Rehabilitation of the mentally ill

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The rehabilitation facilities for mentally ill people (RPK) provide all the necessary medical-therapeutic, psychosocial and professional treatment and support offers. The multi-professional rehabilitation team offers an integrated complex service based on the bio-psycho-social ICF model for people with endogenous or exogenous psychoses , neuroses , severe depression and personality disorders . The rehabilitation team consists of a doctor / psychiatrist , graduate psychologist / psychological psychotherapist , health and nurse , occupational therapist / occupational therapist , physiotherapist with sports-therapeutic competence, social therapist , social pedagogue / worker , workshop manager, specialists for vocational rehabilitation and professional instructors. Additional therapy offers z. B. art therapy , eurythmy therapy , music therapy and others must be requested from the respective RPK provider. Gerontopsychiatric and neurotic-psychosomatic diseases as well as intellectually severe limitations and first-degree addictions are not taken into account. They require other measures.

history

The psychiatric inquiry of 1975 had shown the former serious shortcomings in the West German psychiatric care. This also included the lack of equality for mentally and organically ill people with regard to medical and rehabilitative care. Neither pension insurance , nor health insurance or the labor administration (today Federal Employment Agency ) took over the services for medical and / or vocational rehabilitation measures. This resulted in the first "RPK Recommendation Agreement of November 17, 1986", which was updated by the renewed "RPK Recommendation Agreement of September 29, 2005".

Beginning in 1986, each federal state should offer an RPK facility as a model with 50 places. These facilities should be scientifically monitored for 4 years in order to draw conclusions for a comprehensive supply of medical-professional rehabilitation offers in the sense of the integrated complex service offer. A special "specific therapeutic milieu" should be created that enables independent living and the ability to work, without clinical and hospital structures being offered, so that the affected person can completely abandon their patient role ("everyday life as therapy, therapy as everyday life ").

So from 1986 - often as a further development of existing transitional homes for mentally ill people - the following RPK facilities with 50 places each came into being:

  • ATZ-Saarbrücken (Saarland)
  • ERPEKA Nuremberg (Bavaria)
  • House Jüthornstrasse (Hamburg)
  • REAS GmbH & Co. KG - Rehabilitation center in Asbach (Hessen)
  • CHRISTIANI rehabilitation center (Baden-Württemberg)
  • Wichern Institute (Rhineland-Palatinate).

All RPK facilities later recognized by the service providers were only granted a lower number of places (10 - 30 places).

A new recommendation agreement RPK came into effect on July 1, 2006. The lack of adequate comprehensive rehab diagnostics / rehab assessment instruments was criticized. Only in Baden-Württemberg is there a 6-week “Clinical Stress Test : Rehabilitation Diagnostics / Rehabilitation Assessment” before the RPK procedure is initiated in the RPK facilities in this state.

Legal basis

All "real" RPK facilities have a legally valid contract with the statutory health insurance companies in accordance with "§ 111 Supply contracts with preventive or rehabilitation facilities" SGB V.

In addition, these institutions have a respective contract with a remuneration agreement in accordance with the "RPK Recommendation Agreement" of September 29, 2005 with the German Pension Insurance (respective federal state), the German Federal Pension Insurance, the statutory health insurance companies and the Federal Employment Agency.

Rehabilitation service providers

The costs for the rehabilitation measures take priority

If the insurance law requirements for the assumption of costs by the above-mentioned service providers are not met, then until the introduction of the rehabilitation law in 2001, the social welfare agency could still be considered to assume the costs.

Accommodation

Participation in an RPK measure takes place either

  • Inpatient (accommodation in the RPK facility: large groups, shared apartments, single and couple apartments) or
  • outpatient = partial inpatient (commuting to the RPK facility from your own apartment or from your parents' home).

Application for rehabilitation

Before submitting an application, the regional institutions offer the opportunity to obtain personal information in one-on-one meetings or in regular information events. If the participant would like to start an RPK measure, the application process starts with the support and supervision of the RPK facility. The documents to be submitted essentially include the application form, a statement from the attending physician and a medical statement from the RPK facility.

goals and tasks

The following goals and tasks apply to the participants:

  • Acceptance and understanding of the disease
  • Recognizing stressful factors and dealing with them in everyday life
  • Development of perspectives
  • Recognizing skills and promoting them
  • Professional orientation and testing (e.g. in the facilities' workshops)
  • Decision for a profession with subsequent practical experience in this professional field or start of vocational training or taking up work in the profession you have already learned
  • Development in relation to social skills in living together and working together
  • Establishing relationships in the environment (e.g. at cultural events or during sports)

Sections of rehabilitation

A typical RPK measure can be broken down into the following sections:

  1. Clinical stress tests : Rehabilitation diagnostics / rehabilitation assessment - under RPK conditions in the RPK facilities with housekeeping, horticulture, wood workshop, tailoring, metal, office, etc. (duration usually six weeks and in the workshops of the RPK facility, currently only possible in Baden-Württemberg).
  2. Medical-professional RPK focus on medical (duration 3 to 12 months, internship location usually first job market )
  3. occupational-medical RPK focus on occupational: LTA = benefits for participation in working life (duration 6 to 12 months, internship location usually first labor market )

Thanks to the RPK model, the old phase thinking (the medical phase is followed by the professional phase) was further developed in favor of a modified "person-centered" approach. It is therefore correct to speak of a “medical-professional RPK measure with a focus on medical”, which can usually be further developed into a “professional-medical RPK measure with a focus on professional” at the latest after one year. Only through this principle do the transitions from medical to occupational rehab flow into one another, whereby a daily load of six working hours should be managed to enter occupational rehab. After a completed RPK measure, follow-up care can be requested to ensure the success of the rehabilitation and training can be started at some rehabilitation locations (e.g. Albbruck).

4. RPK facilities are developing into rehabilitation clinics with a focus on medically and professionally oriented rehabilitation (MBOR), particularly in Lower Saxony, but also in Hesse. These include, in particular, medical stress tests to promote work-related psychophysical resilience with a view to future employment. Afterwards, the restored ability to work can be qualified for a future occupation for up to a year within the framework of occupational benefits, provided that employment is not already considered after medical rehabilitation. This development was mainly due to the member institutions of the VpRD. The resulting rehabilitation concepts of a tiered approach were recognized by the rehabilitation providers in 2015.

See also

Web links

Individual evidence

  1. ↑ Rehabilitation Clinic RPK Oldenburg, Center for Psychiatric Rehabilitation, Lower Saxony and RPK Medical, Social and Occupational Rehabilitation REAS GmbH & Co. KG, Modautal / Asbach, Hessen