[Support of working life of persons with schizophrenia]

Abstract

The aim of this study was to review the theories and methodologies for helping persons with schizophrenia to gain employment because working is one of the important factors for normalizing lives. The rate of employment among schizophrenics is determined by several factors including the unemployment rate of the nation, the date, sampling method and so on. However, persons with schizophrenia generally have had a lower employment rate around 20%, calculated as the rate of competitive employment compared to other psychiatric disorders both in the U.S. and Japan. Because traditional vocational rehabilitation did not lead to a good vocational outcome, supported employment has been developed over the last 20 years. Many studies clarified that supported employment led to a better outcome in the competitive employment, especially "Individual Placement and Support (IPS)". The systematic review of the Cochrane database, the Treatment Guideline of Schizophrenia of APA, and the PORT Treatment Guideline of Schizophrenia recommended the use of supported employment. Supplementary programs such as cognitive rehabilitation have been recently developed because psychiatric symptoms and social functioning were not improved and income and tenure of employment were not sufficient, even with supported employment. Cognitive functioning, attention, learning, memory, and executive functioning were verified to have influences on vocational functioning in many studies, and cognitive rehabilitation with supported employment was verified to improve vocational outcome. Six evidence based technologies of vocational rehabilitation were discussed. Vocational rehabilitation centers, day treatment centers aiming at competitive employment, and NPOs for employment of disabled persons are recommended as good clinical models of evidence based vocational rehabilitation. Professionals of the same agency in these models help people concerning both working and independent living, which is one of the important principles of IPS. Finally, we discussed several issues about methodologies and social framework which need further research and social agreement.