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Published Online: 1 November 2014

Long-Term Effectiveness of Supported Employment: 5-Year Follow-Up of a Randomized Controlled Trial

Abstract

Objective:

The individual placement and support model of supported employment has been shown to be more effective than other vocational approaches in improving competitive work over 1–2 years in persons with severe mental illness. The authors evaluated the longer-term effects of the model compared with traditional vocational rehabilitation over 5 years.

Method:

A randomized controlled trial compared supported employment to traditional vocational rehabilitation in 100 unemployed persons with severe mental illness. Competitive work and hospital admissions were tracked for 5 years, and interviews were conducted at 2 and 5 years to assess recovery attitudes and quality of life. A cost-benefit analysis compared program and total treatment costs to earnings from competitive employment.

Results:

The beneficial effects of supported employment on work at 2 years were sustained over the 5-year follow-up period. Participants in supported employment were more likely to obtain competitive work than those in traditional vocational rehabilitation (65% compared with 33%), worked more hours and weeks, earned more wages, and had longer job tenures. Reliance on supported employment services for retaining competitive work decreased from 2 years to 5 years for participants in supported employment. Participants were also significantly less likely to be hospitalized, had fewer psychiatric hospital admissions, and spent fewer days in the hospital. The social return on investment was higher for supported employment participants, whether calculated as the ratio of work earnings to vocational program costs or of work earnings to total vocational program and mental health treatment costs.

Conclusions:

The results demonstrate that the greater effectiveness of supported employment in improving competitive work outcomes is sustained beyond 2 years and suggest that supported employment programs contribute to reduced hospitalizations and produce a higher social return on investment.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 1183 - 1190
PubMed: 25124692

History

Received: 2 June 2013
Revision received: 1 May 2014
Accepted: 9 May 2014
Published online: 1 November 2014
Published in print: November 01, 2014

Authors

Details

Holger Hoffmann, M.D.
From the Center for Psychiatric Rehabilitation, University Hospital of Psychiatry, University of Bern, Switzerland; the Department of Psychotherapy, University Hospital of Psychiatry, Bern; and the Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston.
Dorothea Jäckel, M.A.
From the Center for Psychiatric Rehabilitation, University Hospital of Psychiatry, University of Bern, Switzerland; the Department of Psychotherapy, University Hospital of Psychiatry, Bern; and the Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston.
Sybille Glauser, M.A.
From the Center for Psychiatric Rehabilitation, University Hospital of Psychiatry, University of Bern, Switzerland; the Department of Psychotherapy, University Hospital of Psychiatry, Bern; and the Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston.
Kim T. Mueser, Ph.D.
From the Center for Psychiatric Rehabilitation, University Hospital of Psychiatry, University of Bern, Switzerland; the Department of Psychotherapy, University Hospital of Psychiatry, Bern; and the Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston.
Zeno Kupper, Ph.D.
From the Center for Psychiatric Rehabilitation, University Hospital of Psychiatry, University of Bern, Switzerland; the Department of Psychotherapy, University Hospital of Psychiatry, Bern; and the Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston.

Notes

Address correspondence to Dr. Hoffmann ([email protected]).

Funding Information

The authors report no financial relationships with commercial interests.Supported by grant 3200-064032 from the Swiss National Science Foundation; unconditional grants from the Federal Social Insurance Office; the Stanley Thomas Johnson Foundation; the Gottfried and Julia Bangerter-Rhyner Foundation; the Bank Vontobel Foundation; the Dosenbach-Waser Foundation; and the Karl Mayer Foundation.

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