Abstract
BACKGROUND:
Vocational recovery is a concept that has grown out of the mental health recovery model and has been operationalized as a threshold for work capacity for persons working with serious mental illness (SMI). In this article, is it conceptualized as a process towards gainful employment and overall mental health recovery.
OBJECTIVE:
This article describes the early phases of the vocational recovery process of individuals with serious mental illness participating in a supported employment program and the factors that make up this process. This study describes the vocational recovery process and the mental health related recovery gains attained through employment.
METHODS:
A constructivist grounded theory approach was employed in this study. The primary author conducted participant observations and conducted semi-structured interviews with 10 individuals at a supported employment program to develop a theory about a vocational process that is grounded in data.
RESULTS:
A phase like process emerged from the data, which moved individuals from prevocational to early vocational recovery to active vocational recovery process. Participants experienced both mental health and vocational recovery challenges and benefits as they moved through the supported employment program and substantial support from providers, family members, program director, and peers emerged as a driving force to move individuals through the recovery process.
CONCLUSION:
Participants in this study rapidly placed into a supported employment program were able to move through their psychosocial barriers to employment and move towards an active vocational recovery process. The phase like progression suggests that appropriate interventions can be formulated that best meets the individual’s vocational and mental health needs depending on where individuals are in their overall vocational recovery process. Follow up research is necessary.
Introduction
The mental health recovery model is a game changer for persons living with serious mental illness (SMI), a chronic mental health condition (e.g., schizophrenia, major depression, schizoaffective disorder, bipolar disorder) which impacts functioning in multiple life domains (Dunn, Wewiorski, & Rogers, 2010; World Health Organization, 2001). The recovery model changes the expectations of persons living with SMI on a social and individual level as someone who can live a self-directed life and reach their full potential with appropriate supports (SAMHSA, 2012). In many ways, mental health recovery process for persons living with SMI, is a psychological process of change where the individual becomes aware of the impact of SMI on their lives and begin to find meaningful ways to live productively with their illness (Anthony, 1997).
Gainful employment is integral to the mental health recovery process as it promotes reintegration into the community, social participation, and the fulfillment of important work roles for working-age adults (Gregitis, Glacken, Julian, & Underwood, 2010). Persons with SMI also gain direct benefits by thinking less about mental health problems and focusing on work activities, while indirect effects include decreased hospitalization stays and therapeutic gains from mental health services (Cook, 2003; McQuilken et al., 2003). Despite the psychosocial impact of employment, adults with SMI receiving mental health services, are experiencing an upwards of 85% unemployment rate nationally (National Alliance on Mental Illness [NAMI], 2015) and many are underemployed (Cook & Jonikas, 2002; Onken, Craig, Ridgeway, Ralph, & Cook, 2007). Lack of resources to recovery-orientated psychiatric vocational services, environmental barriers (e.g., workplace stigma, work disincentives), and personal factors (e.g., education level, disability-related factors) contribute to a complex return-to-work process (Baron & Salzer, 2002). Yet, persons with SMI report that they want to work and can work when given the opportunity to participate in evidence-based supported employment and rapid placement services (Cook & Razzano, 2000; Crowther, Marshall, Bond, & Huxley, 2001; Rogers et al., 2001). Moreover, employment outcomes for persons participating in supported employment programs improve over time and improvement happens in a 24-month period (Cook, 2007). Employment supports can contribute to gainful employment and community integration outcomes for persons with SMI (Cook et al., 2007), yet these practices are not widespread as only a small minority of those with SMI have access to innovative vocational services in psychiatric rehabilitation (Bond et al., 2001; Corrigan, 2004; Substance Abuse and Mental Health Services Administration [SAMHSA], 2015).
Emerging within the field of psychiatric vocational rehabilitation is research on the concept coined, vocational recovery, a component of the mental health recovery model. Russinova and colleagues have operationalized vocational recovery as a threshold for work capacity, based on the stability (10 hours a week) and degree (at least 6 months) of workforce participation following the onset of mental illness (Russinova, Wewiorski, Lyass, Rogers, & Massaro, 2002). Thus far, within the vocational recovery literature, findings show that clinical factors, demographic factors, and mental health symptoms do not consistently predict better employment outcomes (Tsang, Lam and Ng et al., 2000) and rather factors such as the person and environment fit and access to evidence-based vocational services are better predictors of employment outcomes (Bond, 2004; Cook et al., 2005; Crowther, R. E., Marshall, M, Bond, G. R., & Huxley, P. (2001); Kirsh, 2000; & et al., 2005). Factors such as choice and desire to participate in employment, the rapid job placement approach for persons expressing a desire to work, paired with well coordinated or integrated with mental health services, lead to better employment commencement and duration (Bond, 2004; Cook et al., 2005).
What is missing thus far in the literature is a better understanding of the subjective experience and processes that persons with SMI experience with rapid involvement in vocational rehabilitation (Dunn, Wewiorski, & Rogers, 2008). Moreover with a myopic focus on employment outcomes, particularly by state vocational rehabilitation programs, albeit important, miss important mental health recovery gains of individual with SMI in a vocational rehabilitation program. In addition, mental health recovery, much like vocational recovery is a process characterized by setbacks, challenges, and symptoms exacerbation, rarely taking a straight course to vocational success. It is important to understand these processes in order to facilitate both mental health and vocational recovery orientated interventions for persons living with SMI.
Aim of this study
The purpose of this paper is to closely examine the vocational recovery process of individuals with SMI participating in an evidence-based supported employment program in the Western United States. A constructivist grounded theory approach was employed which allow researchers to develop a theory about a process that is grounded in data, while constructing theories through interactions with the organization, its practice, and its participants (Charmaz, 2006).
Methods
Participants
Ten individuals with SMI ranging in age from 18 to 65 years (M = 46.52, SD = 9.28) volunteered to participate in this study and slightly more women (60%) than men (40%) were included. Participants identified themselves as White/Caucasian (30%), Asian American (20%), Native Hawaiian or other Pacific Islander (20%), African American (10%), and persons of mixed race (20%). The majority of the participants reported their marital status as single (70%), and a few individuals reported being married (10%), separated/divorced (10%), or widowed (10%). A majority of the participants either had less than a high school education (40%) or had a high school diploma or GED (40%), and a couple of individuals had an associate’s degree (20%). Most participants received Supplemental Security Income (SSI) (80%) and/or Social Security Disability Income 20%) (SSDI) income and all received Supplemental Nutrition Assistance Program (SNAP) (100%) benefits at the time of data collection. Most individuals identified their primary mental health diagnosis as schizophrenia/schizoaffective disorder (60%), few individuals had a mood disorder (40%), and one had identified obsessive compulsive (10%). Table 1 provides a summary of the demographic information of the participants.
Participant Characteristics (N = 10)
Participant Characteristics (N = 10)
Recruitment
The first author conducted an in-person recruitment presentation at a supported employment program in the Western United States that offered employment opportunities on-site. The recruitment presentation included information about the study, information about the researchers, an informed consent process, their rights to terminate the interview or participation at any time, and the disclosure of participant observation occurring during the weeklong visit to the site. Participants were given the option to participate in work activities off-site if they did not want to participate in the research or be observed. Everyone agreed to the participant observation, although not everyone chose to be individually interviewed. Interested participants were asked to sign up for an interview time slot with the researcher, which was also conducted on-site in a private area. Criteria for participation included: (a) between 18 and 65 years of age; (b) receiving vocational rehabilitation services from the supported employment program of interest in this study; (c) ability to make decisions independently and answer interview questions; and (d) receiving public mental health services. A total of ten participants were interviewed individually lasting on average of 45 minutes. The primary researcher spent several weeks on-site at the vocational program conducting interviews, observing, and participating in the vocational program. Participants were compensated with gift cards on the last day and debriefed about the data collection experience and process. All participants were paid at least a minimum wage.
Data sources
Demographic and health status questionnaire
Participants completed an online questionnaire following the individual interview The questionnaire gathered information regarding age, ethnicity, marital status, the highest level of education completed, public benefits received, and primary mental health diagnosis (see Table 1).
Individual interviews
A semi-structured interview format was utilized to explore the participants’ personal vocational and mental health recovery process. The interviews asked participants to recall information about their past and present experience. The interviews were conducted by the lead author and audio-recorded with permission. Interviews were transcribed by this author and by the second and third author and names were substituted with a participant number to protect participants’ confidentiality.
Participant observation
The lead author spent several weeks observing the classes, the various work shifts and duties, and the meetings that occurred at the supported employment program to better understand the environmental influence on the recovery process and to note any information that was not described in the interview. The notes from the participant observation were served to assist with data analysis and interpretation.
Data analysis
The transcriptions were created as text documents and organized in NVivo 10 (2014), a qualitative research software program developed by QSR International. A constructivist grounded theory approach was used to analyze and examine the participant’s perception of their vocational recovery process (Charmaz, 2006). The primary author rigorously analyzed the transcribed interview text, reviewed observations made in fieldwork, and inductively coded the data based on interpretations of the content. The research team consisting of the lead author and two graduate students met regularly to discuss emerging categories and subcategories. In addition, an external auditor served to “fact check” the initial findings. Consultation with the external auditor and the research team occurred until consensus was reached, and evaluation of the research process and findings for procedural and conceptual accuracy was provided (Creswell, 2009). The credibility and reliability of the data analysis were improved through this process (Guion, Diehl, & McDonald, 2011).
To analyze the narrative data, open-coding techniques were used to identify major categories of information in the data (Glaser & Strauss, 1967). After reading the transcripts rigorously and coding the data line-by-line, similar meanings and patterns were grouped into categories. A selective coding process was then used to identify specific texts and codes related to the vocational recovery process. Core categories and several subcategories were developed during this selective coding process. A cyclical, iterative coding process occurred between the three researchers until data saturation was reached (Charmaz, 2006; LeCompte, 1999).
Results
The participants discussed several factors that led to their current vocational recovery process, which suggested a stage-like progression along the vocational recovery continuum from prevocational recovery, initiation of vocational recovery and early to active stage of the recovery process. These major themes and categories will be discussed more in depth as follows: (1) prevocational recovery functioning; (2) initiation of the vocational recovery process; and (3) early to active vocational recovery process. A summary of results can be found in Table 2.
Summary of Results: Early Vocational Recovery Stages, Characteristics, and Examples
Summary of Results: Early Vocational Recovery Stages, Characteristics, and Examples
Note. Early vocational stages emerged as major themes and characterstics are the major categories that emerged from the data.
Most participants described a substantial period of instability such as criminal justice involvement, mental instability, homelessness, and addiction prior to their engagement in supported employment. It created an additive functional and vocational impediment for participants and substantial intervention was needed to move them towards mental health and vocational recovery. All participants reported not working prior to program involvement although some had tried various other vocational training program and post-secondary education options on their own or with assistance from the state vocational rehabilitation program (VR). Others described a sense of “stuckness” of being in a routine that they were unhappy with and often times were placed into a psychosocial rehabilitation (PSR) program for lack of other options. For those who were not attending a PSR program, reported having lots of unstructured time and not having any goal or future direction.
Psychosocial barriers and instability
Most participants described the substantial disruption to their employment trajectory with the onset of their mental illness and the cascading of events resulting from untreated mental illness such as homelessness, drug addiction, criminal justice involvement, and trauma, which forestalled employment goals. All participants received Social Security Supplemental Income (SSI) benefits prior to and during their participation in the program, indicating that all were receiving financial and medical benefits.
Three of the participants in this study had been involved in the criminal justice system and on probation. One participant reported forgery and theft charges leading to probation, another reported trespassing and charges accrued from chronic homelessness and mental health instability, and another reported repeated incarcerations related to substance abuse charges.
Exhausting other vocational options
Some participants reported working with their vocational rehabilitation counselor on various training, school, or vocational options or had tried job searching on their own prior to committing to the supported employment program. Many echoed the sentiment of not sticking through with their vocational plans due to a loss of interest, or due to the unaccommodating nature of traditional school or work and difficulty in explaining the flare up of their mental health symptoms. One participant had tried various options until he found this program, “I had signed up for computer, creative writing, and I think art class, and I just didn’t make it and I had once tried to join the army. Nothing stuck. At least now between training and work, I have been sticking with this for 13 months and this adds to my resume”.
Lack of direction
Some had been placed into very structured programs for prolonged periods of time that did not help alleviate the feeling of “stuckness”. One participant described this experience as, “I always had to go out and do something at the Clubhouse- this is where I got stuck at, you know? From there I used to wake up, go the Clubhouse, spend at least like 4 to 5 hours over there and well it was either the Clubhouse or this place called PSR [Psychosocial Rehabilitation] at [location omitted]. I know it was good for me but I also didn’t know where I was going and didn’t really feel inspired to do anything else with my life”. Another participant described the idleness he felt due to the lack of any structure of meaningful activity engagement on a daily basis. One participant with unstructured time prior to the start of the program reported:
“I didn’t have any schedules. I did whatever. And I definitely, felt less balanced mentally and emotionally. This place helps balance me and I didn’t have a sense that I had a direction in my life before. I was just going through life and wasting time. I have a focus now and feel a bit more hopeful”.
Initiating vocational recovery
Participants described various ways in which they became involved with the supported employment program. All ten participants were service connected and referred by a service provider (e.g., mental health counselor, probation officer, Clubhouse staff, rehabilitation counselor), although some had heard through word of mouth and alerted their service provider about the opportunity. Most participants were referred by the state-federal vocational rehabilitation (VR) counselor and if not referred by VR, were eligible to become a client due to their serious mental health diagnosis and became a client in order to have additional vocational support such as the training stipends offered to consumers of VR receiving supported employment services. One participant had heard about the program from their mental health case manager and another participant had found the program through their probation officer. It was evident that this program was a valuable resource for mental health providers and probations officers for their clients with SMI seeking meaningful work opportunities. In addition, encouragement from a service provider or having a supportive service provider fueled the participants’ external motivation for joining the program. All participants reported that they did not know anything about the innovative supported farming program at the start of the program, but all expressed a desire to work. A few participants reported that the program was initially just something to do with a lot of encouragement from others to try the program. One participant reported, “So, the thing that brought me here was I was currently a member of the Clubhouse and the other members started working over here and I wasn’t interested at first at all and then the other members were talking so much about it, I got interested too”. Half the participants had exhausted multiple available job training and placement options including postsecondary education. At the time of referral, the program was a preferred option over other limited vocational training options for persons with SMI (i.e., Clubhouse). Additionally, the no wait period to start the program, captured the momentum and motivation of the participants, including those who were unsure about their perceived ability to work.
Early to active stages of the vocational recovery process
The participants described their current vocational and psychosocial functioning in response to the question, “What is your life like now?” Many described the inherent benefits of working, the challenges and barriers both personally and as a participant in the program, and the skills gained in the program. It was evident that participants were making gains in their vocational functioning. A few of the participants were observed to be living between two different worlds: one of restrictions and mandates (e.g., probation, group home, mental health mandates, scheduled intravenous medications appointments) and one with more autonomy through varied work roles with increasing responsibilities and choices over work schedules. The following section describes the early to active phase of the vocational recovery process, which includes vocational recovery benefits, vocational recovery related challenges and growth to the recovery process, mental health recovery related challenges and growth, and the process of moving past the comfort zone.
Vocational recovery related benefits
Many participants reported a sense of moving forward, making progress with goals, having structure, being engaged, having a sense of purpose, and increased social supports, similar to the tenants of the mental health recovery model when describing their current vocational and psychosocial functioning. It appeared that participants were making mental health recovery related gains along with gains to their vocational functioning, which is best described together as a vocational recovery process. Participants described being able to get out of the “stuckness” and doing something different as the immediate benefits of the program. Many described a sense of excitement in doing something different and the inherent benefits of getting out of their previous redundant routine. One person aptly described it as:
“It [name of program omitted] gets me out of that space of just going to doctor’s appointments and then staying at home, so I can come here and do something different, because it was boring after a while to do the same thing over and over and [name of program omitted] is definitely something very different than anything I’ve tried before”.
The opportunity for self-growth and exploration of vocational potentials through an innovative new program was a draw for the participants, particularly as the program offered a slow and supportive introduction to the work related lifestyle changes that was needed by the participants. The program was also responsive to fears and discomfort that occurs with major behavior change and the lack of confidence related to a past history of unsuccessful vocational attempts. Many participants described the induction of structure to their weekday as inherently beneficial to their mental health and allowed them to live outside of being a “full-time patient of the mental health system”. Moreover, having a vocational program to do during the day spilled into an increase in other activities as described by this participant, “I’m more active, I go out and do more things, I do more things with my brother, I go out and I have [name of program omitted] during the week. I didn’t have any inspiration or any energy to do anything [before]”. Another participant reported a sense of hope and security about the future. “Yeah, I hope for the absolute best, because I’d like to get done with work and be driving home and be sitting at home and thinking, I feel secure and my life is going somewhere”.
Many participants reported a sense of ownership in their own vocational development and found continued benefits in staying with the program or had made plans to move on the other career development or job opportunities. One participant reported the possibility of going back to work for a grocery store where he was previously fired, but “they know I’m doing this right now so they’re behind me in coming back when I’m ready and I am thinking about that”. Another participant reported entertaining the idea of going back to the culinary arts and have been talking to a friend who is planning to open a restaurant: “the program is giving me the confidence to go back to the kind of work I really like. I like it here too and maybe will stay but I know I can also go work as a chef in a restaurant and that sounds good too”. Many described being more goal-directed along with having more hope since starting the program, “Well, I have more of a goal. I know how to get from point A and then further down the line. I want to stay with this program and I hope to see a future here being with [name of program omitted]”.
3.3.1.1. Social support. Many participants reported having a strong social support among other peers in the program that added to the overall social support network in their lives. One participant reported, “I feel supported here, most of the people here, when I see them, it brightens me up a little bit”. It is interesting to note that other than the peers and staff at the [name of program omitted] program, participants largely listed other mental health service providers, and sometimes, family members as their support system but many did not have peer relationship outside of the program. Another participant reported, “It [the program] helps us all get to know each other and I’ve been with the program for a couple of years now and a lot of the guys that are in here have been around since the beginning. So it’s a good working relationship. It’s getting them out of their stale behavior and lifestyle and I guess into a more active one and I’m happy to be part of that”.
Vocational recovery related challenges and growth
Many participants had disruptions to their career and vocational development, spanning many years, and faced substantial challenges to their new role as a worker. Adjusting to a work schedule, dressing appropriately, being on time (e.g., getting up early), prioritizing work, and being punctual, were commonly cited work adjustment issues shared by all the participants. Other barriers included having the confidence to get off of Social Security and other benefits, building enough trust with the director and other peers in the program, dealing with substance abuse triggers, and persistent self-stigma around working with SMI. Some of these barriers have persisted with the participants in the program, some left the program due to not being able to meet these challenges, and some have managed to move past these barriers. One participant described her initial resistance to required work attire, “What I wore in high school was no longer appropriate like I was in a tank top and jeans. She [director] was always asking me to get me to dress in the official work shirt and make things look official. I guess it made me feel “official” too like I was a real worker so I started to wear the shirt over my tank top, but I fought this dress code for a long time”.
Lastly, the ability to take constructive feedback from the director, staff, and peers about their progress in the program was an adjustment process for many. For example, one participant reported, “When I first started, I was like, I’m right and you’re wrong and you’re not going to change that, I’m always right period. She [director] changed that big time and guess what, I’m not always right!”
Mental health recovery related challenges and growth
Participants reported areas of challenge and growth, which were largely related to their mental health functioning. Many described a process of “waking up their brain” or a process of cognitive rehabilitation through their engagement with training and employment. Most reported interpersonal skill development through many hours spent in training with peers. This participant describes his previous and present interpersonal skills: “I spent a great amount of time on my own not really interacting with other people. I had that opened to me again. Opened to being up close and personal with people on a regular basis. It’s allowed me to get that back, interacting better with other people”. Another participant reported in response to the question, “What is your life like now?” as: “Maybe the noticeable difference between before and now is that way I interact. My interactions have gotten better in having to do this every day or several times per week”.
Interestingly, many reported an improvement in their mental health management or symptoms. Some employed their own non-traditional method of dealing with any mental health symptoms while on the job and the methods were welcomed by the program director, reflecting a support for mental health recovery strategies. One participant with a diagnosis of paranoid schizophrenia described how rather than going home, a futon couch has been provided in one of the storage rooms/offices just for these occasions. He reported, “Usually, just laying down and resetting my clock completely helps. I notice myself starting to spin a little bit, just lay down. I call it spinning out. So if I’m spinning, I lay down for a little while. Usually it’ll fade out if I rest right away, as long as it hasn’t taken hold”. Many were very aware of their own symptoms, and the safe climate of the program allowed them to explore ways to deal with them while on the job rather than walking away and risk being fired. The participants’ mental health recovery process worked hand in hand with an individuals’ vocational recovery process- meaning as participants learned to manage their mental health symptoms, there was an improvement in their vocational functioning. There were many examples of this. For example, another participant reported the impact of fear and the paranoia on her vocational functioning and she is learning to manage them better: “I have fear and paranoia. That affects me when my mind starts to go through that loop and I can’t stop it. Sometimes I can stop it and get control. I’m getting pretty good at that. I’ve been through it enough times that I know when it’s coming so as to not get in the way of work”. All of the participants were “medication compliant” but recognized the need to find a personal management system beyond just taking medications for a full vocational recovery. This participant shared her progress: “I’ve been diagnosed with schizophrenia and the paranoia sucks so much and when the medication doesn’t kick in I just get so fearful. I would get scared to even talk, eat, be outside, sleep, taking drugs was the scariest thing I was doing. I can cry for help now because I knew someone is there to help me and something like this [program} is just like a miracle, it’s impossible, but look at me now”.
Also apparent in the responses was how the structure of having regular vocational activities contributed to their mental health recovery process. One participant reported how having structure and meaningful work helped alleviate major depressive symptoms:
“I mean I know myself, if I didn’t have to do something, I would just sleep. And is a hard depressive cycle to break. But having this is like, more than just waking up, it’s waking up to something that doesn’t make you feel like crap. It means you wake up to something, come down here and do something positive”.
Participants also reported an increase in their self-esteem and self-confidence as they moved through the program knowing they are involved in something positive for themselves and their community. Positive reinforcement from family members, significant others, and service providers offered feedback on their small mental health and vocational recovery milestones, which helped them develop their vocational self-efficacy.
Moving past the comfort zone
Participants were asked to engage in tasks they were not used to, adapt a new work routine, and were asked to make some lifestyle adjustments as a result of taking on the role of an employee. Workplace adjustments required that participants move past their comfort zone and live a life outside of the “mandates” of living as a mental health patient. One participant described being challenged to work as a team, and had to adjust from taking a directive from someone of authority to one where shared decision making is exercised in the worker cooperative model:
“Well, the thing I had to adjust to was being pushed a little harder than normal on what I was expected to do. I mean people, me as someone with a mental disorder, I – in most of my life, I can take a directive like, “we need to do this”- well almost like a directive. I’m breaking free of that and making more decisions here.”
Discussion
This study explored the early vocational recovery processes of persons living with serious mental illness within the context of an evidence-based supported employment program. The study revealed a process that moves individuals from debilitating psychosocial and vocational functioning to a process of active engagement in their recovery. The subjective experience of the participants highlighted the substantial mental health and vocational recovery gains that are made in a one to two year period with active participation in a vocational rehabilitation program, and like other studies, provides evidence that persons with SMI have the capacity for sustained employment (Russinova, Wewiorski, Lyass, Rogers, & Massaro, 2002). The vocational recovery process, much like personal recovery from a serious mental illness, is characterized by a process of change in one’s attitudes, values, feelings, goals, skills, and roles and recognizing that one can work following its onset (Anthony, 1993). In addition, all participants had met or surpassed Russinova and colleagues’ definition of vocational recovery, of working at least 10 hours of week for a period of at least 6 months. Therefore, all participants in this study had the “vocational capacity” to work and many demonstrated ability that reached beyond this minimum threshold.
What was also apparent in this study was a phase-like progression of vocational recovery. The prevocational recovery phase can be characterized by a lack of work opportunities, mental health instability, poor psychosocial functioning, substance abuse, hospitalizations, criminal justice involvement, lack of structure and meaningful activities, and poor vocational functioning. These are substantial barriers that may pose difficulties to self-initiate the vocational recovery process, but with encouragement or sometimes mandates from service providers to try a supported vocational rehabilitation process, many entered into the program and were able to initiate their recovery process. The support from service providers (e.g., probation officers, mental health case managers, family members, Clubhouse staff), peers, and ongoing support from program staff was crucial in sustaining the vocational recovery process once initiated.
All the participants experienced a recovery process that included both set-backs, challenges, and gains to their mental health and vocational functioning that impacted other aspects of their lives. This second phase of the process may signify the early stage of the vocational recovery process once the commitment to the program was made. There were active adjustments made to mental health symptom management, lifestyle changes, perceived confidence and ability to stick with the program, and plans to move through the probation process and explore other vocational options. There was a period of constant learning and adjustment both personally and vocationally, which was highly supported by the director, peers, family members, service providers, and by the overall flexible structure of the program. These factors all added to the vocational recovery process along with incremental gains made to their mental health symptom management, lifestyle management, and most made substantial gains to much need interpersonal skill development. The vocational recovery process, much like personal recovery from a serious mental illness, is characterized by a process of change in one’s attitudes, values, feelings, goals, skills, and roles and recognizing that one can work following its onset (Anthony, 1993). This process of change is worth further investigation as it can inform appropriate vocational and mental health related interventions at the appropriate phase of the vocational recovery process.
Limitations of the study
There are several limitations to this study. First, the findings are focused on understanding the vocational recovery dynamics of a single supported employment setting and not generalizable to the vocational recovery process of persons living with psychiatric disabilities. Therefore, future studies should include multiple settings (i.e., multiple cases) to track the vocational recovery process of persons with SMI participating in other supported employment settings. Second, since this study focused on the early vocational recovery processes for persons recovering from serious mental illness, studies that focus on active to full recovery is needed to have a fuller understanding of the full spectrum of processes that may occur. Lastly, I was not able to interview consumers who dropped out or did not go through the vocational recovery process so their experiences and barriers to recovery were not captured.
Conflict of interest
None to report.