Supported Employment for Individuals with Severe Mental Illness

Abstract

Occupational dysfunction is one of the most devastating and disabling consequences of severe mental illness. Supported employment (SE) is an evidence-based practice for assisting clients with severe mental illness to find and keep competitive jobs in the community. The key elements of SE include rapid, individualized job searching, job-based assessment, benefits counseling, time-unlimited job support, and integration of vocational and mental health services. Further, any client who wants to participate is eligible for SE services, and all services are based on the client’s individual preferences.

Far and away the best prize that life offers is the chance to work hard at work worth doing.Theodore Roosevelt, 1903.

Appendices

Case Study

Introduction

The theme of this case study concerns supported employment for a person with a severe mental illness.

The students’ tasks include:

• 1. Finding information about supported employment principles (e.g., Becker and Drake 2003).

• 2. Finding information about how supported employment principles are implemented (e.g., Bond GR et al. (2001). Implementing supported employment as an evidence-based practice. (Psychiatr Serv 52(3):313–321)

• 3. Synthesizing the information into a report on how the key principles of supported employment are reflected in this case.

As a starting point, students should use the following references to gather background information. Important references are:

• 1. Becker DR, Drake RE (2003) A working life for people with severe mental illness. Oxford University Press, New York

• 2. Bond GR, Becker DR, Drake RE et al (2001). Implementing supported employment as an evidence-based practice. (Psychiatr Serv 52(3):313–321)

Overview of the Content

Major goals of the actual intervention

The major goals of supported employment are: (1) preparing the client for work and assisting with job searching, (2) competitive job attainment in the community, and (3) job maintenance over time.

Learning Objectives

By the end of studying this chapter the learner will:

• 1. Be able to identify the key activities in supported employment

• 2. Be able to apply knowledge of supported employment principles to a client

The Background History of the Clinical Case

Personal Information

JM is a 25-year-old, African American female with a certificate of high school equivalency, who lives with her parents in an apartment.

Medical Information

JM has a diagnosis of schizoaffective disorder and experiences hallucinations, paranoia, and mood liability and irritability. She was referred to supported employment for assistance with returning to work after having been laid off at the end of a seasonal retail job, and being unsuccessful in her independent job search. She had participated in several interviews, but had not been offered a job. JM’s psychiatrist initially advised her not to seek work due to concerns that the increased stress of work would exacerbate her psychiatric symptoms.

Occupational Therapy Interventions

JM was accepted as a supported employment client based on her stated goal of returning to work. She and the employment specialist discussed the effect of seeking work on a pending disability claim and following this benefits counseling, JM decided that she would prefer to pursue work rather than disability benefits. During their first one to two meetings, JM and her employment specialist discussed JM’s previous work experiences (likes and dislikes) and her preferences for future work. JM expressed interest in applying for both hospitality and security positions. The employment specialist communicated with her employer contacts in the security field to determine where to focus the job search. By the second meeting, JM and the employment specialist began searching for job leads and applying for positions. JM’s employment specialist had regular contact with JM’s psychiatrist and therapist through a shared electronic medical record, telephone calls, emails, and face-to-face contact at treatment team meetings. The employment specialist was able to collaborate with the other clinicians to ensure that the client attended her appointments and refilled her medications on time. All of JM’s clinicians supported her job search and goal of returning to work.

One month after her first appointment with the employment specialist, JM interviewed for and was offered full-time competitive employment with a security firm. She began working and continued to meet with her employment specialist for follow-along support, which included assistance obtaining a uniform, setting up a bank account and direct deposit, and setting up a meal and medication schedule.

One of JM’s security assignments involved guarding a bank. The bank manager complained to the security company that JM was listening to music on headphones and dancing on the job. She was sent home for the day and contacted the employment specialist to discuss the situation. They discussed her options, including going to the hospital, quitting her job, and meeting with her supervisor to try to keep the job. JM requested that the employment specialist accompany her to meet with her supervisor; following the meeting, the client was able to keep her job.

The employment specialist continues to provide vocational support to JM, including supporting life skills and decision making relevant to work, and budgeting her income. JM was considering looking for another full-time job to make more money. Support will continue for JM as long as she needs it.

The Student’s Report

The following guiding questions are intended to help clarify how supported employment principles are implemented:

• 1. How did benefits counseling affect the intervention?

• 2. What are the important issues to attend to when deciding what types of jobs would be a good fit for the client?

• 3. How did the employment specialist involve other clinicians in supported employment, and what was the outcome of the team approach?

• 4. How should the employment specialist respond to the client’s request to look for an additional full-time job?