Commentary

The study by Drake et al, which could prove to be of substantive value to the community of rehabilitation professionals working with clients with SMD, addresses specifically the optimal approach for preparing clients for work.

The study, with a sample of 152 unemployed people living within a large urban centre, addresses an important question relative to work entry or return: should clients with SMD be encouraged to enter the competitive workforce or should they begin their work re-entry through sheltered work settings? At the final point of follow up (18 months), members of the IPS group were more often to be found in competitive employment settings than their colleagues enrolled in EVR, who were placed more often within sheltered settings. This finding, in and of itself, shows the belief of many mental health clinicians, particularly occupational therapists, that attempting to optimise normalisation opportunities for vocational re-entry with clients with SMD is both achievable and desirable.

Not only were direct vocational outcomes influenced positively but other outcome measures, including perceptions of quality of life and self esteem, were markedly enhanced also. Of special interest is the finding that clients within the IPS group reported being more satisfied with the services they received than those in the EVR group. Without a doubt, client satisfaction is a critical component of success and would appear to have a direct link to the personal nature of the intervention for the IPS group. Although client satisfaction alone remains an important, but not sufficient, measure of positive outcome, it should be considered most seriously when coupled with evidence of increased incidence of competitive employment.

This is an important study, which provides not only clearly articulated findings but also suggests a model and directions for further inquiry.