The employment position of people with enduring mental health issues and learning difficulties (intellectual impairment) is a major policy and moral challenge. The continued exclusion from paid work for those disabled people who are otherwise keen to work is marked in Western Europe even in high per capita welfare states. The paradox here is that disabled people have received policy and programme attention, but arguably programmes have become increasingly ‘corporeal’ and medicalized. Condition management programmes (CMPs) epitomize this approach and focus on getting the sick and disabled body/brain more work-ready ahead of wider supports. By way of contrast this article presents the results of a large-scale evaluation of a non-medicalized approach in the UK which concentrated on careful job matching, intensive support and barrier reduction. It argues that flexible personalized approaches will afford greater employment success than a focus on deficits and welfare dependency reduction.