Preliminary Outcomes from an Individualised Supported Education Programme Delivered by a Community Mental Health Service
Robson, Emma, Waghorn, Geoff, Sherring, Joanne, Morris, Adrienne, British Journal of Occupational Therapy
Occupational therapists working in the public mental health system are well positioned to promote evidence-based practices actively in order to improve employment outcomes for people with a mental illness (Lloyd et al 2004). Two forms of assistance are now recommended as evidence-based practice for helping young people to establish careers or to recommence a career path following the onset of severe mental illness. These forms of assistance are supported employment (Bond 2004, Bond et al 2008) and supported education (Unger 1990, Unger et al 1991, Bellamy and Mowbray 1998, Bond et al 2004, Best et al 2008, Neuchterlein et al 2008). However, these forms of assistance are not routinely incorporated into community mental health services (Murphy et al 2005, Rapp et al 2005).
Career development is often interrupted by the onset of severe mental illness, which typically presents at ages 10 to 30 years (Jablensky et al 1999, Waghorn et al 2007). Disruption to secondary and higher education, and school to work transitions, may flatten career trajectories to entry-level jobs or less skilled jobs, resulting in reduced status and income (Waghorn and Lloyd 2005, Waghorn et al 2007). However, among people with severe mental illness, those with bipolar affective disorder often have higher educational attainment than the minimum required by their current job (McPherson et al 1992, Tse and Walsh 2001).
Educational attainment is associated with improved employment outcomes for people with mental illness in both the United States and Australia (Mechanic et al 2002, Waghorn et al 2004). Waghorn and Lloyd (2005) reported employment status from a large Australian community survey. Employment outcomes for people with psychotic disorders increased from 11.6% among those not completing secondary school, to 22.1% among those who completed secondary school and to 34.3% among those with vocational qualifications, reaching 46.7% among university graduates.
Given the many benefits associated with educational attainment and employment for people with psychiatric disability, it is surprising that supported employment and supported education programmes are not yet routinely provided by public mental health services in all developed countries. Although supported employment is becoming more widely available (Bond 2004, Bond et al 2008), supported education is less frequently available (Unger 1990, Waghorn et al 2004) even though youth in particular benefit from the joint provision of both supported employment and supported education services (Murphy et al 2005, Porteous and Waghorn 2007, Killackey et al 2008).
Reports from experimental studies of the effectiveness of supported education are promising (for example, Collins et al 1998). Unger (1990) described three methods by which supported education is typically provided: the self-contained classroom model, the on-site support model and the mobile support model. The self-contained classroom model involves courses run separately for people with a disability, with additional support from either educational or mental health staff. The on-site support describes a model in which students attend mainstream classes and receive additional support from education facility staff. The mobile support model offers slight variation to the on-site support model, with individualised support to students provided by mental health staff either on or off campus.
Little is known about how supported education programmes can be used to complement supported employment programmes (Murphy et al 2005) and whether the joint programme enhances career development. There is also insufficient information to determine which support method is most effective (Waghorn et al 2004). A recent report (Best et al 2008) examined the self-contained classroom method in Australia. Although this study noted promising course completion rates, the self-contained classroom method limits choice of education pathways to those of the host institution. …