Vocational services proved to be effective to find day structuring employment for subjects with severe mental illness. Furthermore it had positive effects on functioning and psychological well-being during a 9-months follow-up period.
Not all subjects profit equally from vocational rehabilitation in terms of improvement of work performance. Unfavorable courses of work skills were shown for participants with schizophrenia and low education. Low individual satisfaction with performance is related to consistently low or moderate performance. Group differences predicted reintegration success. Future research should focus on different responder groups and their identification in early stages of the rehabilitation process to ensure appropriate assistance, particularly for subjects with poorer performance.
Our results show that the rehabilitants' "capability to work" had improved at the six month mark of the rehabilitation program. It appears that baseline variables of the AFP subscales at program intake were largely related to psychopathology and subjective quality of life measures. Sociodemographic parameters, educational level, and attention measures were associated with work capability improvement after six months.
Vocational rehabilitation represents an important element within the mental health care system. To ensure the success of rehabilitation, programs of varying degrees of complexity are needed in order to meet patients' abilities and needs. Rehabilitation success must be examined multidimensionally and not be reduced to the mere integration into competitive employment. Success is also represented by progress in the level of vocational integration, strengthening of work capabilities, the improvement of the functional level, and in a better quality of life. The patient's need for rehabilitation has to be recognized as early as possible to shorten the duration of the patient's disintegration and to avoid stagnation periods. Rehabilitation needs to start in the clinic; with psychiatric help sustained during the rehabilitation process to prevent illness exacerbation and premature program termination. The patient's development regarding his or her functional level, work capability, and subjective wellbeing needs to be evaluated throughout the program to consistently monitor the patient's individual needs and abilities and to ensure appropriate support. Training for cognition and social skills should be integrated into rehabilitation programs to compensate individual deficits.
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