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Functional Recovery

The onset of a first episode of psychosis can often have a significant impact on a person’s ability to maintain their usual work or study activities. The effect of experiencing psychotic symptoms, with some young people also spending time in hospital, can lead to the young person losing their usual employment or dropping out of school or tertiary education. 

This may have a negative impact on self-esteem, self-confidence and social relationships, making return to work or study even more challenging.

Internationally, the rates of unemployment for people with a first episode of psychosis are reported to vary from 35% to 87% (Marwaha & Johnson, 2004) which are significantly higher than for the general population. As well as the personal impact of loss of functioning on individuals and families, there are also economic consequences not only for the individuals concerned, but for the wider community.

Therefore, the inclusion of educational and vocational interventions to promote functional recovery is imperative within a first episode psychosis service.

Core philosophies of functional interventions are:

  • Identifying barriers to returning to work or study, and working with the young person to address or overcome these. (Barriers can include: ongoing psychotic symptoms, medication side-effects, anxiety, depression, low self-esteem, or concerns about stigma)
  • Instilling hope of recovery and a return to normal functioning
  • Addressing the issue of functional recovery as a primary goal rather than secondary to the amelioration of symptoms alone
  • Viewing a planned early return to normal functioning as a therapeutic goal in its own right
  • Encouraging return to work or study as soon as is reasonable, given that prolonged absences can make reintegration even more challenging

 

Interventions

A number of interventions are described in: Killackey, E, Jackson, H.J, Fowler, D, & Nuechterlein K.H (2009) Enhancing Work Functions in Early Psychosis (In) Jackson H.J. & McGorry P.D. (Eds) The recognition and Management of Early Psychosis: A Preventative Approach.

Of particular relevance to a first episode population is the ‘Individual Placement and Support’ (IPS) model. This model focuses on helping people return to competitive employment rather than sheltered work, and is a community-based model rather than being based in a mental health service. 

People are encouraged to engage on a voluntary basis when they feel ready, and support is ongoing rather than ceasing when the person has found employment .

While this intervention has been found to have a positive impact in work with chronic psychotic populations, it has been shown to be particularly effective when utilised with people following a first psychotic episode. 

It has also been shown to be adaptable to different socio-political systems and contexts, and can be applied to both vocational and educational recovery.

To see an overview of the EPPIC vocational recovery program click here

 

Reference
Marwaha, S & Johson, S (2004). Schizophrenia and Employment: A Review.  Social Psychiatry and Social Epidemiology 39, pp 337-349)

 

 

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