While many of the overt symptoms of schizophrenia may be controlled by medication, the associated psychiatric disability requires ongoing psychosocial rehabilitation and support in the community. The general practitioner can play a crucial role in this rehabilitative process, through
Persons with severe mental illness (SMI) have reduced workforce participation, which leads to significant economic and social disadvantage. This theoretical review introduces the strategies that have been implemented to address this issue. These include Individual Placement and Support (IPS) services, the most widely researched form of supported employment, to which cognitive remediation has more recently been recognised in the USA, as an intervention to improve employment outcomes by addressing the cognitive impairments often experienced by people with SMI. The authors review the international literature and discuss specifically the Australian context. They suggest that Australia is in a prime position to engage clients in such a dual intervention, having had recent success with increasing access to supported employment programs and workforce reentry, through implementation of the Health Optimisation Program for Employment (HOPE). Such programs assist with gaining and maintaining employment. However, they do not address the cognitive issues that often prevent persons with SMI from effectively participating in work. Thus, optimising current interventions, with work-focused cognitive skills development is critical to enhancing employment rates that remain low for persons with SMI.
Objective Despite advances in the treatment of people with severe mental illness (SMI), access to work for this community still remains a challenge. Cognitive remediation (CR) is an intervention that can improve employment outcomes, especially when offered alongside employment support. This pilot study aimed to determine whether CR enhances vocational outcomes for job seekers participating in an innovative vocationally oriented psycho‐educational program implemented in Australia. Method Fourteen participants with SMI were enrolled in Health Optimisation Program for Employment (HOPE) and attended 20 sessions of CR. Assessments were performed at baseline, post‐CR, and 3 months follow‐up. Individuals were assessed on a number of occupational and psychosocial variables (e.g., hours of paid and unpaid work, self‐esteem, quality of life, social relationships), in addition to undertaking the MATRICS Consensus Cognitive Battery. Results There was no increase in hours of paid work for those in employment, but 46% of the group initiated tertiary studies between baseline and 3‐month follow‐up. There was a trend towards a significant increase in number of volunteer hours, with 31% of individuals having initiated a non‐paid activity at the end of the CR. As predicted, cognition improved over time as did psychosocial outcomes in the areas of self‐esteem, quality of life and social relationships. Conclusions Consistent with previous studies, CR improved psychosocial and cognitive functioning. While employment benefits were not found, promising outcomes were reported on volunteering and educational participation. This pilot suggests there may be potential for combining CR with HOPE to enhance vocation‐related participation and potential employability of job seekers with SMI in Australia. Given these preliminary findings, a further clinical trial with appropriate control group and sample size is required to validate the effectiveness of HOPE+CR.
Objective: Cognitive impairments contribute to difficulty in obtaining employment for people with severe mental illnesses (SMIs). We describe a pilot evaluation of a programme, Employ Your Mind (EYM), which integrates cognitive remediation therapy (CRT) with vocational rehabilitation. Method: Sixty participants with SMIs enrolled in EYM, a 6-month programme that combines CRT exercises, individual project work and group reflection sessions about social interaction and cognitive functioning. Participants completed assessments of cognitive function (Audio Recorded Cognitive Screen, Wechsler Digit Span Task), psychosocial function (Work and Social Adjustment Scale, General Self-Efficacy Scale) and abilities related to work (Dialogue about Working Ability, Self-Assessment of Thinking Skills) at baseline and postprogramme. Paired t-tests were used to compare assessments of participants who completed the programme between the two time points. Results: The programme was completed by 22 individuals. These individuals demonstrated significant improvement in cognitive function, social and work-related function, and subjective thinking ability after completing the EYM programme. Conclusion: The EYM programme is effective in improving cognition, impairments related to work and social function, and subjective thinking skills for some individuals with SMIs. Future evaluation of the programme should focus on enhanced retention and assessment of employment outcomes.
The Health Optimisation Program for Employment requires further evaluation using rigorous scientific methodology but these initial results are encouraging in terms of vocational attainment for people with a mental illness, in the Australian context.
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