IPS study across six European countries

A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support (IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, the economic case for IPS for people with severe mental health problems was investigated compared to standard vocational rehabilitation.

In the EQOLISE trial, 312 individuals with severe mental illness (schizophrenia and schizophrenia-like disorders, bipolar disorder, or depression with psychotic features, using IDC-10 criteria) were randomly assigned to receive either IPS (n=156) or standard vocational services (n=156). The sample was drawn from six European cities: Groningen (Netherlands), London (UK), Rimini (Italy), Sofia (Bulgaria), Ulm-Günzburg (Germany), and Zurich (Switzerland). People who entered the trial had been ill and experiencing major difficulties accomplishing normal roles for at least 2 years and had not been employed for at least 1 year. They were followed for 18 months.

The EQOLISE trial found that IPS was more effective than vocational services for every vocational outcome studied: 85 (55%) of the individuals assigned to IPS worked for at least 1 day during the 18-month follow-up period compared with 43 (28%) individuals assigned to vocational services. Individuals assigned to vocational services were significantly more likely to drop out of the service (45%) and to be readmitted to hospital (31%) than people in the IPS arm of the trial (13% and 20%, respectively). The trial also found that context was important, with local unemployment rates explaining a substantial proportion of the observed variation in IPS effectiveness.