BackgroundOnly two-thirds of patients admitted to psychiatric wards return to their previous jobs. Return-to-work interventions in Germany are investigated for their effectiveness, but information regarding cost-effectiveness is lacking. This study investigates the cost-utility of a return-to-work intervention for patients with mental disorders compared to treatment as usual (TAU). MethodsWe used data from a cluster-randomised controlled trial including 166 patients from 28 inpatient psychiatric wards providing data at 6- and 12-month follow-ups. Health and social care service use was measured with the Client Sociodemographic and Service Receipt Inventory. Quality of life was measured with the EQ-5D-3L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional QALY (Quality-Adjusted Life Years) gained by receiving the support of return-to-work experts, in comparison to TAU. ResultsNo significant cost or QALY difference between the intervention and control groups has been detected. The return-to-work intervention cannot be identified as cost-effective in comparison to TAU. ConclusionsThe employment of return-to-work experts could not reach the threshold of providing good value for money. TAU, therefore, seems to be sufficient support for the target group.

Objective Patients with mental illnesses often face difficulties when returning to workplace after an episode of inpatient treatment. Available resources intended to support the return-to-work process are often not used. It was the aim of the present study to develop an intervention that facilitates the implementation of patient support at the interface of in- and outpatient care. Methods We used a structured development process for the establishment of a return-to-work intervention for psychiatric inpatients. Results The intervention consisted of the use of return-to-work experts who worked on the basis of a manual. In clearly defined modules, patients were given information on social law basics and details of the return process. Difficult situations (e. g., dealing with the disclosure of the diagnosis, return interview) were discussed and rehearsed. After discharge, further care took place, above all with regard to experiences on the first working day, accompaniment to discussions with the employer and support with any other upcoming difficulties. Conclusion The results of the ongoing study will show whether the chosen approach actually yields the expected results, namely an improvement of the return-to-work process.

Zusammenfassung Ziel der Studie Erwerbstätige mit einer psychischen Erkrankung haben nach einer psychischen Krise oft massive Schwierigkeiten, ihre Arbeit wiederaufzunehmen. Im Mittelpunkt der Studie steht die Frage, wie Menschen den Übergang zwischen akutpsychiatrischer Klinik und Arbeitsplatz erleben. Methodik Der Studie liegt ein qualitatives Forschungsdesign (Grounded Theory) zugrunde. Zehn narrative Interviews mit erkrankten Arbeitnehmern sowie vier Gruppeninterviews mit professionellen „Rückkehr-Begleitern“ (Return-to-Work-Experten) wurden geführt. Ergebnisse Die vorliegende Analyse zeigt, dass das Zusammenspiel der beteiligten Akteure von enormer Bedeutung ist. Wesentlich ist, wie die Beteiligten den Rückkehrprozess deuten und welche Handlungsaufforderungen infolge dessen an die Beteiligten adressiert werden. Schlussfolgerungen Ein arbeitsplatzbezogenes Entlassmanagement sollte Unterstützungsangebote vorhalten, die an den Erwartungshaltungen der Beteiligten ansetzen und einen gemeinschaftlichen Deutungsprozess fördern bzw. in Gang setzen.

BackgroundIf people with episodic mental-health conditions lose their job due to an episode of their mental illness, they often experience personal negative consequences. Therefore, reintegration after sick leave is critical to avoid unfavorable courses of disease, longer inability to work, long payment of sickness benefits, and unemployment. Existing return-to-work (RTW) programs have mainly focused on "common mental disorders" and often used very elaborate and costly interventions without yielding convincing effects. It was the aim of the RETURN study to evaluate an easy-to-implement RTW intervention specifically addressing persons with mental illnesses being so severe that they require inpatient treatment. MethodsThe RETURN study was a multi-center, cluster-randomized controlled trial in acute psychiatric wards addressing inpatients suffering from a psychiatric disorder. In intervention wards, case managers (RTW experts) were introduced who supported patients in their RTW process, while in control wards treatment, as usual, was continued. ResultsA total of 268 patients were recruited for the trial. Patients in the intervention group had more often returned to their workplace at 6 and 12 months, which was also mirrored in more days at work. These group differences were statistically significant at 6 months. However, for the main outcome (days at work at 12 months), differences were no longer statistically significant (p = 0.14). Intervention patients returned to their workplace earlier than patients in the control group (p = 0.040). ConclusionsThe RETURN intervention has shown the potential of case-management interventions when addressing RTW. Further analyses, especially the qualitative ones, may help to better understand limitations and potential areas for improvement.

Background: In recent years it could be shown that psychosocial working conditions and mental health of employees are closely correlated. One well-established instrument to measure psychosocial stress at work is the COPSOQ (Copenhagen Psychosocial Questionnaire, German Standard Version). It is an 84 item self-rating instrument addressing several domains of psychosocial working conditions and is generally used for risk assessments in companies. Aims: To examine associations between COPSOQ ratings with clinical features and symptoms of employees who currently suffer from an episode of a mental illness requiring inpatient treatment. Method: For 265 inpatients with mental disorders who participated in a cluster randomized trial (RETURN-study) COPSOQ-data were available as part of the baseline data acquisition. These data were compared with the German COPSOQ validation sample of the Freiburg research center for occupational sciences (FFAW; approximately 250,000 participants). For subdomains of the COPSOQ that showed major and significant differences between the two samples regression analyses were done to predict COPSOQ scores within the RETURN-sample. Results: Psychiatric inpatients did not assess their working conditions significantly different compared to the population based FFAW sample. However, with regard to the effects of working conditions (general health, burnout, presenteeism, and intention to leave the job) there were major differences between the two samples with the clinical sample expressing more negative views. In the RETURN sample these were predicted by a greater expression of depressive symptoms. Conclusions: The linkage between work and mental wellbeing is complex. Mental illness is not necessarily a result of poor working conditions, while good working conditions may not in every case prevent symptoms of bad health, even if such associations exist.

Clinical interventions for returning to work should focus the support on the expectations of the participants and stimulate a common interpretation.

Zusammenfassung Hintergrund Psychische Erkrankungen sind inzwischen die zweithäufigste Ursache für Krankschreibungen und die häufigste Ursache für krankheitsbedingte Verrentungen. Um Jobverluste zu vermeiden sind besondere Interventionen zur Rückkehr an den Arbeitsplatz erforderlich. Ein erfolgreicher Rückkehrprozess kann eine erneute Krankschreibung sowie Erwerbsunfähigkeit verhindern. Zudem kann eine gelingende Rückkehr in den Berufsalltag positiv auf den Genesungsprozess zurückwirken. Internationale Erfahrungen zeigen, dass Return-to-Work-Programme eine wirksame Handlungsoption sind, um Patienten nach längerer Erkrankung nachhaltig wieder ins Arbeitsleben zurückzuführen. Return-to-Work-Programme bilden hinreichende Unterstützungsangebote, um mangelnde Ressourcen (z. B. fehlende Wertschätzung) und Belastungen (z. B. zu hohes Arbeitsvolumen) zu bewältigen. Methode Für die Studie RETURN wurde ein Return-to-Work Konzept für stationär-psychiatrisch behandelte Patienten entwickelt. Ergebnisse Die Intervention besteht aus dem Einsatz von Return-to-Work- Experten, die auf Basis eines Handbuches arbeiten. In klar definierten Modulen werden mit den Patienten während des stationären Aufenthaltes u. a. sozialrechtliche Grundlagen und Einzelheiten des Rückkehrprozesses besprochen sowie schwierige Situationen (z. B. Umgang mit der Offenlegung der Diagnose, Rückkehrgespräch) vorbereitet. Nach Entlassung erfolgt die Weiterbetreuung v. a. im Hinblick auf Erfahrungen am ersten Arbeitstag, Begleitung zu Gesprächen des BEM (Betriebliches Eingliederungsmanagement) und Unterstützung bei etwaigen Schwierigkeiten. Schlussfolgerung Die Ergebnisse der noch laufenden Studie werden zeigen, ob der gewählte methodische Ansatz zu einer Verbesserung der Rückkehr an den Arbeitsplatz führt.