Work and beyond: Vocational participation for mental health service users

To the Editor

The opportunity to contribute to the community through vocational participation is important for many people with mental illness and the people who care for them (Waghorn and Lloyd, 2005). Clinical and political discourse to date has focused on paid employment as the sole pathway for productive community participation. As occupational therapists, we understand participation in productive and vocational activities to include paid and unpaid employment, education and training, parent or carer duties, and household management. We present the findings of a survey of service users, which aimed to provide a comprehensive basis for service planning by mapping participation in all of these activities.

Approval for this low-risk project was provided by the health service (QA2015060). A total of 304 service users from two area mental health services responded, which represents a sample of approximately 20% of the people currently using these services. Respondents ranged evenly in age from 16 to 66 years, with a small majority aged between 26 and 35 years (27%). Around one-quarter (24%) of respondents were currently involved in paid employment, with smaller numbers engaged in voluntary work (4%), or parenting, caring and home duties (11%). The proportion engaged in paid employment is similar to other Australian studies (Harvey et al., 2013), but overall participation in productive and vocational activities was close to 40%.

In our survey, 37% of respondents were not currently seeking employment. However, 45% of unemployed respondents wanted paid employment, and many of this group (35%) had held paid employment in the previous 2 years. Despite this recent employment and desire to return to the workforce, few respondents were engaged with an employment agency (15%) or completing vocational training (17%). A perceived need for this assistance was identified, with 43% of respondents stating they wanted further training to secure employment.

Occupational therapists are employed by most mental health services and have expertise in supporting people become more productive across all stages of recovery. Employment services embedded within mental health services have been found to be effective in supporting people re-enter the competitive workforce, particularly if using the individual placement and support model (Waghorn et al., 2014). We believe that conceiving productive and vocational participation as a continuum, rather than single destination, would acknowledge that recovery is an ongoing journey. This approach would also support the integration of clinical and employment services and effective approaches to this challenge.