Academic journal article Journal of Rehabilitation Research & Development

Receipt of Employment Services among Veterans Health Administration Users with Psychiatric Diagnoses

Academic journal article Journal of Rehabilitation Research & Development

Receipt of Employment Services among Veterans Health Administration Users with Psychiatric Diagnoses

Article excerpt

INTRODUCTION

It is well known that people with severe mental illnesses, such as schizophrenia and bipolar disorder, face unemployment rates far higher than the general population [1-2], despite the fact that a majority of these individuals report a desire to work [3]. Although people with depressive disorders are not always classified as having a "severe" mental illness, population-based studies suggest that they, too, have lower rates of employment than people without a mood disorder [4]. Moreover, a range of psychiatric disorders is associated with days of work lost [5]. Similarly, a large representative study of working-aged (18-64 yr old) Veterans Health Administration (VHA) patients recently found that those with psychiatric diagnoses of schizophrenia, bipolar disorder, posttraumatic stress disorder (PTSD), depression, or a substance use disorder were more likely to be unemployed, disabled, or retired than patients without psychiatric diagnoses [6]. These findings are particularly striking because, on average, VHA patients are already less likely to be employed than the general population [6].

For people with psychiatric diagnoses, employment is known to be a meaningful indicator of functioning in that it allows access to a valued social role [7] and a sense of meaning and recovery [8]. Additionally, a recent analysis found that having a working-aged member of a household with severe mental illness is associated with a 3.10 increase in the odds of household poverty [9]. While the presence of a working-aged adult with severe mental illness and an unemployed head of household were each uniquely associated with increased likelihood of household poverty, the combination of having a working-aged person with severe mental illness and an unemployed head of household was associated with an even higher likelihood and greater depth of poverty [9]. Hence, employment is critical to improving the economic situation of people with severe mental illness.

Veterans Health Administration Therapeutic and Supported Employment Services

Facilitating opportunities for employment has long been considered a relevant aspect of providing mental health treatment to Veterans with psychiatric diagnoses [10]. Currently, the VHA provides vocational rehabilitative services through the Therapeutic and Supported Employment Services (TSES) program to help Veterans with psychiatric diagnoses obtain employment and experience the therapeutic effects of work. TSES includes four primary types of vocational rehabilitative services: supported employment (SE), transitional work (TW), incentive therapy (IT), and vocational assistance (Voc Assist) [11].

SE utilizes an individualized approach to working with people to help them obtain competitive employment in a job of their choosing in the community [11]. Two meta-analyses of randomized controlled trials indicate that SE helps persons with serious mental illness obtain competitive employment [12-13]; thus, it is considered the gold standard evidence-based practice for improving employment outcomes among people with serious mental illness. By definition, SE is provided in community rather than clinical settings and includes having an employment specialist provide assistance identifying and obtaining jobs that are matched to the Veteran's interests and abilities, identifying and addressing challenges to employment, and providing ongoing support while seeking employment and while employed to the extent desired by the Veteran.

TW is a program in which Veterans gain work experience through time-limited positions in actual work settings in the community or at VHA medical centers. Per VHA policy, work settings include, but are not limited to, the following: housekeeping, grounds maintenance, and clerical duties involving nonsensitive patient information. The goal of TW is to prepare participants to successfully transition into competitive employment. In contrast, IT is a prevocational work program in which Veterans perform work at VHA medical centers. …

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