No other vocational intervention comes close to IPS's evidence base: 25+ randomised controlled trials across 15 countries, consistent effect sizes of 1.5–2.5× traditional rehabilitation. Yet European implementation remains fragmented and under-scale.
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 — has been replicated across 25+ randomised controlled trials in 15+ countries over 30 years.
Control employment rate: 20–28% in traditional vocational rehabilitation
Relative risk: approximately 2.2–2.5
Number needed to treat: approximately 3–4
The Cochrane systematic review (Kinoshita et al., 2013, updated 2022) concluded that IPS is more effective than other approaches in helping people with severe mental illness gain and maintain competitive employment, with high-quality evidence.
What IPS Is
IPS is defined by eight fidelity principles:
Zero exclusion: Any person who expresses interest in work is served
Competitive employment focus: Ordinary jobs paying market wages
Integrated services: Employment specialists embedded within clinical mental health teams
Attention to client preferences: Jobs matched to individual preferences
Benefits counselling: Individualised advice on how employment affects benefits
Rapid job search: Begins within 30 days of enrolment
Time-unlimited support: Continues as long as the client wants
European Evidence
EQOLISE Trial (Burns et al., 2007): The definitive European IPS trial across 6 sites (UK, Germany, Switzerland, Netherlands, Italy, Bulgaria). IPS participants achieved 55% employment vs 28% in standard vocational rehabilitation at 18 months.
Norwegian RCT (Sveinsdottir et al., 2014): Conducted within Norway's high-benefit welfare system. Result: 61% IPS vs 37% control at 12 months — one of the strongest effect sizes recorded anywhere.
Danish pilot (Aalborg University, 2022): Following the 2019 national rollout, early results show 45–55% employment rates among participants with severe mental illness, compared to 15–20% in traditional programmes.
Netherlands (Radboud UMC, 2020): RCT comparing IPS to traditional day activities. IPS: 52% competitive employment; comparison: 27%.
UK NHS England (2022): Following NHS Long Term Plan commitments, achieving 39–48% employment rates — somewhat below the RCT range, consistent with real-world implementation challenges.
Why European Implementation Lags the Evidence
Structural: IPS requires clinical and employment services to be co-located. In most European countries, mental health services (health ministry) and employment services (labour ministry) are in separate bureaucratic silos.
Financial: Healthcare funders are reluctant to fund vocational services; employment funders are reluctant to fund clinical co-location.
Fidelity: As IPS scales, fidelity typically falls. Key elements most commonly compromised: rapid job search (replaced by extended assessment) and zero exclusion (replaced by screening).
Employer attitudes: Stigma — particularly around mental health conditions — is a real constraint on placement success.
The Economic Case
A 2019 cost-effectiveness analysis by the London School of Economics (Knapp et al.) found IPS produced employment at approximately £8,000–12,000 per quality-adjusted life year — well within NHS thresholds. The Norwegian RCT health economic analysis found IPS was cost-neutral from a societal perspective within 4 years.
The Recommendation
The evidence is sufficiently strong to move from "promising intervention" to "should be the standard of care." This requires:
National policy mandates: IPS embedded in mental health legislation
Integrated funding streams: Joint health-employment funding for IPS specialists
Fidelity infrastructure: Independent fidelity review required for any programme using the IPS name
Scale: Norway, for example, has approximately 150 IPS places nationally; the eligible population is 15,000–20,000
For every 1,000 people who receive traditional rehabilitation instead of IPS, approximately 300–350 additional people fail to achieve employment who would have done so with IPS — representing roughly €15–20 million in foregone annual earnings per 1,000 people per year.
Sources: Kinoshita et al., Cochrane Database 2013 (updated 2022); Burns et al., Lancet 2007 (EQOLISE); Sveinsdottir et al., BMC Psychiatry 2014; Radboud UMC 2020; NHS England IPSE Data 2022; Knapp et al., LSE 2019; Aalborg University 2022.