From the Center for Psychiatric Rehabilitation, University Hospital of Psychiatry, University of Bern, Switzerland; the Department of Psychotherapy, University Hospital of Psychiatry, Bern; and the Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston.
Am J Psychiatry. 2014 Nov 1;171(11):1183-90. doi: 10.1176/appi.ajp.2014.13070857.
The individual placement and support model of supported employment has been shown to be more effective than other vocational approaches in improving competitive work over 1-2 years in persons with severe mental illness. The authors evaluated the longer-term effects of the model compared with traditional vocational rehabilitation over 5 years.
A randomized controlled trial compared supported employment to traditional vocational rehabilitation in 100 unemployed persons with severe mental illness. Competitive work and hospital admissions were tracked for 5 years, and interviews were conducted at 2 and 5 years to assess recovery attitudes and quality of life. A cost-benefit analysis compared program and total treatment costs to earnings from competitive employment.
The beneficial effects of supported employment on work at 2 years were sustained over the 5-year follow-up period. Participants in supported employment were more likely to obtain competitive work than those in traditional vocational rehabilitation (65% compared with 33%), worked more hours and weeks, earned more wages, and had longer job tenures. Reliance on supported employment services for retaining competitive work decreased from 2 years to 5 years for participants in supported employment. Participants were also significantly less likely to be hospitalized, had fewer psychiatric hospital admissions, and spent fewer days in the hospital. The social return on investment was higher for supported employment participants, whether calculated as the ratio of work earnings to vocational program costs or of work earnings to total vocational program and mental health treatment costs.
The results demonstrate that the greater effectiveness of supported employment in improving competitive work outcomes is sustained beyond 2 years and suggest that supported employment programs contribute to reduced hospitalizations and produce a higher social return on investment.
支持性就业的个体安置和支持模式已被证明比其他职业方法更有效，可在 1-2 年内改善严重精神疾病患者的竞争性工作。作者评估了该模型与传统职业康复相比在 5 年内的长期效果。
一项随机对照试验将支持性就业与 100 名失业严重精神疾病患者的传统职业康复进行了比较。在 5 年内跟踪竞争性工作和住院情况，并在 2 年和 5 年进行访谈，以评估康复态度和生活质量。成本效益分析比较了项目和总治疗成本与竞争性就业的收入。
支持性就业对 2 年工作的有益影响在 5 年随访期间得以维持。与传统职业康复相比，支持性就业的参与者更有可能获得竞争性工作（65%比 33%），工作时间和周数更长，收入更高，工作任期更长。支持性就业参与者对支持性就业服务的依赖程度从 2 年到 5 年逐渐降低，以保持竞争性工作。与传统职业康复相比，支持性就业的参与者住院的可能性显著降低，住院次数减少，住院天数减少。无论是以工作收入与职业项目成本之比，还是以工作收入与职业项目和精神卫生治疗总成本之比来计算，支持性就业参与者的社会投资回报率都更高。
结果表明，支持性就业在提高竞争性工作成果方面的更大效果在 2 年以上得以维持，并表明支持性就业计划有助于减少住院，并产生更高的社会投资回报率。
