Recent Research on Vocational Rehabilitation for Persons With Severe Mental Illness

Robert E Drake, Deborah R Becker, Gary R Bond


Curr Opin Psychiatry. 2003;16(4) 

In This Article


Research shows that over half of most clinical samples of adults with severe mental illness express strong interests in working. It would be helpful to know not only how many clients have the goal of competitive employment but also how program offerings and staff attitudes influence clients' goals, and what the rehabilitative goals are of clients who are not interested in competitive employment.

Rigorous randomized controlled trials have been important in extending the research on supported employment from rural settings to urban populations with the additional complications of cultural issues, homelessness, and co-occurring addictions. The research evidence regarding the effectiveness of supported employment is now quite robust. Additional, as yet unpublished, studies from the Federal Employment Demonstration Program provide further evidence for the individual placement and support model of supported employment.[1,45] As evidence for supported employment and its principles of practice expands, research will be needed to clarify the limits as well as the effective components of supported employment. Not all clients achieve success in supported employment, and attempts to modify and expand the model, as well as continued research on other approaches, is critical. Individualized approaches for clients with special needs, such as those with cognitive problems, lack of motivation, dual diagnosis, and language and cultural barriers, will need to be developed and tested. Because research shows that pre-employment skills training does not have much impact on employment outcomes, clinicians and researchers are shifting attention to skills training that is provided in conjunction with rapid job search or following job starts. Different models of skills training, including errorless learning, are being used and need rigorous testing. Similarly, controlled research on supported education and its relationship to supported employment and long-term career success is extremely important. Many clients, particularly adolescents and young adults, have education as a primary goal, with the long-term aim of enhancing career opportunities.

Supported employment and the related improvement in employment outcomes have suddenly gained momentum in other countries as well as the US. Initial studies of supported employment are underway in Canada and several countries in Europe and Asia.

Better understanding of the relationship between work, recovery, and longitudinal outcomes is critical because vocational services must reflect clients' goals to achieve long-term success. Because most of the current research has a short-term perspective (typically 1-2 years), it will be important for future studies to assume a long-term perspective. Studies of job retention, changing jobs, developing careers, and the impacts of employment are critical.

Although studies of the Americans with Disabilities Act are appearing, we identified no studies of other administrative and regulatory barriers to employment for persons with mental illness. The complex benefits system remains a major barrier for many, and studies of benefits counseling, regulatory changes, and other system changes are needed.


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