NTT Medical Center Tokyo, Dept of Neuropsychiatry, Tokyo, Japan
The ultimate purpose of psychiatric treatment is to assist recovery of the person suffering from mental illness. Restoration of capacity to work is essential for recovery of those who were working before the onset of mental illness, since work provides a basis of self-esteem, social independence and opportunities to have a family.
However continuation to work without relapse is not easy. With given individual vulnerability and work stress a person has an onset of mental illness. After the onset, the individual vulnerability increases and the person returns to the same work stress. Therefore, relapse can be a rule.
In order to reverse the rule, the person should improve readiness to work beyond simple symptomatological remission and acquire skills to cope with work stress. In Netherlands and Japan psychiatrists have provided such rehabilitative program to facilitate return-to-work and to assist relapse-prevention.
In Netherlands Schene et al (2007) reported that the addition of occupational therapy (OT) to treatment as usual (TAU) improved productivity and was cost-effective. In 2012 Hees et al reported that those in TAU+OT showed better long-term symptom remission and long-term work in good health than TAU group.
In Japan, such program has been systematically provided since 1997 and is called as Re-work program. Re-work program consists of individual and group work, psychoeducation, monitoring skill learning, cognitive behavioral and problem solving therapy, and reflection on the onset process of mental illness and understanding of individual vulnerability. In 2012 Ohki et al reported that patients who returned to work after receiving Re-work program had a better work continuation than TAU group. In 2017 Sakamoto et al reported that over 90% of those who returned to work after receiving Re-work program did not take another sick leave during the 12 months follow-up and the working periods after the program were significantly longer than those before the program.
Re-work program facilitates recovery and reduces financial loss from mental illness. This effect will be clearly visible to society and improve stigma against psychiatry and mental illness. Recovery of working patients means recovery of appreciation for psychiatry as useful humane service.