Employment constitutes a major and important pa rt of our lives and contributes to welfare and wel l-being. Yet, the competitive employment rate of p eople with (severe) mental health problems is low. The Individual Placement and Support (IPS) m odel of Supported Employment is an evidence-b ased vocational rehabilitation (VR) model proved t o increase competitiveemployment rates. For t his, IPS programs adhere to some important princip les, e.g. working with patients’ preferences , quick job searching, focusing on competitive emp loyment and integration of employment counselorsin ¨mental health teams. Within the V R process, three stakeholders need to join forces: ¨the patient, the mental health practitioner andth e VR counselor. The VR process can be hindere d when the patient and the mental health practitio ner have different ideas and goals concerning ¨the VR process. Moreover, when even the VR counse lor is not intending tofocus on competitive jobs,¨ low competitive employment outcomes can be expecte d. Although there is some proof that the abovement ioned barriers can occur, many questions rema in. This doctoral project aims to increase knowled ge and consists of two research parts covering thr ee studies. In the first research¨ part we answered the following questions: “W hich vocational goals are held by hospitalized pat ients with severe mental health problems?” a nd “Do patients and mental health pract itioners hold the same perspectives concerning VR¨ goals, barriers and support?”. For thi s, a cross-sectional study in which answers of pat ients were linked with answers of their mental hea lth practitioners. The second research part covere d two studies. First, VR programs were assessed on ¨whether they implement IPS principles. Second, we ¨answered the question “What determines VR counselors’ intentions to focus on compe titive jobs?” using a questionnaire based on the Theory of Planned Behavior. T he results of the first studies show that more pat ients than practitioners find a competitive job a prospect. They also hold different perspectiv es concerning vocational barriers and supports nee ded to overcome goals.In the second research part, ¨we conclude that VR services focus too less on in tersectoral collaboration with mental health servi ces, a quick job search and a focus on competitive ¨jobs. VR counselors seem to focus onsuch job s when they hold positive attitudes, are supported , have prior experiences with focusing on competit ive jobs and when they recognize the fact that the ir behavior can have an important influence o n the life of others (moral aspect of the job ). Different practical implications can ¨be made. Practitioners must actively assess vocat ional goals and try to work out a treatment plan.¨ For this, the VR counselor must be involved. The V R counselor should be trained and coached intensiv ely in order to stimulate positive attitudes¨ towards competitive jobs. Colleagues and superviso rs must form a solid team in which they offer supp ort toeach other. Moreover, practitioners and VR c ounselors must be regularlyupdated about outcomes¨ of VR counseling, even after counseling has ended. The study calls for more research conc erning those who no longer desire a job as a resul t of inconsistent regulations, stigma, and ne gative perspectives of professionals. Summary Samenvatting Contents List of figures List of abbreviations Chapter 1. Introduction 1 1. Evolutions in mental health care 3 2. Employment 8 3. Vocational rehabilitation 13 4. Stakeholders in the VR process 25 Chapter 2. Objectives and methods 33 1. Research gaps 35 2. From research gaps to studies 37 Chapter 3. The Theory of Planned Behavior 41 1. Core concepts of the TPB 43 2. Appraisal of the TPB 46 Chapter 4. Hospitalized patients and their practitioners 51 Chapter 5. VR programs and IPS 69 Chapter 6. Counselors’ focus on competitive employment: Theory of Planned Behavior 93 Chapter 7. Beliefs of Vocational Rehabilitation Counselors 115 Chapter 8. General discussion 141 1. Key findings 144 2. Strengths, limitations and future perspectives 153 3. Suggestions for future research 158 4. Implications and general policy recommendations 162 5. Conclusion 167 References 169 Appendices 179 Professional career 187 List of publications 189 List of national and international presentations 189 List of reports and articles in non-peer reviewed journals 190 Dankwoord 193 nrpages: 207 status: published