Implementing Integrated Supported Employment in Mainland China: A Case Vignette

China has 16 million people suffering from severe mental illness (SMI) (Zhou & Li, 2013) constituting a prevalence rate of 1%. Wuxi, a city in Jiangsu province, has 75,000 individuals with this condition which translated to a prevalence rate of 1.7% (Wuxi Mental Health Center, 2003). People with SMI have low employment rates around the globe. In mainland China, the figure is 15% (Wang et al, 2007). Vocational rehabilitation is an important intervention to help them reintegrate into the community (Ruesch et al, 2004). To help patients with SMI obtain jobs, the mainstream intervention rests with the Individual Placement and Support approach (IPS; Drake & Becker, 1996) which was reported to have success rate of 56% (Bond, 2004). Its main limitation is that the job tenure of participants is relatively short (Murphy et al, 2005; Mueser et al, 1997; Mueser et al, 2005). To further improve the employment outcomes, the Integrated Supported Employment model (ISE; Tsang, 2003) that combines IPS with a 10-session manualized work-related social skills training (WSST) (Tsang & Pearson, 1996) was first postulated in 2003 in the Journal of Rehabilitation (see figure 1) to help them obtain and maintain competitive employment. The first RCT that shows its effectiveness was conducted and published in 2009 (Tsang et al, 2009). The study found that ISE had significantly higher employment rates (78.8% vs 53.6%) and longer job tenure (23.84 vs 12.34 weeks) up to 15 months of follow up than IPS participants when used in Hong Kong. A more long term study reported that ISE again had significantly higher employment rate of 82.8% (vs 61.5% of IPS participants) and job tenure (47 weeks vs 37 weeks of IPS participants) up to 39 months (Tsang et al, 2010). In Chinese culture, employment discrimination is a major hurdle for recovery among people with SMI (Tsang et al, 2010). Stigmatizing attitudes among employers in mainland China are more severe than Hong Kong and western countries (Tsang et al. 2000; Lam et al., 2010). This suggests that the application of ISE to mainland cities is timely and urgently needed. To assess the effectiveness of ISE in China, we conducted a RCT in Wuxi, a rapidly developing city, by the Wuxi Major Technology Grant (Reference: YGZX1109). While the results of the RCT will be reported elsewhere, this paper illustrates the successful application of ISE in the mainland using a case report. This case report fills the literature gap by providing an in-depth description on the application of the model which serves to provide triangular evidence on the effectiveness of the model in the real-life context of a market-driven urban city in the mainland. Moreover, reflections of the case worker are also reported to provide insight to future case workers on how the vocational outcomes of ISE may be maximized. Case Description Ms. Wang was a 37-year-old housewife living with her husband and son in a private apartment. She was first diagnosed by a certified psychiatrist with paranoid schizophrenia in 1992 when she was 19. This was then confirmed by our researcher by using the Chinese Version Structural Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders IV (So et al., 2005) when she was admitted in our ISE study. The last hospital admission was in October 2009 (see table 1). Referral When Ms. Wang expressed her intention for open employment, the case psychiatrist referred her to the ISE service which was a joint project between Wuxi Mental Health Center and The Hong Kong Polytechnic University. Throughout the study, the case was under the supervision of a case manager who was a qualified psychiatric nurse by basic training. An intake interview conducted by the case manager found that Ms. Wang was unable to continue her studies after the onset of mental illness. Instead she started to work after graduation from high school. …