NHS Health Scotland
Outcome Indicators
4.2 Activities to increase prospects for employment and engaging in meaningful activity will increase the skills and self-efficacy of individuals in attaining employment. This, in turn, will increase the prospects for good and sustained employment, and ultimately result in increased social inclusion.


Supported employment

Job search, retraining and vocational programmes

Job retention programmes

Supported employment/engaging in meaningful activity
Review level evidence suggests that supported employment is superior to prevocational training programmes in achieving competitive employment and spending more time in competitive employment for people with mental health problems.[1, 2] NICE clinical guidelines 82 on Schizophrenia [3] recommended that supported employment is provided for those who wish to return to work or gain employment though this should not be limited to paid employment if individuals are not able to work or are unsuccessful in gaining work. NICE clinical guidelines 38 on bipolar disorder [4] recommended that mental health services, in partnership with social care providers and other local stakeholders, should consider providing: vocational rehabilitation (specifically, individual supported placements) for people with bipolar disorder who want help returning to work or gaining employment and support to return to or engage with education or other structured, purposeful activities. It should be noted that NICE clinical guidelines have no formal status in Scotland.

Job search, retraining and vocational programmes
There is evidence from primary research that providing job search retraining and vocational programmes for low income unemployed groups can be effective in increasing their prospects of employment and results in better quality employment. The JOBS programme has been most extensively evaluated and focuses on improving participant job search skills and increasing self-esteem, confidence and motivation to persist in job search activities. Randomized Controlled Trials in the USA have shown positive effects on rates of re-employment, the quality and pay of jobs obtained and job search self-efficacy and mastery, as well as reduce depression and distress.[5]

Job retention programmes
There is increasing recognition that helping people remain in work wherever possible and thus avoid long-term unemployment can be achieved if the right steps are taken when employees’ health conditions are first identified in the work place. Whilst there is no highly processed evidence of effective interventions to improve job retention, the Sainsbury Centre for Mental Health has identified a set of guiding principles and practice to govern good job retention based on primary research and expert opinion6 and the report on social exclusion and mental health [7] suggest that GPs and occupational health services have a crucial role in facilitating job retention.


  1. Grove, N (2008). State of Science Review: SR:B9 Factors influencing recovery from serious mental illness and enhancing participation in family, social and working life. The Government Office for Science, London.

  2. Crowther R, Marshall M, Bond GR & Huxley P (2001). Vocational rehabilitation for people with severe mental illness. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD003080. DOI: 10.1002/14651858.CD003080.

  3. NICE (2009). NICE clinical guidelines 82 Schizophrenia: Core interventions in the treatment and management of schizophrenia in primary and secondary care (update). NICE: London.

  4. NICE (2006). NICE clinical guidelines 38 Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. NICE: London.

  5. Hosman C & Jané-Llopis E (2005). The Evidence of Effective Interventions for Mental Health Promotion. In H Herman, S Saxena & R Moodie (Eds). Promoting mental health: Concepts, emerging evidence and practice. WHO: Geneva.

  6. Butterworth R (2004, revised 2005, 2008). Providing effective job retention services for people with mental heath difficulties: Principles and practice. Sainsbury Centre for Mental Health.

  7. Social Inclusion Report (2004). Mental Health and Social Exclusion: Social Exclusion Unit Report. HMSO: London.