Employer-Based Interventions for Schizophrenia: A Systematic Literature Review and Psychiatric Nursing Perspective
DOI:
https://doi.org/10.51143/jksi.v11i1.1165Keywords:
Employment Outcomes, Individual Placement And Support, Schizophrenia Supported Employment, Vocational RehabilitationAbstract
Employment is crucial for the recovery and social inclusion of individuals with schizophrenia and other severe mental illnesses (SMI), yet significant barriers to competitive employment persist. Although various employer-based vocational interventions have been developed, their efficacy remains variable across settings. Guided by the PRISMA framework, this systematic review evaluates the effectiveness of employer-based interventions in improving employment outcomes for this population. A comprehensive search of Scopus, Web of Science, and PubMed was conducted for studies published between 2020 and 2026. Following rigorous screening, 19 studies from nine countries were selected for qualitative synthesis. The interventions assessed included Individual Placement and Support (IPS), Supported Employment (SE), integrated vocational-psychiatric programs, and return-to-work initiatives. Results indicate that IPS and SE consistently provide the strongest evidence for improving competitive employment rates, job acquisition, and job retention, with one study reporting a 7.5% increase in job availability post-SE implementation. Conversely, interventions relying exclusively on employer-directed communication demonstrated limited efficacy. In conclusion, IPS and Supported Employment are the most effective strategies for enhancing employment outcomes in this population. Integrating vocational support with comprehensive mental health services is critical for fostering sustainable employment and facilitating long-term recovery.
References
Alligood, M. R. (2021). Nursing Theorists and Their Work (10th ed.). Elsevier Health Sciences.
Berglund, E., Anderzén, I., Helgesson, M., Lytsy, P., & Andersén, Å. (2024). Work participation after receiving multidisciplinary treatment or acceptance and commitment therapy intervention for return to work: long-term follow-up of a randomized controlled trial among sick-listed individuals with mental disorders and/or chronic pain. BMC Public Health, 24(1), 3558. https://doi.org/10.1186/s12889-024-21116-1
Björkelund, C., Saxvik, A., Svenningsson, I., Petersson, E.-L., Wiegner, L., Larsson, M., Törnbom, K., Wikberg, C., Ariai, N., Nejati, S., Hensing, G., & Hange, D. (2023). Rehabilitation cooperation and person-centered dialogue meeting for patients sick-listed for common mental disorders: 12 months follow-up of sick leave days, symptoms of depression, anxiety, stress, and work ability - a pragmatic cluster randomized control. BMJ Open, 13(6), e074137. https://doi.org/10.1136/bmjopen-2023-074137
Borowska, M. A., Ørjasæter, K. B., Borg, M., Stenvall, B., Silbermann, A., Rinaldi, M., Killackey, E., Mykletun, A., & Moe, C. (2025). “ Without IPS I Think I Would Really Fall Apart ”?: Individual Placement and Support as Experienced by People With Mental Illness — Phenomenological Peer Research Study. https://doi.org/10.1177/10497323241275046
Bushra, A., Dragovic, M., Chalmers, M., Ayres, H., & John, A. P. (2026). Employment outcomes and their predictors among people with severe mental illness participating in an individual placement and support program. Australasian Psychiatry, 34(1), 40–46. https://doi.org/10.1177/10398562251370880
Chimara, M., van Biljon, H., Adams, F., & van Niekerk, L. (2025). Perspectives of service providers on vocational rehabilitation for mental health service users in Namibia: a qualitative study. Disability and Rehabilitation, 47(4), 992–1000. https://doi.org/10.1080/09638288.2024.2362944
Fisker, J., Poulsen, R. M., Rosenberg, N. K., Nordentoft, M., Bojesen, A. B., & Eplov, L. F. (2022). Scandinavian Journal of Work, Environment Health. 48(5), 361–371. https://doi.org/10.5271/sjweh.4021
Fontenay, S., & Tojerow, I. (2025). Is supported employment effective for Disability Insurance recipients with mental health conditions? Evidence from a randomized experiment in Belgium. Journal of Health Economics, 100. https://doi.org/10.1016/j.jhealeco.2024.102958
Geerdink, E. O., Kempen, M. A. H. H. Van, & Motazedi, J. V. W. E. (2025). Individual Placement and Support and Participatory Workplace Intervention on the Work Participation of People with Disabilities?: A Randomized Controlled Trial. Journal of Occupational Rehabilitation, 35(3), 520–532. https://doi.org/10.1007/s10926-024-10219-6
Grethe, L., Larry, K., Ketil, D., Oedegaard, J., & Langeland, E. (2025). Struggling with Fitting in?: Clients' Mixed Experiences of Receiving Job Support and Getting a Job When Participating in Individual Placement and Support in Norway. Journal of Occupational Rehabilitation, 35(2), 356–365. https://doi.org/10.1007/s10926-024-10206-x
Hoff, A., Poulsen, R. M., Fisker, J., Hjorthøj, C., Rosenberg, N., Nordentoft, M., Bojesen, A. B., & Eplov, L. F. (2022). Integrating vocational rehabilitation and mental healthcare to improve the return- ? work process for people on sick leave with depression or anxiety?: results from a three- ? arm , parallel randomized trial. Cmd, 134–142. https://doi.org/10.1136/oemed-2021-107894
Id, D. E. F., & Vanderweele, T. J. (2019). Supported employment?: Meta-analysis and review of randomized controlled trials of individual placement and support. Plos ONE, 14(2): e0212208. 1–26. https://doi.org/10.1371/journal. pone.0212208
Isaacs, A. N., & Mitchell, E. K. L. (2024). Mental health integrated care models in primary care and factors that contribute to their effective implementation?: a scoping review. International Journal of Mental Health Systems, 1–16. https://doi.org/10.1186/s13033-024-00625-x
Jäckel, D., Bechdolf, A., Burkhardt, E., Kallenbach, M., Gamig, M.-L., Mößnang, A., & Leopold, K. (2025). Efficacy of Individual Placement and Support (IPS) on Employment, Education, and Training in Young Adults With Early Psychosis—A Randomized Controlled Trial. Brain and Behavior, 15(5). https://doi.org/10.1002/brb3.70469
Kinn, L. G., Davidson, L., Oedegaard, K. J., & Langeland, E. (2025). Struggling with Fitting in: Clients' Mixed Experiences of Receiving Job Support and Getting a Job When Participating in Individual Placement and Support in Norway. Journal of Occupational Rehabilitation, 35(2), 356–365. https://doi.org/10.1007/s10926-024-10206-x
Li, M., Chen, Y., Hu, X., & Wang, S. (2023). The preferences for the telemedicine and standard health care services from the perspective of the patients with schizophrenia. BMC Psychiatry, 23(1), 1–11.
Liljeholm, U., Argentzell, E., & Bejerholm, U. (2020). An integrated mental health and vocational intervention: A longitudinal study on mental health changes among young adults. NURSING OPEN, 7(6), 1755–1765. https://doi.org/10.1002/nop2.560
Malmberg-Heimonen, I., Tøge, A. G., Bråthen, M., Frøyland, K., Spjelkavik, Ø., Bond, G. R., Tøge, A. G., Bråthen, M., & Frøyland, K. (2025). Assessing Program Fidelity Patterns within the IPS for Young Adults in Norway Assessing Program Fidelity Patterns within the IPS for Young Adults in Norway ABSTRACT. Journal of Evidence-Based Social Work, 22(6), 893–908. https://doi.org/10.1080/26408066.2025.2528910
Mazzetti, G., Paganin, G., Mastrocola, A., Trono, V., Guglielmi, D., & Fioritti, A. (2026). Longitudinal Outcomes of Individual Placement and Support for Patients With Severe Mental Illness in Italy. International Journal Public Health, 71(February), 1–9. https://doi.org/10.3389/ijph.2026.1608701
Moe, C., Brinchmann, B., Kolstad, U., Steen, K., McDaid, D., & Killackey, E. (2025). A qualitative study of the IPS employment specialist role in the context of Nav employment in Norway. BMC Psychiatry, 1–10. https://doi.org/10.1186/s12888-025-06991-1
Nischk, D., Herwig, U., Senner, S., & Rockstroh, B. (2024). Effectiveness and Cost-Effectiveness of Individual Placement and Support (IPS) in Germany - A Controlled Trial with Individuals with Psychosis. PSYCHIATRISCHE PRAXIS, 51(02), 84–91. https://doi.org/10.1055/a-2165-8728
Ørjasæter, K. B., & von Heimburg, D. (2025). Becoming a valued member of society: the meaning of Art-Based vocational rehabilitation in the Norwegian labor and welfare service. BMC Psychology, 13(1). https://doi.org/10.1186/s40359-025-02597-0
Pai, N., Dark, F., & Castle, D. (2021). The Importance of Employment for Recovery in People with Severe Mental Illness. Journal of Psychosocial Rehabilitation and Mental Health, 8(3), 217–219. https://doi.org/10.1007/s40737-021-00245-5
Pedersen, P., Olsen, B. B., Vernal, D. L., Rydborg, M. P., Gasse, C., & Mors, O. (2025). Vocational Rehabilitation in Young Adults With Incident Schizophrenia—A Danish Retrospective Cohort Study. Early Intervention in Psychiatry, 19(6). https://doi.org/10.1111/eip.70062
Pulido, F. R., Pérez, D. O., Hernández, G. H., & Bond, G. (2025). A Randomized Controlled Trial of IPS in Severe mental illness?: Mental Health , Functional , and Vocational Outcomes in a High-Unemployment Setting. International Journal Public Health 70(December), 1–9. https://doi.org/10.3389/ijph.2025.1608796
Schjøtt-Pedersen, O., Bull, H. C., Falkum, E., Ueland, T., Gjerdalen, O. S., Haaland, V. Ø., Evensen, S., & Lystad, J. U. (2025). Exploring the Benefits of Vocational Activity for People with Schizophrenia Spectrum Disorder in Norway. Journal of Psychosocial Rehabilitation and Mental Health, 12(2), 219–235. https://doi.org/10.1007/s40737-024-00389-0
Yamaguchi, S., Koike, J., Igarashi, M., Kawaguchi, T., Shiozawa, T., Usui, K., Iwanaga, M., Matsunaga, A., Yoshida, K., Sato, S., & Fujii, C. (2025). Comparative Analysis of Independent Reviewer-Rated and Self-Rated Fidelity Scores in Individual Placement and Support Programs: Repeated Cross-Sectional Surveys. Administration and Policy in Mental Health and Mental Health Services Research, 52(2), 379–389. https://doi.org/10.1007/s10488-024-01413-y
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References
Alligood, M. R. (2021). Nursing Theorists and Their Work (10th ed.). Elsevier Health Sciences.
Berglund, E., Anderzén, I., Helgesson, M., Lytsy, P., & Andersén, Å. (2024). Work participation after receiving multidisciplinary treatment or acceptance and commitment therapy intervention for return to work: long-term follow-up of a randomized controlled trial among sick-listed individuals with mental disorders and/or chronic pain. BMC Public Health, 24(1), 3558. https://doi.org/10.1186/s12889-024-21116-1
Björkelund, C., Saxvik, A., Svenningsson, I., Petersson, E.-L., Wiegner, L., Larsson, M., Törnbom, K., Wikberg, C., Ariai, N., Nejati, S., Hensing, G., & Hange, D. (2023). Rehabilitation cooperation and person-centered dialogue meeting for patients sick-listed for common mental disorders: 12 months follow-up of sick leave days, symptoms of depression, anxiety, stress, and work ability - a pragmatic cluster randomized control. BMJ Open, 13(6), e074137. https://doi.org/10.1136/bmjopen-2023-074137
Borowska, M. A., Ørjasæter, K. B., Borg, M., Stenvall, B., Silbermann, A., Rinaldi, M., Killackey, E., Mykletun, A., & Moe, C. (2025). “ Without IPS I Think I Would Really Fall Apart ”?: Individual Placement and Support as Experienced by People With Mental Illness — Phenomenological Peer Research Study. https://doi.org/10.1177/10497323241275046
Bushra, A., Dragovic, M., Chalmers, M., Ayres, H., & John, A. P. (2026). Employment outcomes and their predictors among people with severe mental illness participating in an individual placement and support program. Australasian Psychiatry, 34(1), 40–46. https://doi.org/10.1177/10398562251370880
Chimara, M., van Biljon, H., Adams, F., & van Niekerk, L. (2025). Perspectives of service providers on vocational rehabilitation for mental health service users in Namibia: a qualitative study. Disability and Rehabilitation, 47(4), 992–1000. https://doi.org/10.1080/09638288.2024.2362944
Fisker, J., Poulsen, R. M., Rosenberg, N. K., Nordentoft, M., Bojesen, A. B., & Eplov, L. F. (2022). Scandinavian Journal of Work, Environment Health. 48(5), 361–371. https://doi.org/10.5271/sjweh.4021
Fontenay, S., & Tojerow, I. (2025). Is supported employment effective for Disability Insurance recipients with mental health conditions? Evidence from a randomized experiment in Belgium. Journal of Health Economics, 100. https://doi.org/10.1016/j.jhealeco.2024.102958
Geerdink, E. O., Kempen, M. A. H. H. Van, & Motazedi, J. V. W. E. (2025). Individual Placement and Support and Participatory Workplace Intervention on the Work Participation of People with Disabilities?: A Randomized Controlled Trial. Journal of Occupational Rehabilitation, 35(3), 520–532. https://doi.org/10.1007/s10926-024-10219-6
Grethe, L., Larry, K., Ketil, D., Oedegaard, J., & Langeland, E. (2025). Struggling with Fitting in?: Clients' Mixed Experiences of Receiving Job Support and Getting a Job When Participating in Individual Placement and Support in Norway. Journal of Occupational Rehabilitation, 35(2), 356–365. https://doi.org/10.1007/s10926-024-10206-x
Hoff, A., Poulsen, R. M., Fisker, J., Hjorthøj, C., Rosenberg, N., Nordentoft, M., Bojesen, A. B., & Eplov, L. F. (2022). Integrating vocational rehabilitation and mental healthcare to improve the return- ? work process for people on sick leave with depression or anxiety?: results from a three- ? arm , parallel randomized trial. Cmd, 134–142. https://doi.org/10.1136/oemed-2021-107894
Id, D. E. F., & Vanderweele, T. J. (2019). Supported employment?: Meta-analysis and review of randomized controlled trials of individual placement and support. Plos ONE, 14(2): e0212208. 1–26. https://doi.org/10.1371/journal. pone.0212208
Isaacs, A. N., & Mitchell, E. K. L. (2024). Mental health integrated care models in primary care and factors that contribute to their effective implementation?: a scoping review. International Journal of Mental Health Systems, 1–16. https://doi.org/10.1186/s13033-024-00625-x
Jäckel, D., Bechdolf, A., Burkhardt, E., Kallenbach, M., Gamig, M.-L., Mößnang, A., & Leopold, K. (2025). Efficacy of Individual Placement and Support (IPS) on Employment, Education, and Training in Young Adults With Early Psychosis—A Randomized Controlled Trial. Brain and Behavior, 15(5). https://doi.org/10.1002/brb3.70469
Kinn, L. G., Davidson, L., Oedegaard, K. J., & Langeland, E. (2025). Struggling with Fitting in: Clients' Mixed Experiences of Receiving Job Support and Getting a Job When Participating in Individual Placement and Support in Norway. Journal of Occupational Rehabilitation, 35(2), 356–365. https://doi.org/10.1007/s10926-024-10206-x
Li, M., Chen, Y., Hu, X., & Wang, S. (2023). The preferences for the telemedicine and standard health care services from the perspective of the patients with schizophrenia. BMC Psychiatry, 23(1), 1–11.
Liljeholm, U., Argentzell, E., & Bejerholm, U. (2020). An integrated mental health and vocational intervention: A longitudinal study on mental health changes among young adults. NURSING OPEN, 7(6), 1755–1765. https://doi.org/10.1002/nop2.560
Malmberg-Heimonen, I., Tøge, A. G., Bråthen, M., Frøyland, K., Spjelkavik, Ø., Bond, G. R., Tøge, A. G., Bråthen, M., & Frøyland, K. (2025). Assessing Program Fidelity Patterns within the IPS for Young Adults in Norway Assessing Program Fidelity Patterns within the IPS for Young Adults in Norway ABSTRACT. Journal of Evidence-Based Social Work, 22(6), 893–908. https://doi.org/10.1080/26408066.2025.2528910
Mazzetti, G., Paganin, G., Mastrocola, A., Trono, V., Guglielmi, D., & Fioritti, A. (2026). Longitudinal Outcomes of Individual Placement and Support for Patients With Severe Mental Illness in Italy. International Journal Public Health, 71(February), 1–9. https://doi.org/10.3389/ijph.2026.1608701
Moe, C., Brinchmann, B., Kolstad, U., Steen, K., McDaid, D., & Killackey, E. (2025). A qualitative study of the IPS employment specialist role in the context of Nav employment in Norway. BMC Psychiatry, 1–10. https://doi.org/10.1186/s12888-025-06991-1
Nischk, D., Herwig, U., Senner, S., & Rockstroh, B. (2024). Effectiveness and Cost-Effectiveness of Individual Placement and Support (IPS) in Germany - A Controlled Trial with Individuals with Psychosis. PSYCHIATRISCHE PRAXIS, 51(02), 84–91. https://doi.org/10.1055/a-2165-8728
Ørjasæter, K. B., & von Heimburg, D. (2025). Becoming a valued member of society: the meaning of Art-Based vocational rehabilitation in the Norwegian labor and welfare service. BMC Psychology, 13(1). https://doi.org/10.1186/s40359-025-02597-0
Pai, N., Dark, F., & Castle, D. (2021). The Importance of Employment for Recovery in People with Severe Mental Illness. Journal of Psychosocial Rehabilitation and Mental Health, 8(3), 217–219. https://doi.org/10.1007/s40737-021-00245-5
Pedersen, P., Olsen, B. B., Vernal, D. L., Rydborg, M. P., Gasse, C., & Mors, O. (2025). Vocational Rehabilitation in Young Adults With Incident Schizophrenia—A Danish Retrospective Cohort Study. Early Intervention in Psychiatry, 19(6). https://doi.org/10.1111/eip.70062
Pulido, F. R., Pérez, D. O., Hernández, G. H., & Bond, G. (2025). A Randomized Controlled Trial of IPS in Severe mental illness?: Mental Health , Functional , and Vocational Outcomes in a High-Unemployment Setting. International Journal Public Health 70(December), 1–9. https://doi.org/10.3389/ijph.2025.1608796
Schjøtt-Pedersen, O., Bull, H. C., Falkum, E., Ueland, T., Gjerdalen, O. S., Haaland, V. Ø., Evensen, S., & Lystad, J. U. (2025). Exploring the Benefits of Vocational Activity for People with Schizophrenia Spectrum Disorder in Norway. Journal of Psychosocial Rehabilitation and Mental Health, 12(2), 219–235. https://doi.org/10.1007/s40737-024-00389-0
Yamaguchi, S., Koike, J., Igarashi, M., Kawaguchi, T., Shiozawa, T., Usui, K., Iwanaga, M., Matsunaga, A., Yoshida, K., Sato, S., & Fujii, C. (2025). Comparative Analysis of Independent Reviewer-Rated and Self-Rated Fidelity Scores in Individual Placement and Support Programs: Repeated Cross-Sectional Surveys. Administration and Policy in Mental Health and Mental Health Services Research, 52(2), 379–389. https://doi.org/10.1007/s10488-024-01413-y
