An Update on Supported Employment for People With Severe Mental Illness

Objective: This review examines the effectiveness of supported employment for people with severe mental illness. Methods: A comprehensive search was made for quantitative studies, primarily in the published literature. Results: Seven descriptive studies, three surveys, one quasi-experimental study, and six experimental studies were found. All studies suggested significant gains in obtaining employment for persons enrolled in supported employment pro-grams. In experimental studies, a mean of 58 percent of clients in supported employment programs achieved competitive employment, compared with 21 percent for control subjects, who typically received traditional vocational ser-vices. Employment outcomes relating to time employed and employment earnings also favored clients in supported employment over control subjects. No evidence was found that supported employment led to stress levels pre-cipitating higher rehospitalization rates. Two features of many supported em-ployment programs have the most empirical support: integration of mental health and vocational services within a single service team and the avoidance ofpreplacement training. Two other widely held principles-ongoing support and attention to client preferences-have not been systematically evaluated. Conclusions: Supported employment appears to be a promising approach for people with severe mental illness, but more studies are needed, with close at-and long-term follow-up. (Psychiatri