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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Evidence for effective schemes to support people into work



1.    Supported Employment Schemes

Traditionally people with long-term and severe mental health problems have been offered pre-vocational training and sheltered employment.  However there is now a great deal of evidence that an alternative approach called ‘Individual Placement and Support’ (IPS) is much more effective in getting people into open employment. The difference is that IPS emphasises rapid placement in work and on-going support after placement (‘place-and-train’) rather than the traditional ‘train-and-place’ models which focus on a prolonged period of assessment and preparatory training. 

The key principles of the IPS approach are:

 

  • Services should be focused on competitive employment, with a primary goal of integration into the general workforce.
  • Eligibility should be based on the individual’s preferences.
  • Programmes should involve rapid job search and minimal pre-vocational training.
  • Vocational services should be integrated into the work of the clinical team
  • Support should be available for an unlimited period, which should be tailored to the individual’s needs

The effectiveness of IPS has been internationally evaluated in over 15 randomised controlled trials in North America, Europe, Australia and Hong Kong and only one trial has shown no effect.  On average those who are give IPS show employment rates of 30-40% compared to rates in the control group of 10-12%.  Those supported by IPS work significantly more hours per month, have higher earnings and better job tenure.  There is no evidence that they have a negative effect on clinical well-being and relapse and some show reduced rates of hospital admission and less time spent in hospital.  Follow-up studies over  8-12 years confirm that the better outcomes are maintained over the longer term.  These schemes have also been shown to be cost-effective.

 

IPS should be routine practice for specialist mental health services which aim to improve the employment opportunities of people with long-term mental health problems who are currently unemployed.  Unfortunately it is not yet widely instituted in the UK, although some NHS Trusts have successfully deployed this approach in routine clinical practice in a number of NHS Trusts, notably South West London and St George’s Mental Health Trust.

 

2.    Schemes for people with common mental health problems

The evidence for schemes to help people with anxiety and depression stay in or get back to work is less clear cut and little evaluative work has been done in the UK.  The existing evidence suggests that:

  • To help people keep their jobs - individual approaches are more effective than organizational ones - the most effective programmes focused on personal support, individual social skills and coping skills training.  Multiple approaches have the most long lasting effects.
  • To help people get back to work after mental health problems at work - brief individual psychological therapy, especially those which are cognitive/behavioural in nature, are effective.  These techniques had a stronger effect in employees in high-control jobs and may be effectively delivered face-to-face or via computer-based applications.

Different practitioners have valuable and complementary roles to play, in achieving positive work outcomes – including the General Practitioner, Occupational Health practitioner, line manager, and independent case managers (for example, labour experts or employment advisers).  A revised medical statement – the fit note – now enables GPs to provide better return-to-work advice for patients to share with employers.

 

 

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The value of a WRAP (Wellness Recovery Action Plan)

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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