Over the past 20 years high quality research originating from the USA (Bond 2004, Bond et al. 2008) has revolutionised the way vocational rehabilitation is conceptualised and provided to people with the most severe forms of psychiatric and psychological disorders. Traditional vocational rehabilitation was typically considered a gradual stepwise process over months or years (train then place). People often began with pre- vocational training in group settings, followed by long periods of assessment preceding the provision of more customised employment assistance. Unpaid positions and forms of sheltered employment were considered helpful or even necessary to prepare people for competitive employment in the open labour market (Waghorn and Lloyd 2005).