Mastering the World of Work for Mental Illness

Overseen By Sue Guarino, RNBC

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Boston University Charles River Campus

Disqualifiers: Inability to give consent

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 18 months

60 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this study is to conduct a randomized clinical trial for an innovative intervention entitled "Mastering the World of Work" (MWW). MWW aims to improve the employment outcomes of individuals with psychiatric disabilities who experience metacognitive deficits. Metacognitive deficits are represented in diminished capacity to form an integrated sense of self and others and respond to challenges in life. The randomized trial (N=60) will be conducted with recipients of Supported Employment (Individual Placement and Support) services at the Mental Health Center of Greater Manchester, in Manchester, NH. Given COVID-19 safety considerations, the MWW intervention will be delivered in a hybrid manner depending on the preferences of both clinicians and clients at the MHCGM at any given point of the study. The feasibility of remote delivery of the intervention has been established as part of a pilot study conducted at BU CPR. Thus, clinicians may deliver the intervention using HIPAA-complaint ZOOM connection and/or in person. The assessments will be administered at baseline, 6, 12, and 18 months post baseline remotely by BU staff using a HIPAA-complaint ZOOM connection. The RCT will establish preliminary evidence about the incremental effectiveness of the MWW intervention to improve the employment outcomes of individuals with metacognitive deficits who receive high fidelity IPS services. Study participants randomized to the control condition will receive IPS services as usual.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment Mastering the World of Work (MWW) for mental illness?

Research shows that work therapy can be a useful part of treatment for people with chronic mental illness, helping them engage in active and social life, which is important for recovery. Employment is linked to self-respect and recovery, and programs like Individual Placement and Support (IPS) are recognized as effective in vocational rehabilitation. ^{1 2 3 4 5}

How is the treatment Mastering the World of Work (MWW) unique for mental illness?

Mastering the World of Work (MWW) is unique because it focuses on helping individuals with mental illness gain and retain employment, which is an important part of recovery. Unlike other treatments that may focus solely on symptoms, MWW addresses the social and professional aspects of living with mental illness, providing support for work integration and employment. ^{6 7 8 9 10}

Research Team

Zlatka Russinova, PhD

Principal Investigator

Boston University Center for Psychiatric Rehabilitation

Eligibility Criteria

This trial is for English-speaking adults over 18 with serious mental illness, including dual diagnosis, who are unemployed but receiving Supported Employment services in Manchester, NH. Participants must be willing to engage via Zoom and consent to audio recordings of sessions.

Inclusion Criteria

Not currently employed for one of the following reasons: i. newly enrolled in IPS and have not yet been placed in a job ii. have been enrolled in IPS for at least three months and have not yet obtained a job iii. have lost a job after enrollment in IPS and have not obtained a new job for at least a month following the loss of their last job

I am getting job support services at the Mental Health Center in Manchester, NH.

I can use Zoom for assessments and interventions if needed.

Exclusion Criteria

I am unable to understand and give consent for treatment.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the MWW intervention, consisting of 29 sessions over 7 modules, delivered in a hybrid manner based on preferences and safety considerations.

18 months

Weekly sessions (in-person or virtual)

Follow-up

Participants are monitored for employment outcomes and metacognitive capacity through assessments at baseline, 6, 12, and 18 months.

18 months

4 assessments (virtual)

Treatment Details

Interventions

• Mastering the World of Work (MWW)

Trial Overview The 'Mastering the World of Work' (MWW) intervention is being tested alongside usual Supported Employment services. The study will assess if MWW improves job outcomes for those with psychiatric disabilities and metacognitive deficits through a mix of remote and possibly in-person sessions.

Participant Groups

Group I: Experimental Experimental Treatment 1 Intervention

Study participants randomized to the experimental condition will receive IPS services as usual in conjunction with the MWW intervention.

Group II: Control Active Control 1 Intervention

Study participants randomized to the control condition will receive IPS services as usual.

Who Is Running the Clinical Trial?

Boston University Charles River Campus

Lead Sponsor

Trials

125

Recruited

14,100+

Findings from Research

A prospective study involving 126 outpatients across 7 clinical work therapy departments indicates that outpatient work therapy is beneficial as part of a comprehensive treatment plan for chronically mentally ill patients.

Despite the lack of robust evidence for the therapeutic effectiveness of work therapy in psychiatric treatment, this study suggests it plays a valuable role in patient care, highlighting the need for further empirical research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Ambulatory occupational therapy. Results of a multicenter, prospective evaluation study]. Reker, T., Eikelmann, B.[2019]

The author argues that a flexible, long-term sheltered workshop is necessary for psychiatric patients, as many cannot achieve a lasting cure and often struggle with vocational performance in the community.

Despite challenges, the author emphasizes that patients can engage in work both in hospital workshops and community settings, highlighting the importance of employment for self-respect and rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The case for a flexible, long-term sheltered workshop for psychiatric patients. Wilder, JF.[2019]

Employment plays a crucial role in the recovery process for individuals with mental illness, as it fosters hope and the possibility of returning to an active social life.

The recovery approach emphasizes that individuals can work towards recovery without needing to fully eliminate their mental health issues first, highlighting the importance of vocational rehabilitation practices like Individual Placement and Support (IPS) that align with recovery-oriented values.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Employment and Recovery Process]. Pachoud, B.[2018]

Schizophrenia significantly impacts individuals and their families, highlighting the need for comprehensive management strategies.

Effective management of schizophrenia involves understanding diverse outcomes and utilizing various treatment approaches to support patients in reaching their full potential.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Working with schizophrenia: a clinician's personal experience. Jeffries, JJ.[2019]

Participants in an eight-week peer-led intervention called Wellness Recovery Action Planning (WRAP) showed significant improvements in self-reported symptoms, recovery, hopefulness, self-advocacy, and physical health after the program, based on interviews with 80 individuals.

Those who attended six or more sessions experienced greater benefits, indicating that higher engagement in the program may lead to better psychosocial outcomes, suggesting the need for further research to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Initial outcomes of a mental illness self-management program based on wellness recovery action planning. Cook, JA., Copeland, ME., Hamilton, MM., et al.[2019]

There is a significant gap in social work education in Canada regarding training on the importance of employment for individuals with mental illness, despite evidence that work is crucial for recovery.

High unemployment rates among people with mental illness and increasing mental health issues in workplaces highlight the need for social work educators to incorporate employment support training into their curricula.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Work, employment, and mental illness: expanding the domain of Canadian social work. Shankar, J., Barlow, CA., Khalema, E.[2022]

A comprehensive analysis of 100 academic publications and various other documents in Canada identified five key perspectives that shape work integration for individuals with mental illnesses: competency, citizenship, workplace health, potential and growth, and community economic development.

Understanding these diverse perspectives helps clarify how work integration is perceived and addressed, revealing the rationale behind different solutions and guiding future policy and practice in this field.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Canadian model of work integration for persons with mental illnesses. Kirsh, B., Krupa, T., Cockburn, L., et al.[2010]

The book offers a thorough examination of the theoretical frameworks and legal regulations in the United States that support the employment of individuals with mental health disabilities.

It emphasizes best practices for successfully integrating and supporting employees with mental health challenges in the workplace.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Handbook of mental health in the workplace Jay C Thomas and Michel Hersen Handbook of mental health in the workplace Sage 574 £77 0761922555 0761922555 [Formula: see text]. [2019]

The WorkingWell mobile app was found to be a feasible tool for providing employment support to individuals with serious mental illnesses, with 87% of participants completing the 2-month study and reporting it as user-friendly and helpful for job management.

Participants rated the app positively on usability, with 86% agreeing it would assist them in managing their work better, indicating its potential effectiveness in supporting this population in the workplace.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The WorkingWell Mobile Phone App for Individuals With Serious Mental Illnesses: Proof-of-Concept, Mixed-Methods Feasibility Study. Nicholson, J., Wright, SM., Carlisle, AM., et al.[2023]

In Poland, nearly 1.5 million people received outpatient psychiatric care in 2010, highlighting the significant prevalence of mental health issues, yet only 17% of those with mental disabilities were employed, indicating a major gap in workforce participation.

Research shows that professional activity can stabilize mental health and aid recovery, but individuals with mental disorders face stigma and barriers in the job market, necessitating collaboration among medical professionals to enhance social and professional rehabilitation efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Employees with mental illness - possibilities and barriers in professional activity]. Cybula-Fujiwara, A., Merecz-Kot, D., Walusiak-Skorupa, J., et al.[2015]

References

1. Germany pubmed.ncbi.nlm.nih.gov

[Ambulatory occupational therapy. Results of a multicenter, prospective evaluation study]. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

The case for a flexible, long-term sheltered workshop for psychiatric patients. [2019]

3. Canada pubmed.ncbi.nlm.nih.gov

[Employment and Recovery Process]. [2018]

4. United States pubmed.ncbi.nlm.nih.gov

Working with schizophrenia: a clinician's personal experience. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Initial outcomes of a mental illness self-management program based on wellness recovery action planning. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Work, employment, and mental illness: expanding the domain of Canadian social work. [2022]

7. England pubmed.ncbi.nlm.nih.gov

A Canadian model of work integration for persons with mental illnesses. [2010]

8. England pubmed.ncbi.nlm.nih.gov

Handbook of mental health in the workplace Jay C Thomas and Michel Hersen Handbook of mental health in the workplace Sage 574 £77 0761922555 0761922555 [Formula: see text]. [2019]

9. Canada pubmed.ncbi.nlm.nih.gov

The WorkingWell Mobile Phone App for Individuals With Serious Mental Illnesses: Proof-of-Concept, Mixed-Methods Feasibility Study. [2023]

10. Poland pubmed.ncbi.nlm.nih.gov

[Employees with mental illness - possibilities and barriers in professional activity]. [2015]