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Individual placement and support (IPS) is a standardised approach to employment support aimed at helping people with severe mental health problems return to competitive employment. IPS has seven core elements: a focus on competitive employment; acknowledgement of the individual's personal interests; a rapid job search; integration of mental health and employment services; programme entry based on client choice; time-unlimited client support; and benefits counselling. This approach has been proven to be effective when compared to other styles of vocational support (Bejerholm et al. , 2015), and is a cost-effective intervention (Knapp et al. , 2013). Nonetheless, there is room for improvement in employment rates and job tenures. In order to improve outcomes, possible adjuncts to the scheme have been suggested, notably cognitive-behavioural therapy (CBT) (Loveland et al. , 2007).
In a rapid evidence assessment of the effectiveness additional interventions delivered alongside IPS for people with severe mental illness, only six randomised controlled trials (RCTs) were found (Boycott et al. , 2012). Each of the adjunct treatments targeted one of two broad domains - improving interpersonal skills and problem-solving skills in the workplace, and cognitive rehabilitation aimed at improving attention, language, memory, and executive functioning. Both types of adjunct intervention improved competitive employment rates. It seems reasonable to suppose that including both skills training and cognitive rehabilitation components in the same programme might further improve outcomes, hence evidence on the specific common individual-level barriers to employment for people with severe mental health problems was sought from the literature.
There is evidence of an association between schizophrenia and memory impairment, and these common cognitive difficulties may contribute to lower levels of employment (McGurk and Mueser, 2004). In addition, it is well documented that anxiety and depression are very common in people diagnosed with schizophrenia, with these conditions impairing job-seeking and work-functioning (Dewa and Lin, 2000; Marwaha and Johnson, 2005). Individuals with schizophrenia often have low self-confidence, believing the challenges of work are too much to overcome, and therefore they give up on seeking employment (Lysaker et al. , 2005). Negative social experiences such as real or perceived stigma can have a further negative impact (Link et al. , 2001). Furthermore, it is also known that people with schizophrenia are impaired on measures of social problem solving...