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Individual placement and support in Europe: the EQOLISE trial


Burns, T; White, S J; Catty, J (2008). Individual placement and support in Europe: the EQOLISE trial. International Review of Psychiatry, 20(6):498-502.

Abstract

BACKGROUND: Individual Placement and Support (IPS) has been demonstrated to increase return to open employment significantly in individuals with mental health problems in the USA. Previous experience (e.g. with assertive community treatment) has demonstrated the sensitivity of complex community mental health interventions to local social and healthcare cultures. Europe has conditions of generally greater employment security than the USA, and varying (generally higher) unemployment rates and welfare benefits. Evidence of the effectiveness of IPS in these conditions, and its potential variation across them, would guide local policy and provide possible insights into its mechanism. METHODS: We conducted a randomized controlled trial of IPS versus high-quality train-and-place vocational rehabilitation in six European centres with very different labour market and health and social care conditions. A sample of 312 individuals with psychotic illness was randomly allocated (50 per site). Inclusion criteria were a minimum of two years illness duration, with at least one year of continuous unemployment and six months contact with their current mental health services. Follow-up was 18 months. The primary outcome was any open employment, and secondary outcomes included time to employment, duration of employment and hospital admission. FINDINGS: IPS was more effective than the vocational services for all vocational outcomes. 85 IPS patients (54.5%) worked for at least one day compared to 43 vocational service patients (27.6%). They were significantly less likely to have been rehospitalized. Local unemployment rates explained a significant amount of the variation in IPS effectiveness and both national economic growth and welfare systems influenced overall employment rates in both services. CONCLUSIONS: IPS doubles the access to work of people with psychotic illnesses, without any evidence of increased relapse. Its effectiveness is not independent of external circumstances, particularly local unemployment rates.

Abstract

BACKGROUND: Individual Placement and Support (IPS) has been demonstrated to increase return to open employment significantly in individuals with mental health problems in the USA. Previous experience (e.g. with assertive community treatment) has demonstrated the sensitivity of complex community mental health interventions to local social and healthcare cultures. Europe has conditions of generally greater employment security than the USA, and varying (generally higher) unemployment rates and welfare benefits. Evidence of the effectiveness of IPS in these conditions, and its potential variation across them, would guide local policy and provide possible insights into its mechanism. METHODS: We conducted a randomized controlled trial of IPS versus high-quality train-and-place vocational rehabilitation in six European centres with very different labour market and health and social care conditions. A sample of 312 individuals with psychotic illness was randomly allocated (50 per site). Inclusion criteria were a minimum of two years illness duration, with at least one year of continuous unemployment and six months contact with their current mental health services. Follow-up was 18 months. The primary outcome was any open employment, and secondary outcomes included time to employment, duration of employment and hospital admission. FINDINGS: IPS was more effective than the vocational services for all vocational outcomes. 85 IPS patients (54.5%) worked for at least one day compared to 43 vocational service patients (27.6%). They were significantly less likely to have been rehospitalized. Local unemployment rates explained a significant amount of the variation in IPS effectiveness and both national economic growth and welfare systems influenced overall employment rates in both services. CONCLUSIONS: IPS doubles the access to work of people with psychotic illnesses, without any evidence of increased relapse. Its effectiveness is not independent of external circumstances, particularly local unemployment rates.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Clinical and Social Psychiatry Zurich West (former)
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2008
Deposited On:29 Jan 2009 13:16
Last Modified:18 Feb 2018 10:41
Publisher:Informa Healthcare
ISSN:0954-0261
OA Status:Closed
Publisher DOI:https://doi.org/10.1080/09540260802564516
PubMed ID:19085404

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