Transcript Psychiatric Rehabilitation: 2006 Update

IPS Research Update
Bob Drake
Dartmouth Medical School
2011
Dilemma in 1990
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3-5% population disabled by mental illness
People with severe mental illness identify work as
their top goal
– More than 70% want to work
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Less than 10% working
No effective interventions
• Bond, 1992
The President’s New Freedom
Commission Report (2003)
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“The main goal of the mental health system is to help people to
live, learn, work, and participate fully in their communities”
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Mike Hogan (2006): “Work is the most direct step to recovery”
Current Status of IPS
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IPS model is simple and effective
 Other benefits accrue with consistent work
 Work outcomes improve over time
 IPS is relatively easy to implement
Competitive Employment Rates
in 16 Randomized Controlled Trials
of Individual Placement and Support
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
96
NH
10
AL
07
IL
04
CT
08
HK
10
CA
08
AUST
IP S
06
SC
99
DC
Cont rol
11
SWIT Z
Cont rol 2
08
CA
07
EUR
06
QUE
10
HOL
02
MD
11
UK
CT Supported Employment Study
(Mueser, 2004)
Impact on
Other Outcomes
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Improved self-esteem, symptom control, quality
of life
 Related to sustained competitive employment
 No changes with sustained sheltered employment
(Bond, 2001)
Long-Term Outcomes
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4 studies with 10-year follow-ups
(Test, 1989; Salyers, 2004; Becker, 2006; Bush,2009)
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Work outcomes improve over time
 Costs decrease dramatically for consistent
workers (Bush, 2009)
8-12 Year Follow-up:
Day Treatment to IPS
71% working at follow-up
 85% in competitive jobs
 71% worked more than 50% of FU
 90% still receiving benefits
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(Becker, 2006)
Cost Savings
Figure 1. Cost Outpatient Services and Institution Days
Minimum Work
48000
Steady Work
Mean Cost
43000
38000
33000
28000
23000
18000
13000
8000
0
1
2
3
4
5
6
7
8
9
10
Years
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Each person with a SMI who becomes employed achieves an average savings in
health costs of $5,000 per year (Bush et al. 2009)
People with Severe Mental Illness in
Treatment
No
Employment
services
40%
Already
Employed
10%
Ineffective
Employment
Services
23%
EvidenceBased
Supported
Employement
2%
Not Interested
in Employment
25%
Johnson & JohnsonDartmouth Project
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Mental health-vocational rehabilitation collaboration
implement evidence-based SE = IPS
Local programs selected by states
Dartmouth provides training, consultation, evaluation
National Learning Collaborative
States: CT, DC, KS, MD, OR, SC, VT, IL, MN, MO,
OH, KY, WI
Special Projects: NJ, OH, IL
International Collaborative
J&J-Dartmouth Program: Real
World Agencies
Early Intervention
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First episode psychosis (Nuechterlein, 2005; Rinaldi,
2009; Killackey, 2009)
Early Intervention (Nuechterlein, 2005)
% of Employment or
school
IPS Supported Employment for Clients with Firstepisode Schizophrenia
100
80
IPS
SAU
60
40
20
0
Baseline
6 Months
12 Months 18 Months
Addressing Cognition
Concentration, memory, reaction speed,
and problem-solving
 Job match
 Improve cognitive function
 Compensatory strategies
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(McGurk, 2008)
Cognitive Training
Practicing cognitive tasks may create
new neuronal connections
 Tasks directly relevant to work tasks
 New capacity may translate to work
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(McGurk, 2005)
Total Number Correct
Computer Training and Memory
50
45
40
35
30
Baseline
3 Months
Hours worked per Month
Computer Training and Work
30
25
20
15
10
5
0
Baseline
3 Months
Benefits Reform
People are socialized into disability
 Changing benefits structure essential
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Policy Changes
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People with disabilities need cash, health
insurance, and a job
 They do not need to be assigned to a
lifetime of unemployment and poverty in
order to get health insurance
 Legislative change is critical
Carl Suter, CSAVR (2006)
Federal Funding Reform
We need simple payment system
 Federal committees
 Advocacy
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Conclusions
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IPS has created hope for for people with
psychiatric disabilities, their families, and
MH/VR practitioners
 Outcomes can be enhanced further
 New research
 Policy changes
Financial Support
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Grants from NIDA, NIDRR, NIMH, RWJF,
SAMHSA
Contracts from Guilford Press, Hazelden Press,
MacArthur Foundation, Oxford Press, New York
Office of Mental Health, Research Foundation for
Mental Health
Gifts from Johnson & Johnson Corporate
Contributions, Segal Foundation, Thomson
Foundation, Vail Foundation, West Foundation
Many Thanks
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Deborah Becker
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Gary Bond
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Greg McHugo
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Haiyi Xie
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Jon Skinner
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Phil Bush
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Will Torrey
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Kim Mueser
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Rob Whitley
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Susan McGurk
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Eric Latimer
Elizabeth Carpenter-Song
Matt Merrens
Paul Gorman
Sarah Swanson
David Lynde
Howard Goldman
Sandy Reese
Kikuko Campbell
Will Haslett
Saira Nawaz
Crystal Glover
Information: books,
videos, research articles
Patti O’Brien
 Patti.O’[email protected]
 603-448-0263
 http://dms.dartmouth.edu/prc
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