Despite the high rate of unemployment, it has been reported that most clients with severe mental illness want to work3637
Evidence shows that people are far more likely to recover from mental health problems if they are in employment than if they are not [80% and 22% respectively over 18 month follow-up38.
NICE recommends that supported employment programmes should be provided for people with schizophrenia who wish to return to work or gain employment. However, they should not be the only work-related activity offered when individuals are unable to work or are unsuccessful in their attempts to find employment.
Prevocational training includes sheltered workshops, transitional or trial employment, volunteer placement, skills training, and other preparatory activities. These programs consist of the traditional, stepwise, and “train then place” approach39.
Individual Placement and Support (IPS) employment programs place clients on competitive jobs without extended preparation. Rapid job search and attainment by matching clients to jobs based on their interests and skills take place prior to teaching them new skills to prepare for future jobs40. There is International evidence that people supported into regular employment via IPS had fewer, shorter stays in hospital with an associated reduction in cost than those who are not41. However, in recent studies, IPS wasn’t able to have the positive effect on employment in the UK setting seen in the US and other European countries, possibly because of factors related to the welfare benefit system42.
The IPS model uses assertive outreach, based on the assertive community treatment case-management model for severe mental illness)43 and is the most widely studied approach to supported employment44. In IPS, employment specialists provide a full range of vocational services to each client, including engagement in services, identifying job interests and vocational assessment, job finding, and job support.
The emphasis on providing community-based services in IPS may be especially critical for the retention of clients in vocational services, whose motivation to work may fluctuate over time45, and for whom assertive outreach may provide a critical bridge to maintaining continuity of services. Although IPS helps people get jobs, IPS may not help them retain them44. Nearly half of supported employment participants do not obtain competitive work at any time during the periods studies have covered39.
Social firms provide employment and are a popular European model4647. Clubhouse, US user-led projects, in two studies had good employment outcomes with better tenure and pay than the comparison IPS intervention41.