The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial
Abstract
Background The value of the individual placement and support (IPS) programme in helping people with severe mental illness gain open employment is unknown in Europe. Our aim was to assess the effectiveness of IPS, and to examine whether its effect is modified by local labour markets and welfare systems.Methods 312 patients with severe mental illness were randomly assigned in six European centres to receive IPS (n=156) or vocational services (n=156). Patients were followed up for 18 months. The primary outcome was the difference between the proportions of people entering competitive employment in the two groups. The heterogeneity of IPS effectiveness was explored with prospective meta-analyses to establish the effect of local welfare systems and labour markets. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, with the number NCT00461318.Findings IPS was more effective than vocational services for every vocational outcome, with 85 (55%) patients assigned to IPS working for at least 1 day compared with 43 (28%) patients assigned to vocational services (difference 26.9%, 95% CI 16.4-37.4). Patients assigned to vocational services were significantly more likely to drop out of the service and to be readmitted to hospital than were those assigned to IPS (drop-out 70 [45%] vs 20 [13%]; difference -32.1% [95% CI -41.5 to -22.7]; readmission 42 [31%] vs 28 [20%]; difference -11.2% [-21.5 to -0.90]). Local unemployment rates accounted for a substantial amount of the heterogeneity in IPS effectiveness.Interpretation Our demonstration of the effectiveness of IPS in widely differing labour market and welfare contexts confirms this service to be an effective approach for vocational rehabilitation in mental health that deserves investment and further investigation.
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Previous research has offered an explanation for the lower UK outcomes compared with US studies: differences in employment protection legislation and availability of welfare/disability benefits.
“Previous research has offered an explanation for the lower UK outcomes compared with US studies are differences in employment protection legislation availability of welfare/disability benefits [64, 65].”
From An enhanced individual placement and support (iPS) intervention based on the model of human occupation (MOHO); a prospective cohort study (2020) · cites this paper as [64]
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Self-citationBarriers in implementation of evidence‐based practice
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Self-citationSupport and process in individual placement and support: A multiple case study
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Can SSDI and SSI Beneficiaries With Mental Illness Benefit From Evidence-Based Supported Employment?
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Self-citationIPS Support Employment: A 20-Year Update
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A randomized controlled trial of individual placement and support in Japan.
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- Authors
- Burns, T., Catty, J., Becker, T., Drake, R. E., Fioritti, A., Knapp, M., Lauber, C., Rössler, W., Tomov, T., van Busschbach, J., White, S., & Wiersma, D.
- Affiliations
- Warneford Hospital (GB)
- St George's, University of London (GB)
- Universität Ulm (DE)
- Dartmouth Psychiatric Research Center (US)
- London School of Economics and Political Science (GB)
- Psychiatrische Universitätsklinik Zürich (CH)
- University Medical Center Groningen (NL)
- Corresponding author
- Burns, Tom
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 370
- Issue
- 9593
- Pages
- 1146-1152
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2128678354
- Cited by
- 613
- References
- 30
- Citations by year
- 2026: 15 · 2025: 11 · 2024: 15 · 2023: 11 · 2022: 17 · 2021: 25 · 2020: 32 · 2019: 36 · 2018: 29 · 2017: 26 · 2016: 42 · 2015: 37 · 2014: 54 · 2013: 56 · 2012: 44
- FWCI
- 111.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Social Sciences › Safety Research › Disability Education and Employment
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- supported employment, Individual Placement and Support, severe mental illness, vocational rehabilitation, competitive employment, vocational services, local labor markets, welfare system, unemployment, service dropout, hospital readmission, treatment effect heterogeneity
- MeSH terms
- Adult, Mental Disorders, Europe, Female, Hospitalization, Humans, Male, Rehabilitation, Vocational, Program Evaluation, Logistic Models, Employment, Supported
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