Does Individual Placement and Support really ‘reflect client goals’?

Accessible summary•  Some people and organizations in the UK claim that most unemployed mental health service users want to work and that working will improve their mental health. They use an estimate of up to 90% of service users wanting to work in justifying vocational support services which solely support clients with finding and keeping a regular paid job. This kind of approach is called Individual Placement and Support, or IPS. •  Research shows that just because someone says they want to work it does not follow that their goal is a regular paid job. Only about 15% of people who use community mental health services provided by the National Health Service actually seem to want help finding this sort of work. •  Saying that up to 90% of service users want work is possibly a useful way to persuade people that IPS is the best way forward. But there are questions about whether this is applicable evidence, when so few people start out believing a paid job is for them. •  Claiming that working improves mental health could also be confusing as a result of ‘mental health’ sometimes being used now to mean well‐being apart from medically diagnosed mental illness. •  A paid job might largely help service users feel better because they are entering what society judges to be a ‘normal’ life. But the opposite effect is that other people could feel guilty or worse if the standard for ‘normal’ work in society is too difficult for them to manage.Abstract Individual Placement and Support (IPS) is considered the only evidence‐based practice available for providing vocational support within secondary mental health services. Clients are supported into and during competitive employment, with proponents claiming IPS ‘reflects client goals’ because most service users want to work. The idea that work improves mental health is also involved in promoting IPS in the UK. This paper examines the evidential basis for these claims in policy documents and cited research. It additionally draws upon qualitative research in representing the value, meaning and challenges of working described by service users, while briefly considering the UK socio‐economic context for IPS implementation. Statistical claims that most unemployed service users want to work are found misleadingly applied to IPS because only a minority say they want competitive employment. Discussion centres on the power interests such statistics serve and their role in underpinning the relevance of IPS randomized control trials. Assertions that work improves mental health are found confusing as a result of use of a dual continua model of mental illness and mental health. The internalized moral basis for work acting as a seemingly healthy ‘normalization’ experience is suggested as paradoxically feeding self‐stigma in those who feel they cannot work.