Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence

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Individual placement and support (IPS) is a vocational rehabilitation programme that was developed in the USA to improve employment outcomes for people with severe mental illness. Its ability to be generalised to other countries and its effectiveness in varying economic conditions remains to be ascertained.


To investigate whether IPS is effective across international settings and in different economic conditions.


A systematic review and meta-analysis of randomised controlled trials comparing IPS with traditional vocational services was undertaken; 17 studies, as well as 2 follow-up studies, were included; 4 studies in Asia and Australia, 6 in Europe and 9 in North America. Meta-regressions were carried out to examine whether IPS effectiveness varied according to geographic location, unemployment rates or gross domestic product (GDP) growth. The first meta-analysis was to determine the effectiveness of IPS compared with traditional rehabilitation. Meta-regressions analysed associations between IPS and region of origin, unemployment rate and GDP (gross domestic product) growth (total value of goods produced and services provided in a country annually, obtained from World bank database). The second and third meta-analyses determined whether IPS effects would remain stable over a 2-year period. Main outcome was measured as binary (yes/no), so could be calculated as Risk Ratios (RRs). This essentially calculated the likelihood of successfully entering competitive employment using IPS relative to traditional rehabilitation models.


The overall pooled risk ratio for competitive employment using IPS compared with traditional vocational rehabilitation was 2.40 (95% CI 1.99–2.90). Meta-regressions indicated that neither geographic area nor unemployment rates affected the overall effectiveness of IPS. Even when a country's GDP growth was less than 2% IPS was significantly more effective than traditional vocational training, and its benefits remained evident over 2 years.


Overall, Individual Placement and Support was effective in helping individuals with severe mental illness to gain competitive employment across multiple settings when compared with traditional vocational rehabilitation. Those in the IPS group were more than twice as likely to get employment, regardless of country, unemployment rate, or GDP. Furthermore, these effects remained stable over a 2-year period. Although IPS was slightly less effective during times of economic downturn, it still remained significantly more effective than traditional rehabilitation.