The research, conducted by Amanda Susan Philip, Shalini Quadros, and Vinita A. Acharya of the Department of Occupational Therapy at Manipal College of Health Professions, Manipal Academy of Higher Education, was published in BMC Health Services Research. The team set out to explore the lived experiences of occupational therapists who conduct work skill assessments, often abbreviated WSAs, for individuals with mental illness. A WSA evaluates a person’s abilities, skills, values, and interests for employment using a range of tools and techniques, and for therapists working in mental health it serves a dual purpose: determining readiness for employment and guiding the design of intervention plans that can bridge the gap between clinical progress and workplace demands.

Methodologically, the study employed a qualitative phenomenological design, an approach that seeks to capture the essence of a lived experience as described by the people who live it. Twelve occupational therapists participated, and their accounts were analyzed using thematic analysis, a technique in which researchers systematically code interview data and distill it into recurring patterns of meaning. From this process, three major themes emerged: familiarity guided practice, unseen pitfalls, and moving towards awareness. Together, these themes sketch a portrait of a professional community that has learned to improvise in the face of structural gaps, and that is only now beginning to recognize and articulate the limits of its own methods.

The first theme, familiarity guided practice, describes how therapists lean heavily on the tools, frameworks, and routines they know best. Rather than drawing from a validated battery of vocation-specific instruments, clinicians reported adapting whatever was at hand, including measures designed for other purposes such as the Canadian Occupational Performance Measure, functional capacity evaluations, and assessments of activities of daily living. This adaptive, almost artisanal approach allows therapists to piece together a picture of a client’s work readiness, but it also means that the quality and comparability of assessments can vary dramatically from one clinician, clinic, or region to the next. Two clients with similar presentations may receive very different readiness judgments depending on which therapist evaluates them and which tools that therapist happens to favor.

The second theme, unseen pitfalls, captures the hazards embedded in this improvisational system. Without standardized assessments, therapists risk overlooking critical dimensions of work performance, such as the cognitive and social stamina required to sustain a full shift, the ability to respond to supervisor feedback, or the tolerance for the sensory and interpersonal demands of specific workplaces. The study also points to a deeper structural problem: many assessments are conducted in clinical settings that bear little resemblance to actual work environments. A clinic-based simulation can measure task accuracy, but it cannot reproduce the unpredictability of a busy workplace, the pressure of deadlines, or the subtle social negotiations that determine whether a person with mental illness can maintain a job over time. The absence of institutional support, including dedicated time, funding, and vocational infrastructure, compounds these blind spots.

The third theme, moving towards awareness, suggests that the profession is not standing still. Therapists in the study described a growing consciousness of the possibilities and limitations of current WSA practices, an emerging recognition that creative tool modification, however valuable, is not a substitute for validated, context-appropriate assessment methods. This awareness, the authors suggest, is a necessary first step toward reform. It opens the door to developing standardized protocols suited to the Indian context, building partnerships with employers to create authentic evaluation settings, and advocating for the institutional support that would allow therapists to conduct thorough, ecologically valid assessments rather than hurried clinical approximations.

The technical significance of these findings extends beyond occupational therapy. Vocational rehabilitation for people with severe mental illness is a cornerstone of community-based mental health care, and the accuracy of work readiness assessments directly shapes whether clients are placed in jobs they can sustain, referred to further skills training, or prematurely labeled as unable to work. When assessment practices rest on unstandardized, individually modified tools, the entire chain of vocational decision-making inherits that uncertainty. The Manipal study provides qualitative evidence for what many clinicians have long suspected: the field’s assessment infrastructure has not kept pace with its clinical ambitions, particularly in low- and middle-income countries where formal supported-employment systems are still maturing.

The study also carries practical implications for health service planners. If therapists lack access to real-world settings for evaluation, health systems could invest in vocational simulation spaces, workplace partnerships, and supported employment programs such as individual placement and support models, which emphasize placing clients in competitive jobs and providing on-site assessment and coaching. Standardized WSA protocols, developed and validated for local labor markets and cultural contexts, would allow therapists to benchmark client performance against meaningful criteria and to communicate findings to employers, families, and interdisciplinary teams in a shared professional language. Training curricula could likewise incorporate explicit instruction in vocational assessment, ensuring that new graduates enter practice with a repertoire that goes beyond improvised adaptation.

For the therapists themselves, the study validates a difficult professional reality. These are clinicians who, in the absence of perfect instruments, have become expert modifiers, stitching together assessments from fragments of standardized measures, observation, and clinical rapport. Their creativity is a strength, but the research makes clear that it should not be the system’s permanent foundation. The findings emphasize both the possibilities and limitations of current work skill assessment practices: therapists use and modify tools creatively, but the lack of standardized assessments, institutional support, and access to real-world settings hinders accurate evaluation of clients’ work abilities. Closing that gap, the authors argue, is essential if occupational therapy is to fulfill its promise of helping people with mental illness not just imagine employment, but achieve and sustain it.

As mental health systems worldwide increasingly recognize work as a health outcome in its own right, studies like this one offer a grounded, clinician-centered view of where practice stands today. The voices of twelve occupational therapists in India reveal a field in transition, aware of its constraints and beginning to chart a path toward more rigorous, more authentic, and ultimately more equitable vocational assessment for one of the most underserved populations in health care.

Subject of Research: Occupational therapists' lived experiences in assessing work skills of people with mental illness in India

Article Title: The lived experiences of occupational therapists in assessing work skills of people with mental illness

Article References: Susan Philip, A., Quadros, S., & Acharya, V. A. (2026). The lived experiences of occupational therapists in assessing work skills of people with mental illness. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15584-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15584-x

Keywords: occupational therapy, work skill assessment, mental illness, mental health, vocational rehabilitation, qualitative research, phenomenology, thematic analysis, employment, psychological assessment, health services research, India