Supported employment (IPS) and vocational rehabilitation

Domain IX · Biomedical, neuro & digital · Deborah Becker, Robert Drake, Gary Bond · 1993

What it is

Individual Placement and Support (IPS) is a model of supported employment for people with serious mental illness (and, increasingly, other behavioural health conditions) who want to work. It was developed by Deborah Becker and Robert Drake (first described in A Working Life, 1993, per the IPS…

Format

• Mercer (September 2025) reports that 29 states have implemented IPS, funded through braided Vocational Rehabilitation and Medicaid funding (VR paying for activities such as work planning and employment assistance; Medicaid for rehabilitative skill-building), Medicaid 1915(i) and 1915(c) home- and…
• An IPS unit has at least two employment specialists and one supervisor who meet weekly for client-based group supervision and cover each other's caseloads (fidelity item 7); a full-time specialist carries 20 or fewer active people (item 1) and spends at least 96% of time on employment services…

Who practises it, and how they are trained or regulated

• NICE CG178 Psychosis and schizophrenia in adults: prevention and management (2014), recommendation 1.5.8.1: offer supported employment programmes to adults with psychosis or schizophrenia who wish to find or return to work. NICE quality standard QS80, statement 5, turns this into a quality measure. QS80 defines supported employment programmes as "also called" IPS: any vocational approach that aims to place people in…
• IPS Grow: set up by Social Finance in 2019 as the national support system for the rollout of IPS into NHS mental health teams in England; it offers implementation support, training (including free e-learning), independent fidelity reviews with action plans, communities of practice and a quality mark; it reports supporting over 200 IPS teams to mobilise (page updated December 2025).
• Centre for Mental Health publishes the UK IPS fidelity scale adapted by IPS Grow and the Connect to Work Expert Reference Group, and runs two-day IPS training for employment specialists in Connect to Work programmes (covering the eight principles, the 25-item fidelity scale, integration with treatment teams, benefits advice, vocational profiling, disclosure, employer engagement and in-work support). The…

Evidence status, as the guide reports it

• What it is. Individual Placement and Support (IPS) is a model of supported employment for people with serious mental illness (and, increasingly, other behavioural health conditions) who want to work. It was developed by Deborah Becker and Robert Drake (first described in A Working Life, 1993, per…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• duplicated or conflicting job plans. Working when: one shared plan.
• families drawn into clinical discussions. Working when: family support is practical.
• the team concluding "not ready". Working when: a new search or education plan begins.
• pressure that feels coercive. Working when: people return without having to "start again".
• setbacks followed by withdrawal. Working when: risk is assessed and the person re-engages.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.