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Anthony F. Lehman, MD, MSPH; Richard Goldberg, PhD; Lisa B. Dixon, MD, MPH; Scot McNary, PhD; Leticia Postrado, PhD; Ann Hackman, MD; Karen McDonnell, PhD

Arch Gen Psychiatry. 2002;59:165-172.

Background  Unemployment remains a major consequence of schizophrenia and other severe mental illnesses. This study assesses the effectiveness of the Individual Placement and Support model of supportive employment relative to usual psychosocial rehabilitation services for improving employment among inner-city patients with these disorders.

Methods  Two hundred nineteen outpatients with severe mental illnesses, 75% with chronic psychoses, from an inner-city catchment area were randomly assigned to either the Individual Placement and Support program or a comparison psychosocial rehabilitation program. Participants completed a battery of assessments at study enrollment and every 6 months for 2 years. Employment data, including details about each job, were collected weekly.

Results  Individual Placement and Support program participants were more likely than the comparison patients to work (42% vs 11%; P<.001; odds ratio, 5.58) and to be employed competitively (27% vs 7%; P<.001; odds ratio, 5.58). Employment effects were associated with significant differences in cumulative hours worked (t₂₁₁ = -5.0, P = .00000003) and wages earned (t = -5.5, P = .00000003). Among those who achieved employment, however, there were no group differences in time to first job or in number or length of jobs held. Also, both groups experienced difficulties with job retention.

Conclusions  As hypothesized, the Individual Placement and Support program was more effective than the psychosocial rehabilitation program in helping patients achieve employment goals. Achieving job retention remains a challenge with both interventions.

From the Department of Psychiatry, University of Maryland (Drs Lehman, Goldberg, Dixon, McNary, Postrado, and Hackman); the Mental Illness Research Education and Clinical Center, Veterans Affairs Integrated Service Network 5 (Drs Lehman, Goldberg, and Dixon); and The Johns Hopkins School of Hygiene and Public Health (Dr McDonnell), Baltimore, Md.