Innovative Policy 2013 on Employment

UK’s individual placement and support system

Not receiving adequate assistance to find and retain employment, persons with psychosocial disabilities are regularly categorized as unemployable by medical staff and employers. The UK started to address this problem successfully by embedding employment specialists in clinical treatment teams.

Individual Placement and Support
Founded on:1998
Country/Region
of origin
United Kingdom
Beneficiaries targetedPersons with mental health conditions in (primary and) secondary care.
Responsible bodyDepartment of Health, National Health Services, Department for Work and Pensions
StakeholdersPublic sector (National Health Services)

IN BRIEF

Piloted in the UK in 1998, Individual Placement and Support (IPS), also known as evidence-based supported employment, addresses the problem that the majority of mental health service clients do not receive help with finding paid work. Based on the rationale that everyone is capable of working in the open labour market if the right work is found, the programme, most importantly and unlike the traditional sequential rehabilitation approach, embeds employment specialists in clinical treatment teams so that clinical treatment and employment support are integrated and occur in parallel. The generalizability of IPS has been demonstrated.

FACTS & FIGURES

  • An average of 61% of people with psychosocial disabilities can successfully gain open competitive employment using IPS, as compared with 23% for traditional vocational rehabilitation services.
  • Furthermore, drop-out rates are far lower; people sustain their jobs for longer, work more hours and earn more. Among those who gain employment, mental health service usage and costs decrease significantly.
  • The majority of people find part-time employment.
  • Since the establishment of the centre for excellence, 12 out of 50 National Health Services trusts offer IPS, four are doing excellent work.

INNOVATIVE ASPECTS

Focusing on abilities
The overriding philosophy of IPS is that anyone is capable of working competitively in the community if the right kind of job can be found and the right kind of support provided.

Adherence to a principled methodology
Principles include competitive employment as the primary goal, employment support along with clinical treatment and respect of the individual’s choice.

Sustainable use of financial resources
The savings for inpatient costs, over an 18-month period, were calculated at around £6,000 per person, with evidence suggesting that further, long-term savings could accrue.

Generalizability
Sixteen randomised controlled trials have demonstrated that IPS achieves far superior outcomes across varying social, economic and welfare contexts.

HISTORY

Individual Placement and Support is a proven methodology, developed in the USA in the ‘80s, whereby employment specialists are integrated into mental health teams to support service users to return to work. In 1998, a pilot programme in the National Health Service trust of South West London was implemented and proved its successfulness, which led to the introduction of IPS into a series of policy documents recommending its use: the Mental Health and Social Exclusion Report of the Social Exclusion Unit of the UK Office of the Deputy Prime Minister in 2004, the Commissioning Guidance of the UK Department of Health in 2006, as well as the Action Plan for Social Exclusion of the Prime Minister’s Strategy Unit of the UK Cabinet Office in 2006. Most importantly, in 2007, the number of secondary mental health services users in employment became a national indicator on which all mental health trusts needed to report data. In 2009, an independent review of the Department for Work and Pensions reiterated the IPS Guidance to Commissioners, which was reaffirmed by the Government’s strategy No Health without Mental Health and its supporting document, where IPS was recommended as an effective vocational support and skills development service. The next step was to set up the centre of excellence (2009) and a programme to train employment specialists at the London Metropolitan University.

«By revolutionizing traditional thinking, Individual Placement and Support is a compelling bridge for most people with psychosocial disabilities who have always wished to find and retain employment. »

Rachel Perkins, Chair of Equality 2025

KEY FEATURES

Individual Placement and Support helps persons with psychosocial disabilities in (primary and) secondary care to get open, competitive employment, commensurate with their interests and preferences as quickly as possible, and provides all the support, (ideally) as long as necessary, that both the individuals and their employers need to make a success of the employment. IPS consists of the adherence to seven principles. The most important principle is, unlike the traditional sequential approach, to embed employment specialists in clinical treatment teams so that clinical treatment and employment support are integrated and occur in parallel. The other principles include competitive employment as the primary goal, rapid job search consistent with individual preferences, time-unlimited and individualized support to both the employer and employee, and benefits counselling. A typical IPS case management process follows five steps: firstly, building an understanding of the service user’s needs; secondly, developing a clear vocational profile; thirdly, setting up of a vocational action plan; fourthly, early job search and placement; and, finally, giving support ensuring the individual sustains employment.

FUTURE DEVELOPMENT

IPS cannot be imposed on mental health trusts because of the decentralized National Health System. Attitudinal barriers amongst mental health staff and lack of funding limit the IPS’s potential.

CONTACT

Ms. Rachel PERKINS
Chair of Equality 2025 and former Director of Quality Assurance and Service User Experience at South West London & St George’s Mental Health NHS Trust
+44 20 87 67 09 10
rachel.e.perkins1@btinternet.com
www.odi.dwp.gov.uk/equality-2025/index.php


Mr. Miles RINALDI
Head of Recovery and Social Inclusion at South West London &. St George’s Mental Health NHS Trust
+44 20 35 13 50 00
Miles.Rinaldi@swlstg-tr.nhs.uk
www.swlstg-tr.nhs.uk


Mr. Geoff SHEPERD
Senior Policy Adviser, Centre for Mental Health
+44 20 78 27 83 00
Geoff.Shepherd@centreformentalhealth.org.uk
www.centreformentalhealth.org.uk

SOURCES

Miles Rinaldi et al, Individual placement and support: from research to practice, Advances in Psychiatric Treatment 14 (2008), available at: http://apt.rcpsych.org/content/14/1/50.abstract

Department for Work and Pensions, A review to Government by Rachel Perkins, Paul Farmer and Paul Litchfield, Realising ambitions: Better employment support for people with a mental health condition, December 2009, available at: http://www.dwp.gov.uk/policy/welfare-reform/legislation-and-key-documents/realising-ambitions/

Nominated by: Ms. Marion WILKINSON, National Disability Authority