Are “place and train” principles suited to support people with severe mental illness into work? A questionnaire-based survey in a public employment service

Abstract BackgroundIndividual Placement and Support (IPS) has repeatedly been reported to increase employment rates in patients with severe mental illness. Despite this, IPS is only available to a small minority. Translation from evidence to practice is often slow and hindered by a variety of barriers. Barriers include organizational, contextual and attitudinal factors. Despite evidence, many believe that people with severe mental illness are generally dangerous, in need of rest and at risk of harm from work-related stress. Such stigma fosters negative attitudes that may constitute significant barriers to employment for people with mental illness. Employees in the Norwegian Labour and Welfare Administration hold important gatekeeping positions in relation to the employment schemes that people with mental illness are offered. The aim of this study was to measure the attitudes of these employees towards the core principles of IPS. Secondly, we examine whether attitudes change for Labour and Welfare Administration employees exposed to IPS practice.MethodsA case vignette describing a person with severe mental illness and statements referring to this vignette was developed. The survey was administered to a sample of employees at two different timepoints four years apart. The respondents were asked to indicate their attitudes on a six-point Likert scale between statements in accordance to IPS and statements in accordance with treatment as usual. Independent two tailed samples t-tests were used to analyse differences between responses between employees in municipalities with IPS experience, compared to municipalities without. Multiple linear regressions with attitudes as dependent variable, were used to test if attitudes changed over time, dependent on exposure to IPS.ResultsAttitudes were in general more aligned with IPS than current practice. The region with exposure to IPS was associated with more favorable attitudes (p < .01). The development in attitudes to IPS were minimal over time and did not differ between IPS regions and regions without.ConclusionsAttitudes of statutory Labour and Welfare employees will not be a substantial barrier for implementation of IPS. This is a necessary but not sufficient requirement for IPS implementation.The regional ethics committee approved the study (2012/2239).