An intervention at an adult inpatient unit to engage people with schizophrenia and work goals with supported employment.

OBJECTIVE: Test an intervention for individuals with schizophrenia at an Adult Inpatient Unit with employment and social inclusion goals, compared to treatment as usual. METHOD: A single-blind, randomised, controlled trial assigned 25 participants to treatment as usual and 26 participants to receive an Individual Placement and Support (IPS) Disability Employment Service (DES) information pack and an offer of support from a nurse. Outcomes were measured at 6 and 12 months using Job Acquisition, IPS DES employment provider, Activity Participation Questionnaire-Revised, Brief Psychiatric Rating Scale, and Adult Hope Scale questionnaires, and Digit Span and Trail Making tests. RESULTS: The intervention did not result in significant contact with the DES employment provider or paid employment outcomes. Secondary outcomes from combining groups due to high attrition rates: A significant proportion of participants obtained unpaid work from baseline to 6 months follow-up (N = 24, p = 0.001). CONCLUSIONS: The 'light touch' intervention did not promote change. More support is required during inpatient admissions and after discharge to assist people with schizophrenia achieve their vocational goals.

Clinical psychology referral for individuals with auditory verbal hallucinations and schizophrenia: Therapy engagement, hallucination severity and distress.

OBJECTIVE: Test an intervention for people with schizophrenia and auditory verbal hallucinations at an acute inpatient unit (AIU) to engage with community therapy and reduce hallucination severity and associated distress. The trial cohort consisted of patients who after assessment by an AIU psychiatrist were not selected for an appointment with an AIU clinical psychologist and an opportunity for referral to a post-discharge community psychologist. An intervention providing the appointment and referral opportunity was compared to Treatment As Usual (TAU). METHOD: A single-blind, randomised, control trial compared the intervention with TAU over 6-months post-discharge using Engagement in Community Therapy, Psychotic Symptom Rating Scale (PSYRATS) auditory hallucinations and Revised Beliefs About Voices (BAVQ-R) questionnaires. RESULTS: Post-discharge community therapy engagement increased at 6 months compared to baseline in the intervention, TAU and combined groups. PSYRATS AHS and H-DIS scores decreased from baseline to last follow-up (statistically significant for TAU, and combined treatment groups). BAVQ-R RE scores decreased from baseline to last follow-up but the decrease was not statistically significant. CONCLUSIONS: Most participants chose to engage with a community therapist despite not being initially assigned for referral by their psychiatrist and experiencing moderately severe symptoms.

Integration of alcohol and drug nurses into a mental health unit.

OBJECTIVE: Test whether extra time with alcohol and drug nurses for inpatients at a Mental Health Unit (MHU) reduces post-discharge mental and co-occurring alcohol and drug problems and increases engagement in alcohol and drug treatment more than a Brief Information Pack (BIP). METHOD: Single blind randomised control trial in block design compared two alcohol and drug nurse delivered interventions over 6 months post-discharge using the Alcohol Use Disorders Identification Test (AUDIT) and Brief Symptom Inventory index of overall psychological distress Global Severity Index (GSI). RESULTS: Alcohol and drug nurse delivered BIP was associated with a statistically significant reduction in AUDIT measured alcohol use for the highest follow-up score across the 6-month post-discharge period, n = 20, t = 2.24, p = 0.037, d = 0.50 and for the extra time intervention, n = 11, t = 2.51, p = 0.031, d = 0.76. CONCLUSIONS: MHUs may benefit from the integration of alcohol and drug nurses with community alcohol and drug treatment experience.

A Supported Employment linkage intervention for people with schizophrenia who want to work: a survey of patients' views.

OBJECTIVE: Take into account patient views in developing a linkage intervention to the evidence-based Individual Placement and Support approach to Supported Employment (SE) for patients with schizophrenia on a mental health unit (MHU) who want to work in competitive employment. METHODS: Analysis of 20 once-off, face-to-face interviews, with informed consent, between author and voluntary MHU inpatients with schizophrenia about getting into SE from the MHU. RESULTS: From the major category 'patient ideas about SE linkage intervention from MHU' the three themes of 'patient choice', 'type of support' and 'start from the MHU' emerged. The other major category, 'patient attitude to the author's proposed SE linkage intervention', revealed the theme of 'positive attitude'. CONCLUSIONS: There may be enough interest from patients with schizophrenia on a MHU who want to work, to test a pilot of the author's proposed voluntary SE linkage intervention.

A supported employment linkage intervention for people with schizophrenia who want a chance to work.

OBJECTIVE: Investigate feasibility and development of a linkage intervention to the evidence-based Individual Placement and Support (IPS) approach to supported employment (SE) for patients with schizophrenia on a mental health unit who want to work in competitive employment. METHOD: Literature review about the evidence-based IPS approach to SE in schizophrenia and why it might not be implemented in mental health services. Analysis of 10 adult mental health unit multidisciplinary staff interviews for categories in the literature review of IPS implementation barriers and whether these barriers could be overcome. RESULTS: There was lack of full staff knowledge of the IPS approach to SE. However, all staff knew respect for patient choice was paramount, community employment programs existed for the disabled, an outreach linkage process to such a program and ongoing support for people with schizophrenia would be required. There was staff ambivalence about SE for patients with schizophrenia. CONCLUSION: Despite staff ambivalence about SE for people with schizophrenia there was still enough staff knowledge and openness to shape an IPS linkage intervention from a staff perspective.

Supported employment can reduce social exclusion and improve schizophrenia.

OBJECTIVE: There are significant mental health benefits in schizophrenia associated with integration into society and the workplace. This case examines factors contributing to such reintegration. CONCLUSIONS: A hostel team, an employment officer from an employment agency for the disabled and a community clinic collaborated to foster reintegration into the community through supported employment, improved supported accommodation and family support.