A randomised controlled trial of time-limited individual placement and support: IPS-LITE trial
Open accessAbstract
Background: Individual placement and support (IPS) has been repeatedly demonstrated to be the most effective form of mental health vocational rehabilitation. Its no-discharge policy plus fixed caseloads, however, makes it expensive to provide. Aims: To test whether introducing a time limit for IPS would significantly alter its clinical effectiveness and consequently its potential cost-effectiveness. Method: Referrals to an IPS service were randomly allocated to either standard IPS or to time-limited IPS (IPS-LITE). IPS-LITE participants were referred back to their mental health teams if still unemployed at 9 months or after 4 months employment support. The primary outcome at 18 months was working for 1 day. Secondary outcomes comprised other vocational measures plus clinical and social functioning. The differential rates of discharge were used to calculate a notional increased capacity and to model potential rates and costs of employment. Results: A total of 123 patients were randomised and data were collected on 120 patients at 18 months. The two groups (IPS-LITE = 62 and IPS = 61) were well matched at baseline. Rates of employment were equal at 18 months (IPS-LITE = 24 (41%) and IPS = 27 (46%)) at which time 57 (97%) had been discharged from the IPS-LITE service and 16 (28%) from IPS. Only 11 patients (4 IPS-LITE and 7 IPS) obtained their first employment after 9 months. There were no significant differences in any other outcomes. IPS-LITE discharges generated a potential capacity increase of 46.5% compared to 12.7% in IPS which would translate into 35.8 returns to work in IPS-LITE compared to 30.6 in IPS over an 18-month period if the rates remained constant. Conclusions: IPS-LITE is equally effective to IPS and only minimal extra employment is gained by persisting beyond 9 months. If released capacity is utilised with similar outcomes, IPS-LITE results in an increase by 17% in numbers gaining employment within 18 months compared to IPS and will increase with prolonged follow-up. IPS-LITE may be more cost-effective and should be actively considered as an alternative within public services.
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UK randomised control trials of standard IPS outcomes are 46% and 22%.
“In addition, the UK randomised control trials (RCT) of standard IPS outcomes are 46% [62] and 22% [63].”
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 [62]
The only other adaptation to standard IPS studied in the UK is IPS-Lite, which yielded a success rate of 41% compared to standard IPS employment rate of 46%.
“To date the only other adaptation to standard IPS studied in the UK is the IPS-Lite [62], establishing that a time-limited (up to 9 months) implementation of IPS-Lite yielded a success rate of 41% compared to standard IPS employment rate of 46%.”
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 [62]
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- Authors
- Burns, T., Yeeles, K., Langford, O., Montes, M. V., Burgess, J., & Anderson, C.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Burns, Tom
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2015-10
- Volume
- 207
- Issue
- 4
- Pages
- 351-356
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2148730259
- Cited by
- 48
- References
- 18
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 8 · 2023: 2 · 2022: 1 · 2021: 6 · 2020: 6 · 2019: 4 · 2018: 6 · 2017: 3 · 2016: 7
- FWCI
- 15.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Safety Research › Disability Education and Employment
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- Individual Placement and Support, employment effects, cost-effectiveness, capacity utilization, mental illness, return to work
- MeSH terms
- Adult, Mental Disorders, Cost-Benefit Analysis, Employment, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Rehabilitation, Vocational, Time Factors, Proportional Hazards Models, Kaplan-Meier Estimate
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