Individual Placement and Support: The Most Evidence-Based Employment Intervention in Mental Health

The Evidence Base

Individual Placement and Support (IPS) has the strongest evidence base of any employment intervention for people with mental health conditions. The core finding — that rapid placement in competitive employment with integrated clinical support produces far higher employment rates than traditional pre-vocational training and sheltered rehabilitation — has been tested in 28 randomised controlled trials so far.

The key numbers from the global evidence base:

IPS employment rate: on average 55% of IPS participants achieve competitive employment across 28 RCTs
Comparison employment rate: on average 25% in control groups
Relative risk: about 2.1–2.4 — people in IPS are roughly twice as likely to gain competitive employment (pooled risk ratios of 2.07 across 27 RCTs, Brinchmann et al. 2020, and 2.40 across 17 RCTs, Modini et al. 2016)

The Cochrane review (Kinoshita et al., 2013) found that supported employment increased the chance of getting any job (risk ratio 3.24), but rated the evidence as very low quality, mainly because of bias risks in individual studies. Larger, later meta-analyses are more conclusive: a review of 27 RCTs found that IPS more than doubles employment rates and concluded that "the evidence for efficacy of IPS is very strong" (Brinchmann et al., 2020).

What IPS Is

IPS is based on eight principles, set out by the IPS Employment Center; how faithfully a service follows the model is rated with the 25-item IPS Fidelity Scale (IPS-25):

1. Zero exclusion: Nobody who wants to work is turned away on the basis of readiness, diagnosis, symptoms, substance use history, psychiatric hospitalisations, homelessness, level of disability or involvement with the justice system

2. Competitive employment focus: The goal is ordinary jobs paying market wages, not sheltered work or volunteer positions

3. Integrated services: IPS employment specialists are embedded within clinical mental health teams, not separate

4. Attention to client preferences: Jobs are sought that match the individual's preferences, not predetermined by the programme

5. Benefits counselling: Every client receives individualised advice on how employment affects their benefits

6. Rapid job search: Job search starts straight away rather than after lengthy assessment or training — the first face-to-face contact with an employer happens within 30 days

7. Systematic employer engagement: Employment specialists maintain ongoing relationships with employers, not one-off job placement

8. Time-unlimited support: Support continues as long as the client wants it, including after job placement

European Evidence

The European evidence base for IPS has grown substantially since the EQOLISE trial in 2007:

EQOLISE trial (six-country European RCT, Burns et al., Lancet 2007): The first large European IPS trial. Across six sites (London, Ulm-Günzburg, Zurich, Groningen, Rimini and Sofia), 55% of IPS participants worked in a competitive job for at least one day during 18 months, compared with 28% in standard vocational services. IPS outperformed vocational services overall, but its advantage varied between sites: local unemployment rates explained a substantial part of that variation.

Norwegian RCT (Reme et al., Scandinavian Journal of Work, Environment & Health, 2019): Conducted in Norway, which has a comprehensive welfare system and strong employment protection — a context in which IPS had not been tested before. Result: 36.6% IPS vs 27.1% control at 12 months, with the advantage maintained at 18 months (37.4% vs 27.1%). The effect size is more modest than in some other national trials, but the direction and persistence of the advantage held.

England: Since 2018, IPS has been scaled up as a core part of the transformation of community mental health services in England, with national implementation support from IPS Grow (commissioned by NHS England and the Department for Work and Pensions). An evaluation of a high-fidelity IPS service in South West London, covering everyone who used it between April 2022 and March 2023 (539 people), found that 46% gained or kept a job or were supported into education, which the authors note is in line with outcomes reported across Europe.

Netherlands (Michon et al., Psychiatric Rehabilitation Journal, 2014): A multisite RCT by researchers from the Trimbos Institute, University Medical Center Groningen and Phrenos, comparing IPS with traditional vocational rehabilitation among 151 people with severe mental illness. Over 30 months, 44% of IPS participants found competitive work, compared with 25% in the comparison group.

Why European Implementation Lags the Evidence

Despite the evidence, IPS is not yet standard care across Europe. England and Norway have scaled it up nationally: in Norway, IPS was available in all 19 counties by 2019, and in both countries about 9% of people in contact with mental health services now access it — a large increase, but still a minority of those who might benefit.

Fidelity: Keeping to the model takes ongoing effort, which is why England and Norway use independent fidelity reviews as services expand.

The Economic Case

IPS is not only more effective than traditional rehabilitation — it is also more cost-effective.

A 2013 economic analysis of the six-country EQOLISE trial (Knapp et al., World Psychiatry) found that IPS produced better employment outcomes at lower overall cost to health and social care systems, at five of the six sites. Rather than a quality-adjusted-life-year framework, it measured cost per additional day worked and per additional percentage point of people who worked at least one day. The IPS service itself was also cheaper on average than the vocational services it was compared with (by about £4,000 per person over 18 months, in 2003 prices). The authors concluded that IPS is "probably cost-saving and almost certainly more cost-effective".

The Recommendation

The evidence is sufficiently strong to move from "promising intervention" to "should be the standard of care" for employment support for people with severe mental health conditions. This requires:

1. National policy commitments: IPS should be a standard part of mental health care, as England has made it a core part of community mental health services

2. Integrated funding streams: Joint health-employment funding for IPS employment specialists, removing the bureaucratic barrier to integration

3. Fidelity infrastructure: Independent fidelity review should be required for any programme using the IPS name, as England's national IPS programme already does

4. Scale: Norway shows both the challenge and the possibility. Between 2012 and 2019, the number of IPS units grew from 5 to 55. IPS spread from 4 to all 19 counties, and the share of people living in an area where it was offered rose from 15% to more than 70%. Even so, only around 9% of people using mental health services in Norway and England access IPS.

Sources: IPS Employment Center, Evidence for IPS; Modini et al., British Journal of Psychiatry 2016; Brinchmann et al., Acta Psychiatrica Scandinavica 2020; Kinoshita et al., Cochrane Database of Systematic Reviews 2013; Burns et al., Lancet 2007 (EQOLISE); Knapp et al., World Psychiatry 2013; Reme et al., Scandinavian Journal of Work, Environment & Health 2019; Michon et al., Psychiatric Rehabilitation Journal 2014; Christensen et al., JAMA Psychiatry 2019; Rinaldi et al., BJPsych Bulletin 2025; Aars et al., International Journal of Public Health 2025.