ABSTRACT
Adefining feature of schizophrenia is its association with poor functional status, often even before formal diagnosis (APA, 1994). This phenomenon has been recognized as a core abnormality of the disorder from Kraepelin’s first descriptions of the disease at the turn of the 20th century. Deficits in skills associated with self-care, social interaction, engaging in recreational activities and work function in young, middle-aged and older individuals with schizophrenia are legion (Bellack et al., 1990; Patterson et al, 2001a, b), and are more pronounced than those evident in other forms of severe and persistent mental illness (e.g., Schretlen et al., 2000). In fact, current estimates suggest that 70%-80% of individuals with schizophrenia are unemployed at any one time, and only one half of 1% patients with schizophrenia who receive Social Security Insurance (SSI/SSDI) ever remove themselves from entitlements. With prevalence rates in North America ranging from one half to 1%, the estimated cost of the illness to society, in terms of lost wages and lifelong medical care, is on the order of billions of dollars (Salkever et al., 2007). The effects of chronic social impairment on the sense of self-worth of clients with schizophrenia are incalculable.
