Abstract
Background: Individual placement and support (IPS) has proven to be effective for vocational outcomes in people with mental illness. The original concept of IPS requires temporally unlimited provision of support. Using limited placement budgets and investigating factors that predict their effectiveness may inform decisions about resource allocation. Methods: A range of patient characteristics were tested as predictors of employment outcomes in participants who attended six outpatient psychiatric clinics in Switzerland between June 2010 and May 2011. Overall, 116 patients with the full spectrum of psychiatric conditions were randomly assigned and started an IPS intervention, which was provided by three different placement budgets. Support lasted 2 years for those who found a job, and outcomes were repeatedly assessed over 3 years. The intervention ended for those who failed to find competitive employment by the time their placement budget had run out. Results: Of the 15 variables tested, only Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI) scores were predictors for obtaining work (for ≥1 day) and for maintaining it over a longer period (>3 months). Higher GAF and lower CGI scores increased the odds of obtaining employment and keeping it for at least 3 months. Functional role impairment, quality of life, self-esteem, or education level did not predict employment. Conclusion: Our data suggest that, if time-restricted budgets are offered to a wide range of patients, such as those included in this study, better functioning and lower symptom severity at baseline are predictive of better employment outcomes (finding and maintaining work) on the first (competitive) labor market in Switzerland. It remains to be investigated whether this holds true under different environmental factors. Clinical Trial Registration: ISRCTN, trial number: ISRCTN89670872.
Highlights
Addressing mental ill health among the working-age population has become a key issue for labor market and social policies across Europe [1]
Higher Global Assessment of Functioning (GAF) and lower Clinical Global Impression (CGI) scores increased the odds of obtaining employment and keeping it for at least 3 months
Our data suggest that, if time-restricted budgets are offered to a wide range of patients, such as those included in this study, better functioning and lower symptom severity at baseline are predictive of better employment outcomes on the first labor market in Switzerland
Summary
Addressing mental ill health among the working-age population has become a key issue for labor market and social policies across Europe [1]. In Switzerland, employment rates of people with mental disorders are relatively high compared to those in other European countries. Even under these beneficial circumstances, people with mental illness have an unemployment rate that is almost three times higher than the average population level [2]. The EQOLISE trial has shown IPS to be more effective than vocational services in obtaining employment for patients with severe mental illness in a range of European countries, among those Switzerland [5]. Individual placement and support (IPS) has proven to be effective for vocational outcomes in people with mental illness. Using limited placement budgets and investigating factors that predict their effectiveness may inform decisions about resource allocation
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