Supported employment for people with severe mental illness:Systematic review and meta-analysis of the internationalevidence

BackgroundIndividual placement and support (IPS) is a vocational rehabilitationprogramme that was developed in the USA to improve employment outcomesfor people with severe mental illness. Its ability to be generalised toother countries and its effectiveness in varying economic conditionsremains to be ascertained.AimsTo investigate whether IPS is effective across international settings andin different economic conditions.MethodA systematic review and meta-analysis of randomised controlled trialscomparing IPS with traditional vocational services was undertaken; 17studies, as well as 2 follow-up studies, were included. Meta-regressionswere carried out to examine whether IPS effectiveness varied according togeographic location, unemployment rates or gross domestic product (GDP)growth.ResultsThe overall pooled risk ratio for competitive employment using IPScompared with traditional vocational rehabilitation was 2.40 (95% CI1.99–2.90). Meta-regressions indicated that neither geographic area norunemployment rates affected the overall effectiveness of IPS. Even when acountry's GDP growth was less than 2% IPS was significantly moreeffective than traditional vocational training, and its benefits remainedevident over 2 years.ConclusionsIndividual placement and support is an effective intervention across avariety of settings and economic conditions and is more than twice aslikely to lead to competitive employment when compared with traditionalvocational rehabilitation.