Work and mental disorders
Returning to work after rehabilitationion
In Germany, around one in three people is affected by a mental illness. Days of incapacity for work, health-related early retirement and recognized severe disabilities due to mental disorders have increased significantly in recent years. Mental disorders lead to incapacity for work twice as often as somatic illness. In the rehabilitative care provided by German Pension Insurance, a good sixth of inpatient services are provided due to mental disorders (excluding addiction) (total: 16.7 %; men: 12.7 %; women: 20.7 %). Depression, adjustment disorders, somatoform disorders and anxiety disorders predominate in everyday clinical practice at psychosomatic rehabilitation centers.
Who and what is at stake?
Needs-based access to rehabilitative services is an important component in helping people with mental disorders to return to work and secure employment.
However, various studies have shown that people who have been on sick leave for a long time or who do not believe that they will be able to return to work have a significantly higher risk of failing to reintegrate into the labor market after rehabilitation. A new rehabilitation concept has been developed for these people in recent years: work-related medical rehabilitation, or WRM for short.
During WMR, the aim is to reduce discrepancies between job-related skills and requirements in such a way as to ensure long-term professional participation. This can be achieved both by changing the skills and by adapting the requirements. The therapeutic modules of WMR are usually preceded by a comprehensive requirements-orientated diagnosis, in which it is clarified to what extent the ability profile of the rehabilitants corresponds to the requirements profile of the current or desired activity. Other elements of WMR include intensified social and vocational counselling, job-related psychosocial group activities and workplace training. The content and scope of the therapeutic modules are described in the requirements profile for the implementation of WMR by the German Pension Insurance Association.
LONG ABSCENCEFROM WORK
THERAUPEUTICMODULES
RETURN TO WORK
SUSTAINABLE PARTICIPATION
Current state of research
There is strong evidence for the effectiveness of WMR, particularly for musculoskeletal disorders. Both in randomized controlled trials and under real-life care conditions, participants in WMR returned to work more frequently than participants in conventional orthopedic rehabilitation. With regard to the effectiveness of WMR for mental illness, the evidence to date is based on two randomized controlled trials that tested a very specific approach (external stress testing with accompanying therapeutic groups). There is no clear evidence of the effectiveness of WMR implemented in real-life care practice on the basis of requirement profiles. Based on national and international studies, we assume that additional work-related interventions in psychosomatic rehabilitation lead to more favorable reintegration results.
