Leaving the sheltered workshop

Abstract

Occupational activity is an important part of the psychosocial adjustment even in those mental patients who cannot be fully rehabilitated and integrated into the competitive labour market. Yet some patients do not adhere to the occupational programmes and quit. We studied a group of chronic patients who had left after an average stay of 6.4 months a sheltered workshop designed specifically for seriously disabled patients with mental disorders. We compared these patients with two groups of control patients who remained in the workshop for a shorter (11.9 months on average) or longer (7.4 years on average) time, assessed possible reasons for the patients' leaving the workshop and inquired about their later occupational status. The purpose was to obtain information which could help to improve the patients' work adherence and thus promote their psychosocial adjustment. All patients, 16 in each group, were assessed using three instruments: (1) a self-devised interview schedule with items related to sociodemographic and clinical data, circumstances of patients' entry in the workshop and, if appropriate, situation at the time of their leaving the workshop and afterwards; (2) the ABB ("Arbeitsbeschreibungsbogen") questionnaire measuring patients' work satisfaction; (3) the Work Importance List ("Bedeutungsliste Arbeit") assessing the importance ascribed by the patients to 17 different aspects of work. Regarding sociodemographic and the majority of clinical variables, there were no significant differences between the three groups. All patients entered the workshop relatively late in their illness career at the average age of 39 years. The diagnosis schizophrenia was given to 75% of patients in the long stay group, 50% in the short stay group and to only one patient in the study group. The patients of the study group were mostly diagnosed with personality (borderline) and substance use disorder. They had received higher school education, spent less time in inpatient treatment and were more intensively cared for as outpatients. By all patients the highest values of satisfaction in ABB were given to superiors, the lowest values to payment and career perspectives, however, the patients of the study group indicated less satisfaction in all ABB dimensions. Structuring of the day, possibility to be active and to do something meaningful were indicated as the most important aspects of work in all three groups. There were no significant differences between the groups with regard to the item means and rankings. After leaving the workshop, 5 of 16 patients pursued another rehabilitation programme. However, the majority stayed at home without any occupation and they were not able to give a precise reason for their leaving the workshop. The results indicate that only a small minority of vocationally disabled chronic mental patients who leave a low entry threshold sheltered workshop after a relatively short time do so in order to progress in their rehabilitation process. The majority stay at home without being sufficiently occupied, and they are not able to find an adequate alternative without specialised help. Production oriented simple serial industrial activity in the workshop appears appropriate for the schizophrenic patients, but obviously it did not meet the needs of the study group patients with a higher previous school education. For these patients alternative options in the sheltered workshop itself must be considered along with the new approaches in general, better tailored to their needs and preferences.