Individual placement and support for vocational recovery in first-episode psychosis: randomised controlled trial

Abstract

BackgroundHigh unemployment is a hallmark of psychotic illness. Individual placement and support (IPS) may be effective at assisting the vocational recoveries of young people with first-episode psychosis (FEP).AimsTo examine the effectiveness of IPS at assisting young people with FEP to gain employment (Australian and Clinical Trials Registry ACTRN12608000094370).MethodYoung people with FEP (n = 146) who were interested in vocational recovery were randomised using computer-generated random permuted blocks on a 1:1 ratio to: (a) 6 months of IPS in addition to treatment as usual (TAU) or (b) TAU alone. Assessments were conducted at baseline, 6 months (end of intervention), 12 months and 18 months post-baseline by research assistants who were masked to the treatment allocations.ResultsAt the end of the intervention the IPS group had a significantly higher rate of having been employed (71.2%) than the TAU group (48.0%), odds ratio 3.40 (95% CI 1.17–9.91, z = 2.25, P = 0.025). However, this difference was not seen at 12- and 18-month follow-up points. There was no difference at any time point on educational outcomes.ConclusionsThis is the largest trial to our knowledge on the effectiveness of IPS in FEP. The IPS group achieved a very high employment rate during the 6 months of the intervention. However, the advantage of IPS was not maintained in the long term. This seems to be related more to an unusually high rate of employment being achieved in the control group rather than a gross reduction in employment among the IPS group.Declaration of interestNone.

A meta‐regression of the impact of policy on the efficacy of individual placement and support

“…Hoffmann et al and Howard et al and Heslin et al report the efficacy of IPS for the same patient population at two follow‐up periods, so we only included the latter study from both in our meta‐analysis. The meta‐analysis is based on 27 studies (Fig. ).…”

Improving functional outcomes in early‐stage bipolar disorder: The protocol for the REsearch into COgnitive and behavioural VERsatility trial

“…The outcome measures that have been selected have been widely used, including in our own trials with young people with first episode mania (Berk et al, ; Conus et al, ) and first episode psychosis (Killackey et al, ).…”

Early Intervention and Youth Mental Health: Synergistic Paradigms to Transform Mental Health Outcomes

“…This can be associated with a range of adverse outcomes that include premature death, social isolation, poor functioning, and poor educational and vocational productivity (Gibb et al 2010;Morgan et al 2017;Walker et al 2015). There is compelling evidence that the course and functional impacts of even the most serious forms of mental illness can be positively altered through early intervention (Correll et al 2018;Killackey et al 2019).…”