A randomized controlled trial of a supported employment program for persons with long-term mental illness in Hong Kong.

OBJECTIVES: Supported employment is an evidence-based practice that has proved to be consistently more effective than conventional vocational rehabilitation in helping people with severe mental illness find and sustain competitive employment. Most research on the effectiveness of supported employment comes from the United States. This study examined the effectiveness and applicability of a supported employment program based on the individual placement and support model in a Hong Kong setting. METHODS: Ninety-two unemployed individuals with long-term mental illness who desired competitive employment were randomly assigned to either a supported employment program or a conventional vocational rehabilitation program and followed up for 18 months. Both vocational and nonvocational outcomes were measured. RESULTS: Over the 18-month study period, compared with participants in the conventional vocational rehabilitation program, those in the supported employment group were more likely to work competitively (70% versus 29%; odds ratio=5.63, 95% confidence interval=2.28-13.84), held a greater number of competitive jobs, earned more income, worked more days, and sustained longer job tenures. Repeated-measures analysis of variance found no substantive differences between participants in the two groups and no significant change from baseline over time for psychiatric symptoms and self-perceived quality of life. CONCLUSIONS: Consistent with previous research findings in the United States, the supported employment program was more effective than the conventional vocational rehabilitation program in helping individuals with long-term mental illness find and sustain competitive employment in a Hong Kong setting. The supported employment program based on the individual placement and support model can thus be recommended for wider use in local mental health practice.

Family burdens, Chinese health beliefs, and the mental health of Chinese caregivers in Hong Kong.

This study explored the types of family burdens, mental health and Chinese health beliefs of Chinese caregivers with relatives suffering from a serious mental illness. It also examined the impacts of these beliefs on caregivers' burdens and mental health. A structured questionnaire was administered to 125 Chinese caregivers in out-patient clinics in Hong Kong. Measures included distress (General Health Questionnaire), family burdens and belief in traditional Chinese medicine. Family burdens exerted a significant impact on the mental health of caregivers. Significant differences were found between believers and non-believers of traditional Chinese medical beliefs in terms of financial burdens, disruptions to family interactions and decline in physical health. No [corrected] moderating effect of Chinese health beliefs on family burdens and mental health was found. The lack of a moderating effect of health belief on family burdens may be related to caregivers' changes in perspectives from a traditional Chinese cultural perspective to a psychosocial and personality perspective. Implications for research and service development are discussed.

Vocational outcomes of individuals with psychiatric disabilities participating in a supported competitive employment program.

The objective of this paper is to report on the vocational outcomes of individuals with psychiatric disabilities participating in a supported competitive employment (SCE) program. A total of 458 subjects enrolled in the present SCE program which was developed on the basis of the Supported Employment Model developed by Wehman [23] and the principles of the Individual Placement and Support (IPS) developed by Becker and Drake [5]. Of the 458 subjects, 308 (67.3%) obtained competitive employment. The mean job tenure was 134 days. The mean salary was $4,740 for full-time jobs and was $2,321 for part-time jobs. The majority of subjects (59.4%) could sustain their job placement for more than 30 days, 74 (24.0%) subjects could work for more than six months, and 38 (12.3%) could maintain the job for more than one year. Subjects who became employed were compared to those who did not gain employment on a variety of demographic variables. Significant differences were found between two groups in terms of sex and source of referral. The rate of employment in the current study was slightly higher, but the job retention rate was lower than in earlier studies. Recommendations for future research on evaluation of the effectiveness of SCE program are suggested.