Rehab Rounds: Teaching Fundamental Workplace Skills to Persons With Serious Mental Illness

Introduction by the column editors: Although only a minority of individuals with schizophrenia and disabling forms of other mental disorders find competitive employment, new legislation, public policies, and rehabilitation methods that are being developed promise to substantially increase that minority. For instance, the Americans With Disabilities Act has raised awareness that workers with mental disabilities are protected by federal law from discriminatory practices. In addition, the Social Security Administration has revised its policies to permit recipients of Supplemental Security Income to work part time without incurring a financial penalty. Similarly, partnerships between state agencies responsible for vocational rehabilitation and state and local departments of mental health have made it easier for individuals with mental disorders to use resources traditionally reserved for individuals with physical disabilities.An example of a newer clinical approach to vocational rehabilitation is supported employment. Clients in a supported employment program are placed in competitive employment as soon as possible and receive all the support services needed to learn and keep the job. A previous Rehab Rounds column described a supported employment program called Integrated Placement and Support (IPS), in which supported employment techniques and staff were fully integrated with psychiatric and psychosocial treatment (1). In a study comparing IPS with services provided by separate vocational rehabilitation agencies, IPS resulted in significantly more hours of work and more income for participants (2).However, two of the study's findings pointed to limitations in the effectiveness of the integrated services. First, the accuracy with which the services were implemented varied greatly, and the outcomes mirrored the inaccuracies. The less accurate the implementation, the poorer the outcomes. Second, supported employment showed no advantage over traditional vocational rehabilitation services in helping workers retain their jobs. The proportion of individuals employed at the end of 18 months of participation, the average duration of all jobs, and the average duration of the first job were no better for those enrolled in supported employment.To overcome these limitations, Charles Wallace and his colleagues developed a comprehensive and highly structured treatment, called the workplace fundamentals module, designed to teach mentally ill workers how to keep their jobs.