British Journal of Occupational Therapy

Young people with psychiatric disabilities are particularly disadvantaged when it comes to participating in vocational training or higher education or to seeking and maintaining employment. A review of the literature reveals that this is due to a number of factors, including low expectations by health professionals, stigma and discrimination, symptomatology and the lack of a clear responsibility for promoting vocational and social outcomes. A useful approach for occupational therapists to use is a recovery framework combining evidence-based employment and educational assistance with mental health care, provided in parallel with brief vocational counselling, illness management skills, training in stigma countering and disclosure strategies, context-specific social skills and skills in social network development.

It is concluded that there is an urgent need to link evidence-based vocational practices with quality mental health care, in order to restore hope among young people of ever realising their vocational goals and once again feeling included as valued members of society.

This study explored the recovery experiences from being on a vocational rehabilitation scheme for service users with severe and enduring mental health problems. This was the first phase of a vocational rehabilitation service review and development.

Two associate researchers/service users were integral to the study and increased its validity. A qualitative research method was taken, using a semi-structured interview. Two main themes emerged: moving on and being on the scheme.

The findings were that transitional vocational rehabilitation schemes could have a positive effect on the vocational status, quality of life and mental health of service users with severe and enduring mental health problems given the right environment. It was recommended that the vocational rehabilitation scheme should continue, whilst the support for service users and interagency working alongside the scheme warranted further investigation.

Following the study, the scheme expanded to become an employment service that extends from the public to the independent sector and offers a wider range of vocational rehabilitation schemes within it.

Over recent years, there has been a move away from researching ‘on’ to researching ‘with’ or ‘for’ young people. This reflects the increasingly recognised right of young people to participate in research and to express their views and opinions. It also corresponds with the acceptance that young people both influence and are influenced by the contexts in which they live.

This move has, however, raised many issues that need to be considered when using research methodologies that aim to capture young people's voices, perspectives, interests and rights. Perhaps the most pertinent of these issues are those of competence, power and representation. Without consideration of these issues, it is easy to misrepresent and suppress the very voices and identities that researchers are aiming to represent.

This article illustrates how each issue was dealt with in two research projects conducted with young people who had a motor impairment and with the siblings of young people with a brain injury. It is reflected that occupational therapy researchers should work towards greater collaboration and participation when researching young people. This is particularly relevant because the occupational therapy profession claims to be person-centred and as such this must be reflected in the research that it conducts.

Occupational therapists in acute physical settings face challenges and tensions between their holistic professional values and the often reductionist focus of their work. A hermeneutic phenomenological investigation explored the meaning of practice for nine occupational therapists in an acute National Health Service trust in England. Semi-structured interviews were analysed using a framework for interpretive analysis of phenomenological data. Critical reflective evaluation enables readers to judge the quality and relevance of the research.

The three main themes described in this paper – making a difference, gaining strength from the team and coping strategies – illustrate the tensions, stresses and rewards of practice. The occupational therapists wanted to make a difference to their patients' lives. Although they could not always do as much as they would have liked, making an immediate difference by the provision of equipment was rewarding. Relationships with multidisciplinary colleagues generated both stress and satisfaction, but membership of the occupational therapy team enabled the therapists to cope with difficult situations. Effective coping strategies included acknowledging the realities of the acute setting and using reflection to identify those aspects providing value and satisfaction. Overall, the therapists experienced pride, excitement, reward and enjoyment from their work in the acute setting and were convinced of the value and importance of their role.

A priority for the College of Occupational Therapists' Research and Development Group is to identify and strengthen occupational therapy research capacity. Attainment of, or work towards, an MPhil/PhD is one indicator of a developing research capacity. A postal survey undertaken between April and June 2006 sought to discover the size and nature of the population of occupational therapists obtaining a research degree within the United Kingdom. The survey found that 194 occupational therapists had completed or were registered for a research degree. Of those registered, 90% (78/87) were undertaking their studies on a part-time basis and 79% (69/87) were receiving funding.

Payment by Results represents an important change in the way that the National Health Service reimburses health care providers for services in England. The purpose of this new payment system is to pay health care providers fairly and transparently while rewarding efficiency, encouraging volume growth and supporting patient choice initiatives. Payment by Results will have a profound effect on occupational therapy practice, particularly regarding cost containment, documentation and patient-centred practice. Therapists working under the Payment by Results scheme require a better understanding of financial opportunities and constraints to ensure that occupational therapy services flourish under this new payment system.

Occupational therapists are trained to include reflection within their professional practice. The inclusion of spirituality into occupational therapy has the potential to bring the personal dimension of a therapist's spiritual faith or belief into clinical practice. This opinion piece highlights the connection between spirituality and the shadow and identifies the need for reflection on this dynamic relationship. The shadow is discussed in relation to the need for increased awareness and the development of safe parameters when considering the inclusion of spirituality and the therapeutic use of self in clinical practice.