Individual placement and support

Individual Placement and Support (IPS) addresses the problem that the majority of mental health service clients do not receive help with finding paid work. The programme embeds employment specialists in clinical treatment teams so that clinical treatment and employment support are integrated and occur in parallel.

Not receiving adequate assistance to find and retain employment, persons with psychosocial disabilities are regularly categorised as unemployable by medical staff and employers. The UK started to address this problem successfully by embedding employment specialists in clinical treatment teams. HISTORY: Individual Placement and Support is a proven methodology, developed in the USA in the 1980s, 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. SUMMARY: Not receiving adequate assistance to find and retain employment, persons with psychosocial disabilities are regularly categorised as unemployable by medical staff and employers. The UK started to address this problem successfully by embedding employment specialists in clinical treatment teams. 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 generalisability of IPS has been demonstrated.

Solution, Innovation and Impact

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. Generalisability Sixteen randomised controlled trials have demonstrated that IPS achieves far superior outcomes across varying social, economic and welfare contexts. 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 individualised support to both the employer and employee, and benefits counselling. A typical IPS case management process follows five steps: Building an understanding of the service user’s needs Developing a clear vocational profile Setting up of a vocational action plan Early job search and placement Giving support ensuring the individual sustains employment. 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, and four are doing excellent work.

Funding, Outlook and Transferability

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