Supportive policies hold the key to helping people with mental illness find and keep jobs, 13-country analysis finds

Across Europe, only 15 to 25 percent of people with severe mental illness hold regular employment, despite overwhelming evidence that having a job can help them manage symptoms, boost motivation, and reduce both public and self-stigma. A new consensus-based policy synthesis published in Public Health Reviews argues that closing this gap requires far more than an effective vocational programme alone. Analysing national policies in 13 European countries, a team of 23 researchers from the European IPS learning network concludes that individual placement and support (IPS), one of the most rigorously tested interventions in mental health care, cannot succeed in isolation. It needs supportive policies spanning employment, social welfare, and recovery-oriented mental health care to build a durable bridge between the clinic and the workplace.

IPS flips the traditional logic of vocational rehabilitation. Instead of requiring clients to complete lengthy pre-employment training before they are considered job-ready, it follows a ‘place-then-train’ principle: participants start working in jobs they genuinely want, then learn the necessary skills on the job with tailored support from trained employment specialists. Crucially, employment support and mental health treatment are integrated within a single service, so the two forms of assistance reinforce each other. Employment specialists offer customised guidance to both clients and employers, while mental health treatment underpins clinical recovery and helps working clients self-manage their condition on the job. Many studies have confirmed that IPS is both effective and cost-effective, not only for people with severe mental illnesses such as psychosis but also for those with common mental disorders.

Yet the relationship between employment and mental health is bidirectional and complex. Favourable working conditions promote better mental health, which explains why many clients in mental health care want regular jobs. At the same time, some degree of health is required to remain employed, and European workplaces place high demands on workers’ qualifications, self-reliance, and mental resilience. Mental ill-health is associated with high levels of sickness absence and premature labour-market exit. Concerns about relapse, loss of benefits, and stigma can make people ambivalent about returning to work. The World Health Organization and the International Labour Organization have stated that workers with mental illness need reasonable accommodations, return-to-work programmes, and supported employment to participate fully, but poor working conditions can undermine employee retention and mental health regardless.

To understand why IPS reaches only a small fraction of its potential target group despite international recommendations, the researchers asked country representatives from ten EU member states (Belgium, Czech Republic, Finland, France, Germany, Ireland, Italy, the Netherlands, Spain, and Sweden) plus Iceland, Norway, and the UK to complete a structured template covering the status and governance of IPS policy, implementation barriers, policy priorities, and alignment with workplace mental health and recovery-oriented care. Responses were compared, grouped into recurring categories, and circulated for country-level verification and consensus. The analysis reveals a striking policy-practice gap: only six of the 13 countries currently have national policies on IPS, and formal recognition does not automatically translate into consistent implementation.

The barriers reported were more similar than different across countries. Insufficient cooperation between mental health, employment, and social welfare services was the most common obstacle, identified in nine of the 13 countries. The absence of stable funding mechanisms followed in seven, persisting ‘train-then-place’ cultures in six, and limited implementation capacity or access in five. IPS services often operate in isolation, with limited access to consistent training, data, and cross-sector coordination. The country reports suggest a recurring pattern: local initiatives and professional advocacy often precede formal recognition, followed in some countries by greater attention to sustainable funding, quality assurance, workforce development, and intersectoral governance. Countries with more established IPS infrastructures increasingly address issues beyond programme expansion, such as job retention and job quality in the UK, or national fidelity monitoring and advanced training for IPS workers in Iceland, the Netherlands, Norway, and the UK.

Governance arrangements shape both opportunities and challenges. In Finland, Ireland, and the UK, the Ministry of Health is the primary driver of IPS policy; in the Netherlands, the Ministry of Employment and Social Affairs took the lead; and in Iceland and Norway, it is a combined effort of the Ministries of Health and Employment. In the Czech Republic, Italy, Spain, Germany, and Sweden, IPS is mainly developed through regional initiatives. Decentralised governance in Italy, Spain, and Sweden has facilitated bottom-up implementation but also generated territorial inequalities and fragmented access. Several contributors suggested establishing national frameworks that define core IPS standards while allowing regional adaptation to local contexts, balancing consistency with flexibility.

The researchers stress that IPS alone cannot address the broader workplace and system-level conditions required for decent and sustainable employment. They draw on the concept of ‘decent work’, defined by the International Labour Organization as productive work in conditions of freedom, equity, security, and human dignity, encompassing job creation, rights at work, social protection, and social dialogue. Decent work is embedded in the European Social Charter and connects to the United Nations Sustainable Development Goals. Pursuing decent work is a valid starting point for promoting mental health in the workplace, but it requires psychosocial risk management, interventions to reshape working conditions, cultures, and relationships, and active promotion of mental health literacy and skills so workers can act on mental health conditions and seek support.

Some countries are already moving in this direction, though most lack a unified cross-government framework on mental health at work. In France, conditions resulting from prolonged exposure to psychosocial risks at work are recognised as occupational diseases. In Germany, employers are required to assess psychological strain as part of occupational risk assessment. Norway has introduced employers’ responsibility to identify and manage risk factors such as excessive workload, time pressure, unclear expectations, lack of support, and harassment. In 2024, the Belgian Presidency of the European Union took the initiative to advance these ambitions, aiming for a European directive supporting member states’ efforts to prevent the onset of mental ill-health linked to working conditions and to create an inclusive labour market for groups at high risk of exclusion.

Based on these findings, the contributors agreed on a multifaceted strategy. First, IPS should be formally recognised as a preferred evidence-based intervention, with a sustainable national infrastructure offering implementation support, fidelity monitoring, and a research programme to strengthen services and reduce regional inequalities. Italy proposed making IPS an obligatory standard in the accreditation system for mental health services, while the UK suggested national training pathways, accreditation, and career progression routes for the IPS workforce. Second, intersectoral collaboration should be strengthened by formalising governance mechanisms connecting mental health services, employment services, social services, and employers, with shared outcome measures encouraging services to work towards common goals in recovery, education, and employment. Third, IPS should be accessible to all who need it, with employment outcomes incorporated into the mental health system’s accountability and positioned as a core intervention in national responses to rising inactivity due to mental ill health. Finally, employers need both engagement and incentives to promote equity, diversity, and inclusion, addressing workload, job control, and workplace culture alongside individual-level interventions.

The authors acknowledge that their expert-informed comparison has limitations, as the involvement of all contributors in the European IPS learning network may introduce an IPS-oriented perspective in the selection and interpretation of policy priorities. They also note that healthy workplaces and recovery-oriented mental health care are not the only contexts needed to support IPS and its clients; policies counteracting stigma at interpersonal, organisational, and structural levels are equally essential. IPS is certainly not a panacea for the vocational integration of people with mental illness. But by offering an active labour market strategy to people with mental illness, and employment being a critical health intervention, IPS can act as a catalyst for closer collaboration between health, employment, and social policy sectors, provided that policymakers translate policy commitments into governance arrangements, sustainable financing, workforce capacity, and mechanisms for implementation support and accountability.

Subject of Research: The need for supportive policies: connecting individual placement and support to the domains of employment and mental health care

Article Title: The need for supportive policies: connecting individual placement and support to the domains of employment and mental health care

Article References: van Weeghel, J., Fioritti, A., Jaeckel, D., Johnston, G., Mazzetti, G., Ahola, M., Bejerholm, U., Bergmans, C., Debroas, F., de Winter, L., Einarsdottir, S. E., Guglielmi, D., Jónasson, H., Kárníková, A., Koatz, D., Kropeit, J., Lunder Arvesen, A. L., Manchisi, D., Markerink, J., … Van Audenhove, C. (2026). The need for supportive policies: connecting individual placement and support to the domains of employment and mental health care. Public Health Reviews, 47, Article 1608802. https://doi.org/10.3389/phrs.2026.1608802

Image Credits: AI Generated

DOI: 10.3389/phrs.2026.1608802

Keywords: need, supportive, policies, connecting, individual, placement, support, domains, employment, mental, health, care