Sainsbury Centre for Mental Health

Supported Employment

There are broadly two models used to help people with mental health problems who are not working get jobs:

1. Training, development and sheltered work to prepare and then place the person in paid employment: 'train then place'.
2. Get people into competitive employment first with training and support on the job: 'place then train'.

Individual Placement and Support

The most well-established method of 'place then train' in mental health is Individual Placement and Support (IPS). It has seven key elements:

1. It aims to get people into competitive employment
2. It is open to all those who want to work
3. It tries to find jobs consistent with people's preferences
4. It works quickly
5. It brings employment specialists into clinical teams
6. It provides time unlimited, individualised support for the person and their employer
7. Benefits counselling is included.

There is now overwhelming international evidence that 'place then train' models are much more effective than traditional approaches such as vocational training and sheltered work in successfully getting people into work.

The EQOLISE project (Burns et al 2007) compared IPS with other vocational / rehabilitation services in six European countries. It concluded that:

• IPS clients were twice as likely to gain employment (55% v. 28%) and worked for significantly longer;
• the total costs for IPS were generally lower than standard services over first 6 months;
• clients who had worked for at least a month in the previous five years had better outcomes;
• individuals who gained employment had reduced hospitalisation rates.

The benefits of 'place then train'

IPS is not a magic bullet. But it overcomes many of the drawbacks of traditional approaches such as the loss of motivation and confidence over time and the tendency for health care systems to assume that once someone is ready for work they are better and no longer in need of support.

'Place then train' models not only improve employment outcomes, they also improve people's mental and physical health status over long periods of time.

They are also consistently less expensive than traditional approaches and may bring some cost savings in mental health services and welfare benefits.

The evidence, therefore, provides strong support for the substitution of 'place then train' services for traditional day centres and employment programmes, especially for young people with first episodes of mental illness.

The effectiveness of IPS is, however, contingent on implementing it fully according to the seven principles listed above. If any one ingredient is missing, the results will be less impressive.

This does not negate the value of social firms and social enterprises that offer 'protected employment' but in the form of real jobs for real pay in genuine businesses.

The potential of 'place then train'

While it has yet to be adopted widely in the UK, IPS is recommended in current commissioning guidance for mental health services. We believe that the principles of IPS have potential for other groups who have low levels of employment or are otherwise disadvantaged by the labour market, including:

• People who have become disabled and long term unemployed as the result of common mental health problems such as depression and anxiety
• Prisoners and other offenders.
• People with a 'dual diagnosis' of mental ill health and a substance use problem: for which evidence of the benefits of IPS is now available.
• Young people with mental health problems or complex needs.

More on Supported Employment:
Professor Bob Drake

Professor Robert Drake is Professor of Psychiatry and of Community and Family Medicine at Dartmouth Medical School, New Hampshire, USA. He gave our lecture in March 2008 about the future of supported employment.

We have clips, the transcript and Bob's slides from the lecture here.