Approaches to Improving Employment Outcomes for People with Serious Mental Illness

  • Terry Krupa


The past 20 years have witnessed the advancement of a range of innovative and promising employment initiatives for people with serious mental illness (SMI). This chapter provides a brief review of current approaches to improving employment outcomes for people with SMI. It begins with an overview of principles that provide a shared philosophical foundation for the development of these employment approaches. The chapter then offers a brief overview of three distinct approaches that have demonstrated considerable success in securing and sustaining employment for people with SMI: the Individual Placement and Support model; the community economic development approach; and the creation of affirmative employment opportunities within the mental health system.


Mental Illness Mental Health System Employment Outcome Serious Mental Illness Employment Support 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Bailey EL, Ricketts SK, Becker DR, Xie H, Drake RE (1998) Do long-term day treatment clients benefit from supported employment? Psychiatr Rehabil J 22(1):24–30Google Scholar
  2. Bertolote J, McGorry P (2005) Early intervention and recovery for young people with early psychosis: consensus statement. Br J Psychiatry 187(48):116–119CrossRefGoogle Scholar
  3. Bertram M and, Howard L (2006) Employment status and occupational care planning for people using mental health services. Psychiatr Bull 30(2):48–51CrossRefGoogle Scholar
  4. Bond G (1998) Principles of individual placement and support model: empirical support. Psychiatr Rehabil J 22:11–23Google Scholar
  5. Bond GR, Becker DR, Drake RE, Rapp CA, Meisler N, Lehman AF, Bell MD, Blyler CR (2001) Implementing supported employment as an evidence-based practice. Psychiatr Serv 52(3):313–322PubMedCrossRefGoogle Scholar
  6. Bond GR, Drake RE, Becker DR (2008) An update on randomized controlled trials of evidence-based supported employment. Psychiatr Rehabil J 31(4):280–290PubMedCrossRefGoogle Scholar
  7. Bond GR, McHugo GL, Becker DR, Rapp CA, Whitley R (2008b) Fidelity of supported employment: lessons learned from the National Evidence-Based Practice Project. Psychiatr Rehabil J 31(4):300–305PubMedCrossRefGoogle Scholar
  8. Carlson L, Rapp C, McDiarmid D (2001) Hiring consumer-providers: barriers and alternative solutions. Community Ment Health J 37:199–211PubMedCrossRefGoogle Scholar
  9. Chinman M, Weingarten R, Stayner D, Davidson L (2001) Chronicity reconsidered: improving person-environment fit through a consumer-run service. Community Ment Health J 37(3):215–229PubMedCrossRefGoogle Scholar
  10. Church K, Fontan JM, Ng R, Shragge E (2000) Social learning among people who are excluded from the labour market, part one: context and case studies. The research network to new approaches to lifelong learning. Accessed 24 Aug 2008
  11. Clark CC, Scott EA, Boydell KM, Goering P (1999) Effects of client interviewers on client-reported satisfaction with mental health services. Psychiatr Serv 50:961–963PubMedGoogle Scholar
  12. Davidson L, Chinman M, Kloos B, Weingarten R, Stayner D, Tebes J (1999) Peer support among individuals with severe mental illness: a review of the evidence. Clin Psychol Sci Pract 6(2):165–187CrossRefGoogle Scholar
  13. Drake R, Becker DR, Bond GR (2003) Recent research on vocational rehabilitation for persons with severe mental illness. Curr Opin Psychiatry 16:451–456Google Scholar
  14. Drake R, Bond GR (2008) The future of supported employment for people with severe mental illness. Psychiatr Rehabil J 31(4):367–376PubMedCrossRefGoogle Scholar
  15. Eastabrook S, Krupa T, Horgan S (2004) Creating inclusive workplaces: employing people with psychiatric disabilities in evaluation and research in community mental health. Can J Program Eval 19(3):71–88Google Scholar
  16. Easterly L, McCallion P (2007) Affirmative business: examining the relevance of small business research. J Rehabil 73(1):13–21Google Scholar
  17. Evans LJ, Bond GR (2008) Expert ratings on the critical ingredients of supported employment for people with severe mental illness. Psychiatr Rehabil J 31(4):318–331PubMedCrossRefGoogle Scholar
  18. Friesen M, Viti F (1994) Group hallucinations: overcoming disbelief. Consumer Survivor Business Council of Ontario and the National Network for Mental Health, TorontoGoogle Scholar
  19. Gates L, Akabas S (2007) Developing strategies to integrate peer providers into the staff of mental health agencies. Adm Policy Ment Health Serv Res 34:293–306CrossRefGoogle Scholar
  20. Hanrahan P, Heiser W, Cooper AE, Oulvey G, Luchins DJ (2006) Limitations of system integration in providing employment services for persons with mental illness. Adm Policy Ment Health Serv Res 33(2):244–252CrossRefGoogle Scholar
  21. Henry AD, Nicholson J, Phillips S, Stier L, Clayfield J (2002) Creating job opportunities for people with psychiatric disabilities at a university-based research center. Psychiatr Rehabil J 26(2):181–191PubMedCrossRefGoogle Scholar
  22. Hutchinson DS, Anthony WA, Ashcraft L, Johnson E, Dunn EC, Lyass A, Rogers ES (2006) The personal and vocational impact of training and employing people with psychiatric disabilities as providers. Psychiatr Rehabil J 29(3):205–213PubMedCrossRefGoogle Scholar
  23. Jonikas JA, Laris A, Cook J (2003) The passage to adulthood: psychiatric rehabilitation service and transition-related needs of young adult women with emotional and psychiatric disorders. Psychiatr Rehabil J 27(2):114–120PubMedCrossRefGoogle Scholar
  24. Killackey E, Jackson H, Gleeson J, Hickie I, McGorry P (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
  25. Kirsh B, Cockburn L, Gewurtz R (2005) Best practice in occupational therapy: program characteristics that influence vocational outcomes for people with serious mental illness. Can J Occup Ther 72(5):265–280PubMedGoogle Scholar
  26. Kravetz S, Dellario D, Granger B, Salzer M (2003) A two-faceted work participation approach to employment and career development as applied to persons with a psychiatric disability. Psychiatr Rehabil J 26(3):278–289PubMedCrossRefGoogle Scholar
  27. Krupa T (1998) The consumer-run business: people with psychiatric disabilities as entrepreneurs. Work 11:3–10CrossRefGoogle Scholar
  28. Krupa T, McCourty K, Bonner D, Von Briesen B, Scott R (1999) Voices, Opportunities and Choices Employment Club: transforming sheltered workshops using an affirmative business approach. Can J Community Ment Health 18(2):87–98Google Scholar
  29. Krupa T, Lagarde M, Carmichael K (2003) Transforming sheltered workshops into affirmative businesses: an evaluation of outcomes. Psychiatr Rehabil J 26(4):359–367PubMedCrossRefGoogle Scholar
  30. Lurie S, Kirsh B, Hodge S (2007) Can ACT lead to more work? The Ontario experience. Can J Community Ment Health 26(1):161–171Google Scholar
  31. Macias C, Aronson E, Barreira PJ, Rodican CF, Gold PB (2007) Integrating peer providers into traditional service settings: the Jigsaw strategy in action. Adm Policy Ment Health Serv Res 34:494–496CrossRefGoogle Scholar
  32. Marrone J, Gandolfo C, Gold M, Hoff D (1998) Just doing it: helping people with mental illness get good jobs. J Appl Rehabil Counsel 29(1):37–48Google Scholar
  33. McCarthy TP, Pelletier JR, Accordino MP (2005) Psychiatric rehabilitation education in a rehabilitation counseling graduate program: training effect on vocational rehabilitation counselor knowledge and skills. Rehabil Educ 19(4):215–224Google Scholar
  34. McColl MA, Bickenbach JE (1998) Introduction to disability. W.B. Saunders Company Ltd, LondonGoogle Scholar
  35. Mowbray CT, Collins ME, Bellamy CD, Megivern DA, Bybee D, Szilvagyi S (2005a) Supported education for adults with psychiatric disabilities: an innovation for social work and psychosocial rehabilitation practice. Soc Work 50(1):7–20PubMedGoogle Scholar
  36. Mowbray CT, Holter MC, Mowbray OP, Bybee D (2005b) Consumer-run drop-in centers and clubhouses: comparisons of services and resources in a statewide sample. Psychol Serv 2(1):54–64CrossRefGoogle Scholar
  37. Mowbray CT, Moxley D, Collins ME (1998) Consumers as mental health providers: first person accounts of benefits and limitations. J BehavHealth Serv Res 25:397–411CrossRefGoogle Scholar
  38. Neuchterlain KH, Subotnik KL, Turner LR, Ventura J, Becker D, Drake R (2008) Individual placement and support for individuals with recent-onset schizophrenia: integrating supported education and supported employment. Psychiatr Rehabil J 31:340–349CrossRefGoogle Scholar
  39. Neufeldt A, Albright AL (1998) Disability and self-directed employment: business development models. Captus, Concorde,Google Scholar
  40. Reeve P, Cornell S, D’Costa B, Janzen R, Ochocka J (2002) From our perspective: consumer researchers speak about their experience in a community mental health research project. Psychiatr Rehabil J 25(4):403–408PubMedGoogle Scholar
  41. Rivera JJ, Sullivan AM, Valenti SS (2007) Adding consumer-providers to intensive case management: does it improve outcome? Psychiatr Serv 58:802–9PubMedCrossRefGoogle Scholar
  42. Salzer M, Baron R (2002) Accounting for unemployment among people with mental illness. Behav Sci Law 20:585–599PubMedCrossRefGoogle Scholar
  43. Strauss JS (2008) Is prognosis in the individual, the environment, the disease, or what? Schizophr Bull 34(2):245–246PubMedCrossRefGoogle Scholar
  44. Trainor J, Shepherd M, Boydell KM, Leff A, Crawford E (1997) Beyond the service paradigm: the impact and implications of consumer/survivor initiatives. Psychiatr Rehabil J 21(2):132–140Google Scholar
  45. Warner R (1994) Recovery from schizophrenia: psychiatry and political economy. Routledge, LondonGoogle Scholar
  46. Warner R, Mandiberg J (2006) An update on affirmative businesses or social firms for people with mental illness. Psychiatr Serv 57:1488PubMedCrossRefGoogle Scholar
  47. Woodside H, Krupa T, Pocock K (2007) A conceptual model to guide rehabilitation and recovery in early psychosis. Psychiatr Rehabil J 32(2):125–130CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.School of Rehabilitation TherapyQueen’s UniversityKingstonCanada

Personalised recommendations