Zealand Journal of Psychiatry, vol. 40, no. 11-12, pp. 951–962, 2006.
[11]
K. H. Nuechterlein, K. L. Subotnik, L. R. Turner, J. Ventura, D. R. Becker, and R. E. Drake, “Individual placement and support for individuals with recent-onset schizophrenia: integrating supported education and supported employment,” Psychiatric Rehabilitation Journal, vol. 31, no. 4, pp. 340–349, 2008.
[12]
M. Rinaldi, R. Perkins, E. Glynn, T. Montibeller, M. Clenaghan, and J. Rutherford, “Individual placement and support: from research to practice,” Advances in Psychiatric Treatment, vol. 14, no. 1, pp. 50–60, 2008.
[13]
E. Killackey, H. J. Jackson, and P. D. McGorry, “Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual,” British Journal of Psychiatry, vol. 193, no. 2, pp. 114–120, 2008.
[14]
E. Killackey, “Meaningful lives: supporting young people with psychosis in education, training and employment: an international consensus statement,” Early Intervention in Psychiatry, vol. 4, no. 4, pp. 323–326, 2010.
[15]
S. Marwaha and S. Johnson, “Views and experiences of employment among people with psychosis: a qualitative descriptive study,” International Journal of Social Psychiatry, vol. 51, no. 4, pp. 302–316, 2005.
[16]
G. R. Bond, D. R. Becker, R. E. Drake et al., “Implementing supported employment as an evidence-based practice,” Psychiatric Services, vol. 52, no. 3, pp. 313–322, 2001.
[17]
Ontario Ministry of Health and Long-Term Care, Early Psychosis Intervention Program Standards, Ontario Ministry of Health and Long-Term Care, Toronto, Canada, 2011.
[18]
J. Bertolote and P. McGorry, “Early intervention and recovery for young people with early psychosis: consensus statement,” British Journal of Psychiatry, vol. 187, no. 48, pp. s116–s119, 2005.
[19]
J. Edwards and P. McGorry, “Developing an early psychosis service—'nuts and bolts',” in Implementing Early Intervention in Psychosis: A Guide to Establishing Early Psychosis Services, J. Edwards and P. McGorry, Eds., pp. 85–106, Martin Dunitz, London, UK, 2002.
[20]
International Early Psychosis Association Writing Group, “International clinical practice guidelines for early psychosis,” British Journal of Psychiatry, vol. 187, pp. 120–124, 2005.
[21]
P. A. Garety, T. K. J. Craig, G. Dunn et al., “Specialised care for early psychosis: symptoms, social functioning and patient satisfaction—randomised controlled trial,” British Journal of Psychiatry, vol. 188, pp. 37–45, 2006.
[22]
R. M. G. Norman, A. K. Mallal, R. Manchanda et al., “Does treatment delay predict occupational functioning in first-episode psychosis?” Schizophrenia Research, vol. 91, no. 1–3, pp. 259–262, 2007.
[23]
M. Bertelsen, P. Jeppesen, L. Petersen et al., “Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness : the OPUS trial,” Archives of General Psychiatry, vol. 65, no. 7, pp. 762–771, 2008.
[24]
K. Campbell, G. R. Bond, R. E. Drake, G. J. McHugo, and H. Xie, “Client predictors of employment outcomes in high-fidelity supported employment: a regression analysis,” Journal of Nervous and Mental Disease, vol. 198, no. 8, pp. 556–563, 2010.
[25]
L. Harvey, “New realities: the relationship between higher education and employment,” Tertiary Education and Management, vol. 6, no. 1, pp. 3–17, 2000.
B. C. Ho, N. Andreasen, and M. Flaum, “Dependence on public financial support early in the course of schizophrenia,” Psychiatric Services, vol. 48, no. 7, pp. 948–950, 1997.
[28]
M. McQuilken, J. H. Zahniser, J. Novak, R. D. Starks, A. Olmos, and G. R. Bond, “The work project survey: consumer perspective on work,” Journal of Vocational Rehabilitation, vol. 18, no. 1, pp. 59–68, 2003.
[29]
S. P. Singh, T. Croudace, S. Amin et al., “Three-year outcome of first-episode psychoses in an established community psychiatric service,” British Journal of Psychiatry, vol. 176, pp. 210–216, 2000.
[30]
N. Turner, S. Browne, M. Clarke et al., “Employment status amongst those with psychosis at first presentation,” Social Psychiatry and Psychiatric Epidemiology, vol. 44, no. 10, pp. 863–869, 2009.
[31]
G. Waghorn, D. Chant, and H. Whiteford, “The strength of self-reported course of illness in predicting vocational recovery for persons with schizophrenia,” Journal of Vocational Rehabilitation, vol. 18, no. 1, pp. 33–41, 2003.
[32]
J. A. Cook, “Employment barriers for persons with psychiatric disabilities: update of a report for the president's commission,” Psychiatric Services, vol. 57, no. 10, pp. 1391–1405, 2006.
[33]
P. W. Bush, R. E. Drake, H. Xie, G. J. McHugo, and W. R. Haslett, “The long-term impact of employment on mental health service use and costs for persons with severe mental illness,” Psychiatric Services, vol. 60, no. 8, pp. 1024–1031, 2009.
[34]
E. Westerhout, “Disability risk, disability benefits, and equilibrium unemployment,” International Tax and Public Finance, vol. 8, no. 3, pp. 219–243, 2001.
[35]
Ontario Ministry of Community and Social Services, Ontario Disability Benefits, Ontario Ministry of Community and Social Services, Toronto, Canada, 2010.
[36]
C. S. Dewa and D. McDaid, “Investing in the mental health of the labor force: epidemiological and economic impact of mental disorders in the workplace,” in Handbook of Job Accomodation on Mental Health, I. Schultz and E. Rogers, Eds., Springer, New York, NY, USA, 2009.
[37]
K. L. MacDonald-Wilson, E. S. Rogers, M. L. Ellison, and A. Lyass, “A study of the social security work incentives and their relation to perceived barriers to work among persons with psychiatric disability,” Rehabilitation Psychology, vol. 48, no. 4, pp. 301–309, 2003.
[38]
S. Magura, “The role of work in substance dependency treatment: a preliminary overview,” Substance Use and Misuse, vol. 38, no. 11–13, pp. 1865–1876, 2003.
