Ways to reduce stigma: individual placement and support – collaboration with the world of theatre

Interview with Mr. Hlynur Jónasson, supported employment and creative arts director at Landspítali

Main theme: Stigma in psychiatry

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Employment is one of the most powerful pathways to recovery, social inclusion, and a meaningful life for people experiencing mental health difficulties. Yet stigma—both from society and internalised by individuals themselves—continues to prevent many from pursuing education, work, and creative opportunities. In Iceland, innovative approaches such as Individual Placement and Support (IPS) have helped challenge these barriers by focusing on people’s strengths rather than their diagnoses. In this interview, Hlynur Jónasson, Supported Employment and Creative Arts Director at Landspítali, reflects on more than a decade of work supporting people with severe mental illness into employment, discusses the unique role of theatres, museums, and other creative environments in reducing stigma, and explains how greater openness, diversity, and opportunity can benefit not only service users but workplaces and society as a whole.

Hlynur Jónasson

Hlynur Jónasson has been a supported employment and creative arts director at Landspitali for 14 years. He´s been on the board of the Icelandic Mental Health Alliance. He has worked a side job as a fly fishing guide for 3 weeks in July every year for over 20 years, in a salmon river here in Iceland, and enjoys fly fishing very much. Downhill skiing is also very high on the list. In addition he has done volunteer work for the Role center in Reykjavik with employment services and also for the Mental Health Alliance in Iceland.

Páll Matthíasson: Thank you for speaking with me. First, could you tell me about your background, Hlynur?

Hlynur Jónasson: Originally, I studied sport science at Salem State University in Massachusetts, just outside Boston, with a particular focus on corporate health promotion, occupational health, and training in that area—so-called ergonomics. I worked in this field for the first ten years after returning to Iceland.

But you are, at your core, very much an athlete, aren’t you?

Yes, I practiced virtually every sport available when I was younger—mainly skiing, football, handball, and basketball. That alone filled my schedule.

So you initially worked in this area, but then your focus gradually shifted to other things?

Yes. I held these roles in companies across the country, including state-owned enterprises and public institutions, working in health promotion. Through this I built a network that was perhaps somewhat unusual—I had, at one point, visited almost every company in Iceland to present health promotion initiatives. From there, I increasingly moved into assisting people, in non-traditional ways, to connect with the labour market—particularly individuals who had fewer opportunities through conventional routes. This began through volunteer work at Hlutverkasetrið (a community-based vocational rehabilitation centre offering meaningful roles and activities for people with mental health challenges) around the time of the financial crash. Later, when the most severe impact had passed and the government and labour market partners established VIRK (Iceland’s vocational rehabilitation fund, supporting individuals with reduced work capacity to return to employment), I began working with them as an independent employment specialist. Not long after, Vigdís Jónsdóttir, the CEO of VIRK, approached me and asked whether I would be interested in meeting Nanna Briem, Chief Psychiatrist and director at Landspítali’s mental health services. They were preparing to implement an approach aimed at supporting young people into employment following psychiatric rehabilitation. I met Nanna—having never previously set foot in psychiatric services. I had been fortunate, both personally and as a relative, never to have needed them. I found this very interesting, particularly after reading about the philosophy behind it, which focuses on individuals’ strengths and abilities rather than their limitations.

That was the IPS model?

Yes. I found it very appealing. I familiarised myself with it, and it was not difficult to say yes. I immediately felt a strong connection with Nanna and the workplace—and now fourteen years have passed.

When did you begin engaging with the creative sector?

Almost immediately. Early on, I noticed that when I was searching for jobs for clients, I was often drawn to creative environments— theatres, music centres, galleries, and museums. I found that I never had to explain mental illness there. People in the theatre world, for example, understood the issues and showed both tolerance and insight into what I was describing.

More so than, say, in engineering firms?

Yes, much more so.

Why do you think that is?

Individuals working in highly creative fields—whether theatre, music composition, or other arts—have historically shown a greater propensity toward mood variability than the general population, and often have personal familiarity with such experiences. For them, this does not require much explanation—they have “been there” and recognise it. Later, at Laugarás (an early onset psychosis service at Landspítali), an opportunity arose to open a music studio, which was a donation from a philanthropic association, the Thorvaldsens Society. I saw first-hand how valuable this was for our service users—young people—giving them access to music and music education. I observed how well they felt in that environment, which led me to think more systematically about this. Subsequently, around 2017–2018, I began discussing these ideas with Nanna and continued doing so until the COVID-19 pandemic, which put everything on hold. Then, in spring 2022, I secured funding for a pilot project, which proved highly successful. Following that, I received grants from two ministries to formally launch the Kúnstpása project in autumn 2024. I am currently submitting a report to the Ministry of Health, and it is worth noting that participation in the first two semesters exceeded 50 users. There was considerable effort in introducing the project internally—ensuring that staff understood its purpose—as well as to service users. Despite that, participation was already over 50 in the first winter; in the second winter, it has increased to 164. (Box: The Kúnstpása project—brief description to be added.)

Hlynur Jónasson: "Individuals working in highly creative fields—whether theatre, music composition, or other arts—have historically shown a greater propensity toward mood variability than the general population, and often have personal familiarity with such experiences." Image bu Unsplash.

It is often said that stigma significantly harms and disrupts people with mental health difficulties. What is your view on that?

There is a great deal of truth in that. Stigma is a barrier to all good work, regardless of context, but particularly for individuals with mental disorders—and also in relation to their own internalised stigma. When one visits a workplace seeking employment opportunities for a young person with schizophrenia or another severe mental illness, and one explains that this is not a conventional job search, one can immediately sense in the conversation whether the workplace is a good fit. The discussion quickly reveals whether stigma is present—questions become more awkward—and then it is clear that this is not an environment where the individual will thrive. However, one must be careful not to judge the people or the workplace, but rather recognise that everyone has been at that stage at some point. Ultimately, this is about dialogue and education.

So you don’t give up—you work with them?

Exactly. One might say: “Let’s look at this together. We are working with young people for whom a 30% position may effectively represent full capacity, whereas your 100% position is truly 100%—because we approach things differently.” It is about explaining, at a basic level, what we are doing—creating opportunities. Around 90% of the people we meet are HR managers, many with training in psychology, and they tend to engage positively. One invites them into the conversation, and it often continues later. If a workplace is not ready at that moment, that is simply the situation at that time. When one looks back at individuals who have worked for ten years in the same workplace, built a good life, and formed strong collegial relationships, there are no exceptions—the staff in those workplaces are invariably of high calibre and understanding.

The IPS model focuses on supporting people into employment in mainstream workplaces?

Yes, and it is not only about supporting the individual entering employment—it also involves supporting and educating the employer, and maintaining that dialogue after employment begins.

You mentioned earlier internalised stigma among job seekers themselves. Do you think that discourages people from pursuing their aspirations?

Yes. They often need support at the outset to recognise opportunities—particularly young people who may have spent their adolescence trying to understand what is happening to them, for example during psychosis. Their self-esteem is often low, and their confidence reduced compared with peers who see many opportunities. Therefore, we need to engage in conversations that help them identify possibilities. It is entirely understandable that a 21-year-old who has spent four years isolated in their room does not have the same confidence as someone who has been socially active and engaged in sports and life more broadly.

Is there something specific about collaboration with the creative sector that helps reduce stigma?

Yes. What is important about creative environments is that mental health service users experience them very differently from hospital settings. They feel a need to express themselves in other ways. There is a strong drive for expression because they are often among people they identify with—much more so than within the structured framework of clinical interviews or the “patient role” within hospital walls. The difference is profound. In such settings, they see opportunities that are not visible in hospital environments, where power imbalances are inevitably present. In creative contexts, they experience themselves on a more equal footing and discover their abilities in dialogue with other artists, who may recognise those abilities more readily than we do within the healthcare system.

Many argue that supported employment should be significantly expanded—both to enable participation in society and to focus on strengths rather than illness—and that it would improve well-being and even yield economic benefits. What is your view?

First, expanding this approach is already part of the national mental health policy, and one can refer directly to that. There is a greater need for such support following the COVID-19 pandemic than before. That is clear, and it is entirely reasonable to increase resources accordingly. What is sometimes overlooked is the positive impact on workplaces themselves. Diversity has a strongly beneficial effect. In workplaces where I have visited repeatedly over many years, participation in such initiatives leads to more open discussions about mental health. People become more willing to express themselves and to be curious about their own well-being. For HR managers, the ability to understand workplace dynamics and intervene early is highly valuable. The more open the dialogue around mental health—and diversity supports that—the better the workplace becomes. In some Southern European countries, there are requirements that 3–5% of the workforce enter employment through non-traditional routes. It would be worthwhile to examine how that has worked in practice.

Any final remarks?

I have been connected to Landspítali’s mental health services for 14 years. I see the system evolving in a very positive way, and today there is openness to new approaches that are effective in psychiatric rehabilitation. It was quite different when I started—this was all very new. Employment participation for people with schizophrenia and substance use disorders was not established in Iceland, and there was little belief that it could succeed. Now, everyone sees that it can work, and we have the experience to demonstrate it.

Thank you. I might conclude with some figures. In 2008, the proportion of individuals in psychiatric rehabilitation at Landspítali who entered mainstream employment was examined. It was 3% among those with severe mental illness. What is the figure today?

Much higher—around 30%. If we had the resources to support everyone we would like to, that figure would exceed 50%. We are talking about approximately 1,000 individuals in psychiatric rehabilitation across Landspítali. It is certain that more than half of them—not only want to work but are capable of working, have much to contribute, and would gain significantly better lives as a result. There is therefore much to be gained, but we need to invest both funding and manpower. If we look to Norway, where more resources are allocated, outcomes are better. It is the same as in sports—this is not rocket science! □

AUTHOR: Páll Matthíasson

MD PhD FRCPsych FRCP FRCPE, is a consultant psychiatrist at Landspitali - The National University Hospital of Iceland. He graduated in medicine from The University of Iceland, completed his training in adult psychiatry from the Maudsley & Bethlem Hospitals in London and did a PhD in psychopharmacology from the Institute of Psychiatry, University of London. Páll has been director of Mental Health Services at Landspitali, CEO / Director of Landspitali and honorary senior lecturer at the University of Iceland. Currently he is Chairman of The Icelandic Mental Health Commission, a multi-stakeholder advisory group to the Icelandic government on mental health issues. His research interests include treatment-resistant schizophrenia, reducing coercion in psychiatry, burn-out and resilience.

Image by Ólöf Björnsdóttir.