Rationale for the Review.
In one of the few representative surveys examining the educational attainment of individuals with serious psychiatric disabilities, Waghorn and his colleagues (Waghorn, Still, Chant, & Whiteford, 2004) were able to compare rates of educational attainment among individuals with psychosis to individuals in the general population. While this study was conducted in Australia, other anecdotal information (e.g., Corrigan, Barr, Driscoll, & Boyle, 2008) suggests that the findings would be similar in the United States and other European countries. Waghorn used a population-based, representative, national survey to examine rates of educational attainment. They found that proportionally, more individuals with psychotic disorders left school at a young age when compared to the general population. They also found that a smaller proportion of individuals with psychosis completed post secondary education. These results were also supported by Corrigan in a non-representative survey where he found that only one-third of his sample of individuals with psychiatric disabilities had attempted post secondary education. This compares with data from the US Census reporting that in 2003, 85% of the population aged 25 years or older had completed high school, 53% had attempted college and 27% had completed their Bachelor’s degree (Crissey, 2004).
We know from other threads of research that the rates of unemployment among individuals with psychiatric disabilities are extraordinarily high (Mechanic, Bilder, & McAlpine, 2002; Mueser, Salyers, & Mueser, 2001; Bell & Lysaker, 1995; Twamley, Jeste, & Lehman, 2003). Individuals with psychiatric disabilities are also the least likely to be successful in the state and federal Vocational Rehabilitation (VR) program when compared with individuals with other disabilities (Andrews et al., 1992; National Institute on Disability and Rehabilitation Research, 1997). Work impairment among individuals with serious mental illness has enormous social costs (Cook, 2006; Marcotte & Wilcox-Gök, 2001) and reduces quality of life and life satisfaction (Arns & Linney, 1995; Eklund, Hansson, & Ahlqvist, 2004). Integral to these poor employment outcomes is the need for individuals with psychiatric disabilities to achieve higher levels of educational outcomes as education has repeatedly been demonstrated to predict vocational outcomes.
At the same time, Waghorn and colleagues found that higher education was positively associated with both employment and labor market participation and that unemployment rates were inversely related to educational level among the individuals with psychotic disorders and the general population. The authors also found that vocational training tended to facilitate employment more than higher education, however, due to small sample sizes the authors are not convinced that this is a strong finding (Waghorn et al., 2004).
Clearly educational and vocational attainment are strongly intertwined and linked both theoretically, in policy and in practice, but most importantly, in the lives of individuals with psychiatric disabilities.
Objectives of the Review
The objective of this report is to systematically review all literature related to supported education for individuals with severe mental illness, not limited to randomized clinical trials (RCT’s). The premise for this systematic review was that we believed there to be important and significant research published in the field of supported education that urgently needed to be synthesized for the mental health field at large. It was assumed that valuable information could be gleaned from these articles and that disseminating the findings could be useful to stakeholders, end users, and other constituents in the mental health field.
The study group for this systematic review was guided by the definition of supported education advanced by Collins and Mowbray who defined supported education for the purposes of a national survey as follows: “A specific type of intervention that provides supports and other assistance for persons with psychiatric disabilities for access, enrollment, retention and success in postsecondary education”. They further define supported education as a type of psychiatric rehabilitation intervention that provides assistance, preparation and support to persons with mental illness for enrollment in and completion of postsecondary educational programs. These interventions are designed to assist individuals in making choices about education and training and to assist them in maintaining their “student status” in the program until their educational goal is achieved (Collins & Mowbray, 2005). They describe 4 supported educational models:
- The classroom model in which students with psychiatric disabilities attend closed classes on campus designed for the purpose of providing supported education services;
- The onsite model which is sponsored by a college or university and provides supported education in an individual rather than group setting;
- A mobile support model that provides services through a mental health agency;
- And a more recent classification or model they call the “free-standing model” which is located at the organizational setting sponsoring the supported education program, such as a clubhouse or on site at a college.
Waghorn and colleagues defined 10 critical features that are the hallmarks of supported education which appear to overlap with the Mowbray definition. Supported education includes: 1) coordination of supported education with mental health services; 2) use of specialized supported education staff (not just generic case managers); 3) availability of career counseling, vocational counseling and planning; 4) assistance with financial aid; 5) assistance to develop skills needed to cope with a new academic environment; 6) provision of on-campus information about rights and resources; 7) on or off campus mentorship and personal support during the educational training period; 8) facilitation of access to courses and within-course assistance; 9) access to tutoring, library assistance and other academic support; 10) access to general support (e.g. referral for mental health services).