Berufliche Wiedereingliederung von psychiatrischen Langzeitpatienten

Summary

A rehabilitation programme for long-stay patients has been developed at the University Department of Social Psychiatry in Berne. The programme is based on an industrial workshop with 16 places, in which young adult patients (mostly schizophrenic) are engaged under supervision in doing contract work for local industry, including simple assembly-work, metalwork and engraving. The programme is organized in a series of graduated stages, intended to prepare patients as far as possible for entry into open industry. During their stay in the workshop, which lasts from one to two years, the patients receive a financial allowance, independently of their work achievement, and reside outside the hospital: either in sheltered hostels, or with relatives, or alone in the community. The present study examines the outcome for a total of 121 patients, who had taken part in the rehabilitation programme at some time from its inception in 1967 up to early 1982. At follow-up (average time-interval since discharge 7.6 yr.), information could be obtained on 107 patients (88.4%); five had died and the remaining nine could not be traced. — Only 20% of the patients were in psychiatric hospitals, 4% were in half-way houses and the remaining 76% were living in the community. 45% were working full-time or part-time, 22% were in sheltered occupation and the remaining 33% were wholly unemployed. Despite these generally favourable results, there was in most cases evidence of continuing social handicap and dependence on medical treatment. 54% of the patients were living alone; only 10% were married and in all only 15% were known to have an intimate personal relationship. 90% were under psychiatric care (20% as inpatients and 70% on an ambulatory basis) and 77% were in receipt of a disability pension. These results are compared with analogous findings reported from a number of countries. It is concluded that graduated occupational programmes of the kind described are important in the long-term rehabilitation of chronic psychiatric patients, but in such programmes increased attention must be paid in future to the social networks and leisure activities of the patients.

Zusammenfassung

In einer katamnestischen Studie wurden 121 psychiatrische Langzeitpatienten, die ein Rehabilitationsprogramm zur beruflichen Wiedereingliederung durchlaufen hatten, nach durch-schnittlich über 7 Jahren nachuntersucht. Bezüglich Klinikentlassung und Arbeitssituation fanden sich sehr gute Resultate indem 76% der Patienten außerhalb psychiatrischer Institutionen leben und 67% eine Arbeitsstelle innehaben. Es zeigt sich aber auch eine weiterbestehende Behinderung in Form von Isolation, Behandlungs- und Rentenbedürftigkeit. Die Autoren kommen zum Schluß, daß berufliche Wiedereingliederungsprogramme nützlich sind, da sie die Situation des Patienten in einem hohen Prozentsatz der Fälle und für lange Zeit verbessern können.