Barriers to employment for people with severe mental illness and criminal justice involvement.

Background: People with severe mental illness (SMI) and criminal justice involvement (CJI) are able to achieve competitive employment when provided with evidence-based services, but outcomes are modest compared to studies of SMI in general.Aims: To investigate barriers to employment facing people with SMI and CJI receiving employment services.Method: Employment service providers assessed top three barriers to employment for 87 people with SMI and CJI enrolled in a randomized controlled trial comparing a job club program to supported employment. Main barriers were identified and differences between programs were analyzed. Associations between barriers and client background characteristics were investigated.Results: The most common barriers were failure to engage and disengagement from services, followed by substance abuse. Staff from the two employment programs reported similar barriers.Conclusions: Engagement problems were the single most important barrier to employment across programs. Surprisingly, criminal history was rarely mentioned. This may be explained by barriers arising earlier in the process, before achieving employer contact. The results call for recognition and awareness of the importance of motivational issues as well as factors that may inhibit engagement in services, highlighting possible augmentations to evidence-based employment services that may be necessary in the rehabilitation of this patient group.