New Zealand’s IPS expansion outpaces equitable access

New Zealand’s Individual Placement and Support workforce has more than doubled in five years, reaching 113.4 full-time equivalent employment specialists across 82 clinical teams in 13 of the country’s 19 health districts. Yet a policy analysis finds that this rapid expansion has not produced uniform access or consistently high-quality services. Even with local evidence showing strong employment outcomes, the programme remains dependent on fragmented funding, local leadership and uneven integration with health and welfare agencies rather than a nationally accountable system.

The analysis, published as a policy brief in Public Health Reviews, examines Individual Placement and Support (IPS) in Aotearoa New Zealand since 2019. It combines workforce and coverage data with 38 implementation fidelity reviews conducted between June 2020 and June 2026, then assesses enabling conditions at three levels: national policy and funding, organisational and service systems, and day-to-day practice. This is a policy and implementation analysis rather than a new trial, but it identifies where the country’s existing evidence-based employment intervention is succeeding and where structural gaps threaten further expansion.

IPS is an evidence-based approach in which employment specialists work directly with people with mental health conditions, clinical teams and employers to help participants obtain and retain competitive jobs. Unlike employment support separated from treatment, IPS embeds rapid job search, individualised placement, employer engagement and continuing support for workers after placement. Early pilots in New Zealand placed employment specialists within adult community mental health teams and reported improved outcomes when employment support was integrated with clinical care. The brief concludes that ample evidence supports the effectiveness of IPS in New Zealand; the unresolved question is how to make high-quality delivery a routine and equitable public service.

Coverage has expanded substantially but remains geographically uneven. In 2019, 52.7 FTE employment specialists worked nationwide, equivalent to 3.7 FTE per 10,000 adults accessing specialist mental health and addiction services. By 2026, the reported total had reached 113.4 FTE. Using an assumed caseload of 20 people per specialist with one turnover per year, or 40 people supported annually, the workforce could serve roughly 4,500 people each year—only about 3% of adults who access specialist mental health and addiction services. The estimate depends on those workload assumptions and describes potential annual reach, not the number actually employed.

Growth has also been concentrated geographically. Auckland and Northland recorded substantial increases, while Nelson Marlborough expanded and the West Coast district entered the programme. Yet several districts that had no IPS service in 2019 largely remained without one, and rural inequities persisted. New providers have broadened the delivery ecosystem, including Māori-led mental health and addiction services and an organisation specialising in addiction recovery. In Northland, Māori participants account for nearly half of successful job placements, an association the brief links with Māori leadership and an explicit equity focus rather than presenting the observation as a controlled effect.

Implementation quality tells a similarly mixed story. The 38 fidelity reviews used the 25-item IPS-25 scale, with observed total scores ranging from 52 out of 125, classified as “not IPS,” to 114 out of 125, classified as good fidelity; 14 reviews reached the good-fidelity rating. Relatively strong scores for staffing, integration with mental health teams, supervisor roles, rapid job search, diversity of jobs and employers, and a focus on competitive employment indicate that many services possess important elements of IPS. Lower-scoring areas included zero-exclusion criteria, the organisational focus on competitive employment, executive-team support, frequent employer contact, ongoing support after job placement and time spent in the community. The variation shows that the intervention is not consistently delivered in its entirety across the sites reviewed.

Local research supports the approach’s potential. Ministry of Social Development studies using IPS programme data and New Zealand’s Integrated Data Infrastructure found outcomes exceeding international benchmarks and high relative effectiveness across ethnic groups among people in contact with specialist mental health and addiction services who faced substantial labour-market barriers. A three-year cost-effectiveness analysis found that a larger proportion of IPS participants obtained employment than comparable people without the programme, had higher income from all sources and were more likely to gain qualifications. The analysis also reported increased employment and increased mental health service engagement among Māori participants. One limitation was that female participants’ earnings rose without an increase in total income, apparently because reduced welfare payments offset the earnings gain.

The brief attributes the next stage of expansion less to uncertainty about the intervention than to gaps in the system that authorises and sustains it. Health New Zealand and the Ministry of Social Development operate through parallel policy, funding and commissioning channels, sometimes collaborating locally without unified national governance. Existing performance frameworks do not hold either agency accountable for competitive employment outcomes among people using specialist mental health and addiction services. Regional innovations, including joint Health NZ and MSD funding in Auckland and Northland, have advanced the programme, but national scale-up would require pooled commissioning and stable investment over multiple years. Funding for implementation support has also not risen alongside frontline expansion, creating risks for service quality and sustainability.

The authors propose three interdependent shifts: treating employment as a core outcome of specialist mental health and addiction services; creating shared accountability between Health New Zealand and the Ministry of Social Development through joint commissioning and governance; and sustainably funding the infrastructure needed for high-fidelity IPS. At the organisational level, that means embedding employment goals in treatment planning, using zero-exclusion referral, formalising links with Work and Income and reviewing outcomes at service level. At practice level, teams would discuss employment aspirations early, strengthen employer engagement and provide continuing support once someone starts work. National measures should cover competitive employment alongside clinical outcomes, with explicit accountability for Māori and Pacific access, regular fidelity reviews, benchmarking and better data systems.

The policy landscape has become more supportive, including the 2026 Mental Health and Wellbeing Strategy and its three-year implementation plan, but supportive policy alone does not create accountability or coverage. The central question is no longer whether IPS can help people with mental health conditions enter competitive employment in New Zealand. It is whether public agencies can build a durable system that funds the service, measures its outcomes, supports its practitioners and makes access depend on need rather than location. The brief’s central warning is that growth may otherwise harden into uneven local provision, widening rather than narrowing the gap between districts and populations with the fewest employment opportunities.

Subject of Research: Policy analysis of Individual Placement and Support expansion, implementation quality and equitable access in New Zealand

Article Title: From promise to practice: the growth and future of individual placement and support employment support in Aotearoa New Zealand

Article References: Lockett, H., Elwin, W., & Williams, R. (2026). From promise to practice: the growth and future of individual placement and support employment support in Aotearoa New Zealand. Public Health Reviews, 47, Article 1609475. https://doi.org/10.3389/phrs.2026.1609475

Image Credits: AI Generated

DOI: 10.3389/phrs.2026.1609475

Keywords: Individual Placement and Support, supported employment, mental health services, New Zealand, implementation fidelity, workforce expansion, health equity, policy commissioning, Māori health, employment outcomes, promise, practice