Improving Employment Outcomes in Early Psychosis:
Social and Economic Benefits of Early Intervention
Researchers Professor Henry Jackson, Department of Psychology
Email: [email protected]
Dr Ein Killackey, ORYGEN Research Centre & Department of Psychology
Email: [email protected]
Professor Jeff Borland, Department of Economics
Email: [email protected]
Dr Rosanna Scutella, Melbourne Institute of Applied Economic and Social Research and Brotherhood of St Laurence
Email: [email protected]
Dr Yi-Ping Tseng, Melbourne Institute of Applied Economic and Social Research
Email: [email protected]
Funding source:
ARC linkage grant of $380,286 over the period 2008-2011.
Summary of project: The central aim of this project is to examine the effectiveness of an early vocational intervention, called Individual Placement and Support (IPS), on young people with first episode psychosis.
Using experimental methods, the following questions will be examined:
- Does the intervention improve employment, health and social outcomes of those treated?
- Does the effect last over time - in other words, do those in the intervention group continue to benefit from having received the intervention?
- What are the costs of this intervention and does it provide better value for money than current systems?
Early vocational intervention in mental illness: Unemployment is higher among people with psychotic illness than for people with other mental illnesses or other disability groups. This is despite evidence showing that most people with serious mental illness wish to work in the open labour market. For those with mental illness, unemployment reinforces social and economic marginalisation, has the potential to exacerbate symptoms, increases risk of homelessness, and often persists after other symptoms of illness have resolved. Mental illness most often has its onset in late adolescence and early adulthood precisely when vocational skills are being learned and early employment experience and training gained. An early intervention combining mental health services and vocational support for people with severe mental illness in this critical life stage has the potential to not only help people find work in the short term, but also to improve labour market opportunities and reduce the impact of mental disorder over the longer term. Supported Employment is acknowledged in a Cochrane review and other reviews as being the most effective form of vocational intervention for people with established mental illness. Individual Placement and Support (IPS) is the most defined and most studied form of supported employment. However, nearly all the IPS intervention trials that have been conducted so far have been done in populations with established mental illness. Early intervention has the potential for greater gains in symptoms and functioning than delayed treatment and is therefore cheaper over the longer term. Thus, this study will focus on the impact of IPS for young people (age 15 and 25) with first episode psychosis. To conduct a reliable evaluation, IPS will be implemented under a randomised control trial (RCT) setting. The net impact of the intervention over both the short and longer term will be evaluated followed by a full economic evaluation of the intervention, which will identify the main benefits and costs of the reform to society.
Part I: RCT of vocational intervention The trial will be carried out at the ORYGEN Research Centre (ORC). ORC is a not-for-profit organisation that conducts research on early intervention in mental health. ORC is co-located with ORYGEN Youth Health which is a public mental health service for young people aged 15-25 living in the north and north-west of metropolitan Melbourne. The Early Psychosis Prevention and Intervention Centre (EPPIC), is a subprogram of ORYGEN Youth Health. The aim is to recruit 360 clients of EPPIC to participate in the randomised trial. Inclusion criteria will be an ability to speak and understand English as this is necessary for assessments. The only other inclusion criterion is a desire to seek work. The trial participants will be randomly assigned to treatment and control group. The control group will receive all the normal treatments that they would be eligible for as clients of EPPIC, and the treatment group will receive both normal treatments and IPS. The IPS has the following seven key principles: it is focused on competitive employment as an outcome (i.e., jobs which are not set aside but open to anyone with the appropriate skills or qualifications to apply for); IPS is open to any person with mental illness who chooses to look for work and that acceptance into the program is not determined by measures of work-readiness or illness variables; job searching commences directly on entry into the program; the IPS program is integrated with the mental health treatment team; potential jobs are chosen based on consumer preference; and the support provided in the program is time-unlimited, continuing after employment is obtained, and is adapted to the needs of the individual; and personalised benefits planning is provided.
Part II: Estimating the net impact of the vocational intervention An important feature of randomised control trials is that the baseline characteristics of treatment and control groups are similar enough that comparing outcomes for the two groups provides an estimate of the causal impact of program intervention. To estimate the impact of the intervention compared to non-participation we will therefore compare a range of measurable outcomes including labour market, health, and social function across treatment and control groups. Information on both baseline characteristics and outcome measures at 6 and 12 months will be collected.
Part III: Economic evaluation of the intervention The economic evaluation of the study will quantify the full costs and benefits to society of the intervention. This part of the analysis will involve translating the outcomes of Part 2 of the study, which will estimate the net impact of the intervention, to calculating an estimate of the monetary value of each specific benefit and cost; and then aggregating these estimates to calculate the cost-benefit ratio for the program.
Members of the Labour Economics and Social Policy team.