Job support a key to mental health recovery
The place and train approach of individual placement and support (IPS) has proved effective in keeping people with mental health conditions in jobs
To be unemployed is bad for mental and physical health (Wadell and Burton 2006) . Work provides financial independence, structure and purpose, opportunities for socialising and developing new relationships, a sense of identity, self-worth and meaning in life.
People with mental health conditions often see the ability to return to work as a milestone in their recovery (Dunn et al 2008) . Yet for many who use mental health services, the choice and the opportunity to gain or retain employment have been lacking.
The ‘place and train’ approach of individual placement and support (IPS) has proved effective in keeping people with mental health conditions in jobs
To be unemployed is bad for mental and physical health (Wadell and Burton 2006). Work provides financial independence, structure and purpose, opportunities for socialising and developing new relationships, a sense of identity, self-worth and meaning in life.
People with mental health conditions often see the ability to return to work as a milestone in their recovery (Dunn et al 2008). Yet for many who use mental health services, the choice and the opportunity to gain or retain employment have been lacking.
A community mental health survey by the Care Quality Commission (CQC) suggests that NHS mental health services ‘definitely’ gave less than one quarter of service users help or advice on finding support for obtaining or retaining work in the previous 12 months, even though almost half answered, ‘No, but I would have liked help or advice with finding support’ (CQC 2018).
Support sector in the UK is at a turning point
Individual placement and support (IPS) is an evidence-based model to support people with severe and enduring mental health conditions back into employment. Traditionally, services have focused time and other resources on training and supporting people to develop new skills in segregated and sheltered environments.
In contrast, the primary goal of IPS is to find a job and then provide continued support: a ‘place and train’ approach. IPS directly tackles the lack of integration of mental healthcare and employment services and the disconnection of different specialists by integrating employment specialists into community mental health teams.
Dozens of randomised controlled trials show that IPS clients sustain their jobs for longer at a higher pay rate, experience reduced symptoms, have fewer relapses and spend fewer days in hospital (Frederick and VanderWeele 2019). There is only one trial, from mainland China, where IPS was not as effective as traditional employment support (Zhang et al 2017).
The IPS sector in the UK is at a turning point due to the publication of the Five Year Forward View for Mental Health and the NHS Mental Health Implementation Plan 2019-20 to 2023-24, which states that 55,000 people with severe mental illness will have access to IPS services across England by 2023-24.
As a mental health professional, how will this affect me?
The IPS approach is integrated into community mental healthcare, so that employment specialists will be part of care teams, not resources for them.
Mental healthcare professionals such as care coordinators will work with these employment specialists to support clients to:
- Have vocational expectations.
- Find work by coordinating care plans and interventions.
- Solve problems.
- Choose appropriate work.
- Self-manage their conditions including substance use.
- Manage interpersonal issues at work.
- Interact with familial and non-familial social networks.
- Keep a positive frame of mind about their goals.
IPS is expanding rapidly, providing an opportunity for people with severe and enduring mental illness to secure employment if they want it, something they previously might not have thought was an option.
With the NHS commitment to expanding IPS services, there will be an IPS employment specialist positioned in every community mental health team, promoting employment as a health outcome, building hope and providing practical support to make employment realistic and achievable for those who see work as a core part of their recovery.
Miles Rinaldi is head of recovery and social inclusion at South West London and St George's Mental Health NHS Trust
- Care Quality Commission (2018) Community Mental Health Survey 2018
- Dunn E, Wewiorski N, Rogers E (2008) The meaning and importance of employment to people in recovery from serious mental illness: results of a qualitative study. Psychiatric Rehabilitation Journal, 32, 1, 59-62.
- Frederick D, VanderWeele T (2019) Supported employment: meta-analysis and review of randomized controlled trials of individual placement and support. PLoS ONE 14, 2, e0212208. doi.org/10.1371/journal.pone.0212208
- Waddell G, Burton K (2006) Is work good for your health and wellbeing? The Stationery Office, London.
- Zhang G, Tsui C, Lu A et al (2017) Integrated supported employment for people with schizophrenia in mainland China: a randomized controlled trial. American Journal of Occupational Therapy. 71, 7106165020.
Find out more
- Free IPS course (FutureLearn)
- Individual Placement and Support offers route to employment for people with severe mental health conditions (NHS)
- IPS Grow, an NHS England-backed initiative in partnership with South West London and St George’s Mental Health NHS Trust and others to support the growth of IPS services across England
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