IPS Supported Employment for Severe Mental Illness
Dartmouth Psychiatric Research Center / SAMHSA · Multiple US cities and international sites · 1996
Summary
IPS Supported Employment challenged the conventional wisdom of psychiatric rehabilitation, which held that people with severe mental illness needed extensive skills training before they could handle competitive work. The IPS model turned this sequence upside down: place people in real jobs immediately, and provide support in the actual work environment. Across 11 randomized trials on three continents, IPS consistently doubled or tripled competitive employment rates compared to traditional approaches. The key insights are behavioral: people learn job skills better on the job than in training programs, rapid placement prevents demoralization from prolonged non-employment, and integrated support eliminates the coordination failures between employment and mental health services that derail traditional approaches. The finding that employment rates improve substantially without worsening psychiatric symptoms — and in some trials improving them — overturned the clinical assumption that work would be too stressful for people with severe mental illness.
Research question
"Does Individual Placement and Support — immediately placing people with severe mental illness in competitive jobs while providing ongoing support — achieve higher employment than traditional vocational rehabilitation (skills training first, then job search)?"
Methodology
Intervention
IPS model: rapid placement into competitive employment (real jobs, regular wages) with no prerequisite skills training; integrated mental health and employment services; job coaches provide on-the-job support; ongoing support with no time limit; zero exclusion (anyone who wants to work can participate). Compared to standard vocational rehabilitation: group skills training, sheltered workshops, gradual approach.
Assignment
Randomized controlled trials; Drake et al. (1996) original RCT (143 participants, New Hampshire); Crowther et al. (2001) UK RCT; Johnson (2009) 6-country international trial (1,273 participants); systematic review: Bond et al. (2008) identified 11 RCTs
Sample size
Pooled: approximately 2,500 participants across 11 RCTs in US, UK, Europe, and Australia
Primary outcome
Competitive employment (real job, regular pay) at 18-month follow-up; hours worked; wages; job tenure
Effect estimate
Competitive employment at 18 months: 61% IPS vs. 23% standard vocational rehabilitation (original US RCT); international multi-site trial: 55% vs. 28%; meta-analysis across 11 RCTs: IPS approximately doubles competitive employment rates; no significant difference in psychiatric hospitalizations or symptoms
Decision
IPS adopted by SAMHSA as evidence-based practice; VA implemented IPS across 3,200 veterans with mental illness; UK NHS rolled out IPS nationally with Parliamentary mandate; evidence base considered strongest in psychiatric rehabilitation; IPS implementation fidelity scale developed to maintain model integrity across settings
Result
Positive
Competitive employment at 18 months: 61% IPS vs. 23% standard vocational rehabilitation (original US RCT); international multi-site trial: 55% vs. 28%; meta-analysis across 11 RCTs: IPS approximately doubles competitive employment rates; no significant difference in psychiatric hospitalizations or symptoms
Evidence strength
Strong
Randomized trial, replicated across multiple sites or studies.
Replication status
Replicated
Institution
Dartmouth Psychiatric Research Center / SAMHSA
Location
Multiple US cities and international sites
Year
1996
Policy area
Public Health
Mechanism
Human capital