Sick leave and work-related accidents of social workers in Germany: an analysis of routine data.

PURPOSE: The study aimed to explore the prevalence of sick leave and the risk of work-related accidents among German social workers and to describe causes and time trends in sick leave and accident claims. METHODS: A retrospective analysis of routine data was carried out. Aggregated sick leave data of 195,100 social workers from four health insurance funds and 3037 accident claims of social workers from an accident insurance institution were analysed. Causes of accidents were examined by statistics of the German Social Accident Insurance (DGUV). Sick leave rates per 100 insured person-years were calculated. Relative risks (RR) of accidents were calculated in a multivariate analysis for three occupational groups (social workers and therapists, caregivers in sheltered workshops and teachers in residential institutions) and compared to other health and welfare service workers. RESULTS: Mental disorders caused about one-fifth of the sick leave days of social workers. Sick leave due to mental disorders slightly increased in 2015 compared to 2012 (+ 3% and + 18%). Among the three subgroups of social workers, caregivers in sheltered workshops (RR 1.30; 95% CI 1.14-1.49) and teachers in residential institutions (RR 1.41; 95% CI 1.17-1.70) were at an increased risk of accidents at the workplace. Accidents were mostly caused by slipping (30%) and by violence (22%). CONCLUSIONS: This study confirms that sick leave of social workers is frequently caused by mental disorders. Future studies could further examine differences between practice fields, long-term effects of work hazards and effective workplace interventions.

The impact of Vocational, Education, Training and Employment Coordinator positions on attitudes and practices in a NSW mental health service.

OBJECTIVE: To determine attitudes and practices of community mental health clinicians in relation to employment and education for consumers and to assess the impact of the establishment of Vocational, Education, Training and Employment (VETE) Coordinator positions. METHOD: A snapshot was conducted by surveying community mental health clinicians regarding every consumer on their caseload in 2007. This was repeated in 2010 and the results were compared. RESULTS: From 2007 to 2010, the overall rates of VETE interventions increased, including a doubling of the rate of linkage to employment agencies for job seekers. Services with the consistent presence of a VETE Coordinator showed a greater impact on a number of factors, highlighted by a positive shift in clinician attitudes regarding their consumers' capacity to work. CONCLUSION: The establishment of VETE Coordination positions in the mental health service appears to be an effective way of raising awareness of VETE issues and improving VETE service provision. An important role has been assisting clinicians to begin implementing the principles of the Individual Placement and Support model of Supported Employment and to incorporate support for employment and education as a routine part of practice.

Sheltered Employment Centers: Characteristics and users' perception.

OBJECTIVE: To know the situation of Sheltered Employment Centers (CEE) in the Autonomous Community of Madrid. METHOD: A quantitative approach was developed by using a questionnaire which was sent to all the CEE. With this questionnaire we got information about the performance level of CEE. A qualitative approach was developed too by using an interview applied to a representative sample of users. With the interview we got information about users' perception and satisfaction. PARTICIPANTS: 73 centers from 175 (41.71%) participated in the quantitative approach. For the qualitative approach, 60 workers were selected from 1,899 (3.16%) in a randomized and stratified sample by age and gender. RESULTS: Users of CEE have most of them physical (38.41%) or intellectual (26.88%) disabilities, between 25 and 44 years old (65.44%) with permanent and full-time contract (64.17%). Satisfaction is very high (93.33%), mainly with the task (41.76%) and their coworkers (30.00%), and emphasizing that money is the least attractive feature (35.59%). CONCLUSIONS: CEE need to give careful thought to some of the key aspects of their makeup and practices. We would point out the need to make clear use of the personal and social adaptation services, act as routes for the transition to normalized employment.

Sheltering patterns and utilization following the 2007 southern California wildfires.

The 2007 southern California wildfires resulted in over 500,000 residents being displaced. A team from Johns Hopkins University and the American Red Cross surveyed 163 families at shelters and local assistance centers during the disaster. The responses were used to evaluate the needs and movement patterns of a displaced population. The data were also used to determine the risk factors associated with needing sheltering. There is a lower than expected reliance on public shelters, and displaced persons move frequently.

Mental health in adults with mild and moderate intellectual disabilities: the role of recent life events and traumatic experiences across the life span.

The aim of the present study is to investigate the association between recent life events and traumatic experiences across the life span and psychiatric disorders in people with ID. One hundred seventy-seven individuals with mild and moderate intellectual disability and their principal carers were assessed. Psychiatric disorders were evaluated with a semistructured psychiatric interview, the Psychiatric Assessment for Adults with Developmental Disabilities. This interview also includes a checklist of life events experienced over the previous 12 months, which was assessed through key informants. Presence of traumas was assessed through Allen's trauma history screen, also administered to key informants. After a descriptive analysis, binary logistic regression was used to see whether traumatic events and life events predicted the presence of ICD-10 disorders. A 75% of the participants had experienced at least 1 traumatic event during their life span, and 50% of the participants had experienced at least 1 life event in the 12 months previous to the study. Binary logistic regression showed that exposure to 1 or more traumatic experiences significantly increased the odds of a mental disorder (OR = 1.8), as did exposure to life events (OR = 1.4). However, when both life events and traumatic experiences were entered together in the model, calculation of odds ratios revealed that traumatic experiences significantly increased the odds of ICD-10 disorders (OR = 1.7) although life events were no longer significant. Though they have been less studied by the literature regarding predictors of mental illness in people with intellectual disability, traumatic experiences seem to play a more important role in psychopathology than life events.

Vocational rehabilitation for subjects with severe mental illnesses in Germany. A controlled study.

OBJECTIVE: To assess the longitudinal effectiveness of a comprehensive vocational rehabilitation program in Germany. METHODS: In a non-randomized open study, 106 participants of two comprehensive rehabilitation programs were prospectively and multidimensionally compared to a control group (n = 75) at program termination and at a 9 months follow-up. Primary outcome was employment status at 9 months follow-up, secondary outcome parameters were changes in symptoms (Positive and Negative Syndrome Scale), subjective well-being (WHOQOL-Bref), and level of functioning (Level of Functioning Scale) during the study. RESULTS: Regarding the primary outcome measure, there was significant more day structuring employment (mainly sheltered) in the rehabilitation group than in the comparison group (39.7 vs. 18.7%) at 9 months follow-up. Regarding secondary outcomes, rehabilitation participants showed a better course in general symptoms, subjective well-being and level of functioning. CONCLUSION: Vocational services proved to be effective to find day structuring employment for subjects with severe mental illness. Furthermore it had positive effects on functioning and psychological well-being during a 9-months follow-up period.

The relationship between patient characteristics and psychiatric day care outcomes in schizophrenic patients.

AIM: A retrospective study was conducted to assess the relationship between patient characteristics and psychiatric day care outcomes in 430 Japanese schizophrenic patients. METHODS: The patients were divided into psychiatric day care completers and non-completers. Patients who could not be included in these groups were categorized as unclassifiable. The completers were subdivided into four outcome groups: (i) patients who obtained a part-time job, (ii) patients who began working at community workshops for mentally disabled persons, (iii) patients who obtained a full-time job or returned to their former positions, and (iv) patients who entered or returned to school. The non-completers were subdivided into two outcome groups: (i) patients who discontinued psychiatric day care because of worsened schizophrenia, and (ii) patients who were rehospitalized because of worsened schizophrenia. Age, sex, age of onset of schizophrenia, number and duration of previous psychiatric hospitalizations, number of persons living with the patient, educational background, previous employment type, marital status, chlorpromazine-equivalent doses of antipsychotic drugs used, and psychiatric day care outcomes were compared among the outcome groups with logistic regression analysis using the outcomes as target variables. RESULTS: A later onset of schizophrenia and fewer previous psychiatric hospitalizations were significantly related with better outcomes. A higher educational background was related with the outcomes without statistical significance. CONCLUSIONS: Our results suggest that the assessment of the relationship between patient characteristics and psychiatric day care outcomes is essential to enhance therapeutic effectiveness of psychiatric day care by beginning appropriate communication, support, and programs for individual patients at the initiation of the care.

Body mass index and prevalence of obesity in a French cohort of patients with schizophrenia.

OBJECTIVE: To evaluate the distributions of body mass index in a large sample of patients with schizophrenia, and to examine the association between body weight and antipsychotic drugs. METHOD: The data source was baseline data from a national survey conducted in 2005-2006 in 5756 patients. RESULTS: The mean age of the patients was 37.1 +/- 11.8 years, and the mean BMI was 25.5 +/- 5.2 kg/m(2). In the final logistic regression model, the prevalence of obesity was significantly higher in female patients, age 40-59 vs. 18-29 years, patients in sheltered employment (vs. no income), out-patients (vs. full-time in-patients) and patients treated with concomitant antidepressant. There was a higher rate of obesity, relative to an absence of antipsychotics at entry, for patients receiving the following individual drugs: clozapine, olanzapine, risperidone and amisulpride. CONCLUSION: In patients treated with atypical antipsychotics, we found a significantly higher prevalence of obesity than in those not treated with any antipsychotic medication.

Employment support agencies in the UK: current operation and future development needs.

Disabled people are amongst the most excluded in society, while people with learning disability have the lowest rates of employment. Supported employment promises to address the gaps, but it is a new approach, one whose development has been incremental. The present authors explore some of the features of agencies providing employment support to disabled people, together with their managers' views. This paper describes semistructured telephone interviews with the managers of 31 employment support agencies. The survey sought to understand the types of service provided, the staff and caseload numbers, the training offered, and the targets used. The authors also asked the managers what would help them in delivering employment opportunities to disabled people. The responses of the managers highlight gaps between current policy and practice. Particular attention is given to the use of targets, fragmented funding and what managers consider is required to improve employment opportunities for disabled people. Managers endorsed the vision expressed in current policy, and identified numerous obstacles to its implementation in employment support. Taken together, their views can be used to guide the development of supported employment.

[Frequent use of psychiatric inpatient services analysed from three different perspectives]. / Analyse starker Inanspruchnahme stationär-psychiatrischer Versorgung aus drei unterschiedlichen Perspektiven.

OBJECTIVE: Frequent utilization of psychiatric inpatient care was mainly analysed by quantitative methods. The present study combines quantitative with qualitative methods and discusses the results obtained from these different perspectives. METHOD: The quantitative analysis is based on data from 184 schizophrenia patients, who were observed over a period of 2(1/2) years. Twenty of the identified frequent users and 6 employees of psychiatric facilities were interviewed by means of qualitative methods as to the causes of frequent use of inpatient care. RESULTS: Predictors of frequent use identified in the quantitative study were found again in the qualitative analysis. Opportunities for alternative care for frequent users suggested by the staff of psychiatric facilities include social treatment in the community, day structuring activities and sheltered work. Patients consider work, compliance securing and better contact with office based psychiatrists to be important factors. CONCLUSIONS: Patients and staff give different priorities to their suggestions for interventions, but are, in most cases, of the opinion, that part of hospital admissions of frequent users could be avoidable by means of alternative services.

[Employment situation of psychiatric in-patients with schizophrenic or affective disorders]. / Beschäftigungslage von Schizophrenie- und Affektkranken.

OBJECTIVE: This study is on employment on the competitive as well as the sheltered work market of psychiatric in-patients suffering from schizophrenia or affective disorders. Furthermore it investigates the importance of characteristics of disorder and of educational and vocational background as predictors of occupation. METHODS: A sample of 251 in-patients participated in a structured interview during their hospitalization. RESULTS: 43 % of in-patients suffering from schizophrenia and 46 % suffering from affective disorders were employed on the competitive work market during the year before index-hospitalization. Many were without any occupation too because sheltered employment was rarely used and mostly by schizophrenics (17 % vs 4 % of persons with affective disorders). Predictors of employment are past vocational experiences, education, length of past hospitalization, psychiatric diagnosis and sex. CONCLUSIONS: Results raise the question of deficits in providing with sheltered employment opportunities for the mentally ill and in particular for people suffering from affective disorders. Alternatives to these deficits are discussed.

Helping people with severe mental illness to obtain work: systematic review.

OBJECTIVE: To determine the most effective way of helping people with severe mental illness to obtain competitive employment-that is, a job paid at the market rate, and for which anyone can apply. DESIGN: Systematic review. PARTICIPANTS: Eligible studies were randomised controlled trials comparing prevocational training or supported employment (for people with severe mental illness) with each other or with standard community care. OUTCOME MEASURES: The primary outcome was number of subjects in competitive employment. Secondary outcomes were other employment outcomes, clinical outcomes, and costs. RESULTS: Eleven trials met the inclusion criteria. Five (1204 subjects) compared prevocational training with standard community care, one (256 subjects) compared supported employment with standard community care, and five (484 subjects) compared supported employment with prevocational training. Subjects in supported employment were more likely to be in competitive employment than those who received prevocational training at 4, 6, 9, 12, 15, and 18 months (for example, 34% v 12% at 12 months; number needed to treat 4.45, 95% confidence interval 3.37 to 6.59). This effect was still present, although at a reduced level, after a sensitivity analysis that retained only the highest quality trials (31% v 12%; 5.3, 3.6 to 10.4). People in supported employment earned more and worked more hours per month than those who had had prevocational training. CONCLUSION: Supported employment is more effective than prevocational training at helping people with severe mental illness obtain competitive employment.

Long-term psychiatric patients in vocational rehabilitation programmes: a naturalistic follow-up study over 3 years.

OBJECTIVE: This paper aims at assessing the vocational integration attained after a 3-year period by psychiatric patients who participated in different vocational rehabilitation programmes. METHOD: In the north-western German region of Westphalia-Lippe a naturalistic follow-up study was carried out on 471 patients from three different types of vocational rehabilitation programmes. The sample comprised chronically ill patients with a history of repeated and long-term hospitalization. RESULTS: After 3 years 11% of the patients were in competitive employment, 67% (still) in sheltered employment, 7% in out-patient work therapy programmes and 15% were unemployed. It is important to notice that 74% achieved their subjective rehabilitation goals expressed at baseline. CONCLUSION: Vocational rehabilitation programmes are an essential part in the treatment of people with chronic mental illness. Integration into work varies markedly while patients' satisfaction is comparably good. Competitive employment represents a realistic objective only for patients with high motivation and favourable preconditions.

[Psychiatric vocational therapy--concepts, practice and scientifically-based results]. / Psychiatrische Arbeitstherapie--Konzepte, Praxis und wissenschaftliche Ergebnisse.

Work therapy is a widespread form of socio-therapy. In contrast to pharmacological and somatic forms of treatment, proof of efficacy is difficult to produce in multimodal therapy of psychiatric patients. Within the framework of an extensive study on vocational rehabilitation of mentally ill patients, we carried out a naturalistic follow-up study of 112 mostly schizophrenic patients attending outpatient work therapy programmes. The courses of illness and rehabilitation were documented prospectively over a three-year period. At the end of the study 23% of the patients were integrated into the open labour market, 25% were working in sheltered employment, 25% remained in work therapy, and 27% were unemployed. Controlled studies with schizophrenic patients show, that work therapy contributes to improved vocational integration, a reduction of rehospitalizations and a stabilisation of the psychopathological status.

[Psychiatric management and occupational rehabilitation of psychiatric patients in Japan]. / Zur psychiatrischen Versorgung und beruflichen Rehabilitation psychisch Kranker in Japan.

The article gives an insight into the psychiatric care system in Japan. Psychiatric hospitals mainly are in private ownership and compared to international standards their situation is characterized by lack of qualified personnel and high number of chronically long-stay patients. Complementary community services are still rare, positive developments have started, however, in vocational rehabilitation and occupation of the mentally ill in community workshops.

A second labour market? Vocational rehabilitation and work integration of chronically mentally ill people in Germany.

In Germany, the vocational rehabilitation of chronically mentally ill people is concentrated on the sheltered labour market, supplemented by special programmes for the care and reintegration of mentally ill people on the open labour market. Our investigation covered 502 representatively selected patients in sheltered employment (outpatient work therapy, firms for mentally ill people, workshops for the disabled). The sociodemographic, anamnestic and psychopathological data reveal that these are chronically mentally ill people with significant disabilities, making comprehensive social care and psychiatric treatment essential. Most of the subjects intend to remain in sheltered employment; only 20% hope to change to the open labour market. The level of subjective job satisfaction is surprisingly high despite generally inadequate pay, though it has to be pointed out that many long-term patients are presumably resigned to their circumstances. In conclusion, the relationship of the open labour market to sheltered employment is the subject of critical discussion.