[Job integration as a goal of psychiatric therapy]

The social implications and long term consequences of mental disorders regarding sick days at work, unemployment rates and early retirement are considerable. Outcome in psychiatric treatment should be measured not only by reduction of psychopathological symptoms and improvement of subjective well-being respectively quality of life but also by taking social integration into account. Job inclusion could become a crucial factor indicating successful therapy. It is remarkable that there has been so little focus on the links between reduction of psychopathological symptoms and competitive working skills. Hardly any studies exist evaluating for example psychopharmacological strategies referring to social outcome criteria. Without denying the progress that has been made, the classical paradigm of community psychiatry has reached its limits. Initial hopes of spontaneous social integration did not come true. Vocational rehabililitation sensu strictu is either aiming at the individual's work related skills (personal approach) or at reducing demands on the job (environmental approach) - in Germany being mostly realised at sheltered workshops. Thus most of the rehabilitation programmes are based on the traditional "train and place"-approach. There are some controlled studies about the new innovative supported employment programmes taking the reverse principle of "place and train" into account. These studies could show a clear superiority regarding the number of successfully integrated patients. Scientific evaluation of complex programmes is sophisticated but seems to be necessary for further developments in the field of general psychiatric therapies as well as for the legitimation of financial ressources needed. Foreseeing the perspective of social psychiatry a next substantial step could be the identification of social and functional outcome variables as a basis of validation of numerous therapy strategies.