A Supported Competitive Employment Programme for Individuals with Chronic Mental Illness

ABSTRACT The purpose of this study was to ascertain the vocational outcomes of individuals with chronic mental illness participating in a supported competitive employment programme. 388 patients enrolled in the programme, which was developed on the basis of the Supported Employment Model and the principles of the Individual Placement and Support. Of the 388 patients, 267 (68.8%) obtained competitive employment. The mean job tenure was 133 days. The mean salary was HK$4,737 for full-time jobs and HK$2,329 for part-time jobs. The majority of the patients (59.6%) sustained their job placement for more than 30 days, 69 patients (25.8%) worked for more than 6 months, and 35 (13.1%) maintained the job for more than 1 year. Patients who became employed were compared with those who did not gain employment on a variety of demographic variables. Significant differences in the source of referral were found between the 2 groups. The rate of employment in this study was slightly higher, but the job retention rate was lower, than in earlier studies. This study concluded that a supported competitive employment programme could be an effective approach to enhancing vocational outcomes for individuals with chronic mental illness. Recommendations for future research for evaluation of the effectiveness of the supported competitive employment programme are suggested. Key words: Mental illness, Supported employment, Vocational outcomes, Vocational rehabilitation INTRODUCTION Employment plays an important role in the rehabilitation of individuals with chronic mental illness. According to Scheid and Anderson, work is central to self identity, self esteem, and well being. (1) Work may enhance mental health by providing some form of meaningful activity and a sense of accomplishment. It is generally agreed that if an individual can work, he/ she is fundamentally well. Since work not only provides direct benefits such as remuneration and social contacts but also promotes gains in related areas such as self esteem and quality of life, much attention has been focused on vocational rehabilitation services and their ability to produce positive employment outcomes for individuals with chronic mental illness. To enhance vocational outcomes of individuals with chronic mental illness, a variety of vocational rehabilitation programmes such as vocational assessment and guidance, vocational training, employment services, and sheltered placements have been provided in recent years. However, the results have all been unsatisfactory. It is difficult to find accurate data on the employment rate for individuals with chronic mental illness in Hong Kong. According to statistics from the Labour Department in 1994, the placement rate under the Selective Placement Scheme for individuals with a mental illness was 31%. (2) Overseas research has shown that employment rates among individuals with chronic mental illness in the open competitive market range from 10 to 30%. Only 10 to 15% of those who find work are still employed 1 to 5 years later, and up to 70% of this population remain unemployed. (3-6) In a local study conducted by the University of Hong Kong on employment for people with a disability in Hong Kong, 50% of employers did not wish to employ individuals with a mental illness, indicating the difficulty for this population in returning to work. (2) Supported employment has emerged in recent years as a viable employment service alternative for individuals with chronic mental illness. It is broadly defined as paid competitive work in an integrated setting with the provision of ongoing individualised support to maintain employment over time. Numerous empirical reports on this approach have been found in the literature, demonstrating enhanced vocational outcomes in the areas of employment rate, job retention rate, job tenure, and earnings for individuals with chronic mental illness. (7-11) However, not much is known about the programme outcomes and applicability in the local context. …