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Supported Employment — MRCPsych Paper B MCQ

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ModerateRehabilitationSupported EmploymentMRCPsych Paper B

A 45-year-old woman with schizophrenia has been receiving inpatient rehabilitation for 2 years. Her symptoms are stable, she has developed good daily living skills, and discharge to supported accommodation is being planned. She says that she would like to obtain ordinary paid employment, but the team is considering whether she should first complete a prolonged work-readiness programme. Which vocational rehabilitation approach should be prioritised?

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Correct answer: A — Individual Placement and Support

Individual Placement and Support (IPS) should be prioritised. She wishes to pursue mainstream paid employment and is clinically stable enough for this goal. IPS follows a rapid “place then train” approach: an employment specialist helps the person find competitive work matched to their preferences, integrates support with the mental health team, and continues individualised assistance after employment begins. Sheltered workshops and prolonged work-readiness programmes use more traditional pre-vocational approaches and should not routinely delay attempts to obtain mainstream employment. Volunteering or transitional employment may be appropriate when a person does not yet wish or feel ready to pursue paid work, but volunteering should not be imposed as the only option here. Excluding employment as a rehabilitation objective conflicts with recovery-oriented, strengths-based practice.

Reference: National Institute for Health and Care Excellence. Rehabilitation for adults with complex psychosis, NICE guideline NG181, recommendation 1.8.10 and definition of Individual Placement and Support, 2020 (reviewed 2024). https://www.nice.org.uk/guidance/NG181/chapter/recommendations