[Stigmatization in mental health care. Research among clients and care providers]. / Stigmatisering binnen de ggz; onderzoek onder cliënten en hulpverleners.

BACKGROUND: In addition to impediments to social and social functioning, people with severe mental illness also experience the negative consequences of prejudice and stigmatization. Stigmatization also occurs in mental health care, including addiction care. AIM: To describe the occurrence and manifestations of stigmatization by care providers, from the perspective of clients and care providers. METHOD: Digital surveys among clients of the panel Psychisch Gezien (n = 628) and among care providers (n = 471). RESULTS: More than half (54%) of the panel members had experienced stigmatization by mental health care providers in the past two years. They experienced this mainly through a distant attitude (22%) and the language used by care providers (20%). Two-fifths (40%) of the care providers indicated that stigmatization occured regularly or often in their own team. Both clients and counselors emphasized the importance of normalizing mental health problems, reluctant use of psychiatric labels and recovery-oriented work to reduce stigma. CONCLUSION: Stigmatization by mental health care providers is manifested in many ways, making it a complex and ambiguous problem. Although there is no ‘one size fits all’ solution, normalization of mental problems is an important starting point.

Employment in Personality Disorders and the Effectiveness of Individual Placement and Support: Outcomes from a Secondary Data Analysis.

Purpose Personality disorders (PDs) are associated with severe functional impairment and subsequent high societal costs, increasing the need to improve occupational functioning in PD. Individual placement and support (IPS) is an effective, evidence-based method of supported employment, which so far has been tested in various mixed patient populations with severe mental illness (SMI, including PDs). However, the effectiveness of IPS for PDs per se remains uninvestigated. Methods Data from the SCION trial were used, including 31 SMI patients with PDs and 115 SMI patients with other primary diagnoses (primarily psychotic disorders). First, the interaction effect of diagnosis (PD vs other SMI) and intervention (IPS vs traditional vocational rehabilitation) was studied. Second, in the IPS condition, difference between diagnostic groups in time to first job was studied. Results We did not find evidence of a moderating effect of PD diagnosis on the primary effect of IPS (proportion who started in regular employment) (OR = 0.592, 95% CI 0.80-4.350, p = 0.606) after 30 months. Also, PD diagnosis did not moderate the effect of time until first job in IPS. Conclusions From the present explorative analysis we did not find evidence for a moderating effect of PD diagnosis on the effectiveness of IPS among PD participants. This indicates that IPS could be as effective in gaining employment in participants with PD as it is in participants with other SMI. Future studies, implementing larger numbers, should confirm whether IPS is equally effective in PDs and study whether augmentations or alterations to the standard IPS model might be beneficiary for PD.

[Working effectively towards rehabilitation goals: long-term outcome of a randomised controlled trial of the Boston psychiatric rehabilitation approach]. / Effectiever werken aan rehabilitatiedoelen: langetermijnuitkomsten van een gerandomiseerde studie naar individuele rehabilitatiebenadering.

BACKGROUND: In the Netherlands the Boston psychiatric rehabilitation approach (bpr) is one of the most widely implemented rehabilitation methods. So far, little research has been done on the efficacy of this approach. AIM: To investigate the effect of bpr on the attainment of personal rehabilitation goals, social functioning and empowerment and on care requirements and quality of life in persons with severe mental illness (smi) in the Netherlands. METHOD: In a multicentre randomised controlled trial (rct: CLINICAL TRIAL REGISTRATION NUMBER: isrctn73683215) patients with smi were randomly assigned to bpr (n = 80) or 'care as usual' (cau; n = 76). The primary outcome was the attainment of the rehabilitation goal as formulated by the patient. The secondary outcomes were a change in the work situation and in the degree of independent living, in care requirements (Camberwell Assessment of Needs), in empowerment (Personal Empowerment Scale) and in the quality of life (who-qol). The effects were tested at 12 and 24 months. RESULTS: The degree of goal attainment was substantially higher in bpr at both 12 months (adjusted risk difference: 16%; 95%ci, 2 to 31; nnt = 7) and 24 months (adjusted risk difference: 21%, 95%ci, 4% to 38%; nnt = 5). The approach was also more effective in the area of societal participation (bpr: 21% adjusted increase, cau: 0% adjusted increase; nnt = 5), but not in the other secondary outcome measures. CONCLUSION: The results suggest that bpr is effective in supporting patients with smi to reach self-formulated rehabilitation goals and in enhancing their societal participation.

[Development of the multidisciplinary guideline on 'work and severe mental illness']. / Ontwikkeling van de multidisciplinaire richtlijn 'Werk en ernstige psychische aandoeningen'

BACKGROUND: In the Netherlands only a comparatively low percentage (18-19%) of persons with severe mental illness (SMI) are in paid employment. The problem consists not only of finding a job but also of holding it down. AIM: To develop guidelines that will ensure that patients with SMI have the best possible access to paid employment and that the drop-out rate for this group is as low as possible. METHOD: We reviewed the literature systematically and reviewed the results revealed by focus groups and case studies. RESULTS: There is strong evidence that the integrated approach 'Individual Placement and Support' is effective in keeping people in employment. There are indications that self-management strategies and programmes and assessment instruments are also effective in this regard. CONCLUSION: The guidelines recommend that persons with SMI should be given continuing support so they can remain in paid employment. More research is needed into how effective self-management programmes and assessment instruments can be in keeping this group of persons in employment. Collaborations between various sectors also needs to be further investigated.

Constructing the social: an evaluation study of the outcomes and processes of a 'social participation' improvement project.

This paper reports on an evaluation of a 'social participation' improvement project in a mental health care and care for the intellectually disabled setting. The main research question is how sociality (i.e. clients' social lives) was constructed and what consequences this had for the project and for the clients. We undertook a dual approach: investigating the predefined outcomes and analysing the improvement processes in terms of how these processes construct sociality. As to the predefined outcomes, clients' social networks were not widened, but clients felt significantly less lonely at the end of the project. In a bottom-up analysis of data gathered on the improvement processes, we articulated two ways of constructing sociality: individualization, in which clients had to verbalize their wishes (verbalization) and to act upon them more actively (enterprising); and normalization, in which a good social life was one embedded in 'normal' community. We argue that this (explorative) way of conceptualizing change corresponds with some of the quantitative findings but also brings to light aspects that would have gone unnoticed by using only the predefined outcomes. Therefore, a mixed methods approach in studying effectiveness is a fruitful addition to the quality improvement literature.

[Rehabilitation research in the Netherlands; research review and synthesis of recent findings]. / Rehabilitatieonderzoek in Nederland; overzicht van onderzoek en synthese van recente bevindingen.

BACKGROUND: Interventions aimed at encouraging people with severe mental illnesses (including drug addiction) to participate in social activities are on the increase. Over the last few years the Netherlands has increased its research into the effectiveness of these interventions. However, there are considerable gaps in our knowledge and the research results need to be synthesised. AIM: To synthesise the information collected in recent years concerning the results of these rehabilitation programmes and interventions. METHOD: We performed a systematic review of research databases, focusing on Dutch research (2000 to 2007). With regard to the interventions, we evaluated whether an ideal 'knowledge cycle' had been established (i.e. problem exploration, intervention development, evaluation, systematic implementation and wider dissemination). RESULTS: We found 29 studies of interventions that aimed primarily at societal participation by people with severe mental illness; 23 of these studies were complete. According to a longitudinal comparative controlled study, the most effective interventions were the Boston psychiatric rehabilitation approach, individual placement and support and 'guided peer support'. However, the required 'knowledge cycle' as specified in the Method section, had not been completed in the case of any of the interventions. CONCLUSION: Both the range and the quality of research info the effectiveness of rehabilitation programmes have improved tremendously. In the Netherlands over the last decade, in order to complete the above-mentioned knowledge cycle, a new research agenda needs to be established. We propose some items for this agenda.

Mental disorders and personality traits as determinants of impaired work functioning.

BACKGROUND: Both mental disorders and personality characteristics are associated with impaired work functioning, but these determinants have not yet been studied together. The aim of this paper is to examine the impairing effects that mental disorders and personality characteristics (i.e. neuroticism, locus of control and self-esteem) have on work functioning. METHOD: Data for a representative sample of 3570 working people were derived from the first two waves of the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective cohort study in the Dutch adult population. RESULTS: Higher neuroticism, more external locus of control and lower self-esteem were each significantly associated with subsequent impairment in work functioning, independently of any effects from mental disorders. Associations between mental disorders and subsequent work impairment disappeared once personality traits were taken into account. Personality traits did not moderate the relationships between mental disorders and work functioning. CONCLUSIONS: Working people with vulnerable personalities have a greater risk of impaired work functioning, independent of the risk from any mental disorder they may have.

[The implementation of Individual Placement and Support in the Netherlands]. / De implementatie van Individual Placement and Support in Nederland.

BACKGROUND: Individual Placement and Support is a vocational rehabilitation programme for people with severe mental illness, which was implemented during the period 2003-2005 at four locations in the Netherlands. AIM: To investigate the degree of compliance with the Individual Placement and Support programme, the factors that hindered or facilitated its implementation, and the results. METHOD: The degree of compliance was assessed using the Individual Placement and Support fidelity scale. Data regarding the factors that hindered or facilitated the implementation were collected via interviews and monitoring. In addition, data were collected on patient characteristics, the support provided and the jobs found. RESULTS: None of the locations achieved the highest level of compliance, although two locations came close. Eighteen per cent of the 316 patients were helped to find a regular job. The most important obstacles to implementation were loss of vocational team members, project leaders' lack of time, lack of finance, and insufficient cooperation between the organisations involved. The most important facilitating factors were the skills and commitment of the vocational team member(s) and the integration of the vocational teammember(s) and the mental health team. CONCLUSION: It is not easy to implement Individual Placement and Support. However, if more attention is given to good project management, Individual Placement and Support can succeed in the Netherlands.

Accessibility of government-run sheltered workshops to people with psychiatric histories.

Government-run sheltered workshops in the Netherlands are not as easily accessible to people with psychiatric histories as they are to other groups, such as those with physical and intellectual disabilities. This was found in a large-scale nationwide study in 21 such workshops, commissioned by the Dutch Ministry of Social Affairs and Employment. The workshops varied in their degree of accessibility. The more accessible ones placed stronger emphasis on social objectives and had shorter waiting periods and more lenient admission policies.