Functional Recovery
Group
Functional Recovery
Leader
Members
Gina Chinnery, Zahra Tasha Wahid, Zoe Collins, Pamela Sun, Gennady Baksheev, Jessica Massey, Christina Broussard, Cathy Martin, Kelly Allott, Tina Proffitt, Sue Cotton, Rebecca Creek, Cassie Redlich, Maya Zerman, Sue Connor, Judy Ring, Yi-Ping Tseng, Rosanna Scuttella, Henry Jackson, Jeff Borland
Oveview
For most adults employment is both a key component of their identity, and the key method by which they create means to participate in society and the economy. It is known that being unemployed is, by itself, a risk factor for the development of mental illness and alcohol and substance use and abuse. For people with a pre-existing mental illness such as schizophrenia, unemployment is an almost universal experience (70-92%) which adds greatly to the social marginalisation and economic non-participation of this group.
The intervention utilised in this unit’s research builds on the comprehensive early intervention for symptoms of illness provided at the Early Psychosis Prevention & Intervention Centre (EPPIC), by directly addressing the most tangible area of functional recovery – employment and education. By doing this in the early phase of illness, there is potential to reduce the great functional disability caused by psychotic illness.
In addition to the potential to greatly reduce costs associated with psychotic illnesses, this intervention provides a means by which young people with psychosis are able to participate fully in their society, contributing through their taxes and productivity and gaining through development of positive identity and independence, growth of self-esteem, recognition by others of their skills, and increased quality of life.
Research to date has concentrated on vocational and educational recovery. Future research will investigate not only these domains but also other domains such as social and economic participation. It is the intent of this research group to find ways to maximise the actualisation of potential of each person with psychosis.
Current Research Projects
The first Vocational Recovery Project was funded under the NHMRC Program Grant and with additional funding from Bristol Myers Squibb. The literature regarding chronic patients with schizophrenia suggests that, for clients recovering from an episode of psychosis, obtaining competitive employment is superior to “train and place” and other rehabilitation models. This randomised controlled trial extended this area of research to those recovering from a first episode of psychosis. A pilot project (n=41) was conducted in which 85% of those randomised to the intervention had a positive vocational outcome compared to 10% of those in a control group. The outcomes have informed government policy and have elicited international interest. A number of papers have been published. A follow-up of this cohort is being undertaken by a Masters student from RMIT.
The second vocational project began in March 2008. This is an expanded version of the first project with additional input from economists, substance use specialists and neuropsychologists. The project has attracted over $250,000 of internal and external competitive funding.
The work of OYH-RC in this area has placed us at the international forefront of research in this field with this population. As a consequence, Dr Eóin Killackey has been able to organise international collaboration and expanded research in this area.
Educational Interventions
Educational interventions do not feature in the literature for young people with mental illness. OYH-RC is conducting a small feasibility study of a supported education intervention for young people attending PACE or EPPIC. This trial will determine parameters around this intervention in preparation for applications for larger interventions on this front. This work is supported by funding from Travancore School and the Department of Education.
Homelessness Project
The work of OYH is predicated on a history of clinical research. That is, exploring research questions that arise from clinical experience, and utilising the results to inform clinical practice. The homelessness project is an example of this kind of research. A clinician in EPPIC had some data which she had collected showing that people discharged from the ward to unstable accommodation accounted for two thirds of readmissions in the subsequent month. In this project a retrospective file audit will be used to establish the rate of this problem over a one year period. Secondly, a prospective study will be conducted which will follow people who are admitted to the ward over a year and examine the relationship of their symptomatic and functional outcome to their housing status.
Collaborations have been developed with a number of institutions and organizations. These include:
Australia
Mental Health Council of Australia
Mental Illness Fellowship Victoria
University of Newcastle Centre for Mental Health Studies.
University of Queensland, Queensland Centre for Mental Health ResearchInternational
USA
University of California Los Angeles
University of North Carolina Chapel HillUK
University of Bristol
South London and Maudsley Mental Health Trust