The Individual Placement and Support (IPS) programme is around twice as effective at establishing people with severe mental illness in competitive employment as compared with vocational services*, conclude authors of an Article in this week's edition of The Lancet.
IPS is the most intensively studied "place and train" intervention for severely mentally ill people. It involves job searching based on patient preference and continuing support to patient and employer from an employment specialist from the local mental health service.
Professor Tom Burns, Department of Psychiatry, University of Oxford, UK, and colleagues did a study of 312 patients, across six European centres* to receive IPS (156) or vocational services (156). Patients were followed up for 18 months, and the difference between the proportions of people entering competitive employment in the two groups was measured.
The researchers found that IPS was more effective than vocational services for every vocational outcome, 55% of IPS patients working for at least one day compared with just 28% of patients assigned to vocational services. Patients assigned to vocational services were significantly more likely to drop out of the service than those in IPS (45% versus 13%);and those in vocational services were also more likely to be readmitted to hospital (31% versus 20% for IPS). Local unemployment rates were one of the main reasons for differences in IPS effectiveness between the different European centres.
The authors conclude: "Our demonstration of the effectiveness of IPS in widely differing labour market and welfare contexts confirms this service to be an effective approach for vocational rehabilitation in mental health that deserves investment and further investigation."
In an accompanying Comment, Dr Geoff Waghorn, Queensland Centre for Mental Health Research, University of Queensland, Australia and Dr Paul Gold, University of South Carolina, USA, say that the study warrants optimism that high rates of competitive employment could be achieved by those with severe mental illness.
They conclude: "Further progress will inevitably require new international partnerships, funding from a wide variety of sources, different research designs, a long-term focus to track vocational recovery, and inclusive communities prepared to restore equal rights of citizenship and value human strengths over deficits. Equally important will be the need for researchers to produce evidence for immediate use in developing policy and in sponsoring local evidence based programmes."
Dr Geoff Waghorn, Queensland Centre for Mental Health Research, University of Queensland, Australia
*Vocational services are the standard psychiatric rehabilitation services that aim to train people to return to work (ie train and place as opposed to place and train). They use structured training such as IT training, interview training, time-skills and practice in sheltered settings. They are often day programmes.
**The six European Centres were London, UK; Ulm-Guenzburg - Germany; Rimini - Italy; Zurich - Switzerland; Groningen - Netherlands; Sofia - Bulgaria