Reker T, Eikelmann B
Westfälische Klinik für Psychiatrie und Psychotherapie, Münster.
Psychiatr Prax. 1999 Sep;26(5):218-23.
Vocational integration of mentally ill patients is confronted not only with illness-related restrictions but also with the current situation on the labour market and prejudices on the part of potential employers. The Consultancy Centres for Vocational Integration work with a supported employment approach which was adapted to the German situation. It includes prevocational training, assistance in finding appropriate jobs, cooperation with employing companies and long-term job site support.
Within the scope of a major study on vocational rehabilitation in the German region of Westphalia-Lippe, we carried out a prospective study of the further vocational course of 61 patients who had already been placed in competitive employment within the framework of the Consultancy Centres. These patients (30 men, 31 women) had a mean age of 31 years (+/- 6.9); 54% of them were suffering from schizophrenic disorders; mean duration of illness was 8.2 years (+/- 6.8).
After two years (and for a subsample of 33 patients also after 3 years) two-thirds of patients were still in competitive employment. Predictors of success proved to be 1) a higher ability to cope with vocational stress on introduction of the measure, 2) an earlier start to rehabilitation, and 3) financial assistance for the company. A close correlation was recorded between course of illness (rehospitalizations) and success of rehabilitation.
Even in the current situation of high unemployment rates vocational integration of mentally ill patients is possible and stable in medium term. Especially highly-motivated patients with favourable preconditions (early start of rehabilitation measures, higher ability to cope with work stress) are successful if intensive long-term support--including efforts involving employers--is provided.
精神病患者的职业融合不仅面临与疾病相关的限制，还面临劳动力市场的现状以及潜在雇主的偏见。职业融合咨询中心采用了一种适用于德国情况的支持性就业方法。它包括职业前培训、协助寻找合适工作、与雇主公司合作以及长期的工作现场支持。
在德国北莱茵-威斯特法伦州利珀地区进行的一项关于职业康复的重大研究范围内，我们对61名已在咨询中心框架内获得竞争性就业岗位的患者的后续职业发展进行了前瞻性研究。这些患者（30名男性，31名女性）平均年龄为31岁（±6.9岁）；其中54%患有精神分裂症；平均病程为8.2年（±6.8年）。
两年后（对于33名患者的子样本，3年后也是如此），三分之二的患者仍在从事竞争性工作。成功的预测因素被证明是：1）在措施实施时应对职业压力的能力较高；2）康复开始得较早；3）对公司的财政援助。疾病病程（再次住院情况）与康复成功之间存在密切相关性。
即使在当前高失业率的情况下，精神病患者的职业融合在中期也是可能且稳定的。如果提供强化的长期支持——包括涉及雇主的努力——尤其是那些具备有利前提条件（康复措施开始得早、应对工作压力的能力较高）且积极性高的患者会取得成功。
