Recovery From Schizophrenia: Psychiatry And Political Economy

TREATMENT 253the job is permanent. As the worker adjusts to the demands of the position, worksupports can be gradually withdrawn and provided to another client, morerecently placed in work. As a result the number of supported employmentpositions continues to expand over time. Supported employment offers severaladvantages. Employment can be designed to meet the needs of each individualclient. Job-sharing can be arranged for those who, because of the disincentives inthe social security system and the symptom-generating demands of full-time work,prefer to work part-time. Jobs can be sought to match the skills and preferencesof individual clients, and, since positions are permanent, a career ladder ispossible.A refinement of the supported employment model is referred to as individualplacement and support (IPS). Gary Bond has outlined the six principles of thisapproach, 29 the first of which is somewhat extreme:• Competitive employment is the goal. Supporters of the IPS model contend thatmost people with serious mental illness can achieve competitive employmentand that sheltered work settings are unnecessary. As suggested above, this isplainly not true. If it were, the success rate in placing people in competitivework through supported employment would be close to 100 per cent, not 50per cent.• Rapid job search and placement. The research suggests that preparatory workreadinesstraining does not increase the likelihood of eventual competitiveemployment and that rapid job placement is more successful.• Integration of vocational rehabilitation and mental health services. Better results can beobtained, the research reveals, if vocational programs are an integrated part of amental health agency or team, rather than provided by a separate entity.• Attention to the mentally ill person’s preferences. Most people with mental illnessprefer paid employment and rapid job placement to protracted unpaid trainingperiods, and have specific preferences about the type of work, hours, locationand pay. Matching the person to the job on these sorts of criteria results inhigher rates of job placement and longer job tenure.• Continuous assessment. Some of the most useful assessment is made after theperson with mental illness begins working on a job, not before, as intraditional vocational rehabilitation programs.• Time unlimited support. Traditional vocational services used to rate success bythe number of “closures” of service that occurred 90 days after beginningcompetitive employment. Supported employment coaches, in contrast,recognize that the employee with mental illness may need help withemployment problems for much longer periods of time.These are the vocational models currently available in Britain and America forpeople with mental illness. Can we add to them?