Vocational rehabilitation of chronic mental health patients in the setting of community mental health

Abstract

This article discusses the possible role of the vocational rehabilitation in a changing psychiatry. Some introductory remarks on the significance of work for ‘people with a psychiatric background precede a description of how traditional occupational therapy has dealt with the clients’ need to work. Some counter- productive routines are discussed.

Current pioneering initiatives in vocational rehabilitation from Italy, the United Kingdom, Germany, U.S.A., Spain and the Netherlands, including social firms, clubhouses and outreaching services in vocational rehabilitation are briefly described.

Some of the dilemmas and problems of these new practices are identified and discussed, e.g. the tensions between productivity and rehabilitation and the dangers of an endless training programme aiming at a future which, for some participants, will never arrive.

In the final part of the article, suggestions for a new concept of vocational rehabilitation are offered. A practicable framework for the four complementary functions of vocational rehabilitation (preparation, transition, assistance in sheltered work projects, assistance in regular work situations) is put forward and eleven principles which might-be employed in vocational rehabilitation in changing psychiatry are identified.