Integrated Care to people with mental disorders and his employement

Abstract

The AMPANS Foundation is a social organization founded in 1965 and since September 2007, operates a pre-employment Service (SPL) in coordination with the Division of Mental Health of the Althaia Foundation. The SPL is a social service supplementary to the already existing social, health and work networks. Our survey attends people who have severe mental health disorders and 33% of disability and, who are stabilized; with a total of 113 people. The main aim of the SPL lies in increasing the level of employability and facilitating social integration and employment of people assisted, through training and promoting the acquisition of professional skills required. In order to do so, the SPL performed the following actions: - Analysis of the psychosocial situation of the user. - Professional / vocational orientation. - Motivation and professional development. - Design of a training plan and training support. -Training in basic habits and skills in the workplace. - Support to search for a job. - Placement (settlement) and maintenance support in the workplace. - Family intervention in the process of occupational rehabilitation. Since its beginning, the SPL of AMPANS performs close coordination with mental health services, and both set up the Joint Committee on Evaluation and Monitoring Services, formed by specialists from both the Mental Health Foundation Althaia (psychiatrists, psychologists and social workers) and SPL specialists (occupational therapists, social workers and educators). This committee assesses the people’s suitability for admission in the program; keeps track of throughout the stay period in the SPL and, also when it is decided the program is completed. This committee meets monthly alternatively in an organization or another. Both organizations have positively assessed the existence of this committee because it can provide a person centered care within a framework of integration of health and social assistance. Objective: To analyze the relationship between the level of labor motivation and the rate of employment for people who have been treated in the SPL. Methodology: Participants: People who attended the SPL between 2011 and 2015 and whose work motivation level was evaluated at least twice with an interval of one year. We included 30 people who fulfill this criterion. Instruments used: Labor motivation of a wide range of people with mental health problems Colis et al. (1996). Procedure: We reviewed demographical, clinical and employment data, and the two scores of Labor motivation scale. The data were analyzed with the Statistical Package for Social Sciences (SPSS, version 17.1), using mean and standard deviation and percentages to describe the sample and non-parametric tests to compare two groups (U Mann Whitney). Study’s People profile: - 80% male - 77% living with 1st degree relatives - 63% with primary education - 90% with work experience in ordinary companies - 93% with benefits (63% total disability) - 60% diagnosed with psychotic disorders and 20% with comorbidity in mental retardation. - the average age was 39.8 years with a deviation of 8.6. - Their working deviation time was between 70.7 and 72.8 months. - Their average period of time in SPL was 31.9 months with a deviation of 11.3. - Their average work motivation level in their first assessment was 62.3 with a deviation of 15.6. - their work motivation level after a year was 64.3 with a deviation of 18.1. Current situation of study’s People: - 30% have reached work insertion (77% of contracts were for work and service), - 30% are still attending the SPL (program) - 40% of the people have not complete the SPL program without accomplished all goals (77% of these participants have come back to wealth programs) Results: The comparative analysis of the motivation level indicates that people who have joined the work market have shown higher motivation levels comparing to those who have not [z = -2.83; p = 0.004]. This difference was not detected in initial motivation levels. Motivation year (people inserted): 77.8 + - 6.6; Motivation year (people not inserted): 58.5 + - 18.4. Discussion and conclusions: The profile observed in the SPL of AMPANS includes people with severe mental disorders, with high degrees of disability and fairly high age; conditions that make difficult for them to find employment. Secondly, we perceive that a significant percentage of people do not exhaust the SPL program and their stay period, do not achieved labor market insertion, but they are referred to tertiary mental health rehabilitation programs. Our data also suggest that the work motivation is a significant factor in order to succeed in gaining employment and that their encouragement, by activities within the SPL, could facilitate it. Moreover, we believe that by working in collaboration with both organizations has yielded satisfactory results. We can highlight some assets such as: - Leadership shared between health and social care service ( Althaia i Ampans) - A single referral for the person attended - Regular communication and feedback - Team maintenance during the nine years of operation - Systematic work plan: regular meetings and communications - Coordination with other professionals outside SPL if necessary. - Integrated Care Contributes to the vision of a new and more coherent health and social care service