Predictors of return to work in people with major depression: Results from a supported employment program in Germany.

BACKGROUND: Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work. METHODS: The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses. RESULTS: A total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS. LIMITATIONS: The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited. CONCLUSIONS: People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.

[Discharged, but where to? The Current Situation of Long Stay Patients in German Psychiatric Clinics]. / Entlassen, aber wohin? Zur aktuellen Situation der "Langlieger" in deutschen psychiatrischen Kliniken.

OBJECTIVE: The study analyses the number, characteristics and reasons for a length of stay of patients in German psychiatric clinics in excess of 6 months. METHODS: The study was implemented in the form of a nationwide online survey, which was addressed to chief physicians of psychiatric clinics. RESULTS: In the sample, 174 patients in 80 psychiatric clinics were identified who could not be discharged because no suitable follow-up services were available in the region. The majority of patients are male, often have an F2 diagnosis and exhibit aggressive behaviour during their hospital stay. CONCLUSION: To avoid inappropriate health care and prevent prolonged stays for a subgroup of mentally ill people, individual complex services should be implemented in community psychiatry.

[COVID-19 Pandemic-Related Effects on Psychiatric and Psychosocial Care in Urban and Rural Areas - Two Studies Implementing the Questionnaire PandA-Psy]. / Corona-Pandemie-bedingte Auswirkungen auf die psychiatrische und psychosoziale Versorgung im städtischen und ländlichen Raum ­ Zwei Untersuchungen mit dem Fragebogen PandA-Psy.

OBJECTIVE: To assess COVID-19 pandemic-related changes in psychiatric and psychosocial services and their impact on the care of people with severe mental illness in two contrasting regions. METHODS: Development and use of an online questionnaire (PandA-Psy) in Leipzig (N=50) and Mecklenburg-Western Pomerania (N=126). RESULTS: In community psychiatric care, mostly comparable changes caused by the COVID-19 pandemic were observed in the two selected regions. These mainly concern the decrease in face-to-face contacts and group services, the increase in digital and telephone services, as well as the increasing constraints of staff. Differences between the regions are discussed. CONCLUSION: PandA-Psy was successfully used to map changes caused by the COVID-19 pandemic in psychiatric and psychosocial services in two areas. In addition to the predominantly negative consequences of the pandemic situation, we also found opportunities arising from the crisis.

[LeiP#netz - Leipziger Psychiatrie Netzwerk - A Pilot Project to Implement the Functional Basic Model by Steinhart and Wienberg in a Defined Psychiatric Care Region]. / LeiP#netz ­ Leipziger Psychiatrie Netzwerk.

BACKGROUND: The functional basic model (Steinhart, Wienberg) offers the theoretic ground for a pilot project which emphasis on outpatient treatment in psychiatric care. METHODS: The following subgoals were pursued a) networking with providers/institutions/actors located in the study region; (b) evaluation of the offered services for the purpose of mapping psychosocial care. Consequently, a project-based survey instrument was developed and applied for the survey of all care providers. RESULT: Merging and networking of all actors was started successfully. All services needed for psychiatric care of severe mentally ill people are provided in the study region. While counselling and prevention tend to be well-maintained structures, there is a lack of access to low-threshold care such as crisis management, retreats alternatives to hospitals and assertive multi-professional complex treatment.

[A Standard of Centers for Community Psychiatry in Lower-Saxonia - Checklist and Model Fidelity Scale]. / Ein Standard für Gemeindepsychiatrische Zentren in Niedersachsen ­ Checkliste und Modelltreueskala.

OBJECTIVE: Definition of a standard for structures and processes of Centers for Community Psychiatry (CCP) that aim at providing mobile, multiprofessional, complex and intensive outpatient care to patients with severe mental illness. METHODS: The standard was developed and consented using a mix-method approach and by involving all relevant stakeholders, including first hand experts and service providers of three CCP model-projects in Lower-Saxonia. RESULTS: The standard comprises a checklist with 12 binary and obligatory CCP features as well as a model fidelity scale with 45 scaled items in 9 dimensions. CONCLUSION: For the first time, a CCP-standard is available that offers a quantifiable and verifiable catalogue of features essential for CCPs. The standard orients at the S3 guideline "Psychosocial Therapies".

[Psychiatric-Psychotherapeutic Care in Crisis: Results of the LeiP#Netz Pilot Project]. / Psychiatrisch-psychotherapeutische Versorgung in der Krise: Ergebnisse des Pilotprojekts LeiP#netz.

OBJECTIVE: Analysis of psychiatric-psychotherapeutic crisis services in the Leipzig Psychiatry Network (LeiP#netz), assigning the services to the functional areas of the FBM according to Steinhart and Wienberg. METHODS: A standardized survey of crisis care was conducted using the functions "complex outpatient treatment", "access to acute psychotherapy in crisis", and "24 h complex, intensive treatment" by means of facility-related and function-related instruments. RESULTS: A total of 31 measures were recorded for the three functions. All crisis care services were highly utilized; in up to one-third of cases, no services could be provided when demand was requested. Services that do not require registration or offer 24/7 care are available at very low levels. CONCLUSION: Crisis care services for severely mentally ill people are available in various constellations in the study region. Low-threshold 24/7 crisis services need to be expanded.

LeiP#netz 2.0: mapping COVID-19-related changes in mental health services in the German city of Leipzig.

PURPOSE: The purpose of the study was to investigate the changes in psychosocial and psychiatric services in the German city of Leipzig during the COVID-19-pandemic. METHODS: A participatory, mixed-methods study was used involving a quantitative online survey and qualitative semi-structured interviews with professionals. Quantitative findings were reported with descriptive statistics, and thematic analysis was conducted for qualitative data. RESULTS: Fifty professionals from various mental health services participated in the survey and eleven professionals were interviewed. Quantitative findings showed that some services were closed intermittently and that there was a stiff increase in use of digital/telephonic service and a decrease in face-to-face services. Staff or funding did not change considerably during the pandemic. Psychosocial groups were suspended or reduced, while access to services became more difficult and professional training for staff was stopped. Thematic analysis of the interviews showed that professionals experienced different phases and levels of change during the pandemic, including changes on a structural level, on the users' level, and on the staff' level. Professionals particularly criticised the equivocality of COVID-19 regulations, a defective flow of information and lack of attention for mental healthcare in public policies. They also saw positive aspects, such as the capacity of users and the outpatient care system to adapt to the new situation. CONCLUSION: This study suggests directions for policy and service development, such as communicating clearly in infection-control measures, fostering outpatient care and networks between services.

Participating in Longitudinal Observational Research on Psychiatric Rehabilitation: Quantitative Results From a Patient Perspective Study.

BACKGROUND: Longitudinal observational studies play on an important role for evidence-based research on health services and psychiatric rehabilitation. However, information is missing about the reasons, why patients participate in such studies, and how they evaluate their participation experience. METHODS: Subsequently to their final assessment in a 2-year follow-up study on supported housing for persons with severe mental illness, n = 182 patients answered a short questionnaire on their study participation experience (prior experiences, participation reasons, burden due to study assessments, intention to participate in studies again). Basic respondent characteristics as well as symptom severity (SCL-K9) were also included in the descriptive and analytical statistics. RESULTS: To help other people and curiosity were cited as the main initial reasons for study participation (>85%). Further motives were significantly associated with demographic and/or clinical variables. For instance, "relieve from boredom" was more frequently reported by men and patients with substance use disorders (compared to mood disorders), and participants 'motive" to talk about illness" was associated with higher symptom severity at study entry. Furthermore, only a small proportion of respondents indicated significant burdens by study participation and about 87% would also participate in future studies. CONCLUSIONS: The respondents gave an overall positive evaluation regarding their participation experience in an observational study on psychiatric rehabilitation. The results additionally suggest that health and social care professionals should be responsive to the expectations and needs of patients with mental illness regarding participation in research.

Effectiveness of supported housing versus residential care in severe mental illness: a multicenter, quasi-experimental study.

PURPOSE: Up to now there are only few studies and no RCT comparing efficacy or effectiveness of supported housing (SH) versus residential care (RC) in severe mental illness (SMI) without homelessness. Here we present an observational follow-up study in SMI subjects, who entered SH or RC, to compare clinical and functional outcomes 2 years later. METHODS: In this prospective study in more than 30 locations throughout a German federal state, we included SMI subjects, who entered SH (n = 153) or RC (n = 104). About one quarter suffered from each substance use, psychotic, affective, or other disorders. To avoid sampling bias, we used the propensity score matching method to establish a quasi-experimental design. Outcome measures were social functioning (SFS), the number of psychiatric hospitalisations, psychopathology (SCL-9-K), and quality of life (MANSA). Apart from descriptive methods we analysed primarily using repeated-measures ANOVAS. RESULTS: Our analyses revealed significant effects of time for all outcomes in both study groups. However, there were not any group differences of outcome measures, i.e., not any significant effects of group or interactional effects of group x time. Moreover, these results hold true for intent-to-treat and per-protocol sample analyses. CONCLUSION: The results show, that SH and RC for non-homeless people with SMI achieve the same clinical and psychosocial outcomes across a 2-year period. Taking into account the users' preferences, the present findings should give reason to ensure the availability of affordable housing and to support the expansion of supported housing approaches.

[Vocational Perspectives for People with Mental Illness Under Corona Conditions: An Exploratory Brief Survey]. / Arbeitsperspektiven für Menschen mit psychischen Erkrankungen unter Corona-Bedingungen: Eine explorative Kurzumfrage.

OBJECTIVE: Exploratory study of corona-related impacts on vocational perspectives of people with mental illness. METHODS: Short survey with quantitative and qualitative questions among employees from vocational rehabilitation. RESULTS: More than 90 % of the n = 76 participants stated that the situation regarding vocational reintegration or job search had worsened due to corona. Moreover, 75 % considered that there would still be a negative impact on vocational rehabilitation in the longer term. In addition to the main problem of a lack of job offers, open responses on obstacles also referred to increased psychological stress among clients as well as problems in reaching cooperation partners or in dealing with online processes. CONCLUSIONS: Under Corona conditions, the work-related perspectives and participation opportunities of people with mental illness have been additionally worsened.

[Supported Housing - Development and Validation of the "Supported Housing Fidelity Scale" for People With Mental Health Problems]. / Selbstbestimmtes Wohnen mit Unterstützung ­ Entwicklung und Überprüfung der "Modelltreueskala Selbstbestimmtes Wohnen (MSSW)" für Menschen mit psychischen Beeinträchtigungen.

OBJECTIVE: For supported accommodation settings in mental health care, there is no comprehensive list of criteria for German-speaking countries available. The development and testing of a fidelity scale for independent housing is described. METHODS: By means of a cross-country cooperation a fidelity scale was developed and was utilized in interviews with heads of 87 housing services and institutions in Germany and Switzerland. RESULTS: The fidelity scale consists of 31 items in 4 topic fields. Outreach services demonstrated a slightly higher fidelity compared to residential care. This was particularly true for the topic fields 'Housing conditions' and 'Inclusion orientation'. We found not differences in the topic fields 'Staff/team' and 'Support conditions'. CONCLUSIONS: With this fidelity scale there is a testable list of criteria for independent housing services in mental health care available for the first time in German-speaking countries.

[Person-centered care but living in a closed setting? The situation of closed residential facilities in Germany]. / Personenzentrierte Hilfen, aber geschlossen untergebracht? Zur Situation der geschlossenen Heime in Deutschland.

BACKGROUND: The United Nations Convention on the Rights of Persons with Disabilities and the Federal Participation Act state that all human beings have the right to choose where to live. This human right is compromised by the institutional limitations of the community psychiatric system, where persons with severe mental illnesses and with intensive support needs are often housed in closed (i.e. physically locked) living contexts. How can the concept of person-centered care help to solve this conflict? OBJECTIVE: Description of the nationwide situation of closed residential facilities and discussion of the person-centered approach as a solution to the problem of closed living contexts. METHODS: Summary of current knowledge on the structural and procedural data of closed residential facilities in Germany, which were collated within the framework of the "Coercive measures in the psychiatric care system-Collation and reduction" (ZIPHER) study. RESULTS: The empirical data indicate a great need for regionally based care of the target group and a lack of individual arrangements as alternatives to closed living contexts. The necessity for regional care obligations is highlighted by the example of Mecklenburg-Western Pomerania. CONCLUSION: The avoidance and reduction of closed accommodation can primarily be achieved by individual arrangements within the framework of person-centered and flexible proposal landscapes. For this the service providers of integration assistance, including the psychiatric hospitals, must be committed to the care of all people in their region. An appropriate accompaniment and refunding by the service provider are also necessary.

[Psychiatric Facilities in Germany - Transparency and Structures]. / Psychiatrische Wohnheime in Deutschland ­ Transparenz und Strukturen.

OBJECTIVE: Description of the nationwide housing situation for severely mentally ill people (including substance dependencies). METHODS: Nationwide quantitative survey using an online questionnaire on structural and process data of residential facilities. The survey was conducted as part of the "ZIPHER" study (coercive measures in the psychiatric help system - recording and reduction). RESULTS: A response rate of 20 % was achieved, 11,881 open and 1,268 closed home places were recorded. The present results show that especially male people, who are 50 years of age and older and/or suffering from schizophrenia are living in the psychiatric housing facilities. Both the composition of staff members during the day and the presence of staff at night differ between the open and closed living contexts. CONCLUSION: The first nationwide results refer to a lack of data in the field of inpatient housing facilities and the need for a regionally based social reporting.

[(Closed) Psychiatric Homes as Part of the Regional Networks in Germany?] / (Geschlossene) besondere Wohnformen als unverzichtbarer Teil der regionalen Verbundstrukturen in Deutschland?

OBJECTIVE: Description of the nationwide housing situation for severely mentally ill people (including substance dependencies). METHODS: Nationwide quantitative survey using an online questionnaire on structural and process data of residential facilities. RESULTS: A response rate of 20 % was achieved, 11,881 open and 1,268 closed home places were recorded. The empirical data refer to a lack of individual arrangements after living in a psychiatric housing facility and as an alternative to closed living contexts - even today people are still accommodated far away from their home. CONCLUSION: The high allocation from psychiatric inpatient units to closed housing facilities shows that there has to be a better control of aftercare by the community psychiatry in general and the inpatient units in particular. Required are individual residential arrangements for severely mentally ill that are appropriately funded.