Emotional disturbance

The traditional vocational rehabilitation (TVR) services adopt a step-wise approach which offers pre-vocational training at the beginning of the service. In Hong Kong and mainland China, participants usually undergo a prolonged period of preparation before seeking competitive employment. Rates for competitive employment are usually less than 20%. As TVR is the most common form of vocational rehabilitation in Hong Kong, it was important to local service development to benchmark innovative interventions against standard interventions. IPS is an evidence-based rehabilitation service that includes job development and placement, on-going employment supports, coordination of vocational services with multidisciplinary treatment teams, indefinite services and the opportunity for choice of jobs by participants. PS is less than optimal in clients' maintaining their jobs, with 50% of those employed experiencing job terminations by the six-month follow-up. Over a longer follow-up period, considerably fewer than half of the participants in IPS are working during any single month. In the current study, IPS was amplified by the addition of work-related, social skills training (WSST) together with ongoing supports in the community for aiding generalization of social skills in the workplace following the integrated supported employment (ISE) protocol.

Older people with severe mental illness are frequently assumed to be incapable of returning to work and are not actively recruited to participate in work rehabilitation programs. However, just as healthy older people are working well past traditional retirement age, many older people with schizophrenia want to work. However, very few vocational rehabilitation programs target older clients with psychiatric illness.

There are increasing numbers of middle-aged and older people with schizophrenia-spectrum disorders, most of whom are unemployed. Across all age groups, rates of paid employment among people with these disorders are less than 15%. Yet the potential benefits of employment (e.g., increased income, activity, structure, socialization, and self-esteem) could improve symptoms, everyday functioning, and overall health. Many older people with severe mental illness (SMI) want to work. However, work rehabilitation programs usually do not target older patients, and no published studies have addressed work rehabilitation specifically in middle-aged and older people with SMI.

Sickness leave is generally considered as a major source of societal costs in Western countries. With the increase in mental workload of the past decades, the fraction of psychological problems related to occupational stress has increased rapidly. These problems are also reported in the literature as emotional distress or stress related disorders.

In the Netherlands, a small western European country with 16 million inhabitants,persons with severe mental illnesses consistently have the worst employment outcomes of all disability groups; only 12% are enrolled in competitive jobs. The Dutch approach to vocational rehabilitation for this group has been a cautious one, mainly encompassing prevocational training,sheltered employment, volunteer work, or trainee placements in regular businesses (8). Many clinicians in the Netherlands believe that competitive employment is too ambitious or too stressful for clients with severe mental illnesses. Clients are offered work tasks in segregated settings to prepare them for competitive employment,but the progression from sheltered to competitive jobs is not substantial (9).Another feature of Dutch practice is the parallel organization of mental health services and vocational services,based on the belief that this segregation enables employment specialists to focus solely on vocational issues without causing any stigma.

Major depressive disorder (MDD) has major consequences for both patients and society, particularly in terms of needlessly long sick leave and reduced functioning. Although evidence-based treatments for MDD are available, they show disappointing results when implemented in daily practice. A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners (GPs) and other healthcare professionals with occupational physicians (OPs). The OP may play a more important role in the recovery of patients with MDD.

Unemployment has economic, social and health implications for individuals with first episode psychosis and schizophrenia. The Individual Placement and Support model of supported employment shows promise for individuals with chronic mental illness. However, there are no randomized controlled trials on use of this approach to assist individuals with first episode psychosis with employment.

The topic of employment among persons with mental illness has become increasingly salient in the research literature, as practitioners identify both the benefits of employment to quality of life and the difficulties faced by persons with mental illness in obtaining and maintaining competitive positions (Bond, Drake, & Becker, 2008). These difficulties include the impact of symptoms on work task completion, difficulty coping with work stress, and the impact of interpersonal stressors (Becker et al., 1998).

Supported Employment for persons with serious and persistent mental illness has been termed Individual Placement and Support. In two randomized controlled trials clients who received Individual Placement and Support services were more likely to obtain at least one job in the competitive sector and to work more hours, and to have a higher total income than their counterparts who received more traditional types of vocational rehabilitation. However, individual placement and support did not improve the length of time the employed participants kept their jobs.

Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer purchasers have been slow to adopt these programs based on lack of evidence for cost-effectiveness from their perspective.