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Serious Mental Illness and Employment. Robert E. Drake, MD, PhD Dartmouth College. Four Points. People with serious mental illness want to work Supported employment increases competitive employment by three-fold, to 60-70%

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Serious mental illness and employment

Serious Mental Illness and Employment

Robert E. Drake, MD, PhD

Dartmouth College


Four points
Four Points

  • People with serious mental illness want to work

  • Supported employment increases competitive employment by three-fold, to 60-70%

  • Employment enhances self-esteem, quality of life, management of illness, and decreasing involvement in the mental health system

  • Barriers: lack of health insurance and lack of supported employment


Ips supported employment
IPS Supported Employment

  • Place and Support

  • Rapid job search

  • Participant preferences

  • Team-based approach

  • Individualized supports


Competitive employment rates in 17 randomized controlled trials of individual placement and support
Competitive Employment Rates in 17 Randomized Controlled Trials of Individual Placement and Support


Non employment outcomes
Non-Employment Outcomes Trials of Individual Placement and Support

  • Self-esteem

  • Quality of life

  • Symptom Control

  • Decreased mental health service use

  • No changes with sustained sheltered employment

    (Bond et al., 2001)


Barriers to employment
Barriers to Employment Trials of Individual Placement and Support

  • Fears of losing insurance and benefits

    • Medicaid has been linked to SSI

    • ACA may change

  • Lack of vocational services

    • 1% Medicaid beneficiaries get supported employment

    • Misalignment between CMS, VR, and evidence base


Four points1
Four Points Trials of Individual Placement and Support

  • People with serious mental illness want to work

  • Supported employment increases competitive employment by three-fold, to 60-70%

  • Employment enhances self-esteem, quality of life, management of illness, and decreasing involvement in the mental health system

  • Barriers: lack of health insurance and lack of supported employment


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