It is not only competitive employment that counts: Findings from a longitudinal panel of people with severe mental illness.

OBJECTIVE: Being engaged in work and social activities is associated with a better quality of life. However, little evidence is available on the relationship between different categories of social participation and quality of life in people with severe mental illnesses. Furthermore, longitudinal studies considering this relationship in people with severe mental illnesses (SMI) are scarce. This study attempts to fill this gap by exploring whether and how different categories of social participation and quality of life were associated over a period of 4 years. METHOD: The association between social participation activities and quality of life was analyzed with linear mixed models, using data from a Dutch national panel of people with SMI. Four annual waves including self-reported measures were used. Three categories of participation were assessed: paid employment, voluntary work, outside social activities. RESULTS: From 2015 to 2018, 1.682 panel members (18-75 years old) participated in the survey. All three participation variables show a unique significant positive association with quality of life. Controlling for covariates (age, sex, and mental health) comparable regression coefficients were found: paid employment, .208, 95% CI [.090-.326], voluntary work, .210, 95% CI [.120-.300], and outside social activities, .239, 95% CI [.154-.324]. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The value of participation for people with SMI seems to be not restricted to competitive employment. Engagement in paid employment, voluntary work, and performing outside social activities each have a comparable and additional positive association with quality of life. Therefore, rehabilitation professionals should pay attention to social participation activities in a broad range. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The role of national policies and mental health care systems in the development of community care and community support: an international analysis.

BACKGROUND: The development of adequate community support of persons with severe mental health problems is an ongoing effort. National policies and national health and social care systems play an important role in the effectiveness of these efforts. AIMS: To get a better understanding of the ways in which national policies and (mental) health care systems can enhance the development of community support and social inclusion for people with severe mental illness. METHOD: A comparison was made between the experiences of 75 key persons on regional community support development regarding national policies and systems in Denmark, England and the Netherlands respectively. RESULTS: Four themes stood out as being particularly instrumental in the development of community support: - implementation of a national policy on social inclusion, - development of a national framework of responsibilities, entitlements and services, - solid funding and social inclusion incentivizing reimbursement systems, - integrated care. CONCLUSION: National governments do have opportunities to take or retake the lead to ensure that community support and social inclusion of persons with severe mental illness health problems are not just ideological slogans but solid policy.

Treatment of mental disorder in the primary care setting in the Netherlands in the light of the new reimbursement system: a challenge?

INTRODUCTION: Different professionals provide health care for mental disorder in the primary care setting. In view of the changing reimbursement system in the Netherlands, information is needed on their specific expertise. METHOD: This study attempts to describe this by literature study, by assessment of expert opinions, and by consulting Associations of the relevant professions. RESULTS: There is no clear differentiation of expertise and tasks amongst these professionals in primary care. Notably, distinction between different psychotherapeutic treatment modes provided by psychologists is unclear. DISCUSSION: Research is needed to assess actual treatment modules in correlation with patient diagnostic classification for the different professions in primary care. An alternative way of classifying patients, that takes into account not only mental disorder or problems but especially the level of functioning, is proposed to discern which patients can be treated in primary care, and which patients should not. Integrated care models are promising, because many professionals can be involved in treatment of mental disorder in the primary care setting; especially for collaborative care models, evidence favours the treatment of common mental disorders in this setting. CONCLUSION: Integrated care models, such as collaborative care, provide a basis for multidisciplinary care for mental disorder in the primary care setting. Professional responsibilities should be clearly differentiated in order to facilitate integrated care. The level of functioning of patients with mental disorder can be used as indication criterion for treatment in the primary care setting or in Mental Health Institutions. Research to establish the feasibility of this model is needed.