Promoting Gains in Employment and Education in First-Episode Psychosis (FEP)

Background and Purpose:  Unemployment, disability, and poverty have been inextricably linked for individuals with schizophrenia-spectrum disorders for decades, and studies find that supported employment interventions do little to lift individuals out of poverty (Baron, Draine, & Salzer, 2013; Drake, et al, 2016; Rosenheck, et al, 2017).  A psychiatric paradigm shift toward early intervention for first-episode psychosis (FEP) has shown promise in reducing disability for this population due to a focus on supporting employment and education in earlier stages of treatment (Killackey & Allott, 2013), however, recent studies on FEP and employment have found that roughly 40% of FEP young adults do not enter employment trajectories and instead enter disability trajectories (Abdel-Baki, et al, 2013; Rosenheck, et al, 2017).  This study aimed to explore the ways in which employment or education trajectories formed or were inhibited during the post-early intervention treatment period by examining key moments, significant messages from family and mental health providers, and structural realities experienced by young adults with FEP. 

Methods:  As this study is exploratory in nature, qualitative methods were used to collect and interpret data.  In addition to being framed by the intersection between psychosis, poverty, disability, and employment, this study is also informed by feminist standpoint epistemology which seeks to explore the experiences of marginalized groups as well as the structural contexts that impact them.  Utilizing a critical case design, a total of 19 semi-structured interviews occurred with ten young adult participants who met inclusion criteria of: 1) lived experience with psychosis; 2) age 18-30; 3) had experience with an early intervention program.  Thematic coding of interviews revealed both theoretical and emerging themes that were organized into matrices and refined using feedback from a participant focus group. 

Results:  Results indicate that the initial life disruption from a FEP in young adulthood leads to lost periods of gainful activity, followed by a period of overcoming the experiences of hospitalization and medication regimes.  Regaining ground was characterized by a reconstruction of their self-concepts, becoming social again, and finding peers.  Mental health professionals sent different messages about disability or capability depending on treatment ideology, and families provided varying levels of support and encouragement based on their own SES and subsequent values. Finally, young adults who were successful in entering the labor market did so by moving into direct career pathways instead of looking for work in the secondary labor market, utilized university disability centers, and found support and direction through their involvement with a local advocacy group.

Conclusion: These findings have important implications for early intervention programming, including targeting early-onset FEP with an anti-poverty lens, shifting FEP employment interventions to focus on the primary labor market, promoting adjunctive peer-based support, and challenging the professional mental health discourse about disability.  Implications for research include further study on overcoming structural barriers negatively impacting this population such as low SES, racial minority status, or not being in education or employment before FEP onset.