title: Working with mental health problems: clients' experiences of IPS, vocational rehabilitation and employment.
abstract: BACKGROUND
  Although the effectiveness of individual placement and support (IPS) has been well established, little is known about clients' perceptions of the model compared to usual vocational rehabilitation, nor about their experiences of searching for and returning to work with this kind of support. This qualitative study aimed to explore clients' views of the difficulties of obtaining and maintaining employment, their experiences of the support received from their IPS or Vocational Service workers and the perceived impact of work on clients' lives.
  
  
  METHODS
  Semi-structured interviews were conducted with 48 people with psychotic disorders participating in a six-centre international randomised controlled trial of IPS compared to usual vocational rehabilitation. To assess their experiences of the services and the perceived effects of working, two IPS and two Vocational Service clients at each centre who had found work during the study period were interviewed, along with two IPS and two Vocational Service clients at each centre who had not.
  
  
  RESULTS
  IPS clients reported having received more help seeking and maintaining employment, whereas Vocational Service clients reported having received more help in finding sheltered employment or placements. Clients who had worked associated this with financial stability, improved social lives, increased self-esteem, integration into society and amelioration of their symptoms, as well as reduced feelings of boredom and isolation, but also reported increased levels of stress. IPS clients as well as Vocational Service ones reported not receiving enough follow-up support, despite this being proposed as a key feature of the model.
  
  
  CONCLUSIONS
  Findings from the in-depth interviews reflect differences in service models that have also been tested quantitatively but further work in disaggregating the IPS model and assessing the impact of each component would be valuable.
authors.affiliation: Division of Mental Health, St. George's, University of London, London, UK.
authors.forename: Marsha
authors.initials: M
authors.lastname: Koletsi
authors.forename: Astrid
authors.initials: A
authors.lastname: Niersman
authors.forename: Jooske T
authors.initials: JT
authors.lastname: van Busschbach
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Catty
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Tom
authors.initials: T
authors.lastname: Burns
authors.forename: Angelo
authors.initials: A
authors.lastname: Fioritti
authors.forename: Rana
authors.initials: R
authors.lastname: Kalkan
authors.forename: Christoph
authors.initials: C
authors.lastname: Lauber
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.forename: Toma
authors.initials: T
authors.lastname: Tomov
authors.forename: Durk
authors.initials: D
authors.lastname: Wiersma
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D016832:Employment, Supported / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation*; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation; D012050:Rehabilitation, Vocational / Q000379:methods* / Q000706:statistics & numerical data; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000534:rehabilitation; D016896:Treatment Outcome