Barriers and facilitators to employment for young adults with mental illness: a scoping review.

OBJECTIVES: The issue of gaining employment for those with mental illness is a growing global concern. For many in the young adult population, who are at a transitional age, employment is a central goal. In response, we conducted a scoping review to answer the question, 'What are the barriers and facilitators to employment for young adults with mental illness?' DESIGN: We conducted a scoping review in accordance to the Arksey and O'Malley framework. We performed a thorough search of Medline, EMBASE, CINAHL, ABI/INFORM, PsycINFO and Cochrane. We included studies that considered young adults aged 15-29 years of age with a mental health diagnosis, who were seeking employment or were included in an employment intervention. RESULTS: Our search resulted in 24 research articles that focused on employment for young adults with mental illness. Four main themes were extracted from the literature: (1) integrated health and social services, (2) age-exposure to employment supports, (3) self-awareness and autonomy and (4) sustained support over the career trajectory. CONCLUSIONS: Our review suggests that consistent youth-centred employment interventions, in addition to usual mental health treatment, can facilitate young adults with mental illness to achieve their employment goals. Aligning the mental health and employment priorities of young adults may result in improved health and social outcomes for this population while promoting greater engagement of young adults in care.

A randomized controlled trial of individual placement and support in Japan.

OBJECTIVE: The individual placement and support (IPS) model of supported employment has been implemented throughout North America and Europe, with multiple randomized controlled trials documenting its effectiveness, but it has not been widely implemented in Asia. To date, no rigorous evaluations of IPS have been conducted in Japan. We sought to evaluate whether IPS could be implemented in Japan and produce superior competitive employment outcomes compared with conventional vocational services. METHOD: We employed a randomized controlled trial with a 6-month follow-up; 18 participants were randomly assigned to IPS and 19 to conventional vocational services. We assessed competitive employment rates, hours and weeks worked, and wages earned. RESULTS: Over the 6-month follow-up period, IPS participants were more likely than those in usual care to work competitively (44.4% for IPS vs. 10.5% for controls, p = .022), work more hours (mean of 168 hr for IPS vs. 41 hr for controls, p = .002), and work more weeks (mean of 6.4 weeks for IPS vs. 1.8 weeks for controls, p = .003). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: IPS can be implemented in Japan and yield better competitive employment outcomes than conventional vocational services. Adoption of the IPS model might have a dramatic impact on the mental health service system in Japan where psychiatric hospitals play a central role in mental health care.

"Coffee Stands": a vocational rehabilitation project in the community for people coping with mental disorders.

OBJECTIVES: The "Coffee Stands" project was developed to provide a work place where individuals with long term mental illness can receive job training within the community. It is similar to a supported employment program, except that it does not provide individual job placement services. The objective of the study was to describe the participants who worked at the "coffee stands", with respect to their participation in occupations, functional cognition, executive functions and awareness, perception of their quality of life (QoL), satisfaction and self esteem. Moreover, the study aimed at examining whether changes occurred in these variables during the 6-month period in which participants worked at the coffee stands. METHODS: Participants included 44 people with chronic mental illness; 27 men and 17 women, mean age 43.43 (SD = 9.02); mean years of education 11.81 (SD = 1.83); mean age of illness onset 27.72 (SD = 11.12) and mean number of hospitalizations 3.27 (SD = 2.64). All signed an informed consent to participate in the study. A battery of eight instruments measuring the various variables was administered at two points in time; at the beginning of the work at the coffee stands and 6 months later. RESULTS: Indicated that the training was successful and that participants were able to maintain an average 3 hours of work daily, demonstrating an improvement in their perception of their ability to work. In the area of planning, they needed structure, suggesting some difficulties in executive functions, but they seemed to be aware of their difficulties. After 6 months, participants showed improvements in health related measures of QoL and satisfaction, but not in self esteem. CONCLUSIONS: The findings strengthen the premise that people coping with an emotional disorder place great importance on working, are able to work and derive satisfaction from their work.