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Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first-episode psychosis: employing cautious optimism


  • Eoin J. Killackey,

  • Henry J. Jackson,

  • John Gleeson,

  • Ian B. Hickie,

  • Patrick D. McGorry

Eoin J. Killackey, Research Fellow (Correspondence); Henry J. Jackson, Head of School
Department of Psychology, The University of Melbourne, and ORYGEN Research Centre, Parkville, Melbourne, Victoria 3053, Australia. Email:

John Gleeson, Associate Professor
Department of Psychology, The University of Melbourne, Melbourne, Australia

Ian B. Hickie, Executive Director
Brain and Mind Institute, The University of Sydney, Sydney, Australia

Patrick D. McGorry, Executive Director
Departments of Psychiatry and Psychology, The University of Melbourne, and ORYGEN Research Centre, Melbourne, Australia


Objective:  While there are now effective interventions for the symptoms of psychosis and schizophrenia, treatment for the functional domains of these illnesses has received less attention. A key area affected by psychotic illness is vocational functioning. This area is currently of interest to clinicians, policy-makers, politicians and patients. This paper reviews several forms of vocational intervention practised over the years and highlights the issues around adopting an early intervention approach towards vocational rehabilitation. The paper has four aims: first, to consider some of the consequences of unemployment for those with psychotic illnesses; second, to review methods that have been used to address unemployment among the mentally ill; third, to highlight the importance of vocational development at a developmentally appropriate life stage; and finally, to consider the application of evidence-based vocational rehabilitation to those with first-episode psychosis.

Method:  An initial broad literature search was conducted using PsychInfo and Medline databases. Further narrower searches were conducted electronically where indicated. Finally, some articles were sourced through manual searches of relevant journals.

Results:  People with psychotic illness have a high rate of unemployment at the outset of their illness which tends to worsen over time. This is complicated by systemic factors such as the structure of the welfare system. Approaches for assisting people with mental illness return to work have evolved over the history of psychiatry. There now exists an evidence-based method of intervention. To date this has not been trialled in a systematic way with people in the early stages of psychotic illness.

Conclusions:  There is cause for cautious optimism in the vocational recovery of people with psychotic illnesses. Limited evidence exists that the individual placement and support approach developed with chronic populations is very effective in early episode patients. There are a number of challenges to implementing vocational intervention in first-episode psychosis. Overcoming these obstacles will require the cooperation of clinicians, those with illness, policy-makers and politicians. However, the potential economic, health and personal gains, as well as current and future research should provide sufficient motivation to overcome these barriers.

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