The majority of people with serious mental disorders would like to work, if only on a part-time basis. However, existing integration services allow very few of them to do so. As a result, there is a need throughout Quebec to renew existing approaches. Eric Latimer, a researcher from the Douglas Institute, has just published a study for the Agence d’évaluation des technologies et modes d’intervention en santé du Québec (AETMIS) on the Individual Placement and Support (IPS) model, an approach that is increasingly employed in other countries.

This approach is based on several principles:

• To promote social inclusion and recovery, employment must be in a regular environment (the job pays minimum wage or more, it is not reserved for handicapped individuals, etc.)
• Considering the vast range of possibilities in the regular job market, the job must be defined based on the client’s needs so that it corresponds to his abilities and preferences
• Once the job is defined, the client must receive assistance to find employment as soon as possible; preparatory training is not useful in this case
• Support given to the client must be maintained over time and continue for as long as possible during the employment period
• The employment adviser who provides support must work in close contact with the client’s clinical team

An effective program

An exhaustive review of the scientific literature from the United States, Australia, Hong Kong and the Douglas Institute shows that the IPS model is much more effective than other models in helping individuals with serious mental disorders integrate into a regular work environment. Contrary to what many might believe, the IPS model does not increase hospitalization, probably because employment is adapted to clients’ choices and therefore does not cause them undue stress. In fact, a number of participants succeed, after many attempts, in keeping their jobs for long periods, which leads to great personal benefit. The monograph also shows that the more a program adheres to the principles listed above, the more effective it is.

A need for more spots

The IPS program at the Douglas Institute is one of only a few that have been established in Quebec since 2001. However, to keep up with demand, the study estimates that at least 60 spots per 100,000 people need to be created, or about 4,650 spots province-wide. At an estimated expense of $4,400 per spot, this would represent an annual expense of about $20.3 million. Although this amount may seem high, it should be compared with the $18 to $25 million that Emploi-Québec spends on similar initiatives or the approximately $20 million granted by the MSSS for rehabilitation or social and occupational integration—measures and programs that are generally less effective.

The study also calls for the Ministère de la Santé et des Services sociaux and the Ministère de l’Emploi et de la Solidarité sociale to increase accessibility to this type of program in their provincial networks.