The role of social work in vocational rehabilitation for people with mental health disorders in the Czech Republic, England, and Finland

Vocational rehabilitation for people with mental health problems

Objectives: This study investigated the actual state of people with mental disorders in Korea, in order to present an alternative proposal for their work fitness and vocational rehabilitation. Methods: The authors conducted this study through a review of statistics on the prevalence of mental disorder, labor laws, and the literatures related with work fitness and vocational rehabili tation of people with mental disorders. Results: According to recent surveys, about 3 million people in Korea are likely to have men tal disorders which could lead to discrimination in social life and dishonor in occupational career, either in the present or near future. Therefore, evaluation of work fitness and vocational rehabilitation for persons with mental disorders are important. At present, work fitness for psy chiatric patients is evaluated without suitable guidelines regarding the kinds and severity of mental disorders that impede work capacity. Furthermore, mental disorder-specific fitness for work is not under consideration. Conclusions: It is true that most psychiatric patients have some limitation in performing their job. However, judging from the results of some research, proper displacement, apprehension of co-workers, and adjusted workplace could help them complete their tasks properly despite their troublesome psychiatric symptomatology. The government must help all citizens to do their best in their social life, and show a deep interest in the employment of all disabled people including those with psychiatric disorders. Above all we have to change our attitudes and preconceptions against people with mental disorders. Some labor laws, which presently impede employment of people with psychiatric disorders, need to be revised in their favor. Future work capacity evalu ation should be done on the basis of ability to function in the workplace rather than symptoma tology.

The World Health Organization (WHO) is revising the ICD-10 classification of mental and behavioural disorders, under the leadership of the Department of Mental Health and Substance Abuse and within the framework of the overall revision framework as directed by the World Health Assembly. This article describes WHO's perspective and priorities for mental and behavioural disorders classification in ICD-11, based on the recommendations of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The WHO considers that the classification should be developed in consultation with stakeholders, which include WHO member countries, multidisciplinary health professionals, and users of mental health services and their families. Attention to the cultural framework must be a key element in defining future classification concepts. Uses of the ICD that must be considered include clinical applications, research, teaching and training, health statistics, and public health. The Advisory Group has determined that the current revision represents a particular opportunity to improve the classification's clinical utility, particularly in global primary care settings where there is the greatest opportunity to identify people who need mental health treatment. Based on WHO's mission and constitution, the usefulness of the classification in helping WHO member countries, particularly low- and middle-income countries, to reduce the disease burden associated with mental disorders is among the highest priorities for the revision. This article describes the foundation provided by the recommendations of the Advisory Group for the current phase of work.

Social work is part of the interprofessional rehabilitation team and, for example, provides services in the context of so-called special aids in vocational rehabilitation. However, compared to the field of medical rehabilitation, there is still relatively little research on the practice of social work in vocational rehabilitation. The three research projects Tasks and Use of Social Work in Vocational Rehabilitation (ANSAB), Networks and Cooperation in Vocational Rehabilitation (NEKOBERE) and Social Work in Vocational Rehabilitation (SABER) aimed to address this gap by identifying the tasks and roles of social work in this field. The analysis was based on the qualitative study components of the three projects and an online survey of 109 professionals conducted as part of the ANSAB project. Initially, each research team analyzed its own data. Subsequently, a synthesis of the findings was conducted using a best fit framework synthesis approach. The theoretical framework was based on Dahrendorf's role theory. Professionals working in the field of social work perform a wide range of tasks and take on various roles. Among others, the identified roles included Thread-Holder, Rehabilitation Process Companion, "Motherly" Carer and Networker. Tasks could be assigned to these roles. Professionals perceived tasks linked to the roles of the Thread-Holder and Rehabilitation Process Companion (e. g. individual rehabilitation progress discussions) as particularly frequent and important. A potential for role conflict between these two roles was also identified. This may occur, for example, when rehabilitants perceive professionals as representatives of the funding agency, which can lead to reluctance to disclose psychosocial concerns. The results of the three research projects highlight the central importance of professionals working in the field of social work. Building on these findings, practice-oriented recommendations will be developed to support professionalization and further define the competence profile of these professionals.

Vocational rehabilitation

There is limited evidence about how vocational rehabilitation (VR) for people with multiple sclerosis (MS) can be delivered through the United Kingdom's (UK) National Health Service (NHS) and how it works. To understand the mechanisms and context for implementing a VR intervention for people with MS in the NHS and develop an explanatory programme theory. A realist evaluation, including a review of evidence followed by semi-structured interviews. A realist review about VR for people with MS in the NHS was conducted on six electronic databases (PubMed, MEDLINE, PsychINFO, Web of Science, CINAHL, and EMBASE) with secondary purposive searches. Included studies were assessed for relevance and rigour. Semi-structured interviews with people with MS, employers, and healthcare professionals, were conducted remotely. Data were extracted, analysed, and synthesised to refine the programme theory and produce a logic model. Data from 13 studies, and 19 interviews (10 people with MS, five employers, and four healthcare professionals) contributed to producing the programme theory. The resulting programme theory explains the implementation of VR in the NHS for MS populations, uncovering the complex interplay between the healthcare and employment sectors to influence health and employment outcomes. VR programmes that offer timely support, tailored to the needs of the person with MS, and that support and empower the employee beyond the healthcare context are most likely associated with improved employment outcomes, for example, job retention. Embedding VR support within the NHS requires substantial cultural and organisational change (e.g., increased staff numbers, training, and awareness about the benefits of work). This study emphasises the need to routinely identify people with MS at risk of job loss and follow a collaborative approach to address employment issues. This realist evaluation provides insight on how to improve the quality of care available to people with MS.

Because of the deinstitutionalization of mental health care in Hong Kong that has taken place since the 1980s, many people with mental health problems are being cared for in the community. The majority of clients have a diagnosis of schizophrenia, and many have a long duration of illness and multiple readmissions. There is concern about their quality of life. To investigate quality of life and related factors in clients with a diagnosis of schizophrenia in Hong Kong. A convenience sample was recruited from a psychiatric outpatient department. Structured face-to-face interviews were conducted using the Brief Psychiatric Rating Scale and the Hong Kong Chinese World Health Organization Quality of Life Scale-Brief Version. A total of 172 people participated in the study. Most of them were single and unemployed. They were least satisfied with their psychological health, financial situation, life enjoyment and sexual activity. Women (n = 91) reported less satisfaction with quality of life than men (n = 86). Unemployed people (n = 100) were less satisfied with their quality of life than the employed (n = 76). Higher levels of mental health problems and higher numbers of previous hospitalizations were associated with negative perceptions of quality of life. People with mental health problems had significantly less satisfaction with their quality of life than a sample from the general population in Hong Kong surveyed in a previous study. As well as experiencing distressing mental symptoms, they had many difficulties, such as financial problems, unemployment and lack of opportunities to participate in social activities, that resulted from stigma and discrimination. These had a great impact on their quality of life. Because of the small sample size and its convenience nature, the findings may not be generalizable to all clients in Hong Kong. A generic instrument was used to measure quality of life, and this may not have been sensitive to certain aspects of mental health clients' lives. The findings suggest that there is a need to strengthen social and vocational rehabilitation for people with mental health problems in Hong Kong. A more holistic and intensive model of care is required to meet their complex needs. A larger and more diverse sample should be used in future research, and a quality of life measure specifically designed for people with mental health problems should be used.

The Role of Social Work in Mental Health in a Variable Multicultural Environment Konstantina Sklavou Abstract Over the recent decades the increasing number of migration flows has exerted and continues to exert great pressure on the health system and on the welfare structures of Greece. The bases for the development of a rudimentary reception and integration system -that still is in progress have long been delayed, while there has been no happy medium, between the enormous pressure that foreigner users of this system put on, and the humanitarian obligation of a well-governed state towards all residents of the country. The purpose of this article is to capture this situation within the changes that take place due to it, inside the Greek society where there is a great need for professional social workers who are able to work targeted and effectively with foreigners, both children and adults, who have or develop mental health problems for the very first time. Full Text: PDF DOI: 10.15640/jssw.v6n2a2

IntroductionAmong people with chronic inflammatory arthritis (IA), up to 40% lose their job in the first few years after diagnosis of this condition and are hence at high risk of...

Depression in post-communist Romania

Depression in post-communist Romania

Based on the results of an overview of domestic and foreign studies related to mental health care for students and the role of social work, the article shows the importance of social work in supporting and intervening for students with mental health problems. The main contents focus on the following two aspects: 1) Studies related to the current status of mental health care for students; 2) Studies related to the role of social work in mental health care for students. On that basis, the article offers solutions and recommendations to enhance the role of social work in mental health care for students. Keywords: Social work, situation, mental health care, student, solution, recommendation.

Byline: C. Ramasubramanian Introduction Work is therapeutic and essential for an individual's physical survival and psychological well-being. It is an important part of a cultural role, which occupies much of an individual's time, supplies a source of income, provides a basis of identity, and contributes to one's physiological and psychological well-being in the society.[sup] [1] Many research studies found that participation in paid work activity led to an increase in quality of life and improvement in motivation toward activities. In a 10-year follow-up study conducted by Salyers et al .,[sup] [2] in UK, mental health consumers reported that work improved multiple areas of their lives, which included more self-confidence and hope about the future, and less boredom and loneliness. In the absence of necessary vocational training facilities leading to vocational rehabilitation either in the mental hospital setting or community settings, the mentally disabled persons become more and more dependent on the families which in turn are increasingly frustrated with these individuals and ultimately such unhealthy chain reactions result in patients being thrown out of the families. Thus, wandering becomes their main activity, begging becomes their vocation, and public's mockery becomes reward from the society. Especially when the mentally ill happens to be the head of the family or the only bread winner of the family, lack of vocational rehabilitation programs may lead to many untold miseries. The plight of the children and helpless wife is pathetic. The family gets totally disorganized - young children are forced to give up their schooling in order to earn their livelihood through hard child labor; wife, if not supported either by the relatives or by the social security measures, becomes the personification of sadness and hopelessness. Such family situations, more often than not, become the target of antisocial elements too. Vocational rehabilitation of people with Severe Mental Illness (SMI) has become the focus of psychiatric practice, for the past two decades. The increasing awareness of the low employment rates of people with SMI has speeded up a growing interest in vocational rehabilitation among mental health professionals.[sup] [3] The literature indicates that 75-90% of adults with SMI are unemployed in UK.[sup] [4] . Many action-oriented programs resulting from systematic exploration of the rehabilitation potentials are being initiated and implemented for the welfare of the blind, deaf-mute, and orthopedically handicapped. For example, there are 13 vocational rehabilitation centers organized by the ministry of Labor Employment and Training, Government of India, functioning in different state capitals that deal with the problems of the physically handicapped. Even the special employment exchanges are concerned with the welfare of the physically handicapped. But in the case of mentally disabled - either mentally ill or mentally retarded - only sporadic attempts are made to fully utilize the inherent potentials. Unfortunately, there is neither special employment exchange nor any vocational rehabilitation center for the welfare of the mentally disabled persons. Current Scenario of Mental Disability in India Prevalence A WHO-World Bank study in 1993 revealed four of the top ten conditions resulting in disability are mental disorders worldwide. These are schizophrenia, depression, obsessive compulsive disorders, and alcoholism. In India, it is estimated that about 10% of the general population suffers from common mental disorders, with 1% having major psychiatric illness. In spite of vigorous treatment with continuous medications, about 30% of chronic patients with psychotic illness suffers from various disabilities.[sup] [5] . According to WHO,[sup] [5] 10% of the world population is disabled. Psychiatric disorders account for nearly one-third of the disability in the world. …

Among people with diabetes, co-occurring mental health (MH) or substance use (SU) disorders increase the risk of medical complications. Identifying how to effectively promote long-term medical benefits for at-risk populations, such as people with MH or SU disorders, is essential. Knowing more about how health care accessed before the onset of diabetes is associated with health benefits after the onset of diabetes could inform treatment planning and population health management. To analyze how preexisting MH or SU disorders and primary care utilization before a new diabetes diagnosis are associated with the long-term severity of diabetes complications. This cohort study analyzed medical record data from US Department of Veterans Affairs health care systems nationwide and used mixed-effects regressions to test associations between prediabetes patient or health care factors and longitudinal progression of diabetes complication severity from 2006 to 2015. Participants included patients who received a new diabetes diagnosis in 2008 and who were aged 18 to 85 years at the time of their diagnosis. Data analysis was conducted from March to August 2017. Patients were assigned to groups on the basis of a 2-year look-back period for MH or SU disorders status (MH disorder only, SU disorder only, MH and SU disorder, or no MH or SU disorder diagnoses) and on the basis of the amount of primary care utilization before diabetes was diagnosed. Nine-year trajectories of Diabetes Complication Severity Index (DCSI) scores. Among 122 992 patients with newly diagnosed diabetes, the mean (SD) age was 62.3 (11.1) years, 118 810 (96.6%) were male, and 28 633 (23.3%) had preexisting MH or SU disorders diagnoses. From the onset of diabetes to 7 years later, patients' mean estimated DCSI scores increased from 0.84 (95% CI, 0.82-0.87) to 1.42 (95% CI, 1.36-1.47). Controlling for sociodemographic characteristics and medical comorbidities, SU disorders only (decrease in DCSI score, -0.09; 95% CI, -0.13 to -0.04; P < .001) or both MH and SU disorders (decrease in DCSI score, -0.13; 95% CI, -0.16 to -0.09; P < .001), but not MH disorders only, were associated with lower DCSI scores at the time of the onset of diabetes compared with no MH or SU disorders. More than 90% of patients with MH or SU disorders had primary care visits before diabetes was newly diagnosed, compared with approximately 58% of patients without MH or SU disorders. Patients who had primary care visits before the onset of diabetes had lower baseline DCSI scores, compared with patients who did not have primary care visits (decrease in DCSI score, -0.41 [95% CI, -0.43 to -0.39] for 1-2 visits, -0.50 [95% CI, -0.52 to -0.48] for 3-4 visits, -0.39 [95% CI, -0.41 to -0.37] for 5-8 visits, and -0.15 [95% CI, -0.17 to -0.12] for ≥9 visits; P < .001 for all). Patients with MH or SU disorders had lower overall, but more rapidly progressing, mean DCSI scores through year 7 after the onset of diabetes (MH disorder only, 0.006 [95% CI, 0.005-0.008], P < .001; SU disorder only, 0.005 [95% CI, 0.001-0.008], P = .004; or both MH and SU disorders, 0.008 [95% CI, 0.006-0.011], P < .001), compared with patients without MH or SU disorders. Access to and engagement in integrated health care may be associated with modest, albeit impermanent, long-term health benefits for patients with MH and/or SU disorders with newly diagnosed diabetes.

Meeting the UN Sustainable Development Goals for mental health: why greater prioritization and adequately tracking progress are critical.