Approaches to improving employment outcomes for people with serious mental illness. Work accommodation and retention in mental health

Authors: Kukla, M., & Bond, G. R.
Year Published 2011
Publication Journal of Mental Health
Volume 20
Number 4
Pages 368-380
Publisher ISSN

Certain models of vocational service have been shown to be effective in establishing persons with mental health problems back into employment. The individual placement and support (IPS) model has the widest evidence base in studies conducted in North America. Evidence from North America has led to an increasing interest in the use of IPS in the UK. Employment is dependent on economic and social factors which are often country specific.


This review examines the evidence of the effectiveness of the IPS model of supported employment within the United Kingdom. The study conducted a systematic review of the literature to answer the principal research question: What is the evidence of effectiveness of the IPS model of supported employment within the United Kingdom?


This study is a systematic review. The included studies were undertaken in various locations and settings.


The majority of the population was patients recruited from community mental health teams, including an early intervention in psychosis service. Psychotic illness was the largest diagnostic group in the four studies that reported diagnostic categories.

Data Collection

Five studies met the inclusion criteria. These comprised one European mufti-centre RCT where London was one of six centers, one solely UK-based RCT, one cohort study, one naturalistic study and one small service evaluation. Critical Appraisal of papers was conducted using the NICE Quality appraisal checklist. Each study is awarded an overall study quality grading for internal validity (IV)and a separate one for external validity (EV):
1. All or most of the checklist criteria have been fulfilled, where they have not been fulfilled the conclusions are very unlikely to alter.
2. Some of the checklist criteria have been fulfilled, where they have not been fulfilled, or not adequately described, the conclusions are unlikely to alter.
3. Few or no checklist criteria have been fulfilled and the conclusions are likely or very likely to alter.


Control conditions varied across the studies. Conditions included Group skills training, enhanced vocational rehabilitation, psychosocial rehabilitation, diversified placement, train-place, sheltered workshop, brokered vocational rehabilitation, and traditional vocational services.


The evidence base for the effectiveness of IPS within a UK context is small. There is promising evidence, including from a high quality RCT, that IPS is more effective than conventional training and place vocational rehabilitation in placing people into competitive employment. However, the quality of the evidence was generally weak. Several studies lacked adequate controls, meaning potential confounding factors were not controlled for.


This study has highlighted the need for better quality evidence on the effectiveness and application of IPS in the UK, preferably using an RCT approach. Where controlled trials are not feasible, good quality naturalistic evaluations could improve the evidence base. Evaluation should focus on the nature, quality and occupational level of the employment gained and the length of time employment is sustained. Examining both service (e.g. time from entry into service to employment) and patient factors (e.g. previous vocational history, motivational factors) would add to evidence. Integration of the IPS intervention with mental health teams, positive attitudes to competitive employment among staff and motivational assessment of clients may improve placement rates.

Disabilities Emotional disturbance
Populations Male & Female
Outcomes Employment acquisition
Research Design Systematic reviews and meta-analysis
Peer Reviewed Yes