What do we want to know?
This knowledge review aims to:
- synthesise research evidence on the process and impact of vocational and training interventions that are employing recovery approaches, in community-based adult mental health services
- survey current practice to identify vocational and training interventions being delivered in community-based adult mental health services in the UK that adopt recovery approaches.
Who wants to know and why?
Traditional clinical definitions understood ‘recovery from mental health problems’ as being ‘free of mental health symptoms’.1 The social model of recovery considered in this review stresses the importance of individuals having opportunities to take control of their lives and to engage in all levels of society regardless of whether mental health symptoms persist. The opportunity for people who use mental health services to have access to and engage in vocational and training interventions within adult community mental health services is one aspect of supporting people’s individual journeys of recovery. The review will be of interest to mental health practitioners, educators, trainers, policy makers and people with mental health problems.
What did we find?
The research evidence was not conclusive, with little evidence to suggest that different types of training and vocational interventions lead to differences in non-vocational outcomes.
The areas where there seemed to be consistent effects were:
- voluntary work and supported education programmes impacting on participants’ self-reports of improved self-esteem
- supported education helping participants’ ability to cope with the stress of studying
- integrated services - most studies showed an improvement in engagement in daily living activities and a reduction in mental health symptoms
- integrated services and voluntary work and education - most studies showed an improvement in quality of life.
The findings indicate that although training and vocational interventions are shown to have an impact on vocational engagement, vocational engagement is often weakly related to non-vocational outcomes. It is likely that programme effects on vocational and non-vocational outcomes are specific to the content and delivery of the programme. Another possibility is that people who use services need more time in employment, training or education before vocational gains can be generalised to other non-vocational domains.
Practitioners used both person-centred and strengths-based approaches; they aimed at and believed in working with people to build on their strengths, competencies, accomplishments, goals and motivation and provided support with the wider aspects of people’s lives including when they experienced setbacks in their mental health.
Attempts to provide opportunities for people who use services to support each other featured more as an ‘add on’ to services than being integral to service delivery. The relationship between people who use services and practitioners was the mechanism for providing person-centred and strengths-based approaches, but there appeared to be a tension between developing positive working relationships with people who use services, and the pressure regarding funders to have measurable outcomes such as the number of people working and ‘in a job’.
In many circumstances training and vocational services need to support people who use services to overcome barriers to employment. The most commonly cited issue was supporting people to navigate the complex and sometimes confusing route between receiving benefits and entering into employment or full-time education.
What are the implications
For policy and practice
- To deliver hybrid approaches that can support people at different points in their recovery process; people who are not ready to enter competitive paid employment may still want support to explore avenues towards obtaining meaningful occupation.
- To deliver integrated training and vocational services, such as the approach taken by the individual placement and support (ISP) model, whereby vocational specialists join existing community-based mental health teams.
- To continue building peer support into services to enable people who use services to learn and benefit from other people’s experiences and insights into their own recovery processes.
- To have secure forms of funding for training and vocational services that acknowledge and validate the importance of the work they do.
- To provide additional funds for more services to have open-door policies, whereby people can continue to access services after re-entering the workforce.
- That services continue to consider issues of the power imbalance between people who use services and practitioners and the implications this has for recovery processes.
- To provide accurate advice on and support with the welfare benefit system. This needs to be an essential part of any service that aims to support people to access work, education or other forms of meaningful occupation.
However, further research is needed.
How did we get these results?
A systematic review found 21 outcome evaluations and 6 process evaluations that met the inclusion criteria and were judged to be methodologically sound.
1. Anthony WA (1993) Recovery from mental illness: the guiding vision of the mental health service system in the 1990s, Psychological Rehabilitation Journal, 16 (4): 11–23.
This summary was prepared by the EPPI Centre.
This review should be cited as Dickson K, Gough D (2008) Supporting people in accessing meaningful work: the use of recovery approaches in community-based adult mental health services. London: Social Care Institute for Excellence.