Reha-Integrative – Integrative Treatment of Insured with Special Occupational Needs

What were your goals in the project Reha-Integrative?

Our main goal consisted in maintaining the long-term employability of insured individuals by preventing the chronification of mental illness.

To achieve this, we implemented (a) early psychotherapeutic treatment within the first three months of certified incapacity for work (Ger.: Arbeitsunfähigkeit (AU)), (b) with a focus on the individual and acute needs of those affected. We assumed that combining an initial intensive treatment phase with subsequent standard psychosomatic rehabilitation would increase treatment effectiveness and improve the likelihood of reintegration into working life.

Are there any topics and focal points that have turned out to be particularly important for you in the project when it comes to pursuing these goals? If so, which ones?

One particularly important issue that emerged during the project was access. To initiate early treatment, we had to proactively identify individuals from the target group and reach them.

We invited individuals who had already applied for psychosomatic rehabilitation but were still in the early stages of illness progression (i.e., within the first three months of certified incapacity for work) to participate in Reha-Integrative.

Access to treatment is often difficult for people with mental illnesses – due to stigma, shame, or a lack of initiative caused by the illness itself. Even applying for rehabilitation can represent a significant challenge. This raised the broader question of how access to early medical or psychotherapeutic treatment – or even preventive interventions – can be improved at an early stage of mental health deterioration.

What were key challenges you faced during the project, what strategies did you use to deal with those challenges?

We encountered two main challenges during the project:

First, the COVID-19 pandemic led to temporary clinic closures and a significant drop in the number of patients treated. Fortunately, the project duration was extended, allowing us to almost catch our planned sample size.

Second, project participation by statutory health insurance providers: These insurers refused to co-finance the project, which required us to seek alternative funding. Eventually, the German Pension Insurance took over the funding of the treatment.

Based on the insights and experiences gained during the project, what measures do you as most important when it comes to fostering the project’s aim? What are your recommendations in this context?

Based on our experience, we derived the following insights:

Not every form of therapy suits every patient equally well, and simply increasing therapy intensity within a fixed timeframe does not always improve treatment outcomes.

Instead, we recommend using a differentiated, individualized approach to assess intervention duration and intensity, based on the inclusion of entry factors (such as certified incapacity for work prior to rehabilitation or the severity of illness on admission) and the reactivity of the insured person (e.g. by weekly measurement of symptom severity).

What insights gained during the project do you consider as most important?

Our results suggest that less severely ill patients who undergo intensified rehabilitation within the first three months of a period of sick leave have a good chance of a reliable improvement of their symptoms, whereas this is not to be expected in the case of progressive sick leave or illness severity. An early intervention (within the first three months of a period of incapacity for work) and possibly shorter than standard care could, as a preventive measure in the early stages of an affective disorder (when the symptom burden is not yet severe), relieve people of their personal suffering and prevent chronicity as well as barriers to participation. The decisive factor is the timely and reliable identification of eligible insured persons.

Looking back on the aims and trajectory of the Reha-Integrative project, where do you see a need for further research and which research questions would you name in this context?

While the project focused on the direct effect of therapy dose on symptom reduction and socio-medical parameters, it became clear that other factors – such as treatment needs, work motivation, and self-regulation skills (e.g. sense of self-efficacy) – are also crucial for returning to work.

Key questions for future research include whether these personal factors are influenced by an increased therapy dose, and how such increases have moderating or mediating effects on treatment outcomes.

Qualitative interviews with a randomized subsample suggested that contextual changes and internal control beliefs may influence symptom reduction and reintegration.

Future studies should explore whether stronger internal control beliefs or increased resilience help individuals in dealing with difficult life contexts, and to what extent such traits can be strengthened through intensified therapeutic interventions.