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 programs. 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 services. 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 precipitating higher rehospitalization rates. Two features of many supported employment programs have the most empirical support: integration of mental health and vocational services within a single service team and the avoidance of preplacement 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 attention to program implementation and long-term follow-up.