Facilitators to Gainful Employment in Individuals with Serious Mental Illness: A Qualitative Systematic Review

Background and Purpose: Individuals with serious mental illness (SMI) experience difficulties with obtaining and securing gainful employment without multiple forms of support. Evidence regarding the effectiveness of Individualized Placement Support (IPS) interventions related to job retention and job tenure in the SMI population have proven to be effective and have successfully assisted efforts to place individuals with SMI in gainful employment. Social workers are among the first professionals to recognize both the importance of employment and the use of evidence-based practices; however, a greater understanding of the factors supporting these interventions and their outcomes on quality of life is needed. To understand the lived experiences of individuals with SMI receiving vocational interventions, we conducted a systematic review of the qualitative research to assess how job tenure and social supports contribute to their perceived quality of life.

Methods: We conducted a systematic review of qualitative research around vocational interventions in developed countries since 2014 in individuals with SMI utilizing thematic analysis to assess the body of literature. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically searched PubMed, PsycInfo, SocINDEX with full text, and CINAHL to identify studies that measured job tenure and quality of life or social supports/social network. A search was conducted using keywords (Serious Mental Illness OR Schizophrenia) AND (supported employment OR individual placement and support) AND (social skills training OR therapeutic rapport OR job accommodations OR transitional employment OR job interview training OR Cognitive Remediation OR inclusive work environment) AND (employment OR job tenure OR social network OR social support OR quality of life). Inclusion criteria included a) qualitative studies or case studies published between 2014-2024 in English; b) vocational interventions; c) adults with SMI: Schizophrenia, Bipolar Disorder, Schizophreniform, and Major Depressive Disorder.

Results: Thirteen studies met the inclusion criteria for this review. IPS interventions included supported employment (SE) (n=10), cognitive remediation (n=2), social skills training (n=4), virtual reality job interview training (VR-JIT) (n=1), job counseling (n=4) and transitional employment programming through Clubhouse Model (n=1). Themes facilitating job tenure emerged as overall social support (n=13), the ability to return to work (n=13), strong relationship with employment advisor/specialist (n=3), confidence to return to work (n=8), social support from family and/or friends (n=4), and independence and freedom (n=5). Outcome themes emerged as increased skills and/or confidence (n=10), increase in social occupational functioning (n=10), and increased overall quality of life (n=13).

Conclusions and Implications: This review adds to prevalent research regarding the value of vocational interventions for individuals with SMI by adding insight into the key elements of job tenure and social support and suggests the importance of assessing quality of life as an outcome beyond the measures typically considered within quantitative studies. Further research is needed to assess the facilitation of other forms of social support, such as trust and therapeutic rapport, and how these factors also contribute to job tenure and quality of life within this vulnerable population to better inform social workers.