The Price and Prize for Employment or Education: a Qualitative Study Examining Facilitators and Barriers from the Perspectives of Service Providers working in Supported Employment and Education and Experts by Experience with Psychosis Spectrum Disorders

PURPOSE: Many with psychosis spectrum disorders are not in education, employment, or training. The present study aimed to describe the facilitators and barriers surrounding competitive employment or advanced education. METHODS: Qualitative data were collected through first three interviews with service providers working in SEE (N = 3), followed by two focus groups with experts by experience with schizophrenia spectrum disorders (N = 13). The interviews and focus group discussions were audio taped and transcribed, enabling reflexive thematic analysis. RESULTS: Three themes, each compromising two subthemes, were identified. The participants described the (1) Price and prize of work and study, including (1.1) Breaking points and (1.2) Motivations. In (2) Facilitators: The importance of individualized support, interventions were viewed as either (2.1) Fruitful or (2.2) Futile. The participants described (3) Barriers: Managing the invisible in conjunction with (3.1.) Symptoms and (3.2) Handling stigma. CONCLUSION: Experts by experience with psychosis spectrum disorders are highly motivated to pursue education or employment. Both benefits and challenges of this were identified. While work or study was seen as meaningful and confidence-building, it could also worsen symptoms or trigger first episode psychosis. Professionals taking a special interest in job-seeking were valued, though factors like lacking social skills and stigma formed barriers. Overall, the findings highlight strong motivation alongside a need for flexible, individualized approaches that balance opportunities with mental health risks.