The method chosen is feasible and was accepted by the target group. Project structure and processes proved to be applicable for the implementation of the project aims. The method chosen reaches an up to now "psychiatry-inexperienced" target group characterised by frequent incidence of mental disorders and low utilisation of psychiatric care. Thus, vocational reintegration programmes should be supported by psychiatric services.

Research has shown complex interactions between unemployment and mental health. However, the prevalence of specific mental disorders, utilization of mental health care services and influences on help-seeking behavior have been investigated surprisingly little in the past. In this study, we investigated a sample of long-term unemployed people in a cooperation program of the local unemployment agency and a psychiatric university hospital in a larger city in Germany. Mental disorders, treatment history, accordance of treatment to national treatment guidelines and factors influencing previous treatment were assessed. Participants (n = 879; male 56%, female 44%, mean age 43.9 years) showed a high psychiatric morbidity, mostly with diagnoses from the ICD-10 categories F1 (22%), F3 (61%) and F4 (68%). Currently, 18% were in psychiatric treatment, 6% were in psychotherapeutic treatment, and 28% received psychopharmacological treatment. Mostly young men underutilized the psychiatric–psychotherapeutic system, with middle-aged men and women being most frequently in psychopharmacological treatment. Of those treated, only about 10% of the subjects currently received a treatment according to national guidelines. The utilization of psychotherapeutic treatment was strikingly poor. This study identified high psychiatric morbidity and severe treatment gaps in unemployed people. These results can help to target subjects with specific needs for interventions and to modify counseling programs.

IntroductionThere are complex associations between work and mental health. Self-efficacy, experience of own abilities and appropriate challenges are important prerequisites of mental health. Availability of these factors is specifically decreased in the elder long term unemployed and results in higher vulnerability for mental impairment.ObjectivesInvestigation on mental health of elder long term unemployed personsAimsTo examine incidence of mental disorders in elder long term unemployed personsMethodsSenior long term unemployed participants in a vocational reintegration program were examined. Clients were allocated by choice to the study by their placement officers. An extensive psychiatric examination including structured clinical interviews (SKID) and clinical and personality questionnaires (BDI, STAI, MSWS, SCL 90-R, SF36, AUDIT, FTNA) was performed with each subject.Results90 subjects were included into the study so far and 42 completed the psychiatric examination. The mean age was 54.7 years and gender ratio was balanced. 94% were diagnosed with a psychiatric disorder and 80% were diagnosed with more than one disorder according to ICD-10. In particular, 78.6% of the subjects had depression, 40.5% anxiety disorders, 35.7% combined personality disorders, 26.2% posttraumatic disorders, 21.4% addiction disorders, 16.7% single personality disorders and 7.1% psychotic disorders.ConclusionA large proportion of the long term unemployed persons examined is affected by mental disorders. Along with the high incidence of depressive, anxiety and addiction disorders there was a considerable number of personality and specifically trauma-related disorders. Accordingly, personality disorders may be a risk factor for unemployment in elder people too.

IntroductionUnemployment is associated with various psychosocial strain factors. Previous studies show correlations between unemployment and impaired mental health. Present examinations on this set of problems mainly focused on younger unemployed, while specific psychosocial strains of senior unemployed persons were scarcely presented.ObjectivesInvestigation on psychiatric services for senior long term unemployed personsAimsTo examine the exigency and feasibility of specific mental health interventions for senior long term unemployed personsMethodsSenior long term unemployed participants in a vocational reintegration program underwent psychiatric examination and counseling. Placement officers recommended participation by choice to their clients and diagnostic examinations including clinical interviews and questionnaires were performed. Clients then received either direct treatment by the project staff, e.g. focal short-term therapy, or were placed in appropriate treatments. Numbers of clients who consented and who refused participation, dropout rates, psychiatric diagnoses and treatment placements were recorded.ResultsAttendance in the program was recommended to 161 clients to the date of this report. 136 clients consented with participation and 90 were included into examination. 21% discontinued participation in the course of examination. Of the unemployed persons surveyed, 96% received a psychiatric diagnosis and 80% multiple psychiatric diagnoses. 7% were placed to inpatient-treatment and 31% to ambulatory treatment.ConclusionPsychiatric services were highly requested and senior unemployed persons are specifically affected by mental disorders that presumably interfere with vocational reintegration. According to this, vocational reintegration programs should be flanked by psychiatric services to give consideration to the specific psychosocial strains of unemployed persons.

Unemployment is related to a higher risk for psychological distress and mental disorders, which cause individual suffering and socioeconomic costs for society in general. This selective review surveys the relationship between unemployment and psychological well-being and mental disorders. The most important programs for the improvement of the mental health of the unemployed are summarized: 1. Interventions for the unemployed with the aim of improving coping strategies reduce the risk of developing depressive symptoms. 2. The SUPPORT liaison outpatient unit collaborates closely with the unemployment agency and offers a low-threshold screening for mental disorders for unemployed subjects as well as counseling for those in need of treatment. 3. A group training based on cognitive behavioral therapy improves the psychological well-being of unemployed participants. 4. Supported employment is an effective means of placing severely mentally ill patients in a work-place accompanied by an extensive professional support.