Employment

How is employment related to schizophrenia?

Employment rates are typically low and can be used as a measure of social disability in schizophrenia. Employment function is commonly assessed using outcomes such as rates of employment, success in getting and keeping employment, as well as patient characteristics and the treatments received. Low rates of employment among people with schizophrenia places extended burden on social support and disability services, and significantly affects quality of life. Employment rates may be improved by greater focus on patient education and opportunities for supported employment.

What is the evidence regarding employment?

Reviews with moderate or moderate to high quality evidence show people with schizophrenia are less likely to attain employment and retain it after 3 months than people with other mental disorders. Rates of employment vary considerably, ranging from 4% to 60% in Europe, and from 13% to 80% in the developing world. Rates of employment after a first episode of psychosis range from 13% to 65%. Being employed is consistently related to reductions in outpatient psychiatric treatment and in improved self-esteem, and inconsistently related to fewer psychiatric hospitalisations, less medication, better life satisfaction, and improved wellbeing.

Reviews with moderate or moderate to low quality evidence suggest receiving public support or disability income, having negative symptoms such as social withdrawal, or being young are related to lower rates of competitive employment. Other barriers to employment include illness stigmatisation, economic disincentives, low self-esteem, and poor cognitive functioning. Factors related to higher rates of employment include being married or being in a defacto relationship, receiving medical treatment, or having a work history.

Reviews with moderate or moderate to low quality evidence suggest overall vocational interventions are beneficial for improving employment rates and work function in people with schizophrenia.

 

Also see the vocational rehabilitation treatment topic.

 

February 2019

 

Vocational rehabilitation

What is vocational rehabilitation? 

Vocational rehabilitation refers to any intervention aimed at reducing the high unemployment rates in people with schizophrenia and other severe mental illnesses. Vocational rehabilitation may have wide-reaching benefits, including improved symptoms and personal achievement, and reduced ongoing health care costs. Two key approaches for rehabilitation are prevocational training and supported employment. Prevocational training aims to increase employability by providing community-based preparation before people enter into the competitive workforce (employment that is paid at competitive, or award wages); examples include “clubhouses”, transitional employment, work crews, and skills training. Supported employment aims to assist people with schizophrenia find and maintain a job by placing them in employment within the community (without preparation), and providing training on location as well as ongoing support.

What is the evidence for vocational rehabilitation?

High quality evidence suggests supported employment is more effective than prevocational training for increasing long-term competitive employment rates. Moderate to high quality evidence suggests supported employment provides greater benefit than standard vocational services for attaining competitive employment, increasing the number of hours/weeks worked, total earnings, and reducing time to employment. High quality evidence suggests fewer hospital admissions after prevocational training compared to standard community care, but no differences in employment rates (from moderate quality evidence). Moderate to high quality evidence indicates prevocational training in combination with psychological therapy is more effective for improving employment rates than prevocational training alone. Moderate to low quality evidence suggests supported employment in combination with assertive community treatment improves employment rates compared to standard care. Moderate quality evidence favours paid prevocational training over unpaid prevocational training for increasing employment rates and program participation, and reducing hospital admissions.

Also see the Course and Outcomes employment topic.

June 2016