The shift to rapid job placement for people living with mental illness: An analysis of consequences

Authors: Gignac, M. A. M., Jetha, A., Bowring, J., Beaton, D., & Badley, E.
Year Published 2012
Publication Psychiatric Rehabilitation Journal
Volume 35
Number 6
Pages 428-434
Publisher Psychiatric Rehabilitation Administration

The Individual Placement and Support (IPS) model, a standardized and evidence-based approach to supported employment (SE) for individuals living with mental illness, focuses on minimizing pre-employment training and supporting individuals to enter integrated competitive work settings. In an effort to address poor employment outcomes associated with many traditional approaches to vocational rehabilitation, policy structures and funding mechanisms have been developed that link pay incentives directly to job placement and maintenance rates. . The question of whether policy revisions encourage fidelity to models of best practice is a salient one in light of this observation. Indeed, heterogeneity within the IPS model persists despite the association between fidelity to the model and positive employment outcomes.


This article reports on the consequences of the revised policy for employment supports within the Ontario Disability Support Program, a disability benefit program administered by the provincial government in Ontario, Canada. The revised policy involves a change from a fee-for-service model to an outcome-based funding model. This revision has encouraged a shift from pre-employment to job placement services, with a particular focus on rapid placement into available jobs. This article reports on the findings from a case study of policy revision affecting employment supports for individuals living with mental illness in Ontario, Canada. The purpose is to examine the impact of this policy change, comprised largely of a new outcome-based funding model, with an eye to the principle and practice of rapid job placement.


Recruitment focused on three main stakeholder groups: (1) program informants who were involved in developing and/or delivering employment services for people living with mental illness under the policy; (2) policy informants who were involved in constructing and/or implementing the policy; and (3) consumer informants who self-identified as a person living with a mental illness and were involved in informing the policy, planning services under the policy, or advocacy/activism related to the policy.


Using a qualitative case study approach, 25 key informant interviews were conducted with individuals involved in developing or implementing the policy, or delivering employment services for individuals living with mental illness under the policy. Policy documents were also reviewed in order to explore the intent of the policy. Analysis focused on exploring how the policy has been implemented in practice, and its impact on employment services for individuals living with mental illness.

Data Collection

Interviews were audio-recorded and transcribed verbatim.
The computer software program NVivo was used to organize the data for efficient analysis. Data from the key informant interviews and the documents were analyzed simultaneously. Emerging ideas were used to direct and focus later data collection and analysis according to the constant comparative approach. Guided by the principles of constructivist grounded theory, during initial coding we explored the data and considered different possible theoretical and analytical permutations. Later, coding became more focused and selective as we categorized data by grouping codes together and prioritizing some codes over others.


There was no control or comparison condition.


The findings highlight how employment support practices have evolved under the new policy. Although there is now an increased focus on employment rather than pre-employment supports, the financial imperative to place individuals into jobs as quickly as possible has decreased attention to career development. Jobs are reported to be concentrated at the entry-level with low pay and little security or benefits.


These findings raise questions about the quality of employment being achieved under the new policy, highlight problems with adopting selected components of evidence-based approaches, and begin to explicate the influence that funding structures can have on practice.

Disabilities Emotional disturbance
Populations Male & Female
Outcomes Employment acquisition | Full-time employment | Part-time employment | Wages
Research Design Qualitative
Peer Reviewed Yes