Improving Cognitive Skills for People with Mental Illness to Increase Vocational and Psychosocial Outcomes: The Employ Your Mind Program.

Cognitive impairments contribute to difficulty obtaining employment for people with severe mental illness (SMI). We describe an evaluation of a program, Employ Your Mind (EYM), which integrates cognitive remediation with vocational rehabilitation to improve cognitive skills and psychosocial outcomes relevant to employment. Participants with SMI were referred to WISE Employment and completed the six-month EYM program. Assessments of psychosocial functioning, cognition and vocational data were collected at baseline and completion, and additional vocational outcomes were collected at 12-month follow-up. Psychosocial functioning and cognition were compared pre- and post-EYM and vocational outcomes were compared for the year prior to EYM and for the 12-month follow-up for program completers. Thirty-two participants commenced the EYM program and 21 (65.6%) completed it. Completers reported significant improvements in mental wellbeing, quality of life and enhanced overall perceived working ability. Participants also demonstrated significantly enhanced speed of processing. Of the 15 participants who reported vocational outcomes, four (26.6%) were engaged in competitive paid employment in the year prior to EYM commencement and eight (53.3%) in the year following EYM commencement. The results indicate that EYM helps improve cognitive performance, psychosocial outcomes, and work readiness in people with SMI.

'Employ Your Mind': a pilot evaluation of a programme to help people with serious mental illness obtain and retain employment.

OBJECTIVE: Cognitive impairments contribute to difficulty in obtaining employment for people with severe mental illnesses (SMIs). We describe a pilot evaluation of a programme, Employ Your Mind (EYM), which integrates cognitive remediation therapy (CRT) with vocational rehabilitation. METHOD: Sixty participants with SMIs enrolled in EYM, a 6-month programme that combines CRT exercises, individual project work and group reflection sessions about social interaction and cognitive functioning. Participants completed assessments of cognitive function (Audio Recorded Cognitive Screen, Wechsler Digit Span Task), psychosocial function (Work and Social Adjustment Scale, General Self-Efficacy Scale) and abilities related to work (Dialogue about Working Ability, Self-Assessment of Thinking Skills) at baseline and postprogramme. Paired t-tests were used to compare assessments of participants who completed the programme between the two time points. RESULTS: The programme was completed by 22 individuals. These individuals demonstrated significant improvement in cognitive function, social and work-related function, and subjective thinking ability after completing the EYM programme. CONCLUSION: The EYM programme is effective in improving cognition, impairments related to work and social function, and subjective thinking skills for some individuals with SMIs. Future evaluation of the programme should focus on enhanced retention and assessment of employment outcomes.

What is the personal experience of jobseekers with severe mental illness undertaking a cognitive remediation program? / ¿Cuál es la experiencia de trabajadores con enfermedades mentales severas tras haber participado en un programa de rehabilitación cognitiva?

Background: People with severe mental illness (SMI) can enhance their occupational outcomes by engaging with a comprehensive support team, which might include both cognitive and vocational support. To date, there have been no reports of the personal experience of individuals undertaking such interventions. Aims: This study aimed to explore the subjective experience of participating in cognitive remediation (CR), as an adjunctive treatment to illness-self management psycho-education for jobseekers (HOPE). Methods: Thirteen jobseekers with SMI, who had completed a CR program of 20hours duration, in addition to a 20hours of the HOPE program, responded to an individual semi-structured interview concerning their experience of the program. Data were analysed using content analysis. Results: Feedback was predominantly positive. Participants described CR as a beneficial experience in improving their intrinsic (e.g. self-efficacy, motivation), cognitive and social functioning. It also revealed aspects to be addressed. Conclusions: This study highlights the positive potential of this type of intervention, but also reveals the barriers that people with SMI may confront including the lack of CR availability and vocational/personal support. It is hoped that this study will assist in generating evidence on effective ways to improve the current CR approach

Introducción: Personas con enfermedades mentales severas (SMI) pueden mejorar su funcionamiento laboral participando en programas de intervención integral, los cuales pueden ofrecer apoyo cognitivo y vocacional. Hasta la fecha, no existen reportes de la experiencia personal de individuos participando de tales intervenciones. Objetivos: Esta investigación buscó explorar la experiencia subjetiva de personas diagnosticadas con SMI, tras haber participado de un entrenamiento de rehabilitación cognitiva (CR) en conjunto a HOPE, un programa psicoeducativo destinado al auto manejo de la enfermedad. Métodos: Trece buscadores de empleo diagnosticados con SMI completaron un programa que incluyó 20 h de CR, además de 20 h de HOPE. Tras la intervención, todos los participantes respondieron a una entrevista individual semiestructurada, diseñada para indagar sobre su experiencia tras el programa. Los datos se analizaron mediante análisis de contenidos. Resultados: El feedback fue predominantemente positivo. Los participantes describieron la CR como una experiencia beneficiosa en el mejoramiento de su funcionamiento intrínseco (por ejemplo, autoeficacia, motivación), cognitivo y social. El análisis además reveló aspectos a mejorar. Conclusiones: Este estudio destaca el potencial de este tipo de intervención. También revela los obstáculos que personas con SMI pueden llegar a enfrentar, como son la falta de disponibilidad de CR y el escaso apoyo profesional/personal. Se espera que este tipo de investigación favorezca el generar nueva evidencia sobre maneras efectivas para mejorar el actual modelo de CR

Helping people with a mental illness obtain work: the Health Optimisation Program for Employment.

OBJECTIVE: Inclusion in work and education remains problematic for many people with a mental illness. We describe a structured programme - the Health Optimisation Program for Employment - that supported people with a mental illness to gain employment or commence studies. METHOD: Twenty hours of the Health Optimisation Program for Employment were delivered to 600 individuals. Participants were asked to complete an evaluation survey encompassing vocational status and ratings of self-efficacy. RESULTS: Of the 364 participants who completed the baseline assessment, 168 responded to the evaluation survey 6 months after the delivery of the Health Optimisation Program for Employment. Of these, 21.5% had started a new job, while a further 42.8% were either volunteering or studying. Satisfaction with the programme was high and self-efficacy ratings improved significantly over the short term only. CONCLUSIONS: The Health Optimisation Program for Employment requires further evaluation using rigorous scientific methodology but these initial results are encouraging in terms of vocational attainment for people with a mental illness, in the Australian context.

Enhancing work-focused supports for people with severe mental illnesses in australia.

Persons with severe mental illness (SMI) have reduced workforce participation, which leads to significant economic and social disadvantage. This theoretical review introduces the strategies that have been implemented to address this issue. These include Individual Placement and Support (IPS) services, the most widely researched form of supported employment, to which cognitive remediation has more recently been recognised in the USA, as an intervention to improve employment outcomes by addressing the cognitive impairments often experienced by people with SMI. The authors review the international literature and discuss specifically the Australian context. They suggest that Australia is in a prime position to engage clients in such a dual intervention, having had recent success with increasing access to supported employment programs and workforce reentry, through implementation of the Health Optimisation Program for Employment (HOPE). Such programs assist with gaining and maintaining employment. However, they do not address the cognitive issues that often prevent persons with SMI from effectively participating in work. Thus, optimising current interventions, with work-focused cognitive skills development is critical to enhancing employment rates that remain low for persons with SMI.

A meaningful day: integrating psychosocial rehabilitation into community treatment of schizophrenia.

While many of the overt symptoms of schizophrenia may be controlled by medication, the associated psychiatric disability requires ongoing psychosocial rehabilitation and support in the community. The general practitioner can play a crucial role in this rehabilitative process, through encouraging good physical health in the person with schizophrenia; referring the person to a local day program and other psychiatric disability support services; educating the person about the diagnosis and practical self-help; involving families and referring them to support organisations and group therapy programs; and encouraging use of local community facilities and employment training, where appropriate.