Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study

  • Barnaby S. MajorEmail author
  • Mark F. Hinton
  • Amy Flint
  • Anna Chalmers-Brown
  • Katharine McLoughlin
  • Sonia Johnson
Original Paper



Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.


The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.


The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not (OR = 3.53, 95% CI = 1.25–10.00).


This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.


First episode psychosis Early intervention Vocational rehabilitation Supported employment Education 



We acknowledge the hard work and commitment of the Camden & Islington Early Intervention Service clinical team in collecting and entering the data. Joanna Morrison, Occupational Therapist, played a major role in the development of the VIBE service.


  1. 1.
    Boardman J (2003) Work, employment & psychiatric disability. Adv Psychiatr Treat 9:327–334CrossRefGoogle Scholar
  2. 2.
    Boardman J, Grove B, Perkins R, Shepherd G (2003) Work and employment for people with psychiatric disabilities. Br J Psychiatr 182:467–468CrossRefGoogle Scholar
  3. 3.
    Bond GR (2004) Supported employment: evidence for an evidence based practice. Psychiatr Rehabil J 27:345–359CrossRefPubMedGoogle Scholar
  4. 4.
    Burns T, Catty J, White S, Becker T, Koletsi M, Fioritti A, Rossler W, Tomov T, van Busschbach J, Wiersma D, Lauber C; for the EQOLISE Group (2008) The impact of supported employment and working on clinical and social functioning: results of an international study of individual placement and support. Schizophr Bull [Epub ahead of print]Google Scholar
  5. 5.
    Crowther R, Marshall M, Bond G, Huxley P (2001) Vocational rehabilitation for people with severe mental illness. Cochrane database of systematic reviews Issue 2. Art. No.: CD003080Google Scholar
  6. 6.
    Department of Health (2001) The mental health policy implementation guide. Department of Health, LondonGoogle Scholar
  7. 7.
    Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The global assessment scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33:766–771PubMedGoogle Scholar
  8. 8.
    Fisher H, Theodore K, Power P, Chisholm B, Fuller J, Marlowe K, Aitchison KJ, Tanna R, Joyce J, Sacks M, Craig T, Johnson S (2008) Routine evaluation in first episode psychosis services: feasibility and results from the MiData project. Soc Psychiatry Psychiatr Epidemiol 43:960–967CrossRefPubMedGoogle Scholar
  9. 9.
    Harris MG, Henry LP, Harrigan SM, Purcell R, Schwartz OS, Farrelly SE, Prosser SL, Jackson HJ, McGorry PD (2005) The relationship between duration of untreated psychosis and outcome: an eight year prospective study. Schizophr Res 79:85–93CrossRefPubMedGoogle Scholar
  10. 10.
    Jeppesen P, Abel M, Thorup A, Peterson L, Ohlenschlaeger J, Christensen TO, Krarup G, Jorgensen P, Nordentoft M (2006) Association between premorbid functioning, duration of untreated psychosis and two-year outcome in first episode psychosis [abstract]. Schizophr Res 86(Suppl 1):s43CrossRefGoogle Scholar
  11. 11.
    Kay SR, Opler LA, Fiszbein A (1992) Positive and negative syndrome scale (PANSS): manual. Multi-Health Systems Inc, New YorkGoogle Scholar
  12. 12.
    Killackey EJ, Jackson HJ, Gleeson J, Hickie IB, McGorry PD (2006) Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first episode psychosis: employing cautious optimism. Aust NZ J Psychiatry 40:951–962Google Scholar
  13. 13.
    Killackey EJ, Jackson HJ, McGorry PD (2008) Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual. Br J Psychiatry 193:114–120CrossRefPubMedGoogle Scholar
  14. 14.
    Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR (2005) What does the PANSS mean? Schizophr Res 79:231–238CrossRefPubMedGoogle Scholar
  15. 15.
    Malla A, Payne J (2001) First episode psychosis: psychopathology, quality of life, and functional outcome. Schizophr Bull 31:650–671CrossRefGoogle Scholar
  16. 16.
    Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and outcome in cohorts of first episode patients. Arch Gen Psychiatry 62:975–983CrossRefPubMedGoogle Scholar
  17. 17.
    Marwaha S, Johnson S (2004) Schizophrenia and employment. Soc Psychiatry Psychiatr Epidemiol 39:337–349CrossRefPubMedGoogle Scholar
  18. 18.
    Marwaha S, Johnson S (2005) Views and experiences of employment among people with psychosis: a qualitative descriptive study. Int J Soc Psychiatry 51:302–316CrossRefPubMedGoogle Scholar
  19. 19.
    Marwaha S, Balachandra S, Johnson, S (2008) Clinicians attitudes to the employment of people with psychosis. Soc Psychiatry Psychiatr Epidemiol [Epub ahead of print]Google Scholar
  20. 20.
    Milev P, Ho B, Arndt S, Andreason NC (2005) Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first episode study with 7 year follow-up. Am J Psychiatry 162:495–506CrossRefPubMedGoogle Scholar
  21. 21.
    Norman RMG, Mallal AK, Manchanda R, Windell D, Harricharan R, Takhar J, Northcott S (2007) Does treatment delay predict occupational functioning in first episode psychosis? Schizophr Res 91:259–262CrossRefPubMedGoogle Scholar
  22. 22.
    Office for National Statistics (2006) Annual population survey. Office for National Statistics, NewportGoogle Scholar
  23. 23.
    Perkins DO, Gu H, Boteva K, Lieberman JA (2005) Relationship between duration of untreated psychosis and outcome in first episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 162:1785–1804CrossRefPubMedGoogle Scholar
  24. 24.
    Rinaldi M, McNeil K, Firn M, Koletsi M, Perkins R, Singh SP (2004) What are the benefits of evidence-based supported employment for patients with first episode psychosis. Psychiatr Bull 28:281–284CrossRefGoogle Scholar
  25. 25.
    Rinaldi M, Perkins R, Glynn E, Montibeller T, Clenaghan M, Rutherford J (2008) Individual placement and support: from research to practice. Adv Psychiatr Treat 14:50–60CrossRefGoogle Scholar
  26. 26.
    Simonsen E, Friis S, Haahr U, Johannesen JO, Larsen TK, Melle I, Opjordsmoen SI, Rund BR, Vaglum P, McGlashen TH (2006) Two year outcome and predictors in first episode psychosis [abstract]. Schizophr Res 86(Suppl 1):s155CrossRefGoogle Scholar
  27. 27.
    Singh SP, Cooper JE, Fisher HL, Tarrant CJ, Lloyd T, Banjo J, Corfe S, Jones P (2005) Determining the chronology and components of psychosis onset: the Nottingham onset schedule (NOS). Schizophr Res 80:117–130CrossRefPubMedGoogle Scholar
  28. 28.
    Sturm R, Gresenz CR, Pacula RL, Wells KB (1999) Labour force participation by persons with mental illness. Psychiatr Serv 50:1407PubMedGoogle Scholar
  29. 29.
    Tsang HWH, Angell B, Corrigan PW, Lee Y, Shi K, Lam CS, Jin S, Fung KMT (2007) A cross-cultural study of employers’ concerns about hiring people with psychotic disorder: implications for recovery. Soc Psychiatry Psychiatr Epidemiol 42:723–733CrossRefPubMedGoogle Scholar
  30. 30.
    Tulloch AD, Fearon P, David AS (2006) Social outcomes in schizophrenia: from description to action. Curr Opin Psychiatry 19:140–144CrossRefPubMedGoogle Scholar
  31. 31.
    Turkington AJ, Rushe TM, Cooper SJ, Anderson R, McCaul R, Barrett SL, Mulholland C (2006) Clinical predictors of one year outcome in patients with first episode psychosis [abstract]. Schizophr Res 86(Suppl 1):s153CrossRefGoogle Scholar
  32. 32.
    Vyas NS, Vourdas A, Byrne P, Frangou S (2006) The Maudsley early onset schizophrenia study: predictors of psychosocial outcome at 4-year follow-up (abstract). Schizophr Res 86(Suppl 1):s159CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Barnaby S. Major
    • 1
    Email author
  • Mark F. Hinton
    • 2
  • Amy Flint
    • 2
  • Anna Chalmers-Brown
    • 2
    • 3
  • Katharine McLoughlin
    • 2
    • 3
  • Sonia Johnson
    • 2
    • 4
  1. 1.EQUIPLondonUK
  2. 2.Camden and Islington Early Intervention ServiceLondonUK
  3. 3.Research Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
  4. 4.Department of Mental Health SciencesUniversity College LondonLondonUK

Personalised recommendations