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Br J Psychiatry. 2019 Jul 1:1-6. doi: 10.1192/bjp.2019.154. [Epub ahead of print]

'Placement budgets' for supported employment: impact on employment rates in a multicentre randomised controlled trial.

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Professor,Department of Psychiatry,Psychotherapy and Psychosomatics,University of Zurich,Switzerland;Institute of Psychiatry, Laboratory of Neuroscience (LIM 27),University of Sao Paulo,Brazil; andDepartment of Psychiatry and Psychotherapy,Campus Charité Mitte,Charité - Universitätsmedizin Berlin,Germany.
Senior Consultant,Psychiatrische Dienste Aargau AG,Klinik für Psychiatrie und Psychotherapie,Switzerland.
Senior Researcher,Department of Psychiatry, Psychotherapy and Psychosomatics,University of Zurich,Switzerland.
Senior Researcher,Translational Neuromodeling Unit,Institute for Biomedical Engineering, University of Zurich and ETH Zurich,Switzerland.
Professor,Section of Public Mental Health,University of Ulm,Germany.
Senior Lecturer,Department of Applied Psychology,Zurich University of Applied Sciences,Switzerland.



The most effective rehabilitation model for job (re-)entry of people with mental illness is supported employment. A barrier to introducing supported employment into standard care is its temporally unlimited provision, which conflicts with health and social legislation in many European countries.AimsTo test the impact of different 'placement budgets', i.e. a predefined maximum time budget for job seeking until take-up of competitive employment.


Participants (116) were randomly assigned to 25 h, 40 h or 55 h placement budgets in an intent-to-treat analysis. We applied the individual placement and support model over 24 months, following participants for 36 months. Primary outcome was employment in the labour market for at least 3 months.


The proportion of participants obtaining competitive employment was 55.1% in the 25 h group, 37.8% in the 40 h group and 35.8% in the 55 h group. In a Cox regression analysis, time to employment was slightly lower in the 25 h group relative to the 40 h (hazard ratio 1.78, 95% CI 0.88-3.57, P = 0.107) and 55 h groups (hazard ratio 1.74, 95% CI 0.86-3.49, P = 0.122), but this was not statistically significant. The vast majority of all participants who found a job did so within the first 12 months (80.4%).


A restricted time budget for job finding and placement does not affect the rate of successful employment. In accordance with legislation, a restriction of care provision seems justified and enhances the chances of supported employment being introduced in statutory services.Declaration of interestNone.


Supported employment; individual placement and support; placement budget; serious mental illness; unemployment rates


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