Mental health policy and practice across Europe: an overview

Effectiveness of pre-vocational and supported
employment schemes
Housing and employment 301
What do we know about the effectiveness of these approaches? There is in fact a
growing body of evidence, but it should be noted that much of this evidence
comes from the United States, with comparatively little evaluation conducted
in Europe. It is important to bear in mind that the context in which interventions
are delivered, such as the system of disability benefits, access to health
care, anti-discrimination legislation and the level of stigma towards those with
mental health problems, will all have an impact on effectiveness. Careful evaluation
of interventions shown to be effective in the United States, to determine
whether they will work in different European contexts, is still required.
A Cochrane review of vocational rehabilitation for people with severe mental
illnesses (Crowther et al. 2003) provides a good overview of the research literature
in the area, contrasting the effectiveness of pre-vocational training and
supported employment approaches in terms of their success in achieving
employment in the open labour market. The review points to a consistent finding
across five studies which indicates that supported employment is more
effective than different types of pre-vocational training in terms of achieving
and maintaining employment, with a greater number of hours worked and
higher average earnings. More recently, Marshall (2005) updated Crowther’s
review to include one additional meta-analysis and an additional randomized
controlled trial comparing supported employment with pre-vocational training.
Again the findings of the meta-analysis were consistent with those of the
Cochrane review, while this additional review reported that in a two-year follow-up
27 per cent of those who had participated in a supported employment
programme were still in employment compared with just 7 per cent of those
who had been enrolled in pre-vocational training (Lehman et al. 2002).
Bond (2004) also conducted a review of supported employment interventions
and concluded that the evidence base for these was strong, with a number of
randomized controlled trials demonstrating that supported employment was
effective in getting individuals back into work, and that the rates of employment
were superior to vocational rehabilitation programmes. Another review
undertaken by Schneider (2005) which looked at both rigorous evidence
from meta-analyses and randomized controlled trials, as well as less rigorous
evaluation methods, again concluded that supported employment interventions
that adopted the principles of IPS were most effective in helping
individuals to obtain employment. It also found no evidence that sheltered
workshops were effective; indeed there was evidence that such workshops were
detrimental.
One potential way of strengthening further the effectiveness of supported
employment schemes may be through the improved integration of clinical and
vocational rehabilitation, but little research has been undertaken in this area.
One exception is the work undertaken by Cook et al. (2005) who reported that
supported employment schemes that combine clinical and vocational rehabilitation
programmes had more favourable employment outcomes compared with
usual supported employment. Some studies have suggested that IPS-type supported
employment was no more successful than vocational rehabilitation