neurology, psychiatry, psychotherapy, and pharmacology. Non-medical psychotherapists are also involved in the treatment. The mandatory health insurance agencies will, under certain circumstances, cover the costs of non-medical psychotherapeutic treatment. Socio-psychiatric services, social services and advisory agencies make a major contribution to care and advice. In-patient care involves physicians, nurses, and psychologists, occupational and rehabilitation therapists, and social workers. In addition to specialist psychiatric hospitals, there are psychiatric and psychosomatic departments in general hospitals.

Studies estimate that about 60% of individuals who have had at least one depressive episode in their lives have consulted a physician about it. Surveys show that in neurological practices depression was the main subject in about 9% of consultations.

In general, when symptoms arise, there is easy access to medical help, which is free of charge through the statutory health insurance scheme¹⁴. Pfeiler (1996), however, points out that there exist major uncertainties with regard to adequate diagnosis, mainly on the part of non-psychiatric general practitioners. This of course also affects the efficiency of the treatment measures. He says, "With nearly half the patients diagnosed as depressive - in accordance with the classification criteria of ICD-9 - there is no depression, and in 87% of the cases the diagnostic classification as psychotic, neurotic and reactive depression is not appropriate."¹⁵ Pfeiler also points out that by far the greater number (75%) of outpatients diagnosed as depressive are not suffering from clinically relevant complaints. "Nevertheless a therapy involving psychopharmaceutical drugs is normally applied; psychosocial factors are medicalised, which may not infrequently mean an iatrogenic chronification of wellness disorders."¹⁶

Mental Health and Employment

Information regarding the employment status of the mentally disabled* is difficult to obtain. The data does not differentiate between types of disability. The Federal Employment Agency does not provide information about the connection between type of work and type of disability. Other sources do not provide a separate category for disability caused by mental illness. The Federal Statistics Agency, for instance, does not differentiate between paralysis caused by severance of the spinal cord, cerebral disorders, mental illness, and addictive illnesses.

Kleffmann (1996)¹⁷ states that approximately one third of all patients treated in psychiatric clinics are unemployed. All available studies demonstrate that individuals with mental health disabilities have a greater rate of unemployment than the population at large. Moreover a greater proportion of people with mental health disabilities are unemployed in comparison with other types of disabilities.¹⁸

German Health Reports points out that in comparison with other types of disabilities people with mental health problems often require a longer period of recovery before they can return to work. Particular problems arise for persons with mental health disabilities when they attempt to integrate into the open labour market. It is considerably more difficult to re-integrate

*In Germany, the term "mentally disabled" ("geisteg Behinderte") is used in a legal as well as a popular context to refer to persons with mental health disabilities and persons with intellectual disabilities/mental retardation. (4^th Report of the Federal Government of Germany on the Situation of Persons with Disabilities and the Development of Rehabilitation. Editor Federal Ministry of Labour and Social Affairs, 1998) Since this report does not address persons with intellectual disabilities, the term "mentally disabled" will not be used but rather the phrase "mental health disabilities."