Working for wellness
Take Home Messages:
The success of the “place-train” model suggests that therapeutic return to work can improve outcomes for people with psychiatric disabilities.
Return to work is not something that should happen only after recovery is complete: return to work can form a very important part of the recovery process.
Why the research matters:
One of the main aims of psychiatric rehabilitation is to help get patients back into the workforce.
Traditionally, a train-place model has been used to achieve this aim. The train-place model puts training before placement. That is, people with psychiatric disabilities receive training about how to handle real world situations BEFORE they are placed in a real world, work environment.
Recently, another model – the place-train model – has been advocated by some health professionals. The place-train model puts placement before training. Individuals are placed in real world, work environments, and then provided with training and support to assist them achieve vocational goals.
Knowing when a worker should return to work is vital in achieving good return to work outcomes. This research tackles a very important question: can returning to work be part of the recovery process? In other words, is there such a thing as a therapeutic return to work?
What the research involved:
The researchers looked at several studies on place-train programs, and compared these to studies on train-place programs. They then outlined the evidence in support of place-train programs.
Summary of research findings:
For people with psychiatric disabilities, returning to work without adequate training can have serious consequences, including:
- Being unable to cope with the demands of work because they haven’t learned how to manage their symptoms;
- Diminished feelings of self worth and self sufficiency, which can undermine recovery; and
- Stress, which can exacerbate symptoms and disabilities.
Train-place programs try to avoid these negative outcomes by providing training within safe and protected environments, before workplace placement occurs. However there are disadvantages to this method, which:
- Teaches skills that are more relevant to work in supervised ‘safe’ settings than the workplace;
- Involves disorienting transitions between settings; and
- Does not involve the broader community – including the work community – in the recovery process.
In contrast, the place-train paradigm views the community – and in particular the work community – as a partner in the process of recovery.
Advantages of the place-train model include:
- It almost triples the rate of employment for participants;
- Participants tend to earn considerably more;
- Participants tend to keep their jobs for longer; and
- The program does not often lead to hospitalisation.
Original research:
Place First, Then Train: An Alternative to the Medical Model of Psychiatric Rehabilitation
Corrigan, P. W. and S. G. McCracken
Social Work 50(1): 31-9. 2005