Working with a Severe Mental Illness: Estimating the Causal Effects of Employment on Mental Health Status and Total Mental Health Costs

Indicators to evaluate the labor insertion of people with disabilities in conventional companies in Spain: A Delphi study

INTRODUCTION

The level of labor integration of people with disability (PwD) is notably lower than that of people without disabilities. In order to evaluate the success of the labor market integration of people with disabilities, it is necessary to establish a series of indicators that go beyond hiring rates. Hence, the objective of this study is to develop a list of indicators with their specified individual weight that will serve to evaluate the success of the labor market insertion of PwD in conventional companies.

METHODOLOGY

The Delphi method was used. In Phase 1, an open-ended questionnaire was distributed to 48 human resources and disability experts. From this qualitative analysis, a list of 52 indicators was drawn up and the experts were asked to evaluate their importance using a scale from 0 to 10 points. The convergence of opinion was obtained in the third phase. To evaluate the degree of stability of the experts' responses in the different phases, the Wilcoxon test was applied. Finally, a factor analysis was carried out in relation to the indicators.

RESULTS

After the development of the three phases and the factor analysis, a list of 26 indicators was obtained to measure the success of inclusive employability, structured in four factors: Work Performance, Labor Management, Social and Organizational Impact, Competency Assessment.

CONCLUSIONS

This project has provided a list of indicators that can be the basis for the creation of a scale to assess the successful integration of people with disabilities in the conventional company.

Work re-entry and functioning in people with major depression: a longitudinal study of supported employment participants

BACKGROUND

People with major depression are affected by impaired daily functioning and non-participation in the workforce. At the same time, employment has been associated with improved mental health outcomes. The aim of this study was to examine the relationship between work re-entry and subsequent functioning and depressive symptoms.

METHODS

The present observational study included a sample of 129 participants of a supported employment intervention project in Germany diagnosed with depressive disorders. Participants were assessed before the start of the intervention (baseline) and after two years (follow-up). Functioning and depressive symptom severity were measured using the World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0) and the Beck's Depression Inventory II (BDI-II). After multiple imputation, linear regression analyses were conducted to analyze the relationship between work re-entry and follow-up functioning and symptom severity, controlling for baseline scores and age.

RESULTS

Work re-entry was significantly associated with better overall functioning (p =.002), cognitive functioning (p =.001) and community participation (p =.002), adjusted for baseline scores and age. A significant interaction effect (p =.001) suggested that the association between work re-entry and overall functioning at follow-up was stronger in older participants. After adjustment for baseline functioning and age, work re-entry was not significantly associated with self-care, social interaction and household responsibilities, while associations with mobility (p =.072) and symptom severity (p =.054) were marginally nonsignificant.

CONCLUSIONS

The results support the association between work re-entry and lower disability in people with depression who participated in supported employment. Certain functional domains, especially cognition and participation, may be more closely associated with becoming re-employed. The association between work-re-entry and overall functioning may be stronger in older individuals.

TRIAL REGISTRATION

The data used for this study were collected as part of a clinical trial called "IPS-ZIB" which was prospectively registered with the German register for clinical trials on 12/14/2020 (DRKS; ID: DRKS00023521).

Predicting satisfaction with vocational status among people with serious mental illness in vocational services: the role of perceived skills and support

Background

This study aimed to explore the role of perceived skills and support in satisfaction with vocational status to better address the vocational needs and recovery goals of individuals with serious mental illness (SMI). It focuses on three service types: individual placement and support (IPS), sheltered workshops, and vocational support centers.

Method

The study is a cross-sectional analysis of the nationwide Israeli PR-PROM project data. A sample of 2,968 participants diagnosed with SMI and their service providers self-reported their perceived skills, support, and satisfaction with vocational status.

Results

We found perceived skills and support to be primary predictors of vocational satisfaction across all groups. There were significant differences in satisfaction with vocational status among the three service types: IPS users reported higher satisfaction than sheltered workshop and vocational support center users. The service-provider evaluations reflected similar trends, with higher satisfaction ratings for more integrative services. Additionally, discrepancies were observed between participant and provider satisfaction ratings, varying by vocational service type.

Discussion

The study highlights the importance of perceived skills and support in enhancing satisfaction with vocational status for people with SMI regardless of the vocational service type. Whereas objective factors like employment status and salary contribute to vocational rehabilitation and quality of life, subjective perceptions of skills and support play a significant role in satisfaction with vocational status. The results suggest that vocational rehabilitation services should monitor consumers' perceptions of skills and support to improve their vocational satisfaction, which can promote personal well-being and social integration.

The effects of an interdisciplinary employment program on paid employment and mental health among persons with severe mental disorders

PURPOSE

This study evaluates the effects of the interdisciplinary employment program 'Work As Best Care (WABC)' on employment participation and mental health of persons with severe mental disorders.

METHODS

WABC is a 'work first' employment program for unemployed persons with severe mental disorders in which employment professionals work closely together with mental health professionals. In a longitudinal non-randomized controlled study, participants of WABC (n = 35) are compared with participants of the control group (n = 37), who received regular employment support. Participants were followed for 1 year and filled out questionnaires on individual characteristics and health at baseline, after 6 and 12 months. This information was enriched with monthly register data on employment status from 2015 until 2020. Difference-in-differences analyses were performed to investigate changes in employment participation among participants of WABC and the control group. A generalized linear mixed-effects model was used to compare changes in mental health (measured on 0-100 scale) between the two groups.

RESULTS

Before WABC, employment participation was 22.0%points lower among participants of WABC compared to the control group. After starting WABC, employment participation increased with 15.3%points per year among participants of WABC, compared to 5.6%points in the control group. Among all participants of WABC, no change in mental health was found (β 1.0, 95% CI - 3.4; 5.5). Only female participants of WABC showed a significant change in mental health (β 8.0, 95% CI 2.6; 13.4).

CONCLUSION

To enhance employment participation of persons with severe mental disorders, an interdisciplinary 'work-first' approach in which professionals of employment services and mental health services work in close collaboration, is of paramount importance.

Individual placement and support: History, current status, and future directions

Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.

Examination of Adaptations to the Evidence Based Supported Employment Model: Individual Placement and Support

Individual Placement and Support (IPS) is a long-standing and innovative employment service for individuals with mental illness with dozens of clinical trials demonstrating effectiveness. Little is known, however, about intentional adaptations to IPS, especially those outside of the context of research studies. Using an implementation science framework, we conducted an exploratory study to better understand the characteristics of stakeholder-reported adaptions to IPS, the impetus for their development, and perceived impacts. We conducted qualitative interviews to analyze and describe these adaptations. Numerous adaptations of IPS were found that address the needs of new and underserved populations both within and outside of the mental health field. Programs reported adapting IPS because of the dearth of other evidence-based employment services, to serve diverse populations in need, and based on financial incentives. Benefits of adaptations were weighed against impacts on fidelity. As evidence-based practices (EBPs) are adapted, developers of EBPs should determine how fidelity of a program or service can be assessed or preserved in light of adaptations. This is critical with the increase in different service delivery methods, new populations, new service recipient needs, and new settings in need of EBPs.

The Effectiveness of Day Hospitals in the Personal Recovery of Mental Disorder Patients during the COVID-19 Pandemic

BACKGROUND

In recent years, a new recovery model has gained ground in which recovery is understood as a process of change where individuals are able to improve their health and wellbeing, lead self-sufficient lives and strive to achieve their maximum potential (personal recovery). Despite the existence of data regarding the effectiveness of mental health day hospitals (MHDHs) in reducing relapses in terms of hospital admissions and emergencies, no studies have to date assessed how this change affected the new personal recovery model.

OBJECTIVES

To verify the effectiveness of MHDHs in improving personal recovery processes among people with mental disorders (MDs).

METHODS

A prospective cohort study. A group of patients receiving follow-up at MHDHs was compared with another group of patients receiving follow-up in other therapeutic units over a period of three months.

RESULTS

Patient recovery at the MHDHs, assessed using the Individual Recovery Outcomes Counter (I.ROC), was found to be significantly better than that of patients attended in other units.

CONCLUSIONS

MHDHs can contribute to the recovery of people with MDs. This is particularly important at a time when some patients may have experienced impediments to their recovery processes due to the pandemic.

A Systematic Review and Meta-analysis of IPS Supported Employment for Young Adults with Mental Health Conditions

Young adults with mental health conditions want to work and advance their education, but many need help attaining these goals. Individual Placement and Support (IPS), originally developed for working-age adults with serious mental illness, is an evidence-based employment model that may benefit young adults. This study is the first systematic review and meta-analysis of randomized controlled trials (RCTs) of IPS for this population. We conducted a systematic review of the effectiveness of IPS for young adults with mental health conditions, supplementing our electronic search of the published literature with secondary analyses of two published RCTs. Using meta-analysis, we evaluated employment rate, job duration, and education rate. Seven studies met the inclusion criteria. Four evaluated IPS for young adults with early psychosis and three evaluated IPS for other young adult subgroups. All found a significantly higher employment rate for IPS than the control group. Overall, 208 (58.3%) of 357 IPS participants and 110 (32.4%) of 340 control participants were competitively employed during follow-up, yielding an overall risk ratio of 1.69 (95% CI 1.43, 1.99), z = 6.24, p < 0.001. Six of the seven studies also reported longer job duration for IPS than the control group, yielding an overall g = 0.34 (95% CI 0.09, 0.58), z = 2.72, p < 0.01. None of four RCTs examining education outcomes found a significant difference favoring IPS, but the overall risk ratio was significant: 1.33 (95% CI 1.06, 1.66), z = 2.51, p < 0.01. Although the empirical literature is limited, IPS appears to be effective in helping young adults with serious mental illness or early psychosis gain and keep competitive jobs. The impact of IPS on education outcomes is unclear. Future research should evaluate the generalizability of these findings to the broad range of young adults with mental health conditions needing help with their employment goals.

Comparing Service Use and Costs of Individual Placement and Support With Usual Vocational Services for Veterans With PTSD

OBJECTIVE

Among veterans with posttraumatic stress disorder (PTSD), supported employment that utilizes the individual placement and support (IPS) model has resulted in consistently better employment and functional outcomes than usual vocational rehabilitation services. This study aimed to compare these two approaches in terms of health services use and associated costs.

METHODS

A secondary analysis of a multisite randomized controlled trial of 541 unemployed veterans with PTSD used archival data from electronic medical records to assess the use and costs of health services of IPS and usual care (i.e., a transitional work [TW] program) over 18 months. Comparisons were also made to an 18-month postintervention period.

RESULTS

The two study groups did not differ in number of inpatient days or in utilization or cost of high-intensity services. Annual per-person costs of health services were approximately 20% higher for IPS than for TW participants (mean difference=$4,910 per person per year, p<0.05) during the intervention period, largely driven by higher utilization and costs for vocational services in the IPS group (p<0.001). These costs declined postintervention to nonsignificant differences. The mean annual per-person vocational service cost was $6,388 for IPS and $2,549 for TW (mean difference=$3,839, p<0.001) during the intervention period.

CONCLUSIONS

In keeping with IPS’s intensive case management approach, veterans receiving IPS used more vocational services and had correspondingly higher costs than veterans receiving TW. The two groups did not differ in use or cost of other types of health services. Future research should examine whether higher short-term costs associated with IPS relative to usual care result in long-term cost savings or higher quality of life for persons with PTSD.

Minds@Work: A New Manualized Intervention to Improve Job Tenure in Psychosis Based on Scoping Review and Logic Model

Introduction A significant proportion of people experiencing psychosis are unemployed, despite a strong desire to work. Current supported employment programs appear effective in helping them obtain employment, yet job tenure remains an arduous challenge. The objective of this study was to review the literature and model the results to inform the development of a new manualized group psychosocial intervention-'Minds@Work'-aimed specifically at improving job tenure in psychosis. Methods The study was registered on the Open Science Framework platform ( https://osf.io/he68z ). The literature was searched in Medline, Embase, PsycInfo and Cochrane Library databases for studies examining predictors of job tenure in psychosis and existing occupational psychosocial interventions. Data were extracted using a pre-established form and synthesized using logic models. Results A total of 94 studies were included and their findings were modeled using different categories: intervention typologies, mechanisms of action, predictors of job tenure, outcomes and contextual factors. The 'Minds@Work' program was built based on these modeled findings and aimed to target specific predictors of job tenure while addressing some of the limitations of existing interventions. The program uses evidence-based techniques and is divided into 9 modules covering 4 themes: positive psychology (motivation, character strengths, self-compassion), neurocognitive remediation (attention, memory, problem-solving), cognitive biases training (jumping to conclusions, defeatists beliefs, theory of mind, attributional styles) and socioemotional coping skills (emotion regulation, communication). Conclusions Once validated, this new program is meant to be used either as a stand-alone intervention or integrated in supported employment initiatives, by employment specialists or healthcare workers.

Rates of Inpatient and Emergency Room Use Before and After Discharge Among Medicaid Enrollees in OnTrackNY

OBJECTIVE

This study examined hospital and emergency room (ER) use among Medicaid enrollees before and after discharge from OnTrackNY, a coordinated specialty care program for recent-onset psychosis.

METHODS

Medicaid claims data were linked to program data. Inpatient hospitalization, inpatient days, and ER visits were assessed in the 6 months prior to OnTrackNY enrollment and 6 months prior to and after discharge. The sample consisted of 138 participants with continuous Medicaid enrollment during the study.

RESULTS

Inpatient visits significantly declined from the pre-OnTrackNY enrollment period to the predischarge period (β=-1.23, standard error [SE]=0.22, p<0.001), did not significantly change in the first 6 months after discharge (β=0.19, SE=0.26, p=0.48), and remained significantly lower than before OnTrackNY enrollment (β=-1.05, SE=0.20, p<0.001). Similar patterns were observed for inpatient days and ER use.

CONCLUSIONS

ER and hospital use declined during OnTrackNY participation and did not significantly change in the first 6 months after discharge.