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Article Index
Vocational Rehabilitation in Schizophrenia
Methods
Effects on Vocational Outcomes
Other Outcomes
Controversy
Discussion
All Pages

Schizophrenia Bulletin, Vol 21, No. 4, 1995
National Institute of Mental Health

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Abstract

Schizophrenia exacts a heavy toll on a person's capacity to work, and a variety of vocational rehabilitation interventions have been developed over the past few decades to enhance the vocational capacities of persons with this disorder. The research literature on outcomes of vocational rehabilitation during the era of deinstitutionalization for persons with schizophrenia is reviewed. Most vocational rehabilitation programs have a positive influence on work-related activities, but most have failed to show substantial and enduring impacts on independent, competitive employment. Recent advances in supported employment suggest that vocational rehabilitation offers greater promise than do transitional and sheltered employment approaches. Vocational rehabilitation intervention may also exert positive influences on such clinical outcomes as medication compliance, symptom reduction, and relapse.

Schizophrenia Bulletin, 21(4): 645-656, 1995.

Vocational rehabilitation has assumed increasing importance as part of the array of services available for persons with schizophrenia. Work not only provides financial remuneration but is a normalizing experience, allowing individuals to participate in society, and may promote self-esteem and quality of life. Furthermore, the vast majority of persons with severe mental illnesses identify paid employment as one of their goals (Rogers et al. 1991). Despite this, rates of competitive employment for persons with schizophrenia remain dismally low -- below 25 percent (Anthony et al. 1978).

Many different types of vocational rehabilitation programs have been developed and implemented. These are classified as follows (Bond and Boyer 1988): (1) hospital-based programs; (2) sheltered work; (3) assertive case management; (4) psychosocial rehabilitation, including prevocational training, transitional employment, and volunteer placements; (5) supported employment; and (6) counseling and education. The outcomes targeted by vocational rehabilitation interventions are divided into two broad categories. Vocational outcomes include full-time competitive employment, acquisition of job-related skills, acquisition of any job (paid or volunteer), percentage of time in paid employment (full-time or part-time, competitive or sheltered), total job earnings, level of job (unskilled, skilled, etc.), job satisfaction, and job performance. Vocational rehabilitation also may enhance outcomes other than work. These therapeutic outcomes include treatment compliance and symptom reduction, functional status in other areas (activities of daily living, maintenance of living situation, etc.), self-esteem, and subjective quality of life.

This review addresses the following questions:

1. Do vocational rehabilitation interventions enhance the vocational outcomes of persons with schizophrenia?

2. Do vocational rehabilitation interventions enhance outcomes other than vocational functioning?

3. Are there differences in the effectiveness of the various types of vocational rehabilitation interventions for persons with schizophrenia?

4. What patient characteristics predict response to vocational rehabilitation?

As best as can be determined, all the studies reviewed examine these questions in the context of ongoing clinical treatment. Therefore, these questions are posed with the assumption that patients are receiving adequate clinical care, including antipsychotic medications.

Disorders - Schizophrenia