Supported employment: randomised controlled trial

Abstract

BackgroundThere is evidence from North American trials that supported employment using the individual placement and support (IPS) model is effective in helping individuals with severe mental illness gain competitive employment. There have been few trials in other parts of the world.AimsTo investigate the effectiveness and cost-effectiveness of IPS in the UK.MethodIndividuals with severe mental illness in South London were randomised to IPS or local traditional vocational services (treatment as usual) (ISRCTN96677673).ResultsTwo hundred and nineteen participants were randomised, and 90% assessed 1 year later. There were no significant differences between the treatment as usual and intervention groups in obtaining competitive employment (13% in the intervention group and 7% in controls; risk ratio 1.35, 95% CI 0.95–1.93, P = 0.15), nor in secondary outcomes.ConclusionsThere was no evidence that IPS was of significant benefit in achieving competitive employment for individuals in South London at 1-year follow-up, which may reflect suboptimal implementation. Implementation of IPS can be challenging in the UK context where IPS is not structurally integrated with mental health services, and economic disincentives may lead to lower levels of motivation in individuals with severe mental illness and psychiatric professionals.

Work as treatment? The effectiveness of re-employment programmes for unemployed persons with severe mental health problems on health and quality of life: a systematic review and meta-analysis

“…The evidence for effectiveness on health-related outcomes is scarce. Two RCTs have reported positive effects such as 4% higher quality of life score17 and 38% reduced healthcare costs 18. However, another RCT on employment interventions did not find any beneficial effects on health or healthcare costs 15.…”

The impacts of vocational rehabilitation

“…Hence, it is closely related to an ongoing debate in the literature about the respective achievements of the so-called place-and-train and train-and-place rehabilitation strategies, distinguished by their view on whether required skills-upgrading should take place before a placement in the labor market is attempted or vice versa. While empirical research from the U.S. generally finds that a place-and-train strategy is superior to train-and-place (Skinner et al, 2009;Campbell et al, 2011), European evidence is more mixed (Burns et al, 2007;Catty et al, 2008;Howard et al 2010). Our analysis is also related to a recent U.S. literature, examining labor supply behavior among rejected disability insurance applicants.…”

Employment outcomes for people with schizophrenia spectrum disorder: A meta-analysis of randomized controlled trials

“…It is possible that the consideration of short periods as indicative of job placement success could overestimate the employment rate. For example, Macias et al [54] defined job acquisition as successful if the participants worked "at least five days;" Burns et al [45] and Howard et al [49] defined a period of "at least one day." Therefore, the competitive job tenure and wages earned would reflect the sum of hours or weeks worked by many individuals, each of whom only worked for a short period of time.…”

“…Moreover, there were differences in the methods used for addressing this interest among trials. For examples, Drake et al [46] and Howard et al [49] recruited people interested in work and assessed eligibility through introductory meetings, whereas Macias et al [54], due to the nature of their intervention model, did not screen for work interest. The study by Howard et al [49], which included a single introductory session, is likely to have recruited less motivated methodological quality, illustrating that the quality with which employment programs are implemented is particularly relevant in trials designed to assess the effectiveness of these programs.…”