We know Individual Placement and Support (IPS) works in clinical trials. Can it improve outcomes for patients in the real world?

Mental disorder is the leading cause of disability in most western societies, and the proportion of disability related to mental disorder has increased for decades. Only 5-10 percent of people with schizophrenia are employed in Norway. Employment may increase quality of life and reduce the financial burden on society. There may be a solution to this problem. Individual Placement and Support (IPS) is particularly designed for individuals with severe mental illness. About 20 randomized controlled trials have shown that IPS successfully increases the rate of employment, compared to traditional approaches. Despite overwhelming evidence for efficacy, the IPS method is yet to be implemented as standard practice anywhere in the world. Norwegian policy mandates implementation and spreading of IPS and the importance of integration in working life. IPSNOR is a large-scale initiative to integrate IPS in the specialist health care services, and in community mental health services. We will promote implementation of IPS in selected counties in Norway. The project is organized in work packages: WP1 Effectiveness trial using registry data: Employment, health, social functioning WP2 Health economics WP3 Implementation, operational data / production data WP4 Implementation, qualitative studies WP5 Implementation, surveys among clinicians and NAV personnel ? and patient flow data WP6 How to succeed as an employment specialist? WP7 How does IPS feel? Survey data from job seekers WP8 How does IPS feel? Qualitative data. Users? perspectives and relatives? perspectives WP9 The epidemiology of disability in mental disorder WP10 Implementation papers, PROCTOR framework Research in IPSNOR is funded by the Research Council of Norway. Partners and collaborators include London School of Economics, University of New South Wales, the South West London & St Georges Mental Health NHS, The Arctic University of Norway, Northern Norway Regional Health Authority, Norwegian Institute of Public Health, Norwegian Labour and Welfare Administration, the Directorate of Labour and Welfare, and the regional Centre for Research and Education in Forensic Psychiatry and Psychology at Haukeland University Hospital, Norway. Covid-19 has had consequences for the project. WP1, 3, 4, 5 have been affected as a result of the implementation being disrupted by infection control measures. However, IPS implementation will continue. WP7 and WP8 are postponed pending normal physical meetings. We have results for some of the work packages: WP2: We have carried out a systematic review of the health economic consequences of IPS implementation, which provides evidence that IPS implementation has significant benefits for the public sector. Furthermore, the economic benefits of IPS implementation may accrue over time for sectors other than those bearing the costs of implementation. WP4: We have published an article on the implementation of IPS, with data from before the pandemic. This points to special challenges for job specialists related to uncertainty about role, privacy, responsibilities and guidelines, which in turn is related to the cross-sectoral organisation in Norway where job specialists are employed in the welfare sector and work in the health sector. WP6: We have submitted an article on turnover among job specialists for peer review. There is a higher turnover among IPS job specialists than in the public sector in general. This is partly related to job satisfaction and job stress but also to some extent on personality. WP9: We have submitted an article investigating typical educational, work and welfare-state trajectories up to disability benefits. This article shows that, compared to 15-20 years ago, trajectories up to disability benefits are now less likely to include a period of stable employment or study. This means that initiatives aimed at preventing transitions from work to disability benefits are less relevant than previously for the group that becomes disabled. Results, update for 2022: A qualitative study has documented challenges with implementing IPS in Northern Norway (Moe 2021) . A systematic review and meta-analysis of IPS has documented the economic case for IPS implementation for the public purse (Park 2022). Results, update for 2023: A qualitative study has reviewed the history behind IPS implementation in Norway (Moe et al 2023). We published an article on the challenges Covid-19 provided for IPS services in Norway (Wittlund et al 2023). There is a lot of debate about what is a “typical” job specialist. We have published an article on the personality profile of job specialists (Butenko 2023).

In spite of the advances in treatment of patients with severe mental illness, only a small minority of individuals participate in the workforce. In fact, disability for mental disorder among young people is increasing, which is both fiscal challenge for society, and a quality of life problem for patients. We have documented the efficacy of IPS for successful employment in a recent systematic literature review and meta-analysis, and IPS is piloted in Norway. However, it is still uncertain if IPS will work beyond RCT-contexts, which benefits from enthusiasts and favourable resources. Previous RCTs have also been unable to measure some of the longer-term potential benefits of IPS. It also remains to be seen if IPS may also reduce benefit dependency, improve health, and reduce mortality, crime rates and loneliness among mentally ill. This will require statistical power only achievable in large-scale naturalistic trails and with access to registry data. Full-scale implementation of the IPS-model requires a close collaboration between the welfare sector and the health sector. We have formalized such a collaboration in Northern Norway to deliver IPS in standard psychiatric services for a population of almost 500.000 inhabitants. Registry data are available to monitor effectiveness on a range of long-term outcomes. We will develop resources necessary to deliver IPS at this scale. Resources called for include practical training modules for educating job specialists, resources and systems for supervision, resources for integrating this new professional role in existing psychiatric units, and IT-systems to facilitate and supervise their IPS activity in rural areas. We have teamed up with leading national and international IPS practitioners and experts to develop these resources. This is unique research opportunity to understand how IPS may take the next step from ad-hoc projects to full-scale implementation; from efficacy to effectiveness; from theory to practice.