We first positioned Japan’s employment service policy for people with mental illness within the OECD framework for implementing IPS [17]. To incorporate this framework into the Japanese setting, we conducted a narrative search for policy information on employment services for people with mental illness issued by the Ministry of Health, Labor and Welfare (MHLW), using the MHLW website and Google. Additionally, a systematic search for MHLW-funded IPS research reports was conducted using the query “(IPS OR supported employment) AND (mental OR schizo*).” We searched PubMed and the Japanese database Ichushi for peer-reviewed articles on the policy context of IPS in Japan, using the following title/abstract keywords: “(mental OR schizo*) AND (IPS OR supported employment) AND (Japan*).” We then positioned Japan within the OECD framework to identify its current implementation stage and key system-level challenges and to consider potential policy options for supporting wider dissemination of IPS.

Within Japan’s health and welfare system, three divisions of the MHLW are involved in employment-related services, namely, the Labor Division, the Disability Welfare Division, and the Mental Health and Disability Division (Table 1; Supplementary Table 2). While these divisions cooperate with each other, they have their own missions, and their employment services are administered under separate budgets. In addition, among the 32 OECD countries, Japan ranked as one of the countries with the low total expenditure on employment support [19]. Furthermore, the MHLW recognized IPS as effective employment model for people with a diagnosis of SMI in the United States and United Kingdom [20].

Through a systematic search of MHLW-funded IPS research reports, we identified four IPS projects and corresponding reports (Supplementary Figure 1). The main findings of these projects have been published in peer-reviewed journals. These consisted of relatively small-scale trials examining the effectiveness or cost-effectiveness of IPS [28, 29], fidelity surveys [11], and service process analyses [12]; however, none of them included a macro-level policy analysis. In addition, these IPS projects were conducted by a single health research department, potentially limiting the diversity of stakeholder perspectives on IPS. Furthermore, we identified only two peer-reviewed academic papers that addressed policy proposals related to IPS. These studies emphasized the need for integrated vocational and mental health services and highlighted that existing (reimbursement) systems providing in-house group-based services are not well aligned with IPS or with employment services for individuals with a diagnosis of SMI who require outreach support [10, 30]. As a result, TSE and psychiatric day-care agencies in Japan tend to focus on providing in-house group training to improve work readiness as well as the cognitive and vocational functions of individuals with mental illness [30].

Based on the OECD framework, Japan’s system for implementing IPS appears to fall between Stage 2 (building the foundations for integrated mental health, skills, and work policy) and Stage 3 (shifting from trials to a scaled-up integrated approach). In particular, the Mental Health and Disability Division recognizes the importance of providing integrated services for all individuals, regardless of the presence or severity of mental health conditions. Although IPS programs have gradually expanded following initial research efforts, they have not been scaled up.

The most substantial problem for the implementation of IPS appears to be the lack of a vocational service system for people with a diagnosis of SMI such as schizophrenia. These individuals are the primary target of IPS who often need outreach support. Whereas the number of employed individuals with mental illness largely increased in Japan [31], the proportion of those with a diagnosis of SMI remains small. For example, among the estimated 220,000 people with mental illness who were employed in 2023 by companies with five or more employees, only around 10% had a diagnosis of schizophrenia [3]. In another example, recent Japanese studies reported that a collaborative program between psychiatric day-care and public employment security offices has achieved high employment rates (around 75%). However, the clients’ mean scores of global assessments of functioning (GAF) were approximately 70 at baseline [32, 33] in contrast to the mean GAF scores of around 50 in Japanese IPS studies [12, 14, 29]. These facts imply that people with a diagnosis of SMI or low functions have been potentially excluded from the existing employment systems and services. Additionally, as already mentioned, since most TSE agencies and psychiatric day-care are administered by private organizations, a “financially effective business model” is more likely to benefit individuals who can attend in-house training several times a week for a long period of time. In other words, implementing an IPS model that delivers employment support for people with a diagnosis of SMI and enables them to quickly find a job is difficult under the current systems. Although the Japanese employment service system does not have formal eligibility criteria for potential clients to access specific services, collecting data on rejection rates in real-world settings should be a priority for future research.

The first approach for addressing the structural barriers to IPS involves gradually expanding IPS agencies and promoting IPS awareness among policymakers through grassroots-level activities, leveraging the support of professional groups such as the Japanese Individual Placement and Support Association (JIPSA) ¹ . Established in 2016, JIPSA is a voluntary organization comprising practitioners who provide IPS services beyond the existing system. It plays roles in creating a community of practitioners who want to learn IPS, in negotiating with policymakers, and in building evidence through research. Historically, Japan’s welfare policy environment, unlike that of other developed countries, has not emphasized or utilized scientific evidence for policymaking [37]. In other words, services tend to be instituted based on customs and practices that are already widely accepted by service providers. Consequently, a viable and practical strategy for diffusing IPS will entail increasing the number of stakeholders who empathize with IPS principles and developing financial incentives, particularly tailored for outreach and follow-up services, rather than pursuing entirely new policies precisely aligned with IPS. Under the current Japanese system, rapid expansion or replication of exemplary IPS programs poses financial challenges for individual agencies, even with JIPSA’s support. In this context, acknowledging service providers who are interested in IPS is essential, despite their services not having complete IPS fidelity, because these so-called “quasi-IPS” programs could potentially grow into “mature IPS” programs with the support of existing IPS communities such as JIPSA. Another approach would be to encourage testing IPS with a small number of clients who want to start work early, as it would not significantly affect the agency operations. Such flexible grassroots activities to support IPS would act as a catalyst for policy reorientation towards evidence-based employment services.

Another potential strategy for addressing the structural barriers to IPS is based on human rights for people with mental illness. In September 2022, the United Nations published the results of a review of Japan under the Convention on the Rights of Persons with Disabilities (CRPD) [38]. This report criticized the Japanese employment service system, including such elements as the sheltered workshops with very low salaries and unintegrated workplaces, and the Japanese government has consequently sought ways to resolve these issues. IPS may be viewed as a valuable tool by policymakers because one of its strengths pertains to facilitating inclusive workplaces through helping individuals work in competitive employment settings. Indeed, IPS has been rapidly disseminated across European countries, as employment issues for people with mental illness are considered a human rights issue relating to CRPD in these countries [39]. Drawing from lessons learned in a European context, a discussion based on the broader perspective of human rights rather than simply employment services may contribute to the dissemination of IPS in Japan.

Engaging diverse stakeholders is essential for wider IPS implementation. Although employer perspectives on IPS have rarely been studied in Japan, mandated disability employment quotas may increase employer awareness. Notably, the National Association of Vocational Foster endorsed IPS and, in collaboration with JIPSA, produced educational films in 2025 ² . Since 2024, Japanese employers have been legally required to provide reasonable workplace accommodations. However, a recent survey by an advocacy group led by people with lived experience of mental illness indicated that many individuals with similar experience do not receive appropriate accommodations [40]. The group recommended promoting IPS to provide continued support after job placement. Arranging partnerships with employers and advocacy groups may accelerate IPS implementation.

Potential challenges in disseminating IPS throughout Japan include ensuring constructive policy discussion on how to appropriately allocate budgets according to the severity of the disability and thus maximize employment support services and cost-effectiveness. Although IPS has been demonstrated to yield desirable and cost-effectiveness outcomes [28, 29], particularly for individuals with a diagnosis of SMI, those with milder conditions may not require such intensive support. Since current Japanese policies have successfully increased the employment of individuals with disabilities overall, policymakers may worry that allocating service resources to IPS may lead to a decline in employment opportunities for this population. Ideally, policy design supported by ample budgets should ensure that each client receives support commensurate with their needs. In this context, one possible proposal would be to make minimal changes to the policy to enable quasi-IPS services to support a small number of users within TSE agencies. Another proposal would be targeted investment for individuals with the greatest needs, reflecting a more equitable redistribution of resources. However, reliably assessing service needs presents substantial challenges. Furthermore, eligibility and severity assessments could raise potential ethical concerns if individuals are excluded from IPS on the basis of assessment results. While there is no definitive solution for these issues, they will inevitably be part of the broader policy discussions on the national expansion of IPS in Japan. To support a fair and evidence-informed discussion, national data will likely be required to estimate the costs and return on investment of IPS implementation in the future. Furthermore, if assessments are conducted during the implementation of an IPS, it is essential to ensure that evaluation criteria centered on individual preferences and aspirations are incorporated into the structure, thus guaranteeing the principles of the IPS.