Adding a vocational focus to mental health rehabilitation

OBJECTIVES: The study examined the effect of adding two employment specialists to the staff of a community mental health center; their sole responsibility was to develop the skills and positive work attitudes that clients with severe mental illness need to enter the state vocational rehabilitation system or to seek employment. METHODS: A total of 122 clients were randomly assigned to a program with an employment specialist or to a control group with no specialized vocational services. Clients in the program were taught work skills and attitudes in group and individual sessions and through a trial work experience. A schedule of rewards reinforced positive changes. Outcomes measured were skill gains, changes in work attitudes, attainment of employment, and entry into the state vocational rehabilitation system. RESULTS: At nine months, 34 of the 61 clients in the program achieved positive changes in vocational status that included competitive employment, participation in training and evaluation programs operated by the state vocational system, and formal referral to the system. Only one client in the control group was linked to the state system. Skill gains and positive changes in work attitudes were found for all program clients. Logistical regression suggested that program participation, rather than client characteristics, was an important predictor of a positive outcome. CONCLUSIONS: Over a relatively short time period, targeted vocational programs can help clients with severe mental illness develop the skills and attitudes necessary to attain employment or entry into the vocational rehabilitation system. Vocational rehabilitation can be an integral part of the rehabilitation process for all mental health clients.