Institutional work aimed at increasing employment orientation in mental health services.

Purpose: The importance of employment in recovery from mental health illness has led to broad recognition of the integration of employment-oriented support into mental health treatment. However, there is variation in the extent to which an employment orientation permeates healthcare services. This article explores how managers and advisors in health and welfare services in Norway function as "change agents", who work to increase an employment orientation in mental health services.

Design/methodology/approach: The empirical material consists of 20 interviews with change agents in health and welfare organisations. They work to implement a model - individual placement and support - to integrate an employment orientation in healthcare services. The findings are analysed using the framework of "institutional work" to elucidate the strategies used by change agents.

Findings: The findings underscore a consensus on the health advantages of employment and that employment-oriented support belongs in mental health treatment. However, this concept requires further cultivation within healthcare services, with individual actors playing a key role as change agents. Depending on the stage of the various organisations in the change process and the actors' positions within the institutional context, the actors engaged in both creative and maintenance institutional work.

Practical implications: The article´s findings are significant for how health organisations can work to achieve desired changes.

Originality/value: This article contributes to the literature on collaboration and implementation of employment-oriented practices in healthcare by directing attention to the dynamics of organisational change processes and the efforts of individual actors to promote change.