Our results indicate that middle-aged and older people with schizophrenia or schizoaffective disorder benefited from work rehabilitation and obtained competitive employment, regardless of most demographic and clinical variables. IPS participants were more likely to work than were CVR participants, suggesting that as with their younger counterparts, the supported employment model is more effective than is traditional vocational rehabilitation in helping middle-aged and older clients with schizophrenia obtain work. It may be that the rapid and individualized nature of the IPS “place-then-train” approach suits these clients better than does the “train-then-place” approach.
Despite our efforts to ensure improved access to vocational services in the CVR condition, many participants were not given assistance finding work. All participants had a stated goal of paid work at the time of study enrollment, yet many were steered toward education or training by DOR staff, which probably deterred them from looking for work. Speed of access to services also differed between IPS and CVR. Many IPS clients met with their vocational specialist and began looking for work within a week of enrolling in the study, whereas CVR clients were unable to access services quickly and may have lost their motivation to work while waiting for services to begin.
Treatment group was a significant predictor of employment outcomes, but demographic and clinical variables were not associated with success in obtaining competitive employment. These results are consistent with other research suggesting that most clients with severe mental illness who want to work can do so, given the appropriate support (Bond, 2004
; Bond et al., 2001
; Twamley et al., 2003
). The number of years since last employment in the participants who obtained competitive work ranged from 0-16, suggesting that even those clients who have not worked for over a decade can return to work. Previous studies including younger patients have found that age does not predict attainment of competitive work (see Bond et al., 2001
, for review), but this study extends those results into an older age group. Clients who obtained competitive work reported improved quality of life throughout the course of the study, which may reflect a combination of factors, including increased income, activity, structure, socialization, and self-efficacy.
Several limitations of this study should be considered, including the relatively small sample sizes within the IPS and CVR groups. These findings should be considered preliminary until replicated with a larger sample. Those who participate in work rehabilitation programs represent a self-selected group; these results may not generalize to clients who are less motivated to work or who have no desire to return to work. The oldest subjects in our study were 60 years of age, and more research is needed to address the feasibility and efficacy of vocational rehabilitation for seniors with mental illness. The present study only examined competitive work attainment, job tenure, and wages earned as employment outcomes; future studies will address other types of work situations as well as volunteer work. Further research is also needed to determine other predictors of future employment, such as work-related skills and cognitive functioning.
Finally, although IPS services resulted in higher rates of competitive work, not all clients receiving IPS attained competitive employment, suggesting that adaptations to IPS may be needed for certain clients. Middle-aged and older clients with psychiatric illness face multiple obstacles to employment (e.g., stigma in the workplace, fear of losing benefits, negative symptoms, lack of confidence, limited employment history, and lack of transportation), and more knowledge is needed regarding how to best help them overcome these barriers.