International First Episode Vocational Recovery Consensus

Statement

iFEVR Group

Authors/Contributors

• Australia– Eoin Killackey

• Canada– Eric Latimer

• United Kingdom– Tom Craig– Eric Davis– Martin Hember– Annie Lau– Miles Rinaldi– David Shiers– Jo Smith

• United Kingdom (cont.)– Swaran Singh– Geoff Shepherd– Sarah Sullivan

• United States – Keith Nuechterlein– David Penn

Where we start from

“Everyone has the right to work”

Article 23

Universal Declaration of Human Rights

United Nations, 1948

Early Psychosis Declaration 2005

a) Challenge stigma and discrimination so that young people are not disadvantaged by their experiences

b) Generate optimism and expectations of positive outcomes so that all young people with psychosis achieve ordinary lives.

c) Raise wider societal awareness about psychosis and the importance of early intervention.

d) Encourage practitioners from educational and employment services to reflect on how they can better contribute to supporting young people with psychosis.

Where we want to get to

The Challenge

Employment in psychosis and schizophrenia

• 40-50% unemployment in FEP (Marwaha & Johnson 2004; Killackey et al., 2006)

• 75-95% unemployment in schizophrenia (Marwaha & Johnson 2004; SANE 2002)

Two myths

• People with mental illness don’t want to work– The literature describes open employment as the most

frequently-identified long-term goal of people with mental illness ( Rogers et al, 1991; Secker et al, 2001)

• Work is too stressful for people with mental illness– Work is a known and therefore manageable stress.

Unemployment is an unknown stress which is much more

difficult to manage.

Costs of people with schizophrenia not working

• Loss of earnings due to illness $487.6M• Lost income and sales tax $165.7M• Public cost of carers $88.1M• Accommodation assistance $16.2M• Welfare benefits $274M• Total $1.031 billion (Total cost of illness $1.8b)

• SANE, 2002, based on 2001 data• US$32 billion of total cost US$61billion (Wu et al., 2005)

Our Goals

Our Goals

• Combat stigma, discrimination and prejudice in education, training and work settings

• Support young people to achieve their education, training and employment aspirations

• Ensure that education, training and employment are seen as equally important in recovery as symptom outcomes

Our Goals• Advocate with funding agencies to fund evidence based

interventions that address education, training and employment outcomes

• Combat factors contributing to social exclusion and unfulfilled lives

• Encourage professional attitudes that engender hope and optimism that young people with psychosis can achieve meaningful lives

• Mobilise education, training, employment and benefits agencies to assist those with FEP to complete their education and gain employment

Processes to enable this

Individual Placement and Support

• Described by Becker and Drake 2003• 7 principles

– It is focussed on competitive employment as an outcome; – the service 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; – 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 in provided.

Competitive Employment Rates in 16 Randomized Controlled Trials of Supported Employment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

96 NH (IPS)

07 Aust (IPS)

94 NY (SE)

07 IL

(IPS)

04 CT

(IPS)

05 HK (IPS)

06 SC

(IPS)

06MA

(ACT)

99 DC

(IPS)

07 CA

(IPS)

95 IN

(SE)

07EUR(IPS)

06QUE(IPS)

00 NY (SE)

97 CA (SE)

02MD(IPS)

Supported Employment Control Control 2

Research and analysis carried out by Gary Bond

IPS in FEP

• Emerging international evidence base for value of IPS in FEP:– Rinaldi et al. 2004 & 2009 (UK)– Killackey et al. 2008 (Australia)– Nuechterlein Submitted (USA)– Major et al. Submitted (UK)

• Active confrontation of myths • Educational and work outcomes prioritise• Access to evidence based vocational interventions (IPS) • Access to specialist educational and vocational support• Incentives for employment agencies to provide early and

sustained support• An active and flexible FEP vocational research

programme• Greater understanding of the processes that contribute

to achieving and sustaining employment in FEP

Processes to achieve goals

• Greater understanding of ethno-cultural factors that have an impact on individuals’ access to work

• Employment interventions focusing on retaining and sustaining employment

• More flexibility in employment and benefit systems

• Long term protection of housing and healthcare costs

• Protection of individual disclosure rights

Processes to achieve goals

The iFEVR group: Aims

• Make people aware of the issues. • Promote the statement and evidence• Identify common issues across countries and

cultures• To develop international collaboration around

these common issues• Develop an international platform for clinical,

research, policy, economic and advocacy development in the area of vocational recovery in FEP

What can you do?

• Combat prevailing myths about mental illness and work

• Promote a culture which gives equal priority to educational and vocational functioning

• Advocate to government and funding agencies about the economic and social benefits of education, training and employment outcomes

• Promote positive news stories in local media and with local and larger employers.

• Provision of education for employment professionals and agencies whose mental health literacy may be low.

Download the iFEVR Consensus Statement from:

www.iris-initiative.org.uk