20 years ago I was working in supported employment for social services, trying to support people with mental health difficulties into work by running a job club, going to the Job Centre each Monday morning to copy details of jobs that were available on the job board, and looking at adverts in the local paper! Discovering the Individual Placement & Support (IPS) model was a revelation.
IPS is an evidence-based model. Instead of weeks and weeks of pre-work training or volunteer placements, IPS focuses on rapidly getting people into a job that suits their individual preferences and then providing ongoing support for the person in work for as long as they need it.
I once heard the model described by Professor Bob Drake (founder of IPS in the US) as a ‘social movement for change’. 20 years of IPS in Europe has indeed equalled two decades of incredible change this side of the pond: social change that has meant real and lasting improvements for people, their families, in clinical attitudes, to the status of employment, funding streams and in societal attitudes.
These 20 years of change have helped people realise their employment goals, transformed clinical viewpoints, negotiated employment to be accepted as a health outcome, and improved practice and closer working with treatment teams in supporting people not only to gain work but to sustain it positively.
Research has played a major part in shaping the IPS map of Europe. At first slowly and now rapidly, it has become the preferred and accepted model of supported employment, not only for people living with severe mental illness but also for people with other support needs. Evidence from 28 randomised controlled trials has demonstrated that IPS outperforms other quality supported employment models every time. IPS not only improves job outcomes but has demonstrated improved health outcomes. People find work more quickly, have better job tenure, drop out less, and are less likely to need an inpatient stay in hospital.
At the Centre we continue to play an active role in advocating for IPS as the best model for employment support. Using information from our own and international research, we continue to highlight its importance in supporting people with a mental health difficulty to have an equitable and fair opportunity to secure meaningful paid employment.
The Government’s Back to Work Plan, announced last week, has made a welcome pledge to expand IPS across the country, enabling more people to get support to find meaningful employment when they want to. But parallel plans to increase the threat of benefit sanctions are extremely worrying, as these can be incredibly harmful to people’s mental health and do nothing to help people find work.
Centre for Mental Health has been at the leading edge of IPS’s rollout across the UK. Reflecting on my own humble part in the changes, I have been involved in trialling IPS in community mental health services, and in supporting third sector providers to set up new services. We have also delivered training to teams trialling IPS for people accessing drug and alcohol services, as well as supporting an IPS trial in primary care. The evidence was so strong that it worked in mental health and now it is clear that it works well for people with other needs.
The Centre ran a pilot “Making IPS Work” funded by Department of Health in six areas across the UK in 2015 to evaluate what would help with implementation and the national scale up of IPS. I was an implementation manager of one of those six pilot sites (and a fledgling IPS trainer and reviewer). Thinking back to that time, convincing people to trust in the IPS model was a challenge and the research evidence was a key element in assuring both employment teams and clinical teams of its effectiveness. What was clear from the trials was the importance of good integration with clinical teams, having IPS champions at all levels of an organisation, partnership working, change management skills, good levels of training, and additional resource to support high quality implementation, which enabled a shift in culture and practice. These points are resurfacing with the implementation of IPS in the new settings.
The third IPS Europe conference was held earlier this year at the University of Bologna in Rimini, Italy, one of the original EQOLISE trial sites which began 20 years ago. The six sites were Bulgaria, England, Germany, Italy, Netherlands and Switzerland. We heard from Professor Tom Burns about the rationale for the EQOLISE trial to see if the US model could work in Europe, given its higher rates of welfare provision and increased employment protection. Results showed that 54.5% of people gained employment using IPS, compared to 27.6% of people being supported in an alternative employment programme.
One of the emergent themes from the conference was quality. How do we ensure that we work closely to the IPS model? Quality assurance has always come from conducting fidelity reviews. The controversial question was posed: if a service achieves good outcomes and the clients are happy, do we need to conduct reviews? How do we continue to finance reviews? If we were to stop conducting fidelity reviews, we cannot ensure that people are working to the IPS model.
Advances in technology, collaborative working with DWP partners, shared resources on the Future NHS platform and support from IPS Grow teams have enabled teams to work smarter, have a greater reach and ultimately support more people into better quality employment. Who knows what impact generative AI may bring to IPS?
Funding remains one of the ongoing challenges for all countries with the exception of Norway, who shared with us that funding for IPS would rank them 33rd in the world if they were a state!
One of the key principles of IPS is zero exclusion. With many countries reporting waiting lists (some of up to nine months for services), are we actively reaching out to all client groups representative of local populations? What has happened to people that were looking for work before Covid but are now too anxious to start looking for work again?
How can we as an IPS community continue this social movement for change? How can we use our collective knowledge and data to shape and influence the best quality supported employment practice to support more people into good quality and sustainable work?
So much has happened over the last 20 years. I’m excited to see the change that will happen over the next 20 years, albeit from the comfort of retirement. We have travelled far in the IPS journey but more is still to come.