The experience of individuals with severe mental illness participating in vocational rehabilitation programs: A qualitative study.

摘要

In this study, the following question was asked: “What are the experiences of individuals with severe mental illness who participate in vocational rehabilitation programs?”. A qualitative research method was selected as the best method to reveal the perceptions of these individuals in sufficient depth to understand this phenomenon. Existing research addressed validity of evaluation tools as predictors of future success and outcome studies measuring effectiveness of vocational rehabilitation programs. Poor outcome data revealed that less than 15% of the severely mentally ill remained in ongoing competitive jobs. Investigation into the experience of participating in vocational rehabilitation programs from the clients' points of view had not been undertaken.; The research context was an enhanced vocational rehabilitation program solely for persons experiencing severe mental illness. Naturalistic inquiry was selected to guide data collection and analysis. Five clients served as research participants for in-depth interviewing.; The findings revealed that the participants first needed to tell the stories of their illnesses to explain how they had become clients of the vocational rehabilitation program. Participants experienced multiple disruptions in the path from adolescence into adulthood, caused by psychiatric crises interrupting education and employment typical of adult roles. Repeated job failures led these clients to enter vocational rehabilitation programs designed to return disabled workers to jobs. Shame and stigma of the mental illness created feelings of embarrassment but also relief in being able to rely on a vocational rehabilitation program. Participants needed an intermediate step where they could regain work skills and behaviors in a supportive environment before returning to competitive employment. Ultimately, lack of resolution between their work aspirations and their reduced skills left the participants feeling troubled by these discrepancies. Lack of adaptation to altered performance led to their inability to “come to terms” with their disabilities, with their revised worker roles, and with their inability to find their place in society. A conclusion of the study was that the lack of resolution of these discrepancies limited clients far more than their reduced vocational skills. Adaptation to “living with illness” was crucial to their successful entry into and maintenance of competitive work.