Individual Placement and Support in Sweden—A randomized controlled trial

Abstract

Background: Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden. Aims: To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect. Methods: A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024. Results: One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18–54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this. Conclusions: IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.

• Community integration
• Severe mental illness
• Supported employment
• Vocational rehabilitation

Acknowledgements

Financial support for this study was provided by a grant from the Swedish Research Council for Health, Working life and Welfare, and FINSAM. The Medical Faculty of Lund University and Vårdalinstitutet contributed with the funding of researchers’ and research assistants’ wages. The authors wish to thank all participants, staff in the mental healthcare, Social Insurance Agency and Public Employment Office for being generous. Thanks are especially due to the late Associate Professor Tommy Björkman for being supportive and generous, and Professor Ingalill Rahm Hallberg for providing a critical research environment, and Ph.D. in mathematical statistics Anna Lindgren.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.