Past research has shown that individual support and placement (ISP) is a best practice in the vocational rehabilitation of people with severe mental illness (SMI) – defined as “chronic mental illness that interferes with the person’s ability to deal with ordinary demands of life.” Best practices would be those leading to: employment, which has been associated with a range of non-vocational benefits: satisfaction with personal finances; enhanced time management skills; higher quality of life; greater social interaction; reduced negative symptoms; and a sense of empowerment.
The objective of this study was to improve on past research in this area, which typically has focused solely on outcomes, to provide a better understanding of this target group’s own perspective on factors that affect the success of ISP treatment. The insights gained should ultimately lead to better outcomes for this group.
To do so, the authors – Kate Coombes, occupational therapist, and Kirsti Haracz, Emma Robson, and Carole James, researchers at the University of New Castle in New South Wales, Australia – conducted a qualitative study using semi-structured face-to-face interviews with five people with a SMI participating in an ISP employment program in a health service area in New South Wales, Australia. Data analysis was conducted using an inductive methodology termed grounded theory, which is defined as “the systematic generation of theory … [based on] a set of rigorous research procedures leading to the emergence of conceptual categories.” This is the opposite of traditional research approaches whereby researchers start with a theory or hypothesis and then gather data to prove or disprove.
Analysis of the interview results suggested a three-stage “pushing through” experience for ISP participants with SMI: undergoing discomfort, learning to adapt, and mastery or getting into a “groove.” As it applies to participation in ISP, the three steps comprise: not being in control, then responding to challenges, and finally balancing independence and support. This experience also applied to, and affected and was affected by, SMI clients’ management of their health and their ability to cope with everyday life while engaged in the program.
The participants’ actions and experiences at each stage provide cues to practitioners for tailoring ISP to meet clients’ changing needs. Enhancing their understanding of the process of pushing through, and how each stage affects a participant’s ability to engage in ISP, will enable them to cater supports to reflect each stage of the process. In addition, the fact that understanding that participants’ ISP experience does not happen in isolation highlights the need for practitioners’ assisting SMI clients in managing everyday practicalities and their health. These strategies could in turn contribute to the success of the ISP program in terms of improved employment rates and job tenure.
A note of caution: the small sample size (n=5) in this study raises questions about the reliability of the results as representative of reality. Nevertheless, the results are qualitatively rich and can provide important insights into the perspectives and behaviours of persons with SMI in individualized support programs.
This research will be of particular interest to practitioners searching for ways of improving employment outcomes for clients with severe mental illness.