Objective. This ethnographic study examined what makes work meaningful for persons with persistent mental illness and how this meaningfulness relates to their recovery.

Method. Twelve persons between 32 and 58 years of age who had been involved an average of 19 years with a formal mental health system participated in in-depth interviews and a focus group. Thematic analysis and case studies were understood in the context of the investigator’s 15 months of participant observation of 35 persons with psychiatric disabilities working at an affirmative business.

Results. The meaning of work varied with participants ’perception of their illness and their self-concept. Changes in their self-efficacy and self-concept were driven by their participation in work activities to operate the affirmative business.

Conclusion. Findings suggest that therapists could potentially facilitate these changes in clients’ sense of self-efficacy and self-concept by helping them make connections with meaningful occupations and contributions to organizations in the community and to experience challenges and successes in the context of meaningful work.

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