Pathways into sheltered employment.

Work ranks high in the rehabilitation of the mentally ill. Currently sheltered employment is often the only alternative to unemployment. We present a sample of 121 patients working at various facilities for vocational rehabilitation. All of these patients are chronically mentally ill, 77% of them suffering from schizophrenic disorders. With respect to their vocational backgrounds, they represent four groups that had come to the sheltered workplace by various means. One group of young patients had never had gainful employment, a second group had found jobs on the open labour market after onset of their illness, and a third group had been employed both before and after the onset of mental illness. The largest group, however, comprised those patients who had dropped out of normal working life immediately on onset of their illness to work in sheltered employment. The rate of isolation from working life was found to be influenced neither by professional qualification nor by the extent of vocational integration prior to the onset of mental illness. We discuss the consequences of the subjective experience of patients and the opportunities and problems presented in practice by vocational rehabilitation of the chronically mentally ill. A 5-year prospective study on the course of vocational rehabilitation is being designed by our group to provide further information on this subject.