The psychiatric vocational rehabilitation program is located in a small city center in southern Ontario, Canada. The vocational service is one service element within a multiservice community mental health agency that focuses on supporting recovery and community life for people with mental illnesses, particularly those with serious mental illnesses. The agency is committed to the philosophy and principles of psychosocial rehabilitation and implementing practices that are evidence based. The agency saw the value of applying the ICF core set categories for vocational rehabilitation to its vocational service as a means to develop clarity about the processes and nature of services offered, facilitate communication about services to a range of stakeholders and audiences, and facilitate evaluation of services and as a guide for training and education.

The employment support and vocational rehabilitation services are offered in a phased, but individualized manner, with multiple service components accessible at each phase (see Table 15.2). The core focus of the vocational program, or its central mission, is consistent with the ICF core categories for vocational rehabilitation, d845, acquiring, keeping and terminating a job, and d850, remunerative employment. This distinction is important for clearly communicating the goals of the program; it is solidly focused on connecting people to paid work opportunities. Given the large number of people with serious mental illnesses who are engaged in few or no work-related productivity activities, referrals to the program from other mental health or social service sectors often mistakenly expect that the program will address a broader range of productivity options, such as non-remunerative employment options (d855). Where the expectations of individuals who access the service and the goals of the service are not consistent, efforts are made to connect individuals to more appropriate services that focus on other vocational options. The initial phases of the program, including referral, intake/orientation, and even assessment, reflect a collaborative process to ensure that individuals are, in fact, oriented toward paid work and to begin developing an appreciation for the strengths, challenges, and preferences that individuals bring toward this goal.

Job preparation is a time-limited phase, oriented to solidifying readiness for work. A central focus is building up the capacity for sustained motivation for employment, consistent with b130 energy and drive functions. Challenges related to energy and drive are prevalent among people with serious mental illnesses and can result from biomedical factors associated with the disease process (e.g., negative, avolitional symptoms), psychological processes (e.g., the loss of self-confidence, tentative goal structures), and social processes (e.g., the experience of stigma, poverty). Job preparation is also oriented to addressing the handling of stress and other psychological demands (d240). A particular focus at this point are stress and psychological demands related to: shifting activity patterns to accommodate employment; managing self-care including illness management; beginning to identify triggers for illness experiences, possible supports, and coping strategies; developing crisis plans; and determining eligibility for special government employment resources.

The job development phase of the service focuses on successfully transitioning individuals to one of a range of paid work opportunities. Creating job opportunities is a key activity of dedicated job development staff who engage with labor-related systems, policies, and services to secure employment possibilities (e590). Once in the job, the individual is supported in meeting work-related stress and psychological demands (d240) and acquiring the range of skills associated with the specific job (d150). For many participants, the lack of recent work experience has contributed to physical deconditioning, and individualized fitness programs are offered as an additional support (b455 exercise tolerance functions). Many people experience specific cognitive impairments (e.g., attention, memory) associated with their mental illnesses (b140-b189 specific mental functions), and for these individuals complementary neurocognitive enhancement training is offered in partnership with a local university psychology program.

As service recipients continue in their work situation, issues and challenges (as well as positive experiences) unfold and job retention activities focus on sustaining commitment to work, while promoting a good job match. In this phase, in addition to handling stress and psychological demands of work (d240), an important focus of support is on meeting the challenges associated with a range of complex interpersonal interactions (d720), such as relations with coworkers and customers; people in positions of authority (e330), such as immediate supervisors, and employers; and meeting expectations that require high-level cognitive functions (b164), such as organization and planning, problem solving, and time management. Consistent with evidence-informed principles of psychiatric vocational rehabilitation, the service pays close attention to ensuring the ongoing delivery of health services to ensure the mental health and well-being fundamental to sustained employment (e580) and to labor system policies and practices to sustain motivation for employment (e590).

The exercise of applying the ICF core set categories was a useful one for the vocational service. The process engaged them in clearly defining the objectives of their work and considering how they communicate these to their community partners, potential service recipients, and other stakeholders. It also helped them to further develop the rationale underlying the specific elements of their services. The resulting framework may be applied for training and evaluation purposes.