Effectiveness of vocational interventions for gaining paid work for people living with mild to moderate mental health conditions: systematic review and meta-analysis
Objectives: To evaluate the effectiveness of vocational
interventions to help people living with mild to moderate
mental health conditions gain paid work.
Methods: Systematic review of international, peerreviewed literature. Development of the prepublished
protocol and search strategy was done in consultation
with stakeholder reference groups consisting of people
with lived experience of long-term conditions, advocates
and clinicians. We searched academic databases
MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest
Dissertations and Theses database, and Business Source
Complete for controlled trials comparing a specific
vocational intervention against a control intervention or
usual care, published between 1 January 2004 and 1
August 2019. Two authors independently screened search
results, extracted data and appraised studies using the
Cochrane risk of bias tool.
Results: Eleven studies met inclusion criteria. Seven
studies investigated Individual Placement and Support
(IPS) modified for people who were not in intensive mental
health treatment services. These studies occurred settings
such as community vocational rehabilitation services,
a housing programme and community mental health
services. The studies provided very low quality evidence
that people who receive IPS-style vocational rehabilitation
are more likely to gain competitive employment than
people who receive usual care (risk ratio 1.70, 95%
CI 1.23 to 2.34, seven studies, 1611 participants). The
remaining four studies considered cognitive behavioural
therapy or specific vocational rehabilitation interventions
designed to fit a unique context. There was insufficient
evidence from these studies to draw conclusions
regarding the effectiveness of non-IPS forms of vocational
rehabilitation for people with mild to moderate mental
health conditions.
Discussion: The meta-analysis showed a clear
intervention effect but low precision, and more highquality studies are needed in this field. There is currently
very low quality evidence that IPS-style intervention results
in more participants in competitive employment compared
with ‘usual care’ control groups in populations with mild to
moderate mental health conditions