What Employment Programs Should Health Services Invest in for People with a Psychiatric Disability?

Article excerpt

Abstract

Employment has significant health benefits for people with a psychiatric disability, including improved mental health and wellbeing and a reduction in symptoms and rates of relapse. Systematic reviews show that supported employment is more effective than prevocational training in achieving open employment for this group. Health services should invest in developing partnerships and structures to ensure access to evidence-based supported employment programs for people with a psychiatric disability. We draw on exploratory research in south-west Sydney to discuss some of the challenges that a focus on employment presents for mental health services.

Aust Health Rev 2005: 29(2): 185-188

DESPITE EVIDENCE THAT PEOPLE with a psychiatric disability want to work, this group experiences ongoing difficulties securing and maintaining employment.1 Up to 80% of people with a psychiatric disability are unemployed in Australia at any one time.2 Unemployment is a health hazard for general populations,3 but is particularly hazardous for people with a psychiatric disability, contributing to lower self-esteem; higher levels of psychiatric disturbance; severe social isolation; stigmatisation; and further marginalisation within society.4 Unemployment has unique impacts on the general mental health and wellbeing of people with a psychiatric disability. Even in people with severe psychiatric disabilities, unemployment contributes more to the explanation of general self-rated health than psychiatric symptoms.5

Employment has significant health benefits for people with a psychiatric disability. Studies show that employment: improves psychological health and wellbeing; improves quality of life; reduces psychiatric symptoms; improves general functioning; and reduces rates of relapse for this group.6"8 Employment is a normalising experience that promotes status and integration in the community, economic independence and access to valued social roles; factors that lessen dependency upon health and welfare systems.8 However, even positive life changes can have negative impacts, and work may act as a stressor for some people with a psychiatric disability.9 In fact, people with a psychiatric disability who have clear strategies for managing work-related stressors are more successful in securing and maintaining employment than people who do not possess these strategies.10

Health systems have much to gain from including a focus on employment for people with a psychiatric disability Comprehensive psychiatric rehabilitation approaches that incorporate employment programs report shorter hospitalisation periods and reduced costs compared with standard care.

What employment programs are effective?

There are essentially two models of employment programs for people with a psychiatric disability: prevocational training and supported employment. These approaches differ in terms of when a person with a psychiatric disability is considered to be "well-enough" for work, the methods through which the person is assisted into employment, and what vocational outcomes are considered to be appropriate. A summary of the major differences between prevocational training and supported employment is presented in the Box.

Prevocational training refers to all activities that are designed to prepare people with a psychiatric disability for the workforce.12 Ideally, but not always, this preparation is for entry into open or competitive employment; meaning employment that is paid at the award wage and open to all potential employees. Pratt et al. identify six approaches to prevocational training.13

* Job skills and job clubs: support groups that provide resources and training in job search and employment.

* Hospital-based work programs: on-site employment experience for inpatients of mental health services.

* Sheltered workshops or business services: organisations that solicit manufacturing jobs from local business and provide supervision to people with disabilities. …