Supported employment: randomised controlled trial.
BACKGROUND
There 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.


OBJECTIVE
To investigate the effectiveness and cost-effectiveness of IPS in the UK.


METHODS
Individuals with severe mental illness in South London were randomised to IPS or local traditional vocational services (treatment as usual) (ISRCTN96677673).


RESULTS
Two 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.


CONCLUSIONS
There 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.
Howard
Louise M
LM
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
Heslin
Margaret
M
Leese
Morven
M
McCrone
Paul
P
Rice
Christopher
C
Jarrett
Manuela
M
Spokes
Terry
T
Huxley
Peter
P
Thornicroft
Graham
G
D000328:Adult; D003156:Community Mental Health Services / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D016832:Employment, Supported / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008131:London; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000534:rehabilitation*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales