How Effective is Cognitive Remediation in Enhancing Vocational Outcomes for Job Seekers with Severe Mental Illness in Australia?

Abstract

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.

Vocational Service Models and Approaches to Improve Job Tenure of People With Severe and Enduring Mental Illness: A Narrative Review

“…Both the intervention group and control group improved over time, however there were no significant differences between groups on employment, clinical, or cognitive outcomes (42). Some other studies have indicated that cognitive remediation may be useful, but have not necessarily investigated its impact on job tenure (86,87).…”

Effect of community mental health care programs in Australia: a systematic review

“…Four of five studies that examined substance misuse reported significant reductions in participants' consumption of alcohol (Forbes et al 2012), tobacco (Baker et al 2006;Ashton et al 2015) and other drug use (Nagel et al 2009). Finally, four of seven studies found significant improvements in participants' psychosocial outcomes (Mueser et al 2006;Craigie and Nathan 2009;Nagel et al 2009;Contreras et al 2018). Nagel et al (2009) observed better overall psychosocial wellbeing among participants who received the CBT-based motivational interviewing therapy program than those who did not.…”

“…The remaining four studies implemented different types of therapeutic models of care. Contreras et al (2018) examined cognitive remediation therapy, which involved cognitive skills training to provide individuals with the resources to improve their psychosocial outcomes (e.g. employment, social relationships).…”

“…Nine of the 11 therapeutic programs yielded significant improvements in individual outcomes, including psychiatric symptoms (n ¼ 6/9; Mueser et al 2006;Craigie and Nathan 2009;Nagel et al 2009;Forbes et al 2012;Mills et al 2012;Shawyer et al 2017), substance misuse (n ¼ 4/5; Baker et al 2006;Nagel et al 2009;Forbes et al 2012;Ashton et al 2015) and/or psychosocial outcomes (n ¼ 4/7; Mueser et al 2006;Craigie and Nathan 2009;Nagel et al 2009;Contreras et al 2018). Two of the 11 therapeutic programs (individual CBT and cognitive oriented psychotherapy) found no significant changes in individual outcomes (Jackson et al 2001;Chatwin et al 2016).…”