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Individual placement and support (IPS) programs provide evidence-based employment help for people with serious mental illnesses, such as schizophrenia and bipolar disorder. Implementing IPS in a forensic mental health setting is a complex process.
Dr. Najat Khalifa discussed how a lack of employer interest, negative staff attitudes, and issues specific to justice involvement and mental health can hinder the successful implementation of such programs. He also covered that strong support from senior managers and outside agencies, good interdisciplinary collaboration, and clear communication about the benefits of IPS can aid success.
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What Is IPS and Why Is It Needed?
Compared with unemployment, employment improves mental health, self-esteem, optimism, and social integration while reducing rates of justice involvement.
People with mental health issues and those involved in the justice system each have lower rates of employment.
Supported employment programs place individuals in high-demand, competitive jobs without extensive preparation but with ongoing, on-the-job support. IPS is a form of supported employment that follows 8 principles:
- It aims to get individuals into competitive employment.
- It is open to everyone who wants to work.
- It tries to match individuals with the jobs they prefer.
- It works quickly.
- It brings employment specialists into clinical teams.
- Employment specialists build relationships with employers that individuals want to work for.
- It provides time-unlimited, individualized support for the person and their employer.
- It includes benefits counselling.
Evidence for IPS
Research on work skills programs (aimed at helping justice-involved individuals find employment) showed that participants were more likely to gain employment and to do so more quickly than their peers who were not in a program. However, once they were working, their hours of employment did not increase.
Several research studies on IPS found increases in employment rates, longer hours, and increased length of employment, with participants needing less time to be placed. Studies across Europe as well as in Japan showed IPS to be more cost-effective than traditional vocational training programs, where participants receive skills training before entering competitive employment.
Time-unlimited support can be costly. Research shows no additional benefits beyond 9 months, making IPS-LITE, a 9-month version, as effective and more cost-efficient than standard IPS. Dr. Khalifa said the per-individual cost of IPS is about US$6,000, compared with US$4,000 for IPS-LITE, depending on the jurisdiction and setting.
Barriers to IPS
Most people with mental health issues or justice involvement want to work, and they can with proper support. However, stigma, social isolation, substance use, and having a criminal record and low education are significant barriers.
Structural Barriers
Existing regulations for social insurance and employment, and conflicts between national employment policies and local IPS plans are significant structural barriers.
“Poor interagency collaboration is one of the key issues that we’ve come across,” Dr. Khalifa said. Psychologists, psychiatrists, nurses, and occupational therapists may not have worked with an employment specialist before, which can be uncomfortable. “It takes a bit of time to get people to understand it and feel comfortable and embrace supported employment.”
Organizational Barriers
Organizational barriers include inadequate funding and support for programs, and a lack of engagement of health care managers is a critical issue. Negative attitudes among managers and clinicians about whether people with mental illness can work and about the organizational fit of IPS are also barriers.
Lastly, conflicting priorities between employment and psychological supports may result in poor co-operation between employment specialists and mental health professionals.
Individual Barriers
IPS also faces individual barriers, including clients and family members being unaware of supported employment programs. Clients may be worried about IPS affecting their welfare benefits or whether they are ready to re-enter the workforce. They may also have low expectations.
Facilitators to IPS
Research has also identified factors that can increase the chances of successful IPS implementation. This includes having supportive leadership that clearly communicates the benefits of IPS and provides sufficient funding, time, and training for the multidisciplinary team. Integrating dedicated IPS staff into mental health services and having them become core members of the team helps ensure the free flow of information.
Dr. Khalifa also suggested using the 14-item IPS fidelity scale to guide implementation and having a dedicated employment specialist.
For more details, watch the recording of the May 1, 2025, International Forensic Psychiatry Lecture Series, entitled “Supported Employment for Justice-Involved Individuals with Mental Disorder: Pitfalls and Challenges,” on our website.
Written by Virginia St-Denis and approved by Dr. Najat Khalifa.
