Dr Jason Lowther

Alongside the growing evidence base in areas such as homelessness, local growth and skills, there is increasing attention on how local systems respond to the intersection of mental health and employment. This is a critical issue for local authorities and their partners, given the strong relationship between work, wellbeing and wider social outcomes.

The recent evaluation of Individual Placement Support (IPS) integrated within Improving Access to Psychological Therapies (IAPT), delivered through the Mental Health Trailblazers programme, provides a valuable contribution to this evidence. The programme was designed to address two linked challenges (poor mental health and unemployment) through a combined intervention offering both therapeutic and employment support. It was delivered across three areas (Blackpool, the North East and West London) as locally commissioned “growth deal” projects aimed at improving both economic and health outcomes.

An integrated approach to mental health and work

The overarching premise of the programme is simple but important: mental health and employment are interdependent. Traditional services often treat them separately, with employment support and mental health treatment delivered through different systems. The Trailblazers programme sought to integrate these approaches by embedding employment specialists alongside psychological therapy services.

The evaluation employed a mixed‑methods design, combining an impact evaluation – using a trial‑style comparison between IAPT alone and IAPT plus IPS – with a detailed process evaluation examining implementation, service design and user experience. This dual approach reflects the complexity of the intervention: it is not only about whether outcomes improve, but about how services work together in practice.

Findings on outcomes: modest but promising

On outcomes, the evaluation presents a cautious but broadly positive picture. While the evidence on impact is not definitive, there are indications that combining IPS with psychological therapies can support improvements in both employment and mental health outcomes compared to standard provision.

This aligns with a wider evidence base for IPS, which consistently shows strong performance in helping people with mental health conditions move into and sustain work. Employment itself is recognised as beneficial for recovery and wellbeing, reinforcing the rationale for integrated approaches.

However, the evaluation also highlights the difficulty of demonstrating impact in complex, real‑world settings. Data limitations, variation in local models and challenges in maintaining experimental control all affected the strength of conclusions. This is a recurring issue across many local public service evaluations: outcomes are shaped by multiple interacting factors, making attribution difficult.

What makes the model work in practice?

The process evaluation provides rich insight into the mechanisms behind the model. Several features emerge as particularly important.

First, the relationship between service users and employment specialists is central. IPS is explicitly client‑led, focusing on individual preferences, strengths and readiness rather than predefined pathways. This personalised, relational approach appears to be a key driver of engagement.

Second, integration between services matters. Embedding employment specialists within IAPT teams helped create a more holistic offer, reducing fragmentation and enabling better coordination of support. Where integration was stronger, services were better able to respond to the complex and fluctuating needs of clients.

Third, the model benefits from being less target‑driven than traditional employment programmes. The evaluation notes that a focus on client needs, rather than rigid job outcome targets, enabled more sustained engagement – particularly for individuals with more severe or complex mental health challenges.

At the same time, implementation was not without difficulties. Referral processes, administrative requirements and clinical wait times all created friction in the system. Experiences and outcomes  were inconsistent.

The system challenge: integration is difficult

Perhaps the most important learning from the evaluation is about the difficulty of integrating services across organisational boundaries. Bringing together health and employment support requires alignment between different funding streams, professional cultures and accountability frameworks.

The evaluation highlights challenges such as eligibility criteria, information sharing and differences in service priorities. These issues are not unique to this programme; they reflect broader structural barriers within public services. Even where the case for integration is clear, delivering it in practice requires sustained effort and coordination.

There were also challenges in engaging employers and navigating local labour markets. Employment outcomes depend not only on individual readiness, but on the availability and quality of jobs. This again points to the importance of seeing mental health services within a wider economic context.

What does this mean for local authorities?

The evaluation offers several implications for local government and system partners.

First, integration across services is both necessary and challenging. The evidence supports the case for bringing together health and employment support, but also shows that this requires deliberate design, strong relationships and ongoing coordination.

Second, personalised, relationship‑based support is critical. Models like IPS work because they focus on individuals, not categories. This has implications for commissioning and performance management, which often rely on standardised models and metrics.

Third, employment should be seen as a health outcome. The evaluation reinforces the idea that good work is not just an economic goal, but a key component of wellbeing and recovery. This has implications for how local systems define success.

Fourth, local variation matters. The programme was delivered differently across areas, reflecting local labour markets, service configurations and partnerships. This flexibility is a strength, but also makes evaluation and scaling more complex.

Finally, the evaluation highlights the importance of longer‑term thinking. Supporting people with mental health conditions into work is not a short‑term intervention. Outcomes take time to emerge, and services need stability to build the relationships and capability required.

As with other areas of local government, the evidence increasingly shows what works in principle. The challenge is less about identifying effective models, and more about creating the conditions – organisational, financial and cultural – that allow them to be implemented flexibly and at scale.