Randomized controlled trial of supported employment in England: 2 year follow‐up of the Supported Work and Needs (SWAN) study

Abstract

Studies from North America have concluded that supported employment using the Individual Placement and Support (IPS) model is effective in helping individuals with severe and persistent mental illness gain competitive employment. The aim of this study was to investigate the effectiveness and cost-effectiveness of IPS in England in patients followed up for 2 years. Patients with severe mental illness were randomised to IPS or local vocational services (treatment as usual). Service use and costs were measured. Two hundred-nineteen participants were randomised, and 86% re-assessed 2 years later. In the multivariate analysis, relatively low rates of competitive employment were found in both the intervention group and the treatment as usual group, although significantly more patients obtained competitive employment in the treatment arm (22% vs. 11%, p=0.041). There were no significant differences in costs. The employment rate among participants receiving IPS was lower than in previously published reports, and the number needed to treat to obtain the benefit of IPS was relatively high. This may reflect difficulties in the implementation of IPS where it is not structurally integrated within mental health teams, as well as economic disincentives which lead to lower levels of motivation for patients and mental health professionals.

Work as treatment? The effectiveness of re-employment programmes for unemployed persons with severe mental health problems on health and quality of life: a systematic review and meta-analysis

“…Six studies measured psychiatric symptoms and the pooled effect size was 0.20 (95% CI −0.23 to 0.62) (figure 4). 17 18 27 29 30 34 Within these studies, the percentage of competitive employment ranged from 13% to 55% in the intervention groups compared to 2% to 28% in the control groups. The meta-regression analysis showed that studies with over 50% of male participants had a lower effect size of mental health (β −1.43, 95% CI −2.12 to −0.74).…”

“…Five studies, describing six comparisons, provided enough information to calculate effect sizes, ranging from −0.12 to 0.09, all not statistically significant (figure 3). 17 18 27 29 30 The pooled effect size was −0.01 (95% CI −0.13 to 0.11). Within these studies, the percentage of competitive employed ranged from 13% to 55% in the intervention groups compared to 6% to 28% in the control groups.…”

A meta‐regression of the impact of policy on the efficacy of individual placement and support

“…Eighty‐eight articles met initial criteria and then full texts were examined, whereof 30 studies met our full criteria. Hoffmann et al and Howard et al and Heslin et al report the efficacy of IPS for the same patient population at two follow‐up periods, so we only included the latter study from both in our meta‐analysis. The meta‐analysis is based on 27 studies (Fig.…”

Health and well-being of homeless veterans participating in transitional and supported employment: Six-month outcomes

“…Nor have advantages been found for IPS in studies that specifically evaluated psychiatric symptoms [39-42], quality of life [39,[41][42], self-esteem [40], global functioning [40][41][42], relapses [41], coping [41], social support [42], or substance misuse [42]. When differences on non-vocational outcomes have been identified, they have been small [20] or possibly due to baseline differences and resultant regression to the mean [42].…”