The British Journal of Psychiatry
Vocational rehabilitation in early psychosis: cluster randomised trial
Tom Craig, Geoff Shepherd, Miles Rinaldi, Jo Smith, Sarah Carr, Fay Preston, Swaran Singh
  • Declaration of interest

    J.S. and M.R. are independent consultants to the Catalyst IPS programme with Jannsen Cilag, UK. T.C. has spoken about employment at an educational event organised by Roche.



Individual placement and support (IPS) is effective in helping patients return to work but is poorly implemented because of clinical ambivalence and fears of relapse.


To assess whether a motivational intervention (motivational interviewing) directed at clinical staff to address ambivalence about employment improved patients’ occupational outcomes.


Two of four early intervention teams that already provided IPS were randomised to receive motivational interviewing training for clinicians, focused on attitudinal barriers to employment. The trial was registered with the International Standard Randomised Controlled Trial Register (ISRCTN71943786).


Of 300 eligible participants, 159 consented to the research. Occupational outcomes were obtained for 134 patients (85%) at 12-month follow-up. More patients in the intervention teams than in the IPS-only teams achieved employment by 12 months (29/68 v. 12/66). A random effects logistic regression accounting for clustering by care coordinator, and adjusted for participants’ gender, ethnicity, educational and employment history and clinical status scores, confirmed superiority of the intervention (odds ratio = 4.3, 95% CI 1.5-16.6).


Employment outcomes were enhanced by addressing clinicians’ ambivalence about their patients returning to work.


  • Funding

    The study was funded by a grant from the National Institute for Health Research (NIHR) under its Research for Patient Benefit programme. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

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