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Nischk D, Herwig U, Senner S, Rockstroh B. [Effectiveness and Cost-Effectiveness of Individual Placement and Support (Ips) in Germany - A Controlled Trials with Individuals with Psychosis]. PSYCHIATRISCHE PRAXIS 2024; 51:84-91. [PMID: 37813364 DOI: 10.1055/a-2165-8728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To establish the effectiveness of Individual Placement and Support (IPS) to integrate people with mental illness into the general labor market, controlled comparisons with usual rehabilitative practice in terms of employment rates and cost-effectiveness are needed. METHODS 20 IPS participants with psychoses (primarily schizophrenia spectrum disorders) were compared with 20 controls who were offered usual rehabilitative practices in adjacent counties (rehabilitation as usual, RAU) over 18 months. RESULTS IPS was significantly superior to RAU on all job-related criteria with moderate to high effect sizes, with no differences in absenteeism, hospital days, or dropout rates. IPS was significantly superior to RAU on cost-effectiveness. CONCLUSION This study provides evidence that IPS is an effective and cost-efficient addition to existing vocational rehabilitation services for people with psychoses.
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Affiliation(s)
- Daniel Nischk
- Sozialpsychiatrie, Zentrum für Psychiatrie Reichenau
| | - Uwe Herwig
- Ärztliche Direktion, Zentrum für Psychiatrie Reichenau
| | - Simon Senner
- Sozialpsychiatrie, Zentrum für Psychiatrie Reichenau
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Dehn LB, Suer J, Klein R, Driessen M. [Work and Employment Situation of People with Mental Illness Receiving Independent Supported Housing: An Analysis of Routine Data from a Community Psychiatry Service]. PSYCHIATRISCHE PRAXIS 2023. [PMID: 37989201 DOI: 10.1055/a-2196-2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVES Due to insufficient empirical data on the occupational participation of people affected by severe mental illness receiving integration assistance, routine data from a community psychiatry service were evaluated. METHODS Reference workers filled out a short questionnaire on different occupational and employment aspects of their clients from supported housing/floating outreach. In addition to descriptive and exploratory analyses, overall results from previous survey rounds were also evaluated. RESULTS N=1418 individuals (M=47.6 years) could be included, of whom approximately 45% had no job, sheltered employment, or daytime service. This percentage has remained almost unchanged over the last decades. CONCLUSION Overall, there is an urgent need for action to improve occupational participation opportunities for people with mental illness and substance addiction.
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Affiliation(s)
- Lorenz B Dehn
- Forschungsabteilung, Universitätsklinik für Psychiatrie und Psychotherapie, am Universitätsklinikum OWL der Universität Bielefeld/Evang. Klinikum Bethel (EvKB), Bielefeld
- AG 106 Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät OWL der Universität Bielefeld
| | - Julia Suer
- Forschungsabteilung, Universitätsklinik für Psychiatrie und Psychotherapie, am Universitätsklinikum OWL der Universität Bielefeld/Evang. Klinikum Bethel (EvKB), Bielefeld
| | - Rüdiger Klein
- Referat Unternehmensentwicklung, Bethel.regional, von Bodelschwinghsche Stiftungen Bethel, Bielefeld
- GPV Bielefeld, Gemeindepsychiatrischer Verbund (GPV) Bielefeld
| | - Martin Driessen
- Forschungsabteilung, Universitätsklinik für Psychiatrie und Psychotherapie, am Universitätsklinikum OWL der Universität Bielefeld/Evang. Klinikum Bethel (EvKB), Bielefeld
- AG 106 Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät OWL der Universität Bielefeld
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Steinhart I, Stengler K. ["Psychiatry on Tour": what Remains, what Must Change - Now?]. PSYCHIATRISCHE PRAXIS 2023; 50:60-62. [PMID: 36913946 DOI: 10.1055/a-2010-9292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Worum es gehtSpätestens seit der Corona-Pandemie hat das Thema Krise in der
Versorgungslandschaft in Deutschland, so auch in der Psychiatrie, Konjunktur. Und
wir erkennen, an welchen Stellen die Psychiatrie eher robust oder eher
„anfällig“ aufgestellt war – und heute noch ist.
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Fit for Work and Life—an eight-week program for improvement of functionality and quality of life. NEUROPSYCHIATRIE 2022; 36:104-115. [PMID: 35428933 PMCID: PMC9012433 DOI: 10.1007/s40211-022-00415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/13/2022] [Indexed: 11/18/2022]
Abstract
Background The current two-stage study focused on work integration and quality of life of patients in an acute psychiatric day care unit. There is evidence that a longer absence from work due to illness negatively affects job retention, life satisfaction and clinical prognosis. Furthermore, there are individual supportive methods that proved to be effective in work integration. We therefore developed a specific group program Fit for Work and Life (FWL) for patients in an acute psychiatric day care unit focusing on work integration in the first labor market (in contrast to work in institutions for people with disabilities/second labor market). Methods Between 2018 and 2020, 62 patients (intervention group; IG) were enrolled in an 8‑week prospective job integration program and compared to 74 patients (control group; CG) who received treatment as usual (partly retrospective survey). Patients of both groups held a job when entering treatment. Main outcome was defined as their working status 4 weeks after the end of treatment as well as self-reported life satisfaction. Results At the end of treatment (i.e. the week prior to discharge), the IG participants reported higher overall life satisfaction as well as higher health-, self- and living condition-related satisfaction than controls. Functional and clinical improvement during treatment was linked to subsequently returning to work. Functional improvement was further linked to higher life satisfaction. Mediational analysis revealed an indirect path from functional improvement on life satisfaction via working status, i.e. the higher functional improvement during treatment, the higher the chance of successfully returning to work, which in turn increased life satisfaction. Conclusion Our findings suggest that programs such as FWL are useful interventions for employed patients to improve reintegration into work and life and to help to increase life satisfaction.
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Schniedermann I, Dehn LB, Micheel S, Beblo T, Driessen M. Evaluation of a supported education and employment program for adolescents and young adults with mental health problems: A study protocol of the StAB project. PLoS One 2022; 17:e0271803. [PMID: 35905081 PMCID: PMC9337640 DOI: 10.1371/journal.pone.0271803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022] Open
Abstract
The majority of mental illnesses begins in childhood, adolescence and young adulthood before the age of 25. The transition from adolescence to adulthood is a particularly vulnerable time for adolescents with mental illness, affecting psychosocial functioning and participation in work life. Therefore, they need—in contrast to classic standard vocational interventions—a long-term, holistic and individually oriented vocational rehabilitation program. With the innovative model project "Start in education and employment (StAB)”, adolescents and young adults with mental illnesses are to be supported with regard to their vocational perspectives and participation by a new type of individualized, holistic, long-term job coaching. It follows the Individual Placement and Support (IPS) concept, as a manualized form of the Supported Employment Approach and is based on the "first place–then train" principle. In order to evaluate the effectiveness and feasibility of the StAB program, a double-centre prospective single arm evaluation study in a mixed-methods design will be conducted. The focus is on quantitative research analysing pre-post-effects of the StAB intervention in a two-year observational study. Young people between 15 and 25 years with a psychiatric diagnosis who are currently in receipt of means-tested benefits or are entitled to them will be recruited. The study will take place in two major cities in the north-western part of Germany, Bielefeld and Dortmund. We expect to contribute to gain more empirical data about the implementation of Supported Employment and Education to severely mentally ill adolescents and young adults in German settings. Moreover, these results may also provide the scientific foundation for future measures focusing the improvement of vocational rehabilitation for young people with mental illness. The study was registered in the German Clinical Trials Register (DRKS00027576) on March 10, 2022.
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Affiliation(s)
- Ina Schniedermann
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Lorenz B. Dehn
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- * E-mail:
| | - Sabrina Micheel
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
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Dehn LB, Böske N, Beblo T, Steinhart I, Stengler K, Driessen M. [Vocational Perspectives for People with Mental Illness Under Corona Conditions: An Exploratory Brief Survey]. PSYCHIATRISCHE PRAXIS 2021; 49:152-155. [PMID: 34674200 DOI: 10.1055/a-1623-4622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Lorenz B Dehn
- Universitätsklinikum OWL der Universität Bielefeld, Klinik für Psychiatrie und Psychotherapie am Evang. Klinikum Bethel (EvKB)
| | - Nils Böske
- Universitätsklinikum OWL der Universität Bielefeld, Klinik für Psychiatrie und Psychotherapie am Evang. Klinikum Bethel (EvKB)
| | - Thomas Beblo
- Universitätsklinikum OWL der Universität Bielefeld, Klinik für Psychiatrie und Psychotherapie am Evang. Klinikum Bethel (EvKB)
| | - Ingmar Steinhart
- Universität Greifswald, Institut für Sozialpsychiatrie Mecklenburg-Vorpommern; v. Bodelschwinghsche Stiftungen Bethel, Vorstand
| | - Katarina Stengler
- HELIOS Park-Klinikum Leipzig, Klinik für Psychiatrie, Psychosomatik und Psychotherapie
| | - Martin Driessen
- Universitätsklinikum OWL der Universität Bielefeld, Klinik für Psychiatrie und Psychotherapie am Evang. Klinikum Bethel (EvKB)
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Hussenoeder FS, Koschig M, Conrad I, Gühne U, Pabst A, Kühne SE, Alberti M, Stengler K, Riedel-Heller SG. Leipzig - Individual Placement and Support for people with mental illnesses (LIPSY): study protocol of a randomized controlled trial. BMC Psychiatry 2021; 21:410. [PMID: 34412626 PMCID: PMC8374117 DOI: 10.1186/s12888-021-03416-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Individuals receiving means-tested benefits are at a higher risk of being diagnosed with a psychiatric illness compared to those who are employed, and the rate of those working in the first labor market is low. The intervention (Individual Placement and Support, IPS) aims at maintaining or regaining working ability and at facilitating reintegration into the (first) labor market following a "first place, then train"-approach. The objective of the study is to conduct the first RCT in Germany that addresses a broad group of long-term unemployed individuals with severe mental illnesses that receive means-tested benefits, and to test the effectiveness of the IPS intervention. METHODS In this randomized controlled trial, about 120 eligible participants aged between 18 years and local retirement age will be randomly allocated to an intervention group (IG) or to an active control group (CG) using a parallel arm design. The IG will receive IPS + high quality treatment as usual (TAU), the active CG will receive TAU + a booklet on integration measures. A block-randomization algorithm with a targeted assignment ratio of 1:1 for participants in IG and active CG will be used, stratified by sex and three age groups. Assessments will take place before the intervention at baseline (t0), and 6 (t1), 12 (t2), and 18 (t3) months later. Primary outcome will be the proportion of participants having worked at least 1 day in competitive employment since baseline, as assessed at t3. Secondary outcomes will be related to employment/ vocation and mental health. In addition, there will be a process evaluation. Treatment effects on outcomes will be tested using appropriate panel-data regression models, and acceptability, uptake and adherence will be evaluated using descriptive statistics and appropriate inference testing. DISCUSSION The results of this trial are expected to generate a better understanding of the efficiency, feasibility, acceptance, and relevance of the IPS intervention in a German setting. They could be a first step towards the implementation of the method and towards improving the situation of long-term unemployed individuals with severe mental health problems. TRIAL REGISTRATION German Clinical Trials Register ( DRKS00023245 ), registered on 22.02.2021.
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Affiliation(s)
- Felix S Hussenoeder
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany.
| | - Maria Koschig
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Ines Conrad
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Sophie-Elisabeth Kühne
- Helios Park-Klinikum - Clinic for Psychiatry, Psychosomatics and Psychotherapy, Morawitzstr. 2, 04289, Leipzig, Germany
| | - Mathias Alberti
- Helios Park-Klinikum - Clinic for Psychiatry, Psychosomatics and Psychotherapy, Morawitzstr. 2, 04289, Leipzig, Germany
| | - Katarina Stengler
- Helios Park-Klinikum - Clinic for Psychiatry, Psychosomatics and Psychotherapy, Morawitzstr. 2, 04289, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
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