Employment plays a critical role in symptom remission and functional outcomes

After symptom remission is achieved, supported employment programs, such as Individual Placement and Support (IPS), can significantly bolster a patient’s opportunity for achieving independence and greater fulfillment through work placement.1,2 New research even suggests that employment can accelerate clinical and functional improvement.1,2


Unemployment Rate per Age Group3

General Population Adults With Schizophrenia 62% 89% 88% 92% 24% 88% 87% 10% 6% 33% 15-19 20-29 30-39 40-49 50-66

Unemployment rates among patients with schizophrenia remain staggeringly high3

The unemployment rate among patients with schizophrenia is estimated at approximately 90%.3 Helping patients avoid relapse and achieve sustained clinical remission can dramatically improve employment rates. In a retrospective study of 40 patients with schizophrenia, 100% of relapsed patients were unemployed some or most of the time due to their illness vs just 25% of remitted patients.4

Unemployment rates for schizophrenia patients are consistently high across all age groups vs the general population, highlighting the urgent need for supported employment programs.3


Employment has measurable healing power for patients

Gainful employment has cascading positive effects on patients’ well-being, including their socioeconomic viability, social integration, feelings of self-worth, and independence.1

Moreover, it fulfills schizophrenia patients’ top-stated treatment goal: “To be seen as capable.”2 Research suggests that employment can also improve clinical and social functioning while reducing positive and negative symptoms, depression, and risk of hospitalization.1 Although concerns have been raised about the possibility of competitive employment increasing patients’ anxiety and depression levels, the opposite appears to be true.1

Patients who return to work tend to have lower rates of depression and anxiety and remain in remission for longer compared to patients who are out of work.1


Milestones of Adjustment

Dr. Mary Moller discusses her experience treating patients with schizophrenia and the development of the MAPP recovery model.

Dr. Moller: When I started working in the field of mental illness in 1978, patients' were not even told the name of their illness. They were treated like robots. Take your medicine. Keep them quiet. I knew just by the look in patient’s eyes that there was a person there who was suffering tremendously. And I knew then that that was going to be the focus of my research—it would be on the lived experience of schizophrenia. What’s it really like to be trapped inside a brain that is playing all these tricks on you? It’s horrible. It’s frightening. And as patients learned that it was okay and safe to talk about really scary things, and that I wasn’t going to get all freaked out about it, they started opening up.

So, as a result of studying young people who are recovering from schizophrenia, I was wanting to discover milestones that would indicate recovery so I could share these with patients and families. Just like you do if you have a heart attack—“Okay, after a month we can put you on the treadmill and you should be able to do this”—there are recovery milestones for all other illnesses. There were no recovery milestones for schizophrenia. So, the model that emerged out of the qualitative data from my dissertation I named the MAPP recovery model: “M-A-P-P,” which stands for milestones of adjustment post-psychosis.

There are 50 milestones that are divided into 4 distinct phases of recovery. The 4 phases are named “from the couch to the bus depot to the mall to work.” That’s the layman’s terms, that everyone can relate to. In research terms the 4 phases are cognitive dissonance, which is the acute psychotic phase. Insight, which is when the patient begins to question, “Hm, maybe there really aren’t ghosts trying to follow me—maybe that’s my brain playing tricks on me.” The third phase is cognitive constancy, which is when the person is able to reengage with the world in an interactive way. And the fourth phase is ordinariness, and that phase was named with the help of the participants in the research. When I said, “What’s the ultimate goal that you hope to achieve at the end of this program?” and they said, “I just want to be ordinary, like everybody else.”

In understanding the MAPP trajectory, it’s important to know that these phases are not linear. They overlap. So, when a patient is in the throes of the psychosis and they’re on the couch, they’ll be questioning, they’ll be trying to get some insight. Eventually this person will say, “I’m tired of being isolated“ and they’ll go somewhere rather remote where there is not a lot of people they have to talk to. So typically, that’s a bus depot, and we see a lot of our patients hanging out at the bus depot because at the bus depot you’re sort of a non-entity but yet the person with schizophrenia is craving to be around other people but afraid to speak or still unable to speak. That phase can be another 9 months or so. Then the individual will say “you know I was ready to go to the mall.” And what’s different about the mall is its light, the patient is seen, and they interact, and they purchase things. To make a purchase like everyone else, it’s a huge milestone. Then they’re ready for ordinariness. Then they’re ready to think about going to school, getting some kind of a job, and getting on with it.

Post-psychotic adjustment is a multiphased process that takes time5

Psychosocial recovery is a measured process, one that Dr. Moller, an expert in psychopharmacology, has spent a career benchmarking. The Milestones of Adjustment Post-Psychosis (MAPP) schizophrenia recovery model that she co-developed helps psychiatrists accurately chart a patient’s psychosocial progress over 4 distinct phases5:

Phase 1: Cognitive Dissonance

—Recognizing the effect of psychosis on functioning

Phase 2: Insight

—Understanding the relation of symptoms to reality

Phase 3: Cognitive Constancy

—Achieving stability in thinking and responding to others

Phase 4: Ordinariness

—Performing activities of daily living as others do

The ultimate milestone for patients is to complete normal activities of daily living that are reflective of their pre-psychosis functioning.

Teva is committed to providing education and enhancing care for everyone living with schizophrenia.

The SCZ Now initiative was created to help support this educational effort.