This study assessed the impact of steady competitive or noncompetitive employment on nonvocational outcomes for clients with severe mental illness receiving employment services. We conducted a secondary analysis of 2-year data for 187 clients participating in a randomized controlled trial comparing two employment programs. Participants were classified according to 2-year employment outcomes into four groups: steady competitive work, steady noncompetitive work, minimal work, and no work. We compared these groups on 2-year outcomes including symptoms, hospitalizations, quality of life, and social networks. During follow-up, working clients had fewer days of hospitalization than the no-work group. The steady competitive group had greater reduction in negative symptoms than did the no-work group. The steady noncompetitive group showed greater improvement in social networks compared with the other groups. Extended periods of work are associated with improvements in nonvocational outcomes. Beneficial effects may vary according to the type of employment.

Patient activation, defined as one's attitudes and confidence toward managing illness, has been not been thoroughly studied in consumers with schizophrenia. The current study sought to understand the relationship between patient activation and symptoms, medication adherence, recovery attitudes, and hope in a sample of 119 adults with schizophrenia. The participants were enrolled in an 18-month randomized controlled study of the Illness Management and Recovery program. Data were collected at baseline; correlations and stepwise multiple regressions were used to examine the relationships and determine the unique contribution of variables. Higher patient activation was most strongly associated with positive recovery attitudes, higher levels of hope, and fewer emotional discomfort symptoms. Patient activation was significantly related to a broad measure of illness self-management, providing evidence for the construct validity of the patient activation measure. Our findings emphasize the importance of recovery-based mental health services that recognize level of patient activation as a potential factor in consumer outcomes.

The purpose of this study was to determine the relationship between the working alliance and employment outcomes in persons with severe mental illness receiving vocational services. Another purpose of this study was to determine whether working alliance differences exist between clients receiving evidence-based supported employment services and those receiving traditional stepwise vocational services. This study was a secondary analysis of a 2-year randomized controlled trial comparing two employment programs providing services to people with severe mental illness. Contrary to expectations, no overall relationship was found between the working alliance and employment outcomes. As predicted, supported employment participants each assigned to a single vocational worker had more positive working alliances than participants served by a team of vocational workers in the traditional vocational program. The lack of an association between the working alliance and employment outcomes is inconsistent with previous literature. Further research is needed using standardized working alliance measures and larger samples that include both working and nonworking clients. Evidence-based supported employment, which employs individual caseloads, seems to foster better relationships than a team-based vocational approach, although future research is needed to replicate this finding.