Vocational rehabilitation in first episode psychosis

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The aim of this project is to examine the acceptability and effectiveness of introducing a vocational specialist into the clinical program of a service providing clinical interventions for people aged between 15 and 25 experiencing a first episode of psychosis in the north and west regions of Melbourne. In the project a person with expertise in the rehabilitation employment sector will be employed to provide specialist input with clients of the Early Psychosis, Prevention and Intervention Centre (EPPIC). The proposed intervention is based upon a model called supported employment (sometimes called individual placement and support). This model has been found to be the most effective model of vocational rehabilitation for people with chronic mental illnesses. However, to date only one published pilot study has examined the usefulness of this model in people in the early phase of their illnesses. This study, conducted in England, and another, unpublished from America, suggests that this model may be successfully applied to helping young people with mental illness return to work and study. Unemployment and withdrawal from training and study are often sequelae of psychosis, and for the group who go on to develop schizophrenia, unemployment rates of 80% and above have been reported both in Australia and other comparable countries. Unemployment, leads to social isolation, and lower socio-economic status, both of which, along with unemployment itself, are risk factors for further psychotic episodes. This intervention seeks to prevent this sequence of events from beginning by actively supporting young people who wish to work. Supported employment works by having a specialist who collaborates with the young person to help them identify competitive work (i.e. work opportunities that are open to the public as opposed to sheltered work opportunities available only to particular groups) that they would like to do, prepare for interviews and crucially, supports the person in the role after they have obtained the job. This support is often not at the workplace, but consists of meetings outside work. In all of the interventions the vocational specialist liaises with the clientÿ¢ÿ¿ÿ¿s case manager, and clinical care is continued throughout. The study will be conducted by recruiting clients of the EPPIC service who have expressed an interest in working. They will be randomised to either a group that will work with the vocational specialist or to a group that will receive EPPIC treatment as usual. Participants will be assessed at the time of coming into the study and six months later. The assessment battery will include demographic questions, measures of psychopathology, symptomatology and quality of life. There will also be a questionnaire examining work history in the previous six months. This information will be collected by a trained research assistant.

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