The individual placement and support approach (IPS) has become a widely recognized evidence-based practice to provide work for more people with severe mental illness. The aim of this literature review was to identify and evaluate research on implementation of IPS, focusing on facilitators and barriers. Contextual, local organizational, cooperation/team and individual factors influence the implementation process. Key facilitators are the use of a fidelity scale to measure and develop quality and the employment of skilled local leaders and IPS specialists. Barriers are located at the contextual level, when the national employment policy and regulation contradict the IPS scheme, and at the local level, where mental health professionals' negative attitudes towards the IPS scheme and a culture based on a medical approach challenge the implementation of IPS. The evaluation of research in IPS implementation show that most studies are empirically driven, using different understandings of implementation and have a poor theoretical underpinning of the studies. The need for further studies based on comparative methods and more developed theoretical framework is discussed.

Background: Illness Management and Recovery (IMR) is a curriculum-based rehabilitation program for people with severe mental illness with the short-term aim of improving illness self-management and the long-term aim of helping people achieve clinical and personal recovery.MethodParticipants with schizophrenia or bipolar disorders were recruited from three community mental health centers in the Capital Region of Denmark and randomized to receive group-based IMR and treatment as usual or only the usual intervention. All outcomes were assessed at baseline, postintervention, and the one-year follow-up. Long-term outcomes were categorized according to clinical recovery (i.e., symptoms, global functioning, and hospitalization) and personal recovery (i.e., hope and personal agency). Generalized linear mixed model regression analyses were used in the intent-to-treat analysis.ResultsA total of 198 participants were included. No significant differences were found between the IMR and control groups in the Global Assessment of Functioning one year after the intervention, nor were there significant differences in symptoms, number of hospital admissions, emergency room visits, or outpatient treatment.ConclusionThe present IMR trial showed no significant effect on clinical and personal recovery at the one-year follow-up. Together with the results of other IMR studies, the present study indicates that the effect of IMR on symptom severity is unclear, which raises questions regarding the impact of IMR on functioning. Additionally, IMR did not affect personal recovery. Although more research is needed, the results indicate that the development of other interventions should be considered to help people with severe mental illness achieve a better level of functioning and personal recovery.Trial registrationTrial registered at http://www.clinicaltrials.gov (NCT01361698).

IMR appears not to be better than treatment as usual in any of the outcomes. Further studies with a longer follow-up period, better assessments of recovery and a systematic review of the existing trials are needed to assess if the program is effective.