World Congress of Psychiatry 2011 presentations

In September 2011 Warren Elwin, chief executive Workwise and Helen Lockett, strategic development for Wise Group (which Te Pou is part of) attended the World Congress of Psychiatry in Buenos Aires, Argentina.

This event is organised by the World Psychiatric Association every three years, and is the main international scientific event in the field of psychiatry. The congress aims ‘to provide an overview of the most promising current trends in the various areas of psychiatric research and practice, with the contribution of prominent experts of the various topics’.

The congress attracts researchers, psychiatrists and other clinicians, government and world health policy makers and others who provide mental health services. This year saw one of the largest turnouts for the conference with around 13,000 delegates in attendance.

For the first time ever at this event there was a keynote presentation on evidence-based supported employment given by renowned psychiatrist Professor Bob Drake from Dartmouth Psychiatric Research Centre, in the USA. This was a historic address and other leading international experts in the field of evidence-based supported employment and recovery were present for this moment, and to be involved  with symposia and other presentations throughout the conference.  

An outline of key presentations is made below, and copies of presentations are available to download from the right column of this page.

Professor Bob Drake: IPS supported employment for people with mental illness

Professor Drake’s lecture discussed the development of evidence based supported employment over the past 20 years, the current state of research, and future directions.

He highlighted that people who are disabled by serious mental illnesses comprise 3-5 per cent of the population in most high-resource countries. Most of these people (more than 70 per cent) want to work and would benefit from employment, but typically less than 10 per cent are employed. Twenty years ago, we had no effective interventions. Now individual placement and support (IPS) has emerged as the most effective evidence-based model of supported employment for people with mental illnesses and we know employment is one of the most direct steps to recovery. The principles of the approach were outlined:

• people themselves determine eligibility
• the same team integrates vocational and mental health services
• the goal is competitive employment
• all participants receive benefits counselling
• searching for jobs begins rapidly
• once employed, people receive supports as long as needed
• the client’s preferences determine job choices and all services.

Studies around the world, including 17 randomised controlled trials, show that approximately 65 per cent of IPS participants are able to gain competitive employment and that most become steady workers for many years. The steady workers benefit in terms of increased income, self-esteem, symptom management and quality of life. They also dramatically reduce their use of mental health services. Cost-effectiveness encompasses increased productivity, decreased disability insurance, and decreased mental health service use. Furthermore, people who gained jobs through IPS find jobs quicker, hold onto them longer, work longer hours and earn more than those who gained employment through standard vocational rehabilitation services.

Professor Drake then outlined the international studies currently underway which will address the organisation and financing of IPS services, dissemination of IPS, the effects of IPS on people who are early in the course of illness, and enhancing IPS outcomes for people with severe cognitive deficits.

Professor Drake’s clear observation was that it would be scandal if it were a drug that created improvements and was not being applied like EBSE is not being implemented in many places and he reflected on how he as a psychiatrist practising for 40 years has done a 180 degree U-turn on the value and importance of employment support in mental health treatment.

IPS Symposia: Current research on the IPS model of supported employment

This symposium consisted of four presentations covering recent research on IPS.

Professor Tom Burns from the Department of Psychiatry, University of Oxford, reported on the findings from the EQOLISE randomised controlled trial. This tested IPS against high quality structured vocational rehabilitation in six European countries. It not only demonstrated the effectiveness of IPS in Europe but also how comparative effectiveness was affected by local welfare provision.  From the study there was no evidence that employment has a negative impact on mental health, with some suggestion of the contrary.

Eric Latimer (PhD) from McGill University, Montreal, presented his review of the literature on the costs and cost effectiveness of IPS. Long-term follow up studies have shown the effects gained when people become regular workers, particularly lower health care costs. The review also indicates that high-fidelity programmes operating where there are low unemployment rates and incentives to encourage working longer hours are likely to be most cost-effective.

Associate Professor Eoin Killackey from the Centre for Youth Mental Health, University of Melbourne, Australia, presented the evidence on IPS randomised controlled trials with people with first episode psychosis. Once again IPS is significantly more effective with 69 per cent of people gaining employment compared to 35 per cent in the controls. Furthermore, people who gained employment through IPS services had higher wages and worked longer hours. He also emphasised the importance of providing support to young people to return to education or employment, as young people are the most costly to the state if they are absent from the workforce.

The final presentation in the research symposium was given by Professor Bob Drake, who reported on the findings from the largest randomised controlled trial of IPS in the world – the Mental Health Treatment Study.

Dissemination of the IPS model of supported employment

This symposium also consisted of four presentations from around the world, demonstrating the ways in which IPS is being established in mental health services internationally.

The first presenter was Angelo Fioritti, from the Zavatta Foundation in Rimini, Italy. Angelo outlined the levels of IPS practice in Italy and how they have been successful in accessing funding to extend IPS across eleven mental health services in their region.  Italy is the first partner outside the USA in the Johnson and Johnson implementation program, and as a result is about to appoint the country’s first regional IPS trainer.

Eoin Killackey discussed the implementation of IPS for young people in Australia, highlighting how important it is to work with young people and in particular while their peer group is still intact. The IPS approach is well suited to the Australian labour market and mental health system.

Professor Deborah Becker from Dartmouth Psychiatric Research Centre in the USA presented on the Johnson & Johnson – Dartmouth Community Mental Health Program, a national learning collaborative on IPS. The aim of the programme is to increase access to effective employment services for people with experience of a mental illness across America. The programme uses a train-the-trainer model and the Dartmouth Medical Centre provides training, materials and regular mentoring and updates to all the state trainers. The programme has been running for eight years now with average competitive employment rates of between 38-55 per cent per quarter.

The final presentation was from the UK, where Professor Bob Grove outlined the work of the Centre for Mental Health’s IPS Centres of Excellence programme which has piloted the role of the state trainer in a county in England. The pilot has led to a much better understanding of the role and value of the trainer in the UK context. Although it has only been operating for a year, the role has had a large impact on increasing the employment outcomes IPS services are achieving across the region. The centre is now exploring how this role can be funded and provided across IPS services in the UK.