The Effects of a Supported Employment Program on Psychosocial Indicators for Persons with Severe Mental Illness

Over the past quarter century a shift has occurred from traditional institution-based models of care for persons with severe mental illness (SMI) to more individualized community-based treatments. Along with this, there has been a significant shift in thought about the potential for persons with SMI to be "rehabilitated" toward lifestyles that more closely approximate those of persons without such illness. A central issue is the ability of a person to hold a regular full-time job for a sustained period of time. There have been several attempts to develop novel and radical models for program interventions designed to assist persons with SMI to sustain full-time employment while living in the community. The most promising of these have emerged from the tradition of psychiatric rehabilitation with its emphases on individual consumer goal setting, skills training, job preparation and employment support (Cook, Jonikas and Solomon, 1992). These are relatively new and field evaluations are rare or have only recently been initiated (Cook and Razzano, 1992; Cook, 1992). Most of the early attempts to evaluate such programs have naturally focused almost exclusively on employment outcomes. However, theory suggests that sustained employment and living in the community may have important therapeutic benefits in addition to the obvious economic ones. To date, there have been no formal studies of the effects of psychiatric rehabilitation programs on key illness-related outcomes. To address this issue, this study seeks to examine the effects of a new program of supported employment on psychosocial outcomes for persons with SMI.

Over the past several decades, the theory of vocational rehabilitation has experienced two major stages of evolution. Original models of vocational rehabilitation were based on the idea of sheltered workshop employment. Clients were paid a piece rate and worked only with other individuals who were disabled. Sheltered workshops tended to be "end points" for persons with severe and profound mental retardation since few ever moved from sheltered to competitive employment (Woest, Klein & Atkins, 1986). Controlled studies of sheltered workshop performance of persons with mental illness suggested only minimal success (Griffiths, 1974) and other research indicated that persons with mental illness earned lower wages, presented more behavior problems, and showed poorer workshop attendance than workers with other disabilities (Whitehead, 1977; Ciardiello, 1981).

In the 1980s, a new model of services called Supported Employment (SE) was proposed as less expensive and more normalizing for persons undergoing rehabilitation (Wehman, 1985). The SE model emphasizes first locating a job in an integrated setting for minimum wage or above, and then placing the person on the job and providing the training and support services needed to remain employed (Wehman, 1985). Services such as individualized