Special Issue: Vocational rehabilitation (I)

Abstract

The range of articles included in the first part of this special issue reflects current trends and practices in vocational rehabilitation across four disciplines, with five relating to mental illness and disabilities. Vocational rehabilitation is important because it can counter the social and economic exclusion so often associated with mental illness and other psychiatric conditions. While occupational therapists are aware of the generally beneficial effects of occupation and meaningful activity, they may not be so aware of the leveraging effect on the individual that vocational rehabilitation can produce. Establishing a place in the open labour market seems to enhance recovery in ways that cannot be achieved by medical interventions, talk therapies, or by any other rehabilitation intervention. Each article in this special issue highlights different opportunities for occupational therapists to become involved in vocational rehabilitation. This collection also illustrates a diverse mix of research methods including a randomised controlled trial, a systematic review, a population survey and several qualitative investigations. In the research paper by Schneider et al. (2016), an exploratory feasibility study for a randomised controlled trial reveals the potential for a new intervention to enhance outcomes from an evidence-based supported employment programme for people with first episode psychosis. Although this study was not conclusive, the intervention was promising because 41% of those who received the enhancement obtained employment compared to 29% of those who received the standard employment service without the enhancement. The new intervention consists of work-focused counselling using principles of cognitive behaviour therapy. Occupational therapists have the background training to assist with the further development and delivery of this intervention. A practice analysis from Singapore by Tan et al. (2016) describes another way that occupational therapists can become involved in psychiatric vocational rehabilitation. The authors converted an existing vocational intervention into one that was more integrated with existing psychiatric rehabilitation services, and more in line with evidencebased practices in supported employment. This conversion resulted in good employment outcomes being achieved that were more in line with international expectations for this type of programme. Two qualitative studies examined established workers diagnosed with mental illness or a psychiatric disorder. Cameron et al. (2016) explored the experiences of being on sick leave among people with severe mental illnesses. The results showed how much people treasured their work identity, and how potentially damaging sick leave can be to those that benefit from the structured routines and social interaction that employment provides. This is a new area, with opportunities for occupational therapists to help existing workers retain employment by minimising the unintended negative consequences of sick leave. With a similar focus on job retention, Williams and Lloyd (2016) examined the risk to continuing employment among those who experience a first episode of psychosis. The authors found that only three out of 11 were still employed 6 months later; of those, only two were in the same jobs. The research paper by Waghorn et al. (2016) uses a large population survey to reveal issues in vocational rehabilitation for people diagnosed with a psychotic disorder and co-morbid substance abuse. A key finding was that those with previous lifetime abuse or dependence did not seem to have additional disabilities, but they were less likely to utilise the most appropriate and intensive forms of vocational rehabilitation. In a systematic review of vocational rehabilitation after stroke, Wei et al. (2016) found limited evidence that rehabilitation increases returns to work among those of working age. This suggests that vocational rehabilitation for people post stroke is in its infancy compared to the more advanced form developed for people with mental health or psychiatric conditions. In their research paper, Sergiou-Kita et al. (2016) highlight the low proportions of