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Tijdschrift voor Psychiatrie 7 (1965) 1, 14 - 27

Short report

„Ervaringen met inpassing in het maatschappelijke arbeidsproces van de in de inrichting verblijvende patiënten en hun revalidatie'.

J. van Sluijs

Summary of the activities of the Social Psychiatric Service of the „Wolfheze" Hospital, Wolfheze, with special regard to the rehabilitation of patients.

The rehabilitation, outwith th premises of the hospital, was begun early in 1963. The experiences and progress we have made in the situating patients are recorded as a result of the attached statistical report. As at lst. April 1964, 85 patients have gone daily to either the Beschuttende Werkplaats ( Social Workplace) or the small private business. The above mentioned report gives a total of 109 workers, because those working away from the hospital since the beginning are included.
The majority, 62 in total, come from the group Defect Schizophrenic. The place and type of work is not determined by the diagnosis, but by the patients condition.
It is of importante to observe closely the adaptibility of those involved in order to complete the group and to give the workers the most suitable surroundings.
The fact that the majority are male is no indication that there is more difficulty in obtaining situations for females, but that we have begun with the former in order to approach the technical industries.
Amongst those under rehabilitation are some who have been under care for more than 20 years, but the average period under care is 5 years. At present, there are 58 working at the Social Workplace ( male and female) and 27 in ordinary businesses.
The total under care in the institution is 850.
At the Social Workplaces there are good opportunities, especially for the males, to practise in one or other type of special work.
There are amongst them, those who give good work at an exceptional speed. Most of them present a total physical validity.
The Workplace has priority in cases where we have to deal with a working ability grounded on for example, periodic relapse, extreme changes of mood and irregularities of different nature.
We also give preferente in the above workshop to those with the pedagogic element. We are fortunate in having two Social Workplaces at our disposal, „Presikhaaf" in Arnhem and „Arbeidszorg" in Ede.
Both of which are, for us, a guarantee of a good reeducative grasp and placing with a comprehensive variety of work; overall the balancedhandling of disciplinary instructions is therefor also a continuation of the resocializing process which is applied intramurally.
Also the application of the so called „Merit-Rating" system gives a good answer as to what is carried out and achieved. So the patient can realize his stake and his worth from his wage packet. For those working in general business, care must be taken, in their earnings, against a deception on both sides. Payment must neither be philanthropic nor unjust. Only the correct payment is not deceiving. It is worthy of note, that the average patient attaches so much value on the opinions of those in ordinary life.
A system of standardisation is necessary in the choosing of situations in ordinary business. For example, it is not advisable to place the paranoid patient in a so called „open" family. To put the contact extraresensitive or the exceptionally impressionable schizophrenic by a lady who keeps the contact at short distance and very frontally, will certainly lead to failure via frustration. The more expansive with a psychopatized behaviour should not be situated with an employer who is himself unstable and unrestricted, etc.
Unfortunately, we must report here, that we are not always succesfull in finding and distinguishing the most suitable employment. When we are looking for the most suitable place of work and employer, it is not necessary that the opportunity for working for the patient, be only a satisfaction, in every respect of the word, for him.
On the contrary, it can be of value to place the patient wth a neurotic pattern of behaviour, by a „cool" and businesslike lady who is not interested, or is expressly not interested, in personal feelings and imaginary complaints in order to be of more help to her.
Earnings in General business are more variable. In some instances patients earn more than non-patients for the same work. Against this, there are also those whose speed and precision is below standard.
The patient is allowed to keep 1/3 of his earnings, 2/3 are repaid to the source which is responsible for the costs of the care.
According to the situation as at 1-4-'64 there was, in one year, F. 51.000,— ( £ 4044; $ 14186) was in circulation amongst the patients; F. 100.000,— was repaid to the above mentioned source, and the total income was F. 175.000,— approximately.
The financial aspect is important but not the most important. It is our intention to let this money become a therapeutic medium for the patient and not to allow it to deteriorate to a dead capital.
The total of those rehabilitated increases by approximately 14 per month, and shall, according to our figures, so continue till about 150.
Thereafter the tempo will tend to lessen owing to an increase in the various discharges. It will then be possible to give more pretraining and make greater selection.
We intend, after sufficient experience is obtained, to preselect for the Social Workplace by special pretraining in a particular department.
We have the opportunity, in the social-therapeutic department, of training the female patients in housekeeping.
The amount of work for all the departments is thereby increased by one thing and another, as welt as the administration and living quarters. It is also heavy charge on the budget of the institution, because, the patient who was of real assistante to us, has obtained employment outside and therefor other personel must be introduced to replace him.
The provincial labour exchange helps us with the vacances at the Social Workplaces, and with this there is a tendency to good cooperation.
The social service in many councils of our country, readily give guarantees for the forthcoming costs, although in the beginning they were rather hesitant for various reasons ( i.e. the stoppage of Social Insurance and other payments to the family or institution.)
Now, since it has received some publicity, we come across no opposition and can put what is important for the patient in the first place.
We hope, that in the future the Social Insurance will be prepared to give the mentally disturbed the same scope for work as they do to the physically handicapped. The possibility of obtaining employment for the mental patient without immediate withdrawal of payments to the family, would be welcomed by us and those involved.
Several questions have to be answered:
A. What is the benefit for the patient?
B. Of what significance is it for the department?
C. And for the mental hospital?
D. Of what importante is it for society in general?

A. The personality comes more to the fore and the patient learns that it is possible to apply himself. There is also an apparent increase in the individuality, because he has now something which he did not previously possess, and which others do not yet. He has more available finance and therefor more possibilities are open to him. His thoughts are more on the future and less on his present predicament. Interest is increased and the world enlarged.
The capacity for work is greater and the chances of discharge ( from the hospital) are increased. One reason for his becoming less dependent is the fact that he is helping to pay the costs of nursing, etc.
Many more are so f ar in the their treatment that they now wait on good accommodation. With this in view, there is a movement under hand to establish a residential home.

B. Discipline within the department has to be slackened because of the going to and coming from work of the patients. We have instituted a special department to limit this, also in various ways to acclimatize the patient and facilitate his caring for himself i.e. in the taking of medicine, running club life from his own means and partaking in organizations outwith the hospital etc. Through this it is possible to give more freedom when a greater interest and feeling of responsibility have been obtained. It is noticed by the whole department that there is more living with and round it. The outside working of the patient is important for the whole community. The social conditions are influenced and it gives the medical staff and all the perronnel a greater interest in „WORK".

C. The hospital has more space for in-patients. There is a lessening of the hate against society in general and a greater tendency to work and live with it. Work is increased and there is a greater scope in the selection of personnel owing to the helping patient being no longer available. In many instances a leading to a more satisfactory method of discharge.

D. A lowering of the costs on society. More appreciation of the mentally handicapped, clearer opinion of the patient and less fear of him. Also a welcome relief of the scarcity on the labour market. It is to be hoped, that many of our patients, together through rehabilitation and renewed relationship with the environment of work, can find the return path to normality.
This being the case, the period of nursing and division of the family could he shortened.
Should the time come that the institution be redundant, all the above will have been a contributing factor.