Randomized controlled trial of supported employment in England: 2 Year follow-up of the Supported Work and Needs (SWAN) study

Margaret Heslin*, Louise Howard, Morven Leese, Paul McCrone, Christopher Rice, Manuela Jarrett, Terry Spokes, Peter Huxley, Graham Thornicroft

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

64 Citations (Scopus)


Studies from North America have concluded that supported employment using the Individual Placement and Support (IPS) model is effective in helping individuals with severe and persistent mental illness gain competitive employment. The aim of this study was to investigate the effectiveness and cost-effectiveness of IPS in England in patients followed up for 2 years. Patients with severe mental illness were randomised to IPS or local vocational services (treatment as usual). Service use and costs were measured. Two hundred-nineteen participants were randomised, and 86% re-assessed 2 years later. In the multivariate analysis, relatively low rates of competitive employment were found in both the intervention group and the treatment as usual group, although significantly more patients obtained competitive employment in the treatment arm (22% vs. 11%, p=0.041). There were no significant differences in costs. The employment rate among participants receiving IPS was lower than in previously published reports, and the number needed to treat to obtain the benefit of IPS was relatively high. This may reflect difficulties in the implementation of IPS where it is not structurally integrated within mental health teams, as well as economic disincentives which lead to lower levels of motivation for patients and mental health professionals.

Original languageEnglish
Pages (from-to)132-137
Number of pages6
JournalWorld Psychiatry
Issue number2
Publication statusPublished - Jun 2011


  • Cost-effectiveness
  • Effectiveness
  • Severe mental illness
  • Supported employment
  • Vocational rehabilitation


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