Societal consequences of IPS implementation in Norway 2012-2019: study protocol for the IPSRON effectiveness study.

Individuals with moderate to severe mental illness have low rates of workforce inclusion, resulting in high welfare dependency affecting both societal costs and health.

• This is identified as the core problem motivating the study.
• The paper does not provide specific prevalence figures in the abstract but frames this as a well-established backdrop for IPS research.
• High welfare dependency is noted as a consequence of low employment rates in this population.

Multiple RCTs have indicated that the IPS model enables employment better than treatment as usual, but the broader impacts of large-scale implementation on mental health, quality of life, and social functioning remain unknown.

• IPS aims to help people obtain jobs on the open rather than sheltered labour markets.
• Despite widespread adoption in some jurisdictions, population-level effectiveness data are lacking.
• The gap between RCT efficacy evidence and real-world population-level effectiveness is a key motivation for the study.

Norway introduced IPS between 2012 and 2019 through both local and national government projects, creating a natural variation in IPS availability across regions.

• This variation in rollout across areas forms the basis of the quasi-experimental design.
• The study compares aggregate population-level outcomes over time between areas where IPS was and was not available.
• Work Package 1 (WP1) mapped the availability and implementation of IPS across Norway, analysing funding, resource, and capacity levels.

The study uses a naturalistic design with Norwegian registry data rather than an RCT, evaluating IPS effectiveness at the population level.

• The study focuses on 18-45-year-old people receiving specialist mental healthcare who did not have steady employment at treatment start.
• The design compares areas where IPS was available versus areas where it was not available over time.
• The Regional Committee for Medical Research Ethics Northern Norway (REK North) approved the use of registry data without informed consent (approval number 134553).

The study is structured into three work packages covering IPS implementation mapping, population-level health and social outcomes, and economic/cost analysis.

• WP1 mapped IPS availability and implementation details including funding, resource, and capacity levels across Norway.
• WP2 investigates population-level outcomes including health, mortality, quality of life, and social functioning.
• WP3 assesses the financial implications of implementing IPS from a public purse perspective, synthesising resource use and cost data with WP2 outcomes.

The study will examine a broad range of societal outcomes including employment, welfare dependency, mental healthcare use, emergency care visits, self-harm and suicide, general mortality, crime, and victimisation.

• Emphasis is placed on long-term outcomes.
• Economic consequences of IPS will be modelled.
• The study aims to inform policy making and strategies for implementing IPS at scale.