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The importance of vocation in recovery for young people with psychiatric disabilities
- Authors:
- LLYOD Chris, WAGHORN Geoff
- Journal article citation:
- British Journal of Occupational Therapy, 70(2), February 2007, pp.50-59.
- Publisher:
- Sage
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.
Enhancing mental health services through joint delivery with employment and other essential community services: early lessons from an innovative New Zealand program
- Authors:
- NEPE Melanie, PINI Tyron, WAGHORN Geoff
- Journal article citation:
- Mental Health Review Journal, 16(2), 2011, pp.64-75.
- Publisher:
- Emerald
Clients can be reluctant to attend public mental health services, particularly when they are provided at segregated and stand-alone locations well known to the wider community. The authors hypothesise that one way to address this stigma-driven reluctance to attend appointments is to co-locate mental health services with employment services, education and training, income support, housing, disability support, legal services, and other health services, as an essential suite of community services. This paper outlines the early planning and implementation phases of one such a project: Huntly Community Link project. The findings reveal that ongoing joint governance and management, clear on-site leadership, and an evaluation strategy are needed to ensure joint service delivery goals are attained. Several practical issues emerged, such as differences in organisational culture that take time to change. Early indicators suggest that the Huntly Community highly values the joint delivery of these essential services from a suitable purpose designed building. The authors conclude that it is possible to reduce attendance stigma by nesting the delivery of publicly-funded mental health services among a broad mix of other essential community services.
The importance of service integration in developing effective employment services for people with severe mental health conditions
- Authors:
- WAGHORN Geoff, STEPHENSON Adel, BROWNE Deborah
- Journal article citation:
- British Journal of Occupational Therapy, 74(7), July 2011, pp.339-347.
- Publisher:
- Sage
Integrated mental health and employment services are seen as central to the provision of evidence-based practice in supported employment for those with severe mental health problems. However, implementing integration is challenging in Australia and New Zealand despite both countries having well established but segregated services. The aim of this study was to discover whether segregated services could achieve real world levels of performance similar to those reported in trials of integrated services. The authors explored the service practices and the employment outcomes attained by 270 clients of a segregated employment service in Christchurch, New Zealand. Service practices were examined using an established scale to assess the fidelity of evidence-based practices in supported employment. Employment outcomes were benchmarked to a range of employment outcome variables reported in national and international studies of specialised supported employment services. Despite only a fair overall fidelity score of 64/75, 73.7% of clients commenced competitive employment within a mean of 86 days from programme entry. The mean hours worked by those employed was 22 hours per week, and 41.5% of those who commenced employment worked for 26 weeks or more. The authors conclude that very good implementation of evidence-based practices, other than service integration, can compensate for the disadvantages of service segregation.
Reviewing the theory and practice of occupational therapy in mental health rehabilitation
- Authors:
- WAGHORN Geoff, LLOYD Chris, CLUNE Alexis
- Journal article citation:
- British Journal of Occupational Therapy, 72(7), July 2009, pp.314-323.
- Publisher:
- Sage
The delineation of evidence-based practices in supported employment for people with schizophrenia now represents a paradigm shift in the theory and practice of mental health rehabilitation. The principles and methods of traditional vocational rehabilitation and traditional mental health rehabilitation are giving way to evidence-based practices in supported employment, which are consistently proving two to three times more effective at producing competitive employment outcomes. These practices include close coordination with optimal forms of mental health treatment and care and highly individualised forms of intensive supported employment. There is a focus on the vocational services being provided, whereas the traditional and currently prevailing approach follows a more gradual and stepwise process with less of an individual focus, and where individual characteristics are considered important predictors of vocational rehabilitation success. This paradigm shift now challenges occupational therapists working in mental health rehabilitation to revise their theory and practice critically in order to support the implementation of evidence-based practices in supported employment for people with schizophrenia and related psychotic disorders. This article discusses how occupational therapists can adapt to this paradigm shift and revitalise their theory and practice in mental health rehabilitation.
Conceptualising recovery in mental health rehabilitation
- Authors:
- LLOYD Chris, WAGHORN Geoff, WILLIAMS Philip Lee
- Journal article citation:
- British Journal of Occupational Therapy, 71(8), August 2008, pp.321-328.
- Publisher:
- Sage
Recovery as a concept has gained increased attention in the field of mental health. There is an expectation that service providers use a recovery framework in their work. This raises the question of what recovery means, and how it is conceptualised and operationalised. It is proposed that service providers approach the application of recovery principles by considering systematically individual recovery goals in multiple domains, encompassing clinical recovery, personal recovery, social recovery and functional recovery. This approach enables practitioners to focus on service users' personal recovery goals while considering parallel goals in the clinical, social, and role-functioning domains. Practitioners can reconceptualise recovery as involving more than symptom remission, and interventions can be tailored to aspects of recovery of importance to service users. In order to accomplish this shift, practitioners will require effective assessments, access to optimal treatment and care, and the capacity to conduct recovery planning in collaboration with service users and their families and carers. Mental health managers can help by fostering an organisational culture of service provision that supports a broader focus than that on clinical recovery alone, extending to client-centred recovery planning in multiple recovery domains.