Though most people with psychiatric disabilities show a desire to work, they are more likely to experience negative labour market outcomes than those without these disabilities. Moreover, work is often critical to their recovery and functioning by increasing their self-esteem and their sense of control and belonging. Thus, a large number of programs have been introduced to increase employment access for this group, particularly for people with schizophrenia, to reduce their economic burden as well as the resulting cost to health and social assistance systems. However, there has been little effort to comprehensively synthesize the evidence of the effectiveness of these interventions.
To fill this knowledge gap, the authors of this study — Viviana R. Carmona, Juana Gomez-Benito, Tania B. Huedod-Medina, and J. Emilios Rojo — conducted a literature review to investigate the effectiveness of these treatments in enhancing employment outcomes and evaluated factors influencing these outcomes. They reviewed several online academic as well as “grey literature” databases, reference lists of the retrieved articles, and specialized journals in the field. Targeting outcomes of interest that included job placement, job tenure and wages earned, the researchers identified and analyzed 25 randomized controlled trials of initiatives conducted between 1986 and December 2015 aimed at enhancing these employment outcomes for this client group. The measures used to indicate relative success of the treatment were risk ratios (of probabilities of obtaining a job for those with and without treatment) for job placement, and standardized mean differences (between those with and without treatment) for job tenure and wages earned.
The researchers found that participating in a vocational intervention increases the likelihood of obtaining a competitive job and has a positive impact on hours worked in any job. However, there was no evidence of intervention effectiveness with regard to wages earned from competitive employment. The researchers detected few results for the influence of client characteristics, such as interest in working, on employment outcomes.
Finally, the researchers find that participation in rehabilitative vocational treatment on its own was not enough to ensure work participation for people with schizophrenia. Rather, comprehensive treatments, which may include vocational rehabilitation, are necessary to address functional shortfalls that hinder labour stability and job performance for people with schizophrenia.
This comprehensive review of employment initiatives for people with schizophrenia will be of interest to practitioners and program designers looking for effective approaches to supporting the work transitions for this client group.