Challenges in implementing individual placement and support in the Australian mental health service and policy contextYolande Stirling A B , Kate Higgins C and Melissa Petrakis A B D
A St Vincent’s Hospital Melbourne, Mental Health Service, Hawthorn Community Mental Health Service, 642 Burwood Road, Hawthorn East, Vic. 3123, Australia. Email: email@example.com
B Monash University, Department of Social Work, Faculty of Medicine, Nursing and Health Sciences, PO Box 197, Caulfield East, Vic. 3145, Australia.
C Wellways Australia, PO Box 359, Clifton Hill, Vic. 3068, Australia. Email: firstname.lastname@example.org
D Corresponding author. Email: email@example.com
Australian Health Review 42(1) 82-88 https://doi.org/10.1071/AH16093
Submitted: 7 May 2016 Accepted: 9 December 2016 Published: 20 January 2017
Objective Although Australia’s service and policy context differs from that of the US, studies have highlighted potential for individual placement and support (IPS) to support competitive employment outcomes for people with severe and persistent mental illness. The aim of the present study was to explore why the model is not yet widely available.
Methods A document analysis was conducted to discern reasons for challenges in implementation of IPS practice principles within the Australian service context.
Results The document analysis illustrated that although policy acknowledges the importance of increasing employment rates for people with severe and persistent mental illness, consistent measures, change indicators, direction and time frames are lacking in policy and strategy documentation. Further, IPS principles are not consistently evident in guiding operational documentation that government-funded Disability Employment Services (DES) programs are mandated to adhere to.
Conclusions For IPS to be readily implemented, it is necessary for government to offer support to agencies to partner and formal endorsement of the model as a preferred approach in tendering processes. Obligations and processes must be reviewed to ensure that model fidelity is achievable within the Australian Commonwealth policy and service context for programs to achieve competitive employment rates comparable to the most successful international programs.
What is known about the topic? The IPS model has been established as the most efficacious approach to support people with severe and persistent mental ill health to gain and sustain employment internationally, yet little is known as to why this model has had very limited uptake in the Australian adult mental health service and policy context.
What does this paper add? This paper provides an investigation into the achievability of IPS within DES philosophical and contractual arrangements.
What are the implications for practitioners? Mental health practitioners are typically skilled in their understanding of individual or micro-level challenges faced by consumers in achieving vocational goals: working with symptoms, medication side effects, motivation and anxiety. The present study was designed to offer practitioners an increased understanding of service-level factors, because these present considerable challenges to achieving sustained employment. This paper is a call for greater advocacy towards better integration of employment and mental health service delivery in the Australian policy and practice context.
Additional keywords: consumers, clinical services, health services research, health care reform, supported employment.
References Waghorn G, Lloyd C. The employment of people with mental illness. Austr e-J Advancem Ment Health 2005; 4 1–51.
 Bond GR. Supported employment: evidence for an evidence-based practice. Psychiatr Rehabil J 2004; 27 345–59.
| Supported employment: evidence for an evidence-based practice.CrossRef |
 Bond G, Drake R. Making the case for IPS supported employment. Adm Policy Ment Health 2014; 41 69–73.
| Making the case for IPS supported employment.CrossRef |
 Tsang H, Lam P, Ng B, Leung O. Predictors of employment outcome for people with psychiatric disabilities: a review of the literature since the mid ’80s. J Rehabil 2000; 66 19–31.
 Killackey E, Waghorn G. The challenge of integrating employment services with public mental health services in Australia: progress at the first demonstration site. Psychiatr Rehabil J 2008; 32 63–6.
| The challenge of integrating employment services with public mental health services in Australia: progress at the first demonstration site.CrossRef |
 Department of Education, Employment and Workplace Relations. Evaluation of Disability Employment Services interim report. Reissue March 2012. Canberra: Department of Education, Employment and Workplace Relations; 2012.
 Australian Institute of Health and Welfare (AIHW). Mental health services – in brief 2013. Canberra: AIHW; 2013.
 Department of Health. Victoria’s priorities for mental health reform: 2013–2015. Melbourne: Department of Health; 2013.
 Family and Community Development Committee. Inquiry into workforce participation by people with a mental illness. Melbourne: Parliament of Victoria; 2012.
 Nevile A, Lohmann R. ‘It is like they just don’t trust us’: balancing trust and control in the provision of disability employment services. Canberra: The Australian National University; 2011.
 Fifield M. Cutting red tape for Disability Employment Services. [Media Release] 2013. Available at: http://www.mitchfifield.com/Media/MediaReleases/tabid/70/articleType/ArticleView/articleId/729/Media-Release--Cutting-red-tape-for-Disability-Employment-Services--20-December-2013.aspx [verified 14 December 2016].
 National Employment Services Association (NESA). Strengthening disability employment services. Melbourne: NESA; 2014.
 Rutman ID. How psychiatric disability expresses itself as a barrier to employment. Psychosoc Rehabil J 1994; 17 15–35.
| How psychiatric disability expresses itself as a barrier to employment.CrossRef |
 National Mental Health Commission. Contributing lives, thriving communities – review of mental health programmes and services. 2014. Available at: http://www.mentalhealthcommission.gov.au/our-reports/contributing-lives,-thriving-communities-review-of-mental-health-programmes-and-services.aspx [verified 14 December 2016].
 Australia Government, Department of Health. Australian Government Response to Contributing lives, thriving communities – review of mental health programmes and services. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/0DBEF2D78F7CB9E7CA257F07001ACC6D/$File/response.pdf [verified 19 December 2016].
 Drake RE, Bond G, Becker DR. Individual placement and support: an evidence-based approach to supported employment. New York: Oxford University Press; 2012.
 Mueser KT, Clark RE, Haines M, Bond GR, Essock SM, Becker DR, Wolfe R, Swain K. The Hartford study of supported employment for persons with severe mental illness. J Consult Clin Psychol 2004; 72 479–90.
| The Hartford study of supported employment for persons with severe mental illness.CrossRef |
 Bond GR, Drake RE, Becker DR. Generalizability of the individual placement and support (IPS) model of supported employment outside the US. World Psychiatry 2012; 11 32–9.
| Generalizability of the individual placement and support (IPS) model of supported employment outside the US.CrossRef |
 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 77–101.
| Using thematic analysis in psychology.CrossRef |
 Department of Health. Fourth national mental health plan: an agenda for collaborative government action in mental health 2009–2014. 2009. Available at: http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-f-plan09 [verified 14 December 2016].
 2Australian Government. National Mental Health and Disability Employment Strategy. 2009. Available at: http://www.vicserv.org.au/images/PDF/Resources_and_links/National-Mental-Health---Disability-Ermployment-Strategy.pdf [verified 14 December 2016].
 Evans J, Repper J. Employment, social inclusion and mental health. J Psychiatr Ment Health Nurs 2000; 7 15–24.
| Employment, social inclusion and mental health.CrossRef | 1:STN:280:DC%2BD3cvmvVOjtg%3D%3D&md5=5bc41e0a41cec589a87228bcd23d7afeCAS |
 Sherring J, Robson E, Mrris A, Frost B, Tirupati S. A working reality: evaluating enhanced intersectoral links in supported employment for people with psychiatric disabilities. Aust Occup Ther J 2010; 57 261–7.
| A working reality: evaluating enhanced intersectoral links in supported employment for people with psychiatric disabilities.CrossRef |
 Bond GR, Drake RE, Becker DR. An update on randomised controlled trials of evidence-based supported employment. Psychiatr Rehabil J 2008; 31 280–90.
| An update on randomised controlled trials of evidence-based supported employment.CrossRef |
 King R, Waghorn G, Lloyd C, McLeod P, McMah T, Leong C. Enhancing employment services for people with severe mental illness: the challenge of the Australian service environment. Aust N Z J Psychiatry 2006; 40 471–7.
| Enhancing employment services for people with severe mental illness: the challenge of the Australian service environment.CrossRef |
 Waghorn G, Collister L, Killackey E, Sherring J. Challenges to implementing evidence-based supported employment in Australia. J Vocat Rehabil 2007; 27 29–37.
 Waghorn G, Childs S, Hampton E, Gladman B, Greaves A, Bowman D. Enhancing community mental health services through formal partnerships with supported employment providers. Aust J Psychiatr Rehab 2012; 15 157–80.
| Enhancing community mental health services through formal partnerships with supported employment providers.CrossRef |
 Petrich ML, Ramamurthy V, Hendrie D, Robinson S. Challenges and opportunities for integration in health systems: an Australian perspective. J Integr Care 2013; 21 347–59.
| Challenges and opportunities for integration in health systems: an Australian perspective.CrossRef |