ORIGINAL ARTICLE Interaction, Ideology, and Practice in Mental Health Rehabilitation Taina Valkeapa ¨a ¨ . Kimiko Tanaka . Camilla Lindholm . Elina Weiste . Melisa Stevanovic Received: 15 October 2018 / Accepted: 13 December 2018 Ó The Author(s) 2018 Abstract This paper investigates how two ideolo- gies of mental health rehabilitation—recovery ideol- ogy and communal approach—are realized in interactional practices associated with psychosocial rehabilitation. More spesifically, the paper discusses employee selection in the context of the Clubhouse- created Transitional Employment (TE) programme, which offers employment opportunities for rehabili- tants. The paper describes how joint decisions are established during the moment-by-moment interac- tional processes at the Clubhouse. Drawing from the data set of 29 video-recorded rehabilitation group meetings, and Conversation Analysis as a method, the paper analyzes two questions: (1) How do the participants talk about the decision-making process associated with the TE on a ‘‘meta’’ level? And (2) how are the TE employees actually selected in the turn-by-turn sequential unfolding of interaction? When discussing the TE employee selection proce- dure on a ‘‘meta’’ level, the values of recovery ideology focusing on client empowerment and self- determination are prevalent. Also, the central ideals of the communal approach—openness and collabora- tion—are defended as decision-making guidelines. However, in the meetings where decisions on the TE employees are concretely made, there is a mismatch between the two ideological approaches to rehabilita- tion and the actual practices observable in the relevant interactional encounters. Keywords Rehabilitation Á Professional ideology Á Joint decision-making Á Conversation analysis Á Social interaction ‘‘We made a democratic selection with the members who were interested in the job. It was a joint decision and the selection process went really well.’’ – Support worker evaluates a selection process of a transitional employment worker. Introduction According to WHO [1], mental disorders affect over 300 million people worldwide, being more common than cancer or heart disease. Mental illness has a significant effect on human productivity, constituting a tremendous burden on the global economy [2]. Most of these costs are caused by mental illness reducing individuals’ ability to enter and stay active in the labour market [3, 4]. This problem becomes more T. Valkeapa ¨a ¨(&) Á C. Lindholm Á E. Weiste Department of Finnish, Finno-Ugrian and Scandinavian Studies, University of Helsinki, Helsinki, Finland e-mail: taina.valkeapaa@helsinki.fi K. Tanaka Department of Social Welfare, Tokyo University and Graduate School of Social Welfare, Tokyo, Japan M. Stevanovic Faculty of Social Sciences, University of Helsinki, Helsinki, Finland 123 J. Psychosoc. Rehabil. Ment. Health https://doi.org/10.1007/s40737-018-0131-3