social rehabilitation is carried out by a large variety of agencies and institutions within the framework of the German social security system. The involvement of so many agencies and institutions allows specific preventive activities and the development of defined policies and services. However, the co-ordination of services needs to be improved to avoid inconsistency, difficulties in identifying the appropriate agency, and delays in the delivery of services. Over the past few decades, self-help groups and organisations for the disabled have made an essential contribution to social policy and have provided flexible, individualised help and support to people with disabilities. NGOs are also responsible for large areas of state-financed "professional" rehabilitation
The economic burden of mental illness
On average depression-related work incapacity lasts about two and a half times longer than incapacity due to other illnesses. Depressive disorders account for a considerable portion of premature retirements. In 1995 depressive disorders were responsible for approximately 6.3% of the 297,164 early retirements. The average retirement age was between 50 and 54. Work incapacity due to mental health disorders now accounts for 5.9 % of all days workdays lost. In the 1980s, mental health disorders were still considered of secondary importance in the old Federal States. Today, they are the sixth leading cause of absenteeism. While there is evidence of a downward trend in most other large illness groups, the rate of mental health disorders is growing. This is partly connected to a change in diagnostic criteria. Mental health disorders constitute the third most important diagnostic group in hospitals, accounting for 11 % of treatment days. In 1995, approximately 1% of all registered hospital cases (approximately 159,000 cases) were attributed to depressive disorders. The cost of this in-patient treatment is estimated to be 2 billion DM per year. In 1995, individuals with depression represented 3.3% of the 900,973 rehabilitation treatments paid for by pension insurance. Both direct and indirect costs of medical treatment, such as production losses due to absenteeism, should be included in calculating the total cost of illness. For 1997, based on statistics for employed persons (excluding the self-employed) and gross income from employment, the Federal Institute for Occupational Safety and Health determined that the annual volume of production lost because of illness-related absenteeism came to 89.5 billion DM. According to this estimate, mental health disorders represent costs of 5.2 billion DM.
Managing mental health in the workplace
In Germany, health care in the workplace, including prevention of illness and the rehabilitation of disabled persons, is undertaken through a comprehensive and differentiated social insurance system, which includes unemployment insurance, statutory health insurance, and statutory accident insurance. Both the social partners and the institutions responsible for health and safety in the workplace are active in the area of workplace stress. Corporate health promotion, which uses a variety of approaches to improve health in the workplace, is becoming a higher priority in Germany, as it is in the rest of the Europe. Successful stress prevention programmes have been underway for many years. Stress reduction programs have been designed which include relaxation procedures, role playing, and behavioural training to increase self-confidence and improve interpersonal skills.
