Abstract
The results of the newly published article (Tse et al., 2014) in this Journal add further evidence on the importance of engaging people with schizophrenia in worker roles to facilitate their recovery. It forms an implication of mental health services in Chinese communities. While we totally agree with it, we believe that some critical issues have to be addressed before it can be put into practice. One of the core issues is the insufficient understanding of vocational rehabilitation and hence recognition of the profession specialized in it.
Return-to-work is a significant indicator of recovery. Recovery emphasizes the creation of new meaning and purpose in individual’s life beyond the limitations of mental illness (Anthony, 1993). Hence, vocational rehabilitation as one of the essential components of psychosocial rehabilitation is a crucial intervention for persons with severe mental illness (Tsang & Chen, 2007). It aims to assist them in overcoming both internal and external hurdles of seeking and maintaining jobs (King & Lloyd, 2007). However, there have been limited vocational rehabilitation services tailored for the people with mental illness in Mainland China where a lack of well-trained mental health professionals is a core reason (Yip, 2007). It is not surprising that the strategies for planning and implementing vocational rehabilitation vary among different disability groups. Occupational therapy is a well-recognized profession specialized in vocational rehabilitation for individuals with schizo-phrenia (Moll, Huff, & Detwiler, 2003). Unfortunately, occupational therapists are uncommon in the mental health workforce in Mainland China. To the best of our knowledge, there are no more than 10 occupational therapists currently practicing in psychiatric field, and some elementary and small-scale vocational rehabilitation services are being provided in a few regions by psychiatrists, psychiatric nurses and even volunteers. The development of nationally or provincially specific vocational rehabilitation models and practices hence remains limited and so does the related research. Not until recently was there a small randomized controlled trial study in Wuxi (a city of China) (Li, Yuan, Xu, Zeng, & Zhang, 2013) investigating the effects of supported employment (as an occupational therapy intervention) on persons with schizophrenia. The results showed that the employment rate and job maintenance rate were significantly improved in the supported employment group but not in those receiving conventional intervention (general outpatient follow-up). This study, though small, not only sheds light on the importance of research in developing evidence to inform practices in vocational rehabilitation for people with schizophrenia but also demonstrates the crucial and unique roles of occupational therapy in this rehabilitation. The strategies (based on supported employment modes) adopted in the study to enhance employment rate and job maintenance rate are indeed the critical steps toward re-engagement of rehabilitants with schizophrenia in meaningful worker roles.
Continuous research studies are needed to yield further evidence on the effective modes and strategies of schizophrenia vocational rehabilitation. Meanwhile, manpower issues have to be put into agenda for discussion. Implementation of any interventions is impossible without the presence of the experts concerned. Hence, the shortage of occupational therapists in Mainland China has to be addressed. It is, though, not a simple task, and some difficulties were identified and discussed in a recent article by Li, Tsui and Yuan (2014).
In short, research evidence coupled with manpower preparation is the essential driving force to successfully implement vocational rehabilitation in Mainland China to re-engage people with schizophrenia in meaningful worker roles and hence promote their recovery.