This article presents research-based principles of vocational rehabilitation that have emerged from the study of diagnostically heterogeneous populations of persons with severe mental illness. Employment and vocational functioning outcomes of people with schizophrenia from recently published followup studies are described. In addition, we present research conducted over the past decade concerning differential outcomes of vocational rehabilitation services for people with schizophrenia versus other psychotic and nonpsychotic disorders. We then explore studies of people with schizophrenia that may illuminate the links between specific features of this disorder—including symptomatology, social skills, and neuropsychological impairments—and poorer vocational outcome. We conclude with a set of recommendations for clinical practice that draw upon the most recent discoveries and insights in this field.
Anthony, W.A., and Jansen, M.A. Predicting the vocational capacity of the chronically mentally ill. American
Psychologist, 39:537-544, 1984.
Anthony, W.A.; Rogers, E.S.; Cohen, M.; and Davies, R.
Relationships between psychiatric symptomatology, work
skills, and future vocational performance. Psychiatric
Services, 46:353-358, 1995.
Becker, R.E. An evaluation of a rehabilitation program for
chronically hospitalized psychiatric patients. Social
Psychiatry, 2:32-38, 1967.
Becker, D.; Drake, R.; Farabaugh, A.; and Bond, G.R. Job
preferences of clients with severe psychiatric disorders
participating in supported employment programs.
Psychiatric Services, 47:1223-1226, 1996.
Beiser, M.; Bean, G.; Erickson, D.; Zhang, J.; Iacono, W.;
and Rector, N. Biological and psychosocial predictors of
job performance following a first episode of psychosis.
American Journal of Psychiatry, 151:857-863, 1994.
Bell, M.; Lysaker, P.; and Milstein, R. Clinical benefits of
paid work activity in schizophrenia. Schizophrenia
Bulletin, 22(1 ):51-67,1986.
Bilder, R.; Turkel, E.; Lipschutz-Broch, L.; and
Lieberman, J. Antipsychotic medication effects on neuropsychological functions. Psychopharmacology Bulletin,
Black, B.J., ed. Work as Therapy for the Mentally III. New
York, NY: Altro Institute for Rehabilitation Studies, 1986.
Bolton, B., and Roessler, R. Manual for the Work
Personality Profile. Fayetteville, AR: Arkansas Research
and Training Center in Vocational Research, 1986.
Bond, G.R., and Dincin, J. Accelerating entry into transitional employment in a psychiatric rehabilitation agency.
Rehabilitation Psychology, 32:143-155, 1986.
Bond, G.R., and Friedmeyer, M.H. Predictive validity of
situational assessment at a psychiatric rehabilitation center. Psychosocial Rehabilitation Journal, 11:61-77, 1987.
Bond, G.R.; Dietzen, L.; McGrew, J.; and Miller, L.
Accelerating entry into supported employment for persons
with severe psychiatric disabilities. Rehabilitation
Psychology, 40:75-94, 1995.
Bond, G.R.; Drake, R.; Mueser, K.; and Becker, D. An
update on supported employment for persons with severe
mental illness. Psychiatric Services, 48:335-346, 1997.
Breier, A.; Schreiber, J.; Dyer, J.; and Pickar, D. National
Institute of Mental Health longitudinal study of chronic
schizophrenia. Archives of General Psychiatry,
Brekke, J.; Raine, A.; Ansel, M.; Lencz, T.; and Bird, L.
Neuropsychological and psychophysiological correlates
of psychosocial functioning in schizophrenia.
Schizophrenia Bulletin, 23(l):19-28, 1997.
Brenner, H.; Hodel, D.; Roder, V.; and Corrigan, P.
Treatment of cognitive dysfunctions and behavioral
deficits in schizophrenia. Schizophrenia Bulletin,
Bryson, G.; Bell, M.D.; Kaplan, E.; and Greig, T. The
functional consequences of memory impairments on initial work performance in people with schizophrenia.
Journal of Nervous and Mental Diseases, 186:610-615,
Bureau of Labor Statistics. Employment status of the
civilian noninstitutional population, 1935 to date. In:
Current Population Survey. Washington, DC: The Bureau,
Callahan, M.J. Job site training and natural supports. In:
Nisbet, J., ed. Natural Supports in School, at Work, and in
the Community for People With Severe Disabilities.
Baltimore, MD: Paul H. Brookes Publishing, 1992. pp.
Carpenter, W., Jr.; Heinrichs, D.; and Alphs, L. Treatment
of negative symptoms. Schizophrenia Bulletin,
Chandler, D.; Meisel, J.; Hu, W.; McGowen, M; and
Madison, K. A capitated model for a cross-section of
severely mentally ill clients: Employment outcomes.
Community Mental Health Journal, 33:501-516, 1997.
Charisiou, J.; Jackson, H.; Boyle, G.; Burgess, P.; Minas,
I.; and Joshua, S. Which employment interview skills best
predict the employability of schizophrenic patients?
Psychological Reports, 64:683-694, 1989a.
Charisiou, J.; Jackson, H.; Boyle, G.; Burgess, P.; Minas,
I.; and Joshua, S. Are employment-interview skills a correlate of subtypes of schizophrenia? Psychological
Reports, 65:951-960, 19896.
Ciardiello, J. Job placement success of schizophrenic
clients in sheltered workshop programs. Vocational
Evaluation and Work Adjustment Bulletin, 14:125-129,
Cohen, C.I. Poverty and the course of schizophrenia:
Implications for research and policy. Hospital and
Community Psychiatry, 44:951-959, 1993.
Cook, J.A. "Vocational Rehabilitation for Youth With
Severe Mental Illness: Predictive Validity of Situational
Assessment for Later Employment." Paper presented at
Annual Meeting of the American Public Health
Association, Atlanta, Georgia, 1991.
Cook, J.A.; Bond, G.; Hoffschmidt, S.; Jonas, E.;
Razzano, L.A.; and Weakland, R. Situational assessment.
In: Assessing Vocational Performance Among Persons
With Severe Mental Illness. Chicago, IL: Thresholds
National Research and Training Center on Rehabilitation
and Mental Illness, 1994. pp. 7-16.
Cook, J.A., and Hoffschmidt, S. Comprehensive models of
psychosocial rehabilitation. In: Flexor, R.W., and Solomon,
P., eds. Psychiatric Rehabilitation in Practice. Boston, MA:
Andover Medical Publishers, 1993. pp. 81-97.
Cook, J.A., and Pickett, S.A. Recent trends in vocational
rehabilitation for people with psychiatric disability.
American Rehabilitation, 20(4):2-12, 1995.
Cook, J.A.; Pickett, S.A.; Razzano, L.A.; Fitzgibbon, G.;
Jonikas, J.A.; and Cohler, J.J. Rehabilitation services for
persons with schizophrenia. Psychiatric Annals, 26:
Cook, J., and Razzano, L.A. Natural vocational supports
for persons with severe mental illness: Thresholds supported competitive employment program. In: Stein, L., ed.
Innovations in Mental Health Services. San Francisco,
CA: Jossey-Bass, 1992. pp. 23-42.
Cook, J.A., and Razzano, L.A. Predictive validity of the
McCarron-Dial testing battery for employment outcomes
among psychiatric rehabilitation clientele. Vocational
Evaluation and Work Adjustment Bulletin, 27(2):39-47,1994.
Cook, J.A., and Razzano, L.A. Discriminant function
analysis of competitive employment outcomes in a transitional employment program. Journal of Vocational
Rehabilitation, 5(2):27-139, 1995.
Cook, J.A.; Razzano, L.A.; and Cappelleri, J. Canonical
correlation analysis of residential and vocational outcomes following psychiatric rehabilitation. Evaluation
and Program Planning, 14:351-363, 1996b.
Cook, J.A., and Rosenberg, H. Predicting community
employment among persons with psychiatric disability: A
logistic regression analysis. Journal of Rehabilitation
Administration, 18:6-22, 1994.
Cook, J.A., and Wright, E. Medical sociology and the
study of severe mental illness: Reflections on past accomplishments and directions for future research. Journal of
Health and Social Behavior, 36:95-114, 1995.
Dalton, R.F., and Latz, A. Vocational placement: The
Pennsylvania Rehabilitation Center. Rehabilitation
Literature, 39:336-339, 1978.
Danley, K.; Sciarappa, K.; and MacDonald-Wilson, K.
Choose-get-keep: A psychiatric rehabilitation approach to
supported employment. In: Liberman, R., ed. Effective
Psychiatric Rehabilitation. San Francisco, CA: JosseyBass, 1992. pp. 87-97.
Dauwalder, J.P., and Hoffmann, H. Chronic psychoses
and rehabilitation: An ecological perspective.
Psychopathology, 25:139-146, 1992.
Donegan, K.R., and Palmer-Erbs, V.K. Promoting the
importance of work for persons with psychiatric disabilities: The role of the psychiatric nurse. Journal of
Psychosocial Nursing, 36(4): 13-14, 1998.
Drake, R.; Becker, D.; Biesans, J.; Torrey, W.; McHugo,
G.; and Wyzik, P. Rehabilitative day treatment vs. supported employment: I. Vocational outcomes. Community
Mental Health Journal, 30:519-532, 1994.
Drake, R., and Becker, D. The Individual Placement and
Support Model of supported employment. Psychiatric
Services, 4:473^75, 1996.
Evans, B.; Souyma, A.; and Maier, G. A vocational
assessment and training program for individuals in an
inpatient forensic mental health center. Psychosocial
Rehabilitation Journal, 13:61-69, 1989.
Fabian, E. Longitudinal outcomes in supported employment: A survival analysis. Rehabilitation Psychology,
Fabian, E., and Luecking, R.G. Doing it the company
way: Using internal company supports in the workplace.
Journal of Applied Rehabilitation Counseling, 22:32-35,
Fenton, W., and McGlashan, T. Natural history of schizophrenia subtypes: II. Positive and negative symptoms.
Archives of General Psychiatry, 48:978-986, 1991.
Ferdinandi, A.; Yoottanasumopun, V.; Pollack, S.; and
Bermanzohn, P. Predicting rehabilitation outcome among
patients with schizophrenia. Psychiatric Services,
Glynn, S.; Randolph, E.; Eth, S.; Paz, G.; Leong, G.;
Shaner, A.; and VanVort, W. Schizophrenic symptoms,
work adjustment, and behavioral family therapy.
Rehabilitation Psychology, 37:323-338, 1992.
Goldberg, T; Weinberger, D.; Berman, K.; Pliskin, N.;
and Podd, M. Further evidence for dementia of the prefrontal type in schizophrenia. Archives of General
Psychiatry, 44:1008-1014, 1987.
Golden, C.J.; Moses, J.A.; Coffman, J.A.; Miller, W.R.;
and Strider, F.R. Clinical Neuropsychology: Interface
With Neurologic and Psychiatric Disorders. New York,
NY: Grune and Stratton, 1983.
Green, M.F. What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal
of Psychiatry, 153:321-330, 1996.
Griffiths, R.D. Rehabilitation of chronic psychotic
patients: An assessment of their psychological handicap,
an evaluation of the effectiveness of rehabilitation, and
observations of the factors which predict outcome.
Psychological Medicine, 4:316-325, 1974.
Halford, W.K., and Hayes, R. Psychological rehabilitation
of chronic schizophrenic patients: Recent findings on
social skills training and family psychoeducation. Clinical
Psychology Review, 11:23-44, 1991.
Harding, CM.; Brooks, G.W.; Takamaru, A.; Strauss, J.S.;
and Breier, A. The Vermont longitudinal study of persons
with severe mental illness: II. Long-term outcome of subjects who retrospectively met DSM—III criteria for schizophrenia. American Journal of Psychiatry, 144:727-735,
Harrow, M.; Sands, J.; Silverstein, M.; and Goldberg, J.
Course and outcome for schizophrenia versus other psychotic patients: A longitudinal study. Schizophrenia
Bulletin, 23(2):287-303, 1997.
Hayes, R., and Halford, W. Time use of unemployed and
employed single male schizophrenia subjects.
Schizophrenia Bulletin, 22(4):659-669, 1996.
Heaton, R., and Crowley, T. Effects of psychiatric disorders and their somatic treatments on neuropsychological
test results. In: Filskov, S., and Boll, T, eds. Handbook of
Clinical Neuropsychology, 1981. pp. 481-525.
Ho, B.; Andreasen, N.; and Flaum, M. Dependence on
public financial support early in the course of schizophrenia. Psychiatric Services, 48:948-950, 1997.
Jacobs, H.; Wissusik, D.; Collier, R.; Stackman, D.; and
Burkeman, D. Correlations between psychiatric disabilities and vocational outcome. Hospital and Community
Psychiatry, 43:365-369, 1992.
Jaeger, J.; Burns, S.; Tigner, A.; and Douglas, E.
Remediation of neuropsychological deficits in psychiatric populations: Rationale and methodological considerations. Psychopharmacology Bulletin, 28:367—390,
Jaeger, J., and Douglas, E. Neuropsychiatric rehabilitation
for persistent mental illness. Psychiatric Quarterly,
Johnstone, E.; Macmillan, J.; Frith, C; Benn, D.; and
Crow, T. Further investigation of the predictors of outcome following first schizophrenic episodes. British
Journal of Psychiatry, 157:182-189, 1990.
Kaufmann, C.L. The Self-Help Empowerment Center:
Some outcomes from the first year. Psychosocial
Rehabilitation Journal, 18:145-162, 1995.
Keith, S.J.; Regier, D.A.; and Rae, D.S. Schizophrenic
disorders. In: Robins, L.N., and Regier, D.A., eds.
Psychiatric Disorders in America. New York, NY: Free
Press, 1991. pp. 35-52.
Knoedler, W. Individual placement and support: A community mental health center approach to vocational rehabilitation. [Discussion]. Community Mental Health
Journal, 30:207-209, 1994.
Kouzis, A.C., and Eaton, W.W. Emotional disability days:
Prevalence and predictors. American Journal of Public
Health, 84:1304-1307, 1994.
Kregel, J.; Wehman, P.; and Banks, P.D. The effects of consumer characteristics and type of employment model on
individual outcomes in supported employment. Journal of
Applied Behavior Analysis, 22(4):407^15,1989.
Lehman, A. Vocational rehabilitation in schizophrenia.
Schizophrenia Bulletin, 21(4):645-656,1995.
Lehman, A., and Steinwachs, D. Patterns of usual care for
schizophrenia: Initial results from the Schizophrenia
Patient Outcomes Research Team (PORT) survey.
Schizophrenia Bulletin, 24(l):ll-20, 1998a.
Lehman, A., and Steinwachs, D. At issue: Translating
research into practice: The Schizophrenia Patient
Outcomes Research Team (PORT) recommendations.
Schizophrenia Bulletin, 24(l):l-10, 19986.
Lindstroem, L.H., and Lundberg, T. Long-term effect on
outcome of clozapine in chronic therapy-resistant schizophrenic patients. European Psychiatry, 12:353s-355s, 1997.
Littrell, K. Maximizing schizophrenia treatment outcomes: A model for integration. Psychiatric
Rehabilitation Journal, 19:75-77, 1995.
Lysaker, P., and Bell, M. Work performance over time for
people with schizophrenia. Psychosocial Rehabilitation
Journal, 18:141-145, 1995.
Lysaker, P.; Bell, M.; Milistein, R.; Bryson, G.; Shestopal,
A.; and Goulet, J. Work capacity in schizophrenia.
Hospital and Community Psychiatry, 44:278-280, 1993.
Lysaker, P.; Bell, M.; and Beam-Goulet, J. Wisconsin
Card Sorting Test and work performance in schizophrenia. Psychiatry Research, 56:45-51, 1995.
Malla, A.K.; Lazosky, A.; McLean, T; Rickwood, A.; Cheng,
S.; and Norman, R.M.G. Neuropsychological assessments as
an aid to psychosocial rehabilitation of severe mental disorders. Psychiatric Rehabilitation Journal, 21:169-173,1997.
Mancuso, L. Reasonable accommodations for workers
with psychiatric disabilities. Psychosocial Rehabilitation
Journal, 14(2):3-19, 1990.
Manschreck, T.C. Psychopathology of motor behavior in
schizophrenia. Progress in Experimental Personality
Research, 12:53-94, 1983.
Marshak, L.; Bostick, D.; and Turton, L. Closure outcomes for clients with psychiatric disabilities served by
the vocational rehabilitation system. Rehabilitation
Counseling Bulletin, 33:247-250, 1990.
Massel, H.; Liberman, R.; Mintz, J.; Jacobs, H.; Rush, T.;
Gianni, C; and Zarate, R. Evaluating the capacity to work
in the mentally ill. Psychiatry, 53:31^3, 1990.
McCarthy, M., and Bewley, T.H. Patients working out
from a psychiatric hospital. International Journal of
Social Psychiatry, 26:129-143, 1980.
Miller, L., and Miller, L. ANGELS, Inc.: A consumer-run
supported employment agency. Psychiatric Rehabilitation
Journal, 21:160-163, 1997.
Mowbray, C.T.; Rusilowski-Clover, G.; Arnold, J.; Allen,
C; Harris, S.; McCrohan, N.; and Greenfield, A. Project
WINS: Integrating vocational services on mental health
case management teams. Community Mental Health
Journal, 30:347-362, 1994.
Mowbray, C.T.; Bybee, D.; Harris, S.; and McCrohan, N.
Predictors of work status and future work orientation in
people with a psychiatric disability. Psychiatric
Rehabilitation Journal, 19:17-28, 1995.
Mueser, K.T.; Becker, D.R.; Torrey, W.C.; Xie, H.; Bond,
G.R.; Drake, R.E.; and Dain, B.J. Work and nonvocational
domains of functioning in persons with severe mental illness: A longitudinal analysis. Journal of Nervous and
Mental Diseases, 185:419^26, 1997.
Munk-Jorgenson, P., and Mortensen, P. Social outcome in
schizophrenia: A 13-year follow-up. Social Psychiatry
and Psychiatric Epidemiology, 27:129-134, 1992.
Muntaner, C; Pulver, A.E.; McGrath, J.; and Eaton, W.W.
Work environment and schizophrenia: An extension of the
arousal hypothesis to occupational self-selection. Social
Psychiatry and Psychiatric Epidemiology, 28:231-238,
Nisbet, J., and Hagner, D. Natural supports in the workplace: A re-examination of supported employment.
Journal of the Association for Persons with Severe
Noble, J.H. Policy reform dilemmas in promoting
employment of persons with severe mental illness.
Psychiatric Services, 49:775-781, 1998.
Organisation for Economic Co-Operation and
Development. Labour force statistics 1976-1996.
Statistics Directorate. Paris, France: 1997.
Polak, P., and Warner, R. The economic life of seriously
mentally ill people in the community. Psychiatric
Services, 47:270-274, 1996.
Reker, T., and Eikelmann, B. Work therapy for schizophrenic patients: Results of a 3-year prospective study in
Germany. European Archives of Psychiatry & Clinical
Neuroscience, 247:314-319, 1997.
Rogers, E.S.; Anthony, W.A.; Cohen, M.; and Davies, R.
Prediction of vocational outcome based on clinical and
demographic indicators among vocationally ready clients.
Community Mental Health Journal, 33:99-112, 1997.
Rogers, E.S.; Sciarappa, K.; and Anthony, W.A.
Development and evaluation of situational assessment
instruments and procedures for persons with psychiatric
disability. Vocational Evaluation and Work Adjustment
Bulletin, 24:61-67, 1991a.
Rogers, E.S.; Walsh, D.; and Masotta, L. Massachusetts
Survey of Client Preferences for Community Support
Services (Final Report). Boston, MA: Center for
Psychiatric Rehabilitation, 19916.
Rosenheck, R.; Frisman, L.; and Sindelar, J. Disability
compensation and work among veterans with psychiatric
and nonpsychiatric impairments. Psychiatric Services,
Ruffner, R. The last frontier: Jobs and the mentally ill person. Psychosocial Rehabilitation Journal, 9(3):35—42,
Russert, M, and Frey, J. The PACT vocational model: A
step into the future. Psychosocial Rehabilitation Journal,
Rutman, I. How psychiatric disability expresses itself as a
barrier to employment. Psychosocial Rehabilitation
Journal, 17(3): 15-37, 1994.
Saiiter, A., and Nevid, J. Work skills with chronic schizophrenic sheltered workers. Rehabilitation Psychology,
Schultheis, A.M., and Bond, G.R. Situational assessment
ratings of work behaviors: Changes across time and
between settings. Psychosocial Rehabilitation Journal,
Seidman, L. Schizophrenia and brain dysfunction: An
integration of recent neurodiagnostic findings.
Psychological Bulletin, 94:195-238, 1983.
Silverstein, M.L.; Fogg, L.; and Harrow, M. Prognostic
significance of cerebral status: Dimensions of clinical outcome. Journal of Nervous and Mental Diseases,
Solinski, S.; Jackson, H.; and Bell, R. Prediction of
employability in schizophrenic patients. Schizophrenia
Research, 7:141-148, 1992.
Solomon, P., and Draine, J. The efficacy of a consumer
case management team: 2-year outcomes of a randomized
trial. Journal of Mental Health Administration,
Strauss, J. Mediating the processes in schizophrenia:
Towards a new dynamic psychiatry. British Journal of
Psychiatry, 155(5):22-28, 1989.
Strauss, J., and Carpenter, W. The prediction of outcome
in schizophrenia. Archives of General Psychiatry,
Strong, M. Optimum models: What Really Works?
[Research results report]. Washington, DC: National
Institute on Disability and Rehabilitation Research,
December, 1996. (Available online at http:
Stuve, P.; Erickson, R.; and Spaulding, W. Cognitive rehabilitation: The next step in psychiatric rehabilitation.
Psychosocial Rehabilitation Journal, 15:9-26, 1991.
Taylor, M.; Redfield, J.; and Abrams, R.
Neuropsychological dysfunction in schizophrenia and
affective disease. Biological Psychiatry, 10:467—478,
Ticket to Work and Work Incentives Improvement Act of
1999, Pub. L. No. 106-170, 113 STAT 1860 (1999).
Traupmann, K. Encoding processes and memory for categorically related words by schizophrenic patients. Journal
of Abnormal Psychology, 89:704-716, 1980.
Tsuang, D., and Coryell, W. An 8-year follow-up of
patients with DSM-III-R psychotic depression, schizoaffective disorder, and schizophrenia. American Journal
of Psychiatry, 150:1182-1188, 1993.
U.S. Department of Justice. Enforcing the ADA: A Status
Report From the Department of Justice, July-September.
Washington, DC: U.S. Department of Justice, Civil Rights
Division, 3:1-20, 1998.
van Os, J.; Fahy, T.; Jones, P.; Harvey, I.; Lewis, S.;
Williams, M.; Toone, B.; and Murray, R. Increased intracerebral cerebrospinal fluid spaces predict unemployment
and negative symptoms of psychotic illness. A prospective
study. British Journal of Psychiatry, 166:750-758,1995.
Veteran's Administration. To Work Again, To Live Again:
The Vocational Rehabilitation of Homebound Veterans.
Washington, DC: Veterans Administration, Department of
Veterans' Benefits, 1965.
Walker, R.; Winick, W.; Frost, E.; and Lieberman, J.
Social restoration of hospitalized psychiatric patients
through a program of special employment in industry.
Rehabilitation Literature, 30:297-303, 1969.
Ware, N.C., and Goldfinger, S. M. Poverty and rehabilitation in severe psychiatric disorders. Psychiatric
Rehabilitation Journal, 21:3-9, 1997.
Wehman, P., and Moon, M., eds. Vocational
Rehabilitation and Supported Employment. Baltimore,
MD: Paul H. Brookes, 1988.
Weiden, P.J.; Aquila, R.; and Standard, J. Atypical
antipsychotic drugs and long-term outcome in schizophrenia. Journal of Consulting Psychiatry, 57:53-60, 1996.
Whitehead, C.W. Sheltered workshop study: A nationwide
report on sheltered workshops and their employment of
handicapped individuals. In: Workshop Survey. Vol. 1.
Washington, D.C.: U.S. Department of Labor Service, 1977.
Yozawitz, A. Applied neuropsychology in a psychiatric
center. In: Grant, L., and Adams, K., eds. Neuropsychological Assessment of Neuropsychiatric Disorders. New
York, NY: Oxford University Press, 1986. pp 121-146.
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