Implementation of Individual Placement and Support for individuals with severe mental illness
Authors:   , Vukadin Miljana 
Published: January 2024

Competitive employment contributes to the health and recovery of individuals
with severe mental illness (SMI). However, employment rates among these
individuals are low, often leading them to rely on social assistance or disability
benefits. Individual Placement and Support (IPS) is an evidence-based, effective,
and cost-effective approach for helping individuals with SMI obtain and
maintain competitive employment. Despite its effectiveness and cost-effectiveness,
the implementation of this approach has been challenging worldwide. Inadequate
funding and insufficient collaboration between mental healthcare and vocational
rehabilitation services are major barriers to implement IPS within usual mental
healthcare. To improve the implementation of IPS in the Netherlands, the Dutch
Social Security Institute: the Institute for Employee Benefits Schemes (UWV),
began offering nationwide reimbursement for IPS in 2012 to all mental healthcare
agencies providing IPS services. Multiple health insurance companies also
contributed by funding the intake phase of IPS trajectories. In addition, various
national collaborations among stakeholders in mental healthcare and vocational
rehabilitation were initiated. An example of such an initiative involved stakeholders
from two mental healthcare agencies, UWV, a municipality, and a health insurance
company. This collaboration included a multifaceted implementation strategy
(MIS) for IPS, encompassing an organizational and a financial component.
The organizational component comprised regular meetings at two levels among
the professionals of the different organizations involved (i.e., two mental healthcare
agencies, UWV, a municipality and a health insurance company): 1) at the
management level, there were regular meetings among decision makers who
had a managing or advising role within their organization. Their main goal was
to facilitate involved practitioners and to ensure IPS sustainment; 2) at the
practitioner level, there were regular meetings among IPS employment
specialists and several vocational rehabilitation professionals (i.e., the labor
expert and insurance physician from UWV, and the case manager from the
municipality). Their main goal was to organize the IPS funding for new clients,
and to provide improved benefits counselling as compared to usual IPS practice.
The financial component consisted of secured IPS funding with a ‘pay for
performance’ element, providing mental health agencies with extra payments
for successfully placing IPS participants in competitive jobs.
The research in this thesis primarily focuses on IPS using a multifaceted
implementation strategy (IPS+MIS). The objectives of this thesis are: 1) to gain
insight into the implementation of IPS, the employment outcomes of IPS
participants with SMI, and the factors that influence these employment
outcomes; and 2) to evaluate the effectiveness and cost-effectiveness of IPS implemented through a reimbursement strategy on a nationwide scale, in terms
of achieving sustainable, competitive employment. By addressing these objectives,
this thesis aims to contribute to improving employment outcomes for individuals
with SMI by assisting stakeholders in making better-informed decisions regarding
the implementation, funding, and organization of IPS.
In conclusion, the results of this thesis show that IPS implemented through a
reimbursement strategy on a nationwide scale is effective and seems cost-effective
in individuals with SMI. The results also indicate that the organizational
implementation strategy has positively impacted the implementation of IPS
within usual mental healthcare. However, significant efforts are still required to
address the remaining barriers at the socio-political level as highlighted in this
thesis and to further improve both the implementation of IPS and the work
participation of individuals with SMI. Other barriers can be addressed by
intensifying collaboration between mental healthcare clinicians and social
medicine specialists, and by increasing the involvement of these specialists
within IPS services.