Psychiatric Rehabilitation and Supported Employment

Psychiatric rehabilitation helps people with serious mental illness develop the skills and supports they need to live, learn, work, and socialise in settings of their choice. Supported employment — and in particular the Individual Placement and Support (IPS) model — extends this aim into competitive paid work, helping people obtain and keep mainstream jobs with ongoing support.

Definition

Psychiatric rehabilitation is a set of approaches that help people with serious mental illness restore or develop the functional roles and supports needed for community living, of which supported employment is the vocational component — helping people obtain and maintain competitive employment with individualised, ongoing support.

Scope

This entry covers the goals and principles of psychiatric (psychosocial) rehabilitation, the place-then-train philosophy of supported employment, the IPS model, and the evidence on vocational outcomes. It is an educational overview of rehabilitation approaches, not a vocational treatment plan for any individual.

Core questions

• What are the goals and guiding principles of psychiatric rehabilitation?
• How does supported employment differ from older 'train-then-place' vocational models?
• What defines the Individual Placement and Support (IPS) model?
• What does the evidence show about employment outcomes?

Key concepts

• Psychosocial rehabilitation
• Functional skills and supports
• Supported employment
• Individual Placement and Support (IPS)
• Competitive employment
• Place-then-train
• Integration of vocational and clinical services

Key theories

Place-then-train (supported employment)

Supported employment reverses the traditional sequence: rather than extended pre-vocational training before a job, people are helped to obtain a competitive job quickly and then receive individualised, time-unlimited on-the-job support, the core philosophy of the IPS model.

Mechanisms

Psychiatric rehabilitation focuses on people's chosen roles and environments, building skills and arranging supports rather than treating symptoms alone, consistent with the recovery vision (Anthony 1993). Supported employment, exemplified by IPS, follows principles such as a focus on competitive employment, rapid job search based on client preference, integration of vocational and mental health services, and time-unlimited support. Randomised trials summarised by Bond and colleagues found IPS produces substantially higher competitive employment rates than traditional vocational approaches (Bond 2008). Peer support and assertive community treatment can complement rehabilitation by sustaining engagement (Mead 2001; Marshall 2000).

Clinical relevance

Rehabilitation and supported employment are relevant to how mental health nurses and teams support people toward valued roles such as work and education. This entry summarises the approaches and their evidence at a programme level and is not a basis for individual vocational prescriptions.

Epidemiology

Employment rates among people with serious mental illness are substantially lower than in the general population, and many who are unemployed report wanting to work; supported employment was developed in part to address this gap (Bond 2008).

Evidence & guidelines

Multiple randomised controlled trials, synthesised by Bond and colleagues, indicate that the IPS model of supported employment achieves higher competitive employment rates than traditional vocational services, making it among the better-supported psychosocial interventions for serious mental illness (Bond 2008). Assertive community treatment has systematic review support for engagement and admission outcomes that can underpin rehabilitation efforts (Marshall 2000).

History

Psychiatric rehabilitation developed alongside deinstitutionalisation as a way to support community living for people leaving long-stay hospitals, drawing on the recovery vision articulated by Anthony (1993). Supported employment emerged from disability services in the 1980s, and the Individual Placement and Support model was subsequently standardised and tested in randomised trials, building a substantial evidence base for the place-then-train approach (Bond 2008).

Debates

Job acquisition versus job tenure

Supported employment reliably improves rates of obtaining competitive jobs, but discussion continues about how to improve longer-term job retention and how outcomes vary across economic and policy contexts.

Key figures

• William Anthony
• Gary Bond
• Robert Drake
• Deborah Becker

Seminal works

• anthony-1993
• bond-2008

Frequently asked questions

What is Individual Placement and Support (IPS)?

IPS is a standardised, evidence-based model of supported employment for people with serious mental illness that helps them find competitive jobs quickly based on their own preferences and provides integrated, ongoing support, following a 'place-then-train' philosophy.

How does supported employment differ from traditional vocational rehabilitation?

Traditional models emphasise extended pre-vocational training before placement ('train-then-place'), whereas supported employment helps people obtain a real, competitive job rapidly and then supports them in it ('place-then-train').