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• W1573177712 abstract "s were obtained for relevant titles, and then full papers obtained for those likely to match the inclusion/exclusion criteria.Articles for inclusion were selected by one of the present reviewers (GW,KB or SB) and discussed with the others against the inclusion/exclusion criteria. The characteristics of each included review, and the authors’ main conclusions were extracted and tabulated by one of the reviewers (GW, KB or SB) and checked by a second. Any disagreements were resolved by discussion, and the present reviewers’ comments were added to the tables where appropriate. A dedicated database was constructed, and all included articles were archived. The findings were analysed within a broad biopsychosocial framework • Biological: the key elements were taken to be the health condition, health care, and increasing activities and restoring function. • Psychological: the key element was taken to be some attempt to shift dysfunctional beliefs and behaviour. This might be a modern ‘educational’ approach, or some form of cognitive-behavioural element and/or principles. • Social: the key element was taken to be some attempt to restore normal social function and participation, including return to work. The main focus was occupational. Interest was in the content of the interventions rather than the professional discipline of the providers. The results are presented separately for each of the four main common health problems (back pain being considered separately from other musculoskeletal problems because there is so much scientific data on back pain). The evidence tables are published separately in Appendix 3: online at www.dwp.gov.uk/medical This overall approach was intended to find and include the most recent and important articles over the whole area. Accepting a potential selection bias, it is unlikely that any omitted articles would significantly change the broad general themes identified. Mental health conditions Eleven reviews (4 systematic) of severe mental illness and 13 reviews (3 systematic) of common mental health problems were included, and Tables A3.1 and A3.2 list their main characteristics and conclusions respectively. Table A3.2 includes a further 8 guidance documents. Mental health is a high priority (DH 1999). Rehabilitation and (re)-employment for people with mental health problems is considered to be important (Schneider 1998; Grove 1999; Thomas et al. 2002; Office of National Statistics 2003) because: • One in four people of working age develop some kind of mental health problem. Mental health problems account for 35-40% of work-related health problems, sickness absence, long-term incapacity and early retirement. 40 Concepts of Rehabilitation for the Management of Common Health Problems • Only 21% of people with mental health problems are employed (Labour Force Survey 2002), which is much lower than for any of the other common health problems. Given the high prevalence of mental health problems, this is a waste of lives, skills and resources that society can ill afford (Grove 1999). • The annual cost of mental illness in England was estimated to be £32.1 billion at 1996/97 prices: NHS health care £4.1 billion, DSS costs £7.6 billion, lost employment £11.8 billion (Patel & Knapp 1998). • Sickness absence and long-term incapacity due to mental health problems is rising faster than any other common health problem (DWP administrative data). • A high proportion (50-90% in some surveys (Grove 1999; Thomas et al. 2002)) of unemployed people with mental health problems say they would like to work (though see the earlier discussion of how such findings may be interpreted). The right to live as normally as possible and to work is enshrined in the UN Declaration of Human Rights 1948 (www.un.org/Overview/rights). There is a strong social consensus that sees employment as a desirable form of social participation for all adults. At the same time, there is a stigma attached to disability, and in particular to mental illness, which tends to exclude people affected from all aspects of social participation (Schneider et al. 2002). • Work may be stressful and potentially psychologically detrimental to people with mental health problems. However, the evidence broadly shows that work is therapeutic for people with mental health problems (as for any other form of disability) in terms of symptom management, self-esteem, and self­ identity,‘normalisation’ of activities and participation, improved social functioning and quality of life. Conversely, there is strong evidence that lower socio-economic status, loss of employment and unemployment, social disadvantage and exclusion have powerful negative effects on symptoms, mental health, quality of life and recovery (Office of National Statistics 2003). Such concerns should not preclude work, but rather direct attention towards the quality of work, addressing aggravating factors, matching jobs to abilities, and improving support at work (Schneider 1998).‘Rather than being a factor which causes additional distress to people with mental health problems, work has the potential to be part of the recovery process. Mental health providers, and the health care system more widely, need training to become more aware of the impact that employment, loss of employment and unemployment have on people with mental health problems’ (Thomas et al.2002).‘Helping people (with mental health problems) to get back to work is probably the single most effective thing we can do for them’ (S Wessely, in Patients ­ their employment and their health: a DWP Corporate Medical Group DVD, 2003). Most of the scientific evidence (Appendix 3) is about rehabilitation for severe mental illness (usually termed ‘severe mental illness’ or ‘serious and persistent mental illness’ and defined as schizophrenia, bipolar disorders or depression with psychotic features; some included reviews also cover brain injury and/or severe learning disabilities), rather than common mental health problems. Alcohol and drug abuse were excluded from the present review, because they are too specialised areas. Evidence themes: severe mental illness There is a reasonable amount of evidence and comprehensive, up-to-date reviews (Crowther et al. 2001; Schneider et al. 2002; Schneider et al. 2003; Crowther et al. 2004) on rehabilitation and return to work initiatives for severe mental illness. The Cochrane Review (Crowther et al. 2004) Helping people with severe mental illness to obtain work included eleven RCTs published up to 1998. A UK Dept of Health report (Schneider et al. 2002) updated that review, included a much broader range of some 240 published and unpublished papers, and integrated the findings with expert opinion in the field." @default.
• W1573177712 created "2016-06-24" @default.
• W1573177712 creator A5079774253 @default.
• W1573177712 creator A5090008681 @default.
• W1573177712 date "2004-06-15" @default.
• W1573177712 modified "2023-09-25" @default.
• W1573177712 title "Concepts Of Rehabilitation For The Management Of Common Health Problems" @default.
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