Study findings published in JAMA Psychiatry indicated individual placement and support, with and without adding cognitive remediation and work-focused social skills training enhancements, are viable interventions to boost employment and education among people with severe mental illness.
Although previous findings suggest that individual placement and support (IPS) helps people with serious mental illness get employed, many do not accomplish their vocational goals, according to Thomas Nordahl Christensen, PhD, from University of Copenhagen’s Mental Health Centre, Denmark, and colleagues.
“This may be attributable to cognitive impairments and low-social functioning, which are defined as some of the strongest illness-related factors associated with unemployment among people with [serious mental illness],” they wrote. “In accordance, research suggest that IPS enhanced with either cognitive remediation or work-associated social skills training (IPSE) may improve the positive outcomes of IPS.”
In this randomized clinical trial, researchers compared the effects of IPS vs. IPSE vs. service as usual (vocational rehabilitation at job centers) from November 2012 to February 2016, with follow-up until August 2017 in Danish individuals with severe mental illness. Christensen and colleagues reported the number of hours in competitive employment or education during the 18-month follow-up (primary outcome) as well as intergroup differences in employment or education, time to employment or education, cognitive and social functioning, self-esteem, and self-efficacy (secondary outcomes).
Of 720 participants, 551 had a schizophrenia spectrum disorder. On average, participants who received IPS and those who received IPSE worked or studied for more time than those who received service as usual (n = 411 vs. 488.1 vs. 340.8 hours).
The results showed that compared with participants in the service as usual group, those in the individual placement and support group were more likely to work or be enrolled in education (success-rate difference = 0.134; 95% CI, 0.009-0.257) as were those in the IPSE group (success-rate difference = 0.126; 95% CI, 0.003-0.256) over the follow-up period.
In addition, the investigators found no difference between IPS and IPSE in any vocational outcomes nor any differences in nonvocational outcomes in all three groups, except that those who received IPS and IPSE were more satisfied with the services received than those who received service as usual.
“We demonstrate that IPS and IPSE can be implemented effectively in a Scandinavian welfare model with relatively generous social benefits, a high minimum wage, and complex employment legislation,” Christensen and colleagues wrote. – by Savannah Demko
Disclosure: Christensen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.