Burns Tom, White Sarah J, Catty Jocelyn
Warneford Hospital, University of Oxford, Oxford, UK.
Int Rev Psychiatry. 2008 Dec;20(6):498-502. doi: 10.1080/09540260802564516.
Individual Placement and Support (IPS) has been demonstrated to increase return to open employment significantly in individuals with mental health problems in the USA. Previous experience (e.g. with assertive community treatment) has demonstrated the sensitivity of complex community mental health interventions to local social and healthcare cultures. Europe has conditions of generally greater employment security than the USA, and varying (generally higher) unemployment rates and welfare benefits. Evidence of the effectiveness of IPS in these conditions, and its potential variation across them, would guide local policy and provide possible insights into its mechanism.
We conducted a randomized controlled trial of IPS versus high-quality train-and-place vocational rehabilitation in six European centres with very different labour market and health and social care conditions. A sample of 312 individuals with psychotic illness was randomly allocated (50 per site). Inclusion criteria were a minimum of two years illness duration, with at least one year of continuous unemployment and six months contact with their current mental health services. Follow-up was 18 months. The primary outcome was any open employment, and secondary outcomes included time to employment, duration of employment and hospital admission.
IPS was more effective than the vocational services for all vocational outcomes. 85 IPS patients (54.5%) worked for at least one day compared to 43 vocational service patients (27.6%). They were significantly less likely to have been rehospitalized. Local unemployment rates explained a significant amount of the variation in IPS effectiveness and both national economic growth and welfare systems influenced overall employment rates in both services.
IPS doubles the access to work of people with psychotic illnesses, without any evidence of increased relapse. Its effectiveness is not independent of external circumstances, particularly local unemployment rates.
在美国，已证明个体安置与支持（IPS）能显著提高有心理健康问题者的公开就业回归率。以往经验（如积极社区治疗）表明，复杂的社区心理健康干预措施对当地社会和医疗文化很敏感。欧洲的就业保障总体上比美国更好，失业率和福利水平各不相同（总体较高）。在这些情况下IPS有效性的证据及其在不同情况下的潜在差异，将为地方政策提供指导，并可能为其作用机制提供见解。
我们在六个劳动力市场、健康和社会护理条件差异很大的欧洲中心，对IPS与高质量培训与安置职业康复进行了一项随机对照试验。312名患有精神病的个体样本被随机分配（每个地点50名）。纳入标准为病程至少两年，至少有一年持续失业且与当前心理健康服务机构接触六个月。随访18个月。主要结局是任何形式的公开就业，次要结局包括就业时间、就业时长和住院情况。
在所有职业结局方面，IPS比职业服务更有效。85名接受IPS的患者（54.5%）至少工作了一天，而接受职业服务的患者为43名（27.6%）。他们再次住院的可能性显著更低。当地失业率解释了IPS有效性差异的很大一部分，国家经济增长和福利体系都影响了两种服务的总体就业率。
IPS使精神病患者的就业机会增加了一倍，且没有任何复发增加的证据。其有效性并非独立于外部环境，尤其是当地失业率。
