Introduction: Increasingly functional recovery is seen as an equal focus of attention as symptomatic recovery. A key area of functioning for adults is vocational functioning. The Individual Placement and Support (IPS) model has been shown to be the most effective model of vocational rehabilitation for people with established serious mental illness (SMI) such as schizophrenia and bipolar affective disorder. However, SMI often has onset in the period in which vocational development occurs and can derail this process, limiting later vocational options.

Method: 41 people with first-episode SMI wanting to find work were randomized to IPS (n=20) or treatment-as-usual (TAU, n=21). The IPS group worked with an employment consultant collocated with the clinical team for a six month period. Those in TAU could access all normal clinical services and external vocational agencies. Assessments were at baseline and six months.

Results: More of those in the IPS group became employed or enrolled in courses than those in TAU (17 vs 6, p=0.000). For employment only there was still a significant difference (IPS 13 vs TAU 2, p=0.000). Those in the IPS had a higher median income ($2432 vs $0, p=0.012) and worked more hours per week (median 38 vs 22.5 p=0.006) and more weeks (median 5.0 vs 0, p=0.021) than those in the TAU group. The IPS group also significantly reduced use of welfare benefits.
Conclusions: The IPS approach, previously found to be of use in populations with established SMI, has great potential for those with first episode SMI. This study shows that the results achieved at outcome are significantly better than high quality TAU. Further, these results indicate that early functional rehabilitation should form a key part of treatment approaches to first episode SMI.