Recovery From Schizophrenia: Psychiatry And Political Economy

TREATMENT 249success, for the lodge program offered, in addition, assured accommodation and arelatively sheltered environment coupled to opportunities for autonomy, animportant role within the lodge society and enhanced self-esteem.In the early 1970s researchers painted a dismal picture of the efficacy of mostwork therapy programs, 14 but in recent years modern vocational programs such assupported employment have shown themselves to be more effective in helpingpeople with serious mental illness achieve stable employment. 15 A 1995 review bypsychiatrist Anthony Lehman of research studies using comparison groupsindicates that vocational programs had little or no success in placing people inindependent competitive employment until the late 1970s; however, as programsbecame more effective not only were work-related improvements noted but oftenclinical and social benefits as well. People involved in vocational rehabilitationwere, for example, more likely to engage in activities with friends, to performwell in social and family roles, to have a driver’s license, to take theirantipsychotic medication regularly and to drink less alcohol. Although thoseenrolled in vocational programs were sometimes less likely to be readmitted tohospital, there was rarely any improvement noted in psychiatric symptoms. 16 Asimilar picture has emerged from more recent reviews of the supportedemployment research conducted by psychologist Gary Bond and colleagues—biggains in competitive employment, but rarely any improvement in hospitalizationrates or symptoms. 17A study conducted in New Hampshire follows this general pattern. In 1995 amental health agency decided to reduce the size of a traditional day program andemphasize competitive employment instead. Thirty-two long-term day-treatmentclients volunteered to be switched to a new supported employment program.One year later the rate of competitive employment of the volunteers hadincreased from 13 per cent to 64 per cent, while the employment rate of amatched comparison group who were not assigned to the supported employmentprogram scarcely changed, increasing from 16 to 19 per cent. There was noimprovement in psychiatric symptoms, however, in the supported employmentclients. 18One piece of research does suggest that work can lead to symptom reduction inschizophrenia. In the early 1990s, Morris Bell and his associates placed 150 peoplewith schizophrenia in six-month work placements in a Veterans Affairs medicalcenter in Connecticut and randomly assigned them to either being unpaid or paid$3.40 an hour. As expected, those who were paid worked more hours. Inaddition, those who were paid showed more improvement in their symptoms,particularly emotional discomfort and positive symptoms, such as hallucinationsand delusions, and were less likely to be readmitted to hospital. The more thepatients worked the more their symptoms were reduced. 19Another study that shows progressively improving course of illness for peoplewith serious mental illness who gain employment was conducted in Boulder,Colorado. Thirty-eight people with psychotic disorders who were attending theChinook Clubhouse, a psychosocial clubhouse modeled after Fountain House in