Improving the vocational status of patients with long-term mental illness: a randomized controlled trial of staff training

Authors: O'Neill, J. H. , Zuger, R. R., Fields, A.,Fraser, R., & Pruce, T.
Year Published 2003
Publication Community Mental Health Journal, 39(4), 333-347.
Volume 39
Number 4
Pages 333-347
Publisher Springer Science+Business Media

High unemployment rates are found in people with long-term mental health problems although they want to work. Various approaches to increasing access to work have been described. Currently evidence favors the individual placement and support (IPS) model. Here the aim is to help patients obtain open employment with a minimal period of pre-vocational training; a place-train approach rather than vice versa. Once a job or training place has been obtained as much support as possible is given with the aim of retaining the position. This model is gaining increasing recognition in the United States and a Cochrane review concluded that it was more effective than pre-vocational training in helping people with severe mental illness return to work. However mental health services in Europe have been slower to prioritize this issue.


To investigate the impact of training Community Mental Health Team members in the practice of Individual Placement and Support on the vocational status of long-term patients.


Subjects were recruited from ten Community Mental Health Teams of a large London Mental Health Trust. Subjects were eligible for inclusion if they had been in continuous contact with their Community Mental Health Team for at least one year and were unemployed. All subjects were
over the age of 16. Males over 65 and females over 60 (normal retirement age) were excluded from the study.


Six Community Mental Health Teams received vocational training by a work co-coordinator; four continued with standard care. The best vocational status of the 1037 subjects was ascertained after one year. Factors associated with improvement in vocational status were identified.

Data Collection

Data were entered into SPSS for windows version 10 and cleaned using logical searches. The data were analyzed without adjustment for the cluster design. This was because the inter-cluster correlation coefficient (ICC) was 0.00148, which leads to a design effect of 1.01. The small ICC means that individual behavior is only affected to a minor degree by cluster membership, meaning that the cluster design has little overall effect. To test any effect of the intervention the categorical variables were analyzed using tests and continuous variables were analyzed using independent t-tests. A stratified chi-square analysis was conducted to allow for differences between the groups at baseline. When examining factors associated with return to work differences within categories were compared using the z-test. For all statistical tests a significant p-value was set at 0.05.


The control condition was high quality standard Community Mental Health Team care.


There was no difference in change of vocational status. Age, previous employment and diagnosis influenced outcome.


Training in Individual Placement and support at team level did not improve employment status. A dedicated, vocational worker appears to be essential for successful Individual Placement and Support.

Disabilities Emotional disturbance
Populations Male & Female
Outcomes Employment acquisition
NIDILRR Funded Yes
Research Design Quasi-experimental
Peer Reviewed Yes