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A randomised controlled trial of time-limited individual placement and support: IPS-LITE trial
Tom Burns1, Ksenija Yeeles2, Oliver Langford2
1Tom Burns, Professor of Social Psychiatry, Ksenija Yeeles, Research Fellow, Department of Psychiatry, University of Oxford, Oliver Langford, NIHR Research Methods Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, Maria Vazquez Montes, Senior Statistician & NIHR Oxford BRC Research Fellow, Nuffield Department of Primary Care Health Sciences & the Centre for Statistics in Medicine, University of Oxford, Department of Primary Care Health Sciences, University of Oxford, Jennifer Burgess, Research Assistant, Catriona Anderson, Research Assistant, Department of Psychiatry, University of Oxford tom.burns@psych.ox.ac.uk.
Background:
Individual placement and support (IPS) has been repeatedly demonstrated to be the most effective form of mental health vocational rehabilitation. Its no-discharge policy plus fixed caseloads, however, makes it expensive to provide.
Aims:
To test whether introducing a time limit for IPS would significantly alter its clinical effectiveness and consequently its potential cost-effectiveness.
Method:
Referrals to an IPS service were randomly allocated to either standard IPS or to time-limited IPS (IPS-LITE). IPS-LITE participants were referred back to their mental health teams if still unemployed at 9 months or after 4 months employment support. The primary outcome at 18 months was working for 1 day. Secondary outcomes comprised other vocational measures plus clinical and social functioning. The differential rates of discharge were used to calculate a notional increased capacity and to model potential rates and costs of employment.
Results:
A total of 123 patients were randomised and data were collected on 120 patients at 18 months. The two groups (IPS-LITE = 62 and IPS = 61) were well matched at baseline. Rates of employment were equal at 18 months (IPS-LITE = 24 (41%) and IPS = 27 (46%)) at which time 57 (97%) had been discharged from the IPS-LITE service and 16 (28%) from IPS. Only 11 patients (4 IPS-LITE and 7 IPS) obtained their first employment after 9 months. There were no significant differences in any other outcomes. IPS-LITE discharges generated a potential capacity increase of 46.5% compared to 12.7% in IPS which would translate into 35.8 returns to work in IPS-LITE compared to 30.6 in IPS over an 18-month period if the rates remained constant.
Conclusions:
IPS-LITE is equally effective to IPS and only minimal extra employment is gained by persisting beyond 9 months. If released capacity is utilised with similar outcomes, IPS-LITE results in an increase by 17% in numbers gaining employment within 18 months compared to IPS and will increase with prolonged follow-up. IPS-LITE may be more cost-effective and should be actively considered as an alternative within public services.
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