title: Supported employment: randomised controlled trial.
abstract: 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.
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Howard
authors.forename: Margaret
authors.initials: M
authors.lastname: Heslin
authors.forename: Morven
authors.initials: M
authors.lastname: Leese
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Christopher
authors.initials: C
authors.lastname: Rice
authors.forename: Manuela
authors.initials: M
authors.lastname: Jarrett
authors.forename: Terry
authors.initials: T
authors.lastname: Spokes
authors.forename: Peter
authors.initials: P
authors.lastname: Huxley
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
mesh_terms: 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