Back to Work: Schizophrenia, Recovery and Employment
Although a small percentage of people with schizophrenia recover almost completely, the vast majority of patients have chronic, residual symptoms even with the best medical and psychiatric care. In fact, roughly 20% percent of patients with schizophrenia have symptoms of psychosis that don’t respond to medication, and a greater number have so-called 'negative’ symptoms of schizophrenia which are not improved substantially even under ideal treatment conditions. Frustrations with learning and employment are an all too common occurrence in schizophrenia patients due to lack of motivation, memory problems, and difficulties with concentration and planning.
Psychiatric rehabilitation includes specific social interventions aimed to improve a person’s functioning in society rather than treatment of the primary symptoms of schizophrenia. A patient’s strengths and weakness are considered and ways of thinking, specific skills and behavioral training are used to improve a person’s overall functioning, acquire new skills, and integrate more in the person’s community.
As a mentioned in my last entry, many patients with schizophrenia I’ve encountered who are unemployed want to go to work. Research suggest between 50 - 75% of people with this illness want to be engaged in competitive employment. The medical community has tried many different approaches to help people with schizophrenia gain competitive employment, and one approach is supported employment. A major feature of supported employment is that individualized employment is acquired with little pre-employment training. Often the goal is to start working within three months of starting the job search. The participant begins working a few hours a week, gaining experience and comfort with the job, and then expanding his or her hours.
It is often a concern of physicians and loved ones that employment may cause additional stress to someone struggling with schizophrenia. This is why the plan for employment needs to be individualized. In addition to a psychiatrist and or psychologist, a skilled social worker or case manager would be very helpful in considering employment options. Research has not shown substantial evidence that patients in supported employment have more relapse or more psychiatric instability. In fact, research seems to show a wide variety of benefits, including higher self esteem and improved quality of life. The evidence also suggests that typical patients going to community mental health clinics have a good chance of benefiting from supported employment.
If you or your loved one has schizophrenia and is interested in finding a job, talk to your psychiatrists about options in your local community. Opportunities vary widely depending on where you live and a future entry can discuss other aspects of psychiatric rehabilitation. As always, I welcome your questions or comments.
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Paul Ballas, D.O., wrote about mental health for HealthCentral. He is a member of the American Psychiatric Association and has been a presenter at the American Psychiatric Association and American Academy of Psychosomatic Medicine meetings.