Abstract
Objective: To examine the feasibility of conducting a fully powered randomized controlled trial (RCT) of Individual Placement and Support (IPS). IPS is a form of supported employment which aims to put people into open employment quickly and in accordance with their preferences. It is delivered by employment specialists collocated within clinical teams, and provides time unlimited support for the individual and their employer, along with welfare benefits counselling. Method: A feasibility cluster RCT of treatment as usual (TAU) plus IPS versus TAU alone was conducted over 12 months among patients with offending histories in a community forensic setting in the UK. The feasibility criteria were to achieve 50% recruitment rate; 50% completion rate for IPS; 50% completion rate of all outcome measures; and 80% acceptability rating for IPS. The primary efficacy outcome was the proportion of people in open employment at 12 months. The secondary outcomes were other vocational and educational activities; Brief Psychiatric Rating Scale; Rosenberg’s Self-esteem Scale; Client Service Receipt Inventory; quality of life using the SF12-v2 and EQ5-D3; Social Functioning Questionnaire; Work Limitation Questionnaire; and reoffending. Results: Participants’ mean age was 39.2 years. The majority were male (88.9), White British (72.2), and single (72.2%). Over 72% had no higher qualification beyond secondary education; mean years in education was 10.4. Over one third had schizophrenia, one fifth had depression, and the rest had personality disorder as their primary diagnosis. Participants had a lifetime average of 7.5 convictions for 15.5 offences. The recruitment rate of all referrals was 38.3% (IPS n = 11; TAU n = 7). Completion rate for IPS was 54.5, with 45.5% acceptability rating. Completion rates for outcome measures for the groups at baseline and 12 months ranged from 22.2 to 100%. The proportion of people in open employment at 12 months were 9.1 and 0% for IPS and TAU respectively. Conclusion: It is not feasible to conduct a full RCT of IPS in community forensic settings in the UK owing to recruitment and retention difficulties. Conducting a trial of this kind requires a large pool of patients from multiple sites and longer IPS implementation and recruitment periods than those of this study. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02442193.
Highlights
Mental Disorders Among OffendersIn the UK, 1 in 5 people who are of working age have mental health problems [1]
Based on the recruitment rate in another Individual Placement and Support (IPS) trial in general community mental health settings in the same city [41], and feasibility criteria set out by another trial in the same service in which the feasibility study was conducted [42], we proposed that a definitive trial would be considered feasible if: 1. The recruitment rate to the project was at least 50% of all referrals
The findings of this study suggest that it is not feasible to conduct a full cluster randomized controlled trials (RCTs) to assess the effectiveness of IPS in community forensic psychiatric settings in the UK
Summary
Mental Disorders Among OffendersIn the UK, 1 in 5 people who are of working age have mental health problems [1]. Unemployment is highly prevalent among people discharged from forensic mental health services in the UK These services provide psychiatric treatment for individuals with both mental disorders and offending histories ( referred to as patients with offending histories) in secure forensic hospital and community settings. Davies and colleagues [10] reported on the long-term outcomes of 550 patients discharged from a medium secure unit in England over a 20-year period. They reported that only 14.5% were in competitive employment which was mostly provided by relatives. Using data from the same study, Sahota et al [11] reported that only 13.5% of women secured employment over the same follow-up period
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