Objectives The aim of this study was to evaluate the effectiveness of individual placement and support (IPS) for people struggling with work participation due to moderate-to-severe mental illness. The study was conducted in Norway, a setting characterized by a comprehensive welfare system and strong employment protection legislation. Methods A randomized controlled multicenter trial including 410 participants was conducted. The intervention group received IPS according to the IPS manual. The control group received high-quality usual care. The main outcome was competitive employment at 12- and 18-months follow-up, based on objective registry data. Changes in mental health and health-related quality of life were secondary outcomes. Results At 12-months follow-up, 36.6% of participants in the IPS group and 27.1% of participants in the control group were in competitive employment, while the difference was slightly higher (37.4% versus 27.1%) at 18-months follow-up. Furthermore, IPS yielded positive effects on all the secondary outcomes compared to the control group (all P<0.05). Conclusions The IPS model of supported employment was superior to high-quality usual care on both vocational and non-vocational outcomes for people with moderate-to-severe mental illness, even in a policy context characterized by high job security and a comprehensive welfare system.

Background: Roughly one third of disability pensions in Norway are issued for mental and behavioral disorders, and vocational rehabilitation offered to this group has traditionally been dominated by train-and-place approaches with assisted or sheltered employment. Based on a more innovative place-and-train approach, Individual Placement and Support (IPS) involves supported employment in real-life competitive work settings, and has shown great promise for patients with severe mental illness.

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A randomized controlled trial was conducted of individual placement and support (IPS) for young adults with various social or health-related problems at risk of work disability. The odds of gaining competitive employment were 10.39 (95% CI 2.79-38.68) times higher for IPS than traditional vocational rehabilitation (48% versus 8%). IPS shows promise for early intervention diverting young adults from disability to employment.Affiliation: NORCE Norwegian Research Centre, POB 7810, 5020 Bergen, Norway. visv@norceresearch.no Refers to the following text of the Journal: 2019;45(1):33-41The following article refers to this text: 2020;46(4):410-416 Sveinsdottir V, Lie SA, Bond GR, Eriksen HR, Tveito TH, Grasdal AL, Reme SE. Individual placement and support for young adults at risk of early work disability (the SEED trial). A randomized controlled trial. Scand J Work Environ Health. 2020;46(1):50-59. doi:10.5271/sjweh.3837Objectives Individual placement and support (IPS) is an effective approach for helping people with severe mental illness gain employment. This study aimed to investigate if IPS can be effectively repurposed to support young adults at risk of early work disability due to various social and health related problems.Methods A randomized controlled trial including 96 young adults (18-29 years; 68% men) was conducted in Norway. Participants were not in employment, education, or training, received temporary benefits due to social or health-related problems, and were eligible for traditional vocational rehabilitation (TVR). Participants were randomized to IPS (N=50) or TVR (N=46). Self-reported data were collected at baseline and at 6-and 12-months follow-up. The primary outcome was obtaining any paid employment in the competitive labor market during followup. Secondary outcomes were physical and mental health, well-being, coping, alcohol consumption, and drug use. ResultsSignificantly more IPS participants obtained competitive employment compared to TVR participants during 12-months follow-up (48% versus 8%; odds ratio 10.39, 95% confidence interval 2. 79-38.68). The IPS group reported significantly better outcomes than the TVR group in subjective health complaints, helplessness, and hopelessness. In post hoc analyses adjusted for baseline and missing data, the IPS group reported significantly better outcomes on these measures in addition to level of disability, optimism about future well-being, and drug use.Conclusions IPS is effective for young adults at risk of early work disability. IPS was superior to TVR in increasing competitive employment and promoted improvements in some non-vocational outcomes. IPS services should be offered to improve employment rates in this vulnerable group.