Indication for Inpatient Psychosomatic Rehabilitation in Primary Care Patients with Chronic Mental Disorders and Participation Impairments

Abstract

Mental disorders often result in social and occupational participation restrictions, which may be an indication for an inpatient psychosomatic rehabilitation treatment. These patients are usually treated by general practitioners, who function as an important gate keeper in the pathway to rehabilitation treatment. The question is which patients receive an inpatient treatment, and which do not. A prototypically representative sample of 307 patients with chronic mental disorders from 40 general practitioners were examined by a psychosomatic consultant. The investigation included the medical history, treatment status, illness status, capacity status and participation impairment. The psychosomatic consultant gave a recommendation whether an inpatient rehabilitation was indicated or not. 64% of the patients with chronic mental disorder had not received an inpatient rehabilitation in the past 5 years and there was no present indication. In 5.2% of cases an inpatient rehabilitation had been done before, but there was no indication for a renewal. In 27% there was no rehabilitation in the past five years but now seen indicated. In 3.6% there was an inpatient rehabilitation in the past and a renewed indication now. Patients who had already been in inpatient rehabilitation in the past 5 years were more severely ill and had more severe participation problems. Patients with present indication for rehabilitation had acute work-related problems. Capacity and participation impairment was an important factor to discriminate between patients with and without a present indication for an inpatient rehabilitation. In 13 out of 35 patients who got a recommendation for a new psychosomatic rehabilitation, this rehabilitation was initiated within 6 months after the consult. General practitioners play a central role in long-term treatment of mental disorders. Rehabilitation orientation, i. e. a participation-oriented treatment perspective, should be encouraged in the primary care setting.