Background: For people who have experienced mental health crises or psychosocial disabilities, it is considerably more difficult to receive support to participate in work on an equal basis with others. In the town of Geesthacht, in Northern Germany, an integrative care network was implemented that allows for acute psychiatric treatment as well as participation in work and activities. This paper aims to explore the principles, advantages, and challenges of this innovative project. Methodology: Within the context of a participatory and collaborative process evaluation of a prospective controlled cohort study (PsychCare), researchers with and without experiential expertise conducted expert interviews and focus groups to evaluate the experiences of 37 employees, with and without lived experience, from various institutions associated with this care network. The data was analyzed using qualitative content analysis. Conclusion: This innovative project in Geesthacht demonstrates the multifaceted potential of a global treatment budget system in the field of mental health care. To address certain downsides of the Geesthacht model, further development is necessary. Social Psychiatry and Psychiatric Rehabilitation Volume 12 - 2021 | https://doi.org/10.3389/fpsyt.2021.634080 Background: For people who have experienced mental health crises or psychosocial disabilities it is considerably more difficult to receive support to participate in work on an equal basis with others an integrative care network was implemented that allows for acute psychiatric treatment as well as participation in work and activities Methodology: Within the context of a participatory and collaborative process evaluation of a prospective controlled cohort study (PsychCare) researchers with and without experiential expertise conducted expert interviews and focus groups to evaluate the experiences of 37 employees from various institutions associated with this care network The data was analyzed using qualitative content analysis Results: It was the change from financial compensation paid on a daily basis to a global treatment budget that allowed for a significant reduction of hospital beds in Geesthacht and freed up resources to implement a complex care network These developments now allow for a less bureaucratic and often smooth transition from being a service user to involvement in participatory activities in the role of a peer which is frequently perceived to be empowering and beneficial by participants with lived experience this care model has led to multiple role conflicts and different challenges for all parties involved Conclusion: This innovative project in Geesthacht demonstrates the multifaceted potential of a global treatment budget system in the field of mental health care To address certain downsides of the Geesthacht model the CRPD aims at ensuring equal rights and participation in education A self-determined and autonomous life is intended for everyone in accordance with their own will and preferences In the field of mental health, many of these principles resonate well with long-debated concepts that originated within the social movement of survivors of psychiatric services, who are largely critical of the psychiatric care system. The notion of “recovery” has now been implemented in various health policy programs, implying self-determination, personal growth, participation, and control of one's own living conditions (2) The concept of “empowerment” has equally been coopted by various psychiatric institutions or stakeholders yet its original meaning designated self-determination and choice of those people who should be the focus of care both of which are indispensable conditions for effective participation the majority of people with psychosocial or intellectual disabilities in Germany are still employed in segregated workplaces The increasing number of beds in nursing homes and hospitals almost everywhere in Germany among other structural mechanisms of exclusion leads to a situation in which these people struggle to establish their existence independently from institutions and find inclusion in society This paper presents part of the results from a participatory process evaluation that took place within the context of a larger prospective controlled cohort study (PsychCare) (5) Various opportunities for people with lived experience of mental health crises and disabilities in a psychiatric care network in the town of Geesthacht in Northern Germany to participate in work and activities were explored These opportunities have evolved from a longer process of reorganizing psychiatric care in Geesthacht with the aim to better assist people with lived experience in leading a more autonomous and self-determined life rather than assuming the identity of a help-seeking This paper focuses on only one segment of that transformative process - the gradual development of more prospects for participation in the fields of work and activities as it reflects the main focus of the work carried out in Geesthacht over the past years and demonstrates how these changes are presently perceived and evaluated by the people involved the participation model in Geesthacht is considered critically especially in relation to the question as to whether or not it meets CRPD-compliant criteria To evaluate the Geesthacht model on its own terms we have deliberately avoided comparing it with other models or insight of the international literature instead focusing our discussion on its inherent tensions and ambivalences This text was jointly developed by people with and without lived experience with the psychiatric care system why it is important to us to handle language carefully We purposely omitted terms such as “illness” or “disorder,” instead using the language of the CRPD such as the term “mental health crises” and “psychosocial disabilities.” Considering the variety of possibilities for work it was difficult for us to find a single term to describe all the areas of involvement and roles connected to them activities and/or formal employment are dealt with such as paid employment on the basis of various forms of financial compensation and contracts (the wages ranging from usual market levels until small volunteer work (by people with and without lived experience) or therapeutic activities (in the sense of occupational therapy supported employment or more traditional forms of work therapy) To demarcate these different forms from each other at least to some extent we refer in the following to paid work as “employment” and to unpaid work as “activities.” The gray area of supported employment [covering both place and train (individual placement and support) and train and place (in the sense of vocational training) versions] or more traditional forms of work therapy in which therapeutic support may transition into employment will be indicated accordingly All opportunities that are mentioned are offered by the same or different institutions meaning that one and the same institution may offer one or more types of work and/ or activities or another form that has been developed and offered by peers the employees with lived experience offer support without any previous peer training which is due to the historical development of the project The Psychiatric Department at the Johanniter Hospital in Geesthacht was founded in 1997 and is in charge of providing care for the Duchy of Lauenburg county a catchment area of 195,000 inhabitants to the east of Hamburg and south of Lübeck The Duchy of Lauenburg is a rural area with 156 inhabitants per km2 Resources were released through this reorganization that were reinvested in various forms of home treatment housing therapy (“Housing First”) and supported employment as well as to support cross-sectoral cooperation occupational therapy taking place in outpatient practices was included in the budgets as it had been traditionally used heavily in this catchment area prior to the years of reorganization in Geesthacht A more detailed description of these reorganization processes cannot be given in this paper due to limited space (9) a complex and comprehensive network of institutions inside and outside of the hospital was established spanning across different treatment sectors and including various non-profit organizations and forms of peer-organized crisis centers and respites Developing this network enabled more continuous and empowering treatment and support across the sectors and within the service users' home environment Even more noteworthy is the fact that this network was created and built up at a time when neither the CRPD recovery or peer support had been applied on a larger scale Table 1 lists the actors and institutions cooperating with the Geesthacht model Some of the participating partners receive payment for their services either through health care funding (according to the German Social Code Books V and XI) or via funds from rehabilitation programs (according to the German Social Code Some collaborating institutions generate their own income or finance work based on donations the global treatment budget was somewhat flexible making transfers of funding between the institutions and sectors involved possible fewer of these options exist due to structural reasons (see discussion) the cooperation between the actors and institutions involved has become more limited thus hampering the continuity and flexibility of the related services Overview of the main institutions (and provided services) that cooperate with the Geesthacht model together with the concepts of recovery and empowerment that over time developed into some of the guiding principles of the care network as it is practiced now This origin of the Geesthacht model in the 1970's and its evolution over time has led to certain conceptual tensions for instance understanding work as therapy or as a right tension that will be discussed to be productive further below this region showed several structural idiosyncrasies that were not sufficiently captured through this multicenter study This was taken as an opportunity to study in further detail the range of services available in Geesthacht One of these discussions involved clinical staff of the hospital in Geesthacht (n = 5; employees without lived experience) while the second group was constituted exclusively of employees with lived experience (n = 8) individual interviews were conducted with employees with lived experience (n = 7) with non-professional employees without lived experience and no formal training in psychosocial care (n = 2) as well as with employees without lived experience (n = 5) The latter included the current and former heads of the Department of Psychiatry and Psychotherapy in Geesthacht Additional questions focused on the home treatment system in Geesthacht and on the Housing First program but are not listed in the supplement due to the focus of this paper All participants who were interviewed gave their informed written consent The study was approved by the Ethics Committee of the Brandenburg Medical Association (Landesärztekammer Brandenburg) [2017 S7(a)] and by the Ethics Committees of the Federal States the participating hospitals were located in Only results related to the areas of work and activities are listed and discussed with the objective of making this paper easier to understand and accessible we have omitted a discussion of other innovations in the fields of treatment and housing that have nevertheless also occurred in Geesthacht Roughly half of them (n = 19; 51.1%) called themselves employees with lived experience 81.1% had several years of experience as users of the mental health care system in the study region 64.8% (n = 24) of all study participants were female The majority of the participants without lived experience worked in executive positions To guarantee the anonymity of the participants a more detailed presentation of the sociodemographic characteristics was omitted in this paper the results are presented in two parts: Part I explains how participation in the fields of work and activities is ensured in Geesthacht Part II provides the participants' experiences and evaluations This division into two parts does not represent the multiple recursive and circular connections of our analytical codes that made this evaluation very elaborate and interesting It also reduces the lived complexity in Geesthacht where different forms of participation are interlaced with each other citations are marked either by E (employee without lived experience) or ELE (employee with lived experience) Opportunities for work and activities in Geesthacht are described in this section using both citations and figures whereas the evaluations of the participants are reserved for part 2 The form of activity or work varies depending on both clinical requirements and the person's needs and capabilities employees without lived experience are the ones who start looking for activities or work for persons with lived experience: “It's a bit like placing a volunteer or something like that Together with the people that are interested you simply see [what's possible].” (E) opportunities for activities or work evolve from a definite situation or people find out from others that it is possible to work in the mental health care system as a (former) service user: service users sometimes said: ‘Come on let me continue to help out.’” (ELE) it has to do with how people progressively recover […] how people hear about it somehow by word of mouth…” (E) there is a networking group that acts as a hub for work placements and organizes various forms of participation: “[The group on Tuesday] is kind of a group meeting […] if someone says the first step would be to join us in one of these meetings now we have to make a contract’ […] at some point you notice if it works out or not you don't have to report or send an application to participate but first you have to […] get to know each other a little Different opportunities for work and activities may exist and alternate for former service users These opportunities involve different roles and kinds of work that may lead to increasing autonomy in accomplishing tasks and also be financially rewarding “For example it may have started [with cooking]: ‘Back then it was good but it's not really my thing anymore they may go on to do other tasks: ‘I have become pretty stable […] I want to be part of the peer advisory group The transitions between first the use of therapeutic services (in the role of a user/patient) “This lady […] made coffee in the shelter for many years [as part of outpatient occupational therapy] she worked as the supervisor for the Saturday occupational therapy sessions she has been engaged in peer support.” (E) The conditions of expenditure of the regional psychiatric budget allowed for greater flexibility in terms of use and transiting between these stages of the program how resources from the regional budget were used to establish an outpatient care service under the supervision of an employee with lived experience: “There is this nurse manager who was suffering from depression […] who says: ‘I want to do something useful again […]’ ‘and the others said: ‘Okay we need a new nursing service.’ And she got the financial support to build up a nursing service.” (E) The gradual opportunities for work and activities are displayed in Figure 1 The opportunities to participate in the fields of work and activities are shown as a gradient in relation to the implementation of work-related participation and the different roles (i.e. The ABC team makes a flexible change possible between workplaces and tasks occupational support facilities are regulated by the underlying financial structure in each case The opportunities for participation and related financial rewards, if available, can only be addressed descriptively due to limited space. A more detailed description can be found in the Supplementary Table 1 a plethora of different activities for employees with lived experience exist that are continuously evolving Many of these activities do not fall within the definition of peer support and involve areas where experiential expertise is not directly necessary or applied the total share of employees with lived experience has increased through the availability of these different types of work and activities The activities that are offered require and encourage different levels of autonomy and self-determination and can therefore be helpful at different stages of the recovery process through psychiatric nursing or everyday support) or through personal budgets allocated many of these resources were administered by the relevant institutions and could be managed jointly making it possible to hire a number of employees with lived experience The transition from a regional budget to the global treatment budget in 2013 resulted in lesser financial flexibility The system described in this paper requires a certain way of thinking and acting on behalf of the institutions involved The following section consists primarily of thoughts and citations from executive staff (all of them without lived experience) therefore presenting a potentially idealized (and idealistic) image of the Geesthacht model the initiative to make these changes in Geesthacht was based on genuine values of traditional forms of work therapy work has a therapeutic benefit and therefore plays an important role in every person's life: “The idea has always been: everyone wants to be needed Especially people with no opportunities on the regular job market.” (E) I get to go out and get to do something useful.” (ELE) A second principle in Geesthacht is orientation based on the person's needs All processes are geared to the perspective of what the person explains they need and want participation is implemented in daily routines allowing for “organic growth,” which leaves sufficient space for spontaneity “I cannot say that that he is or is not able to do that the people [employees with lived experience] have to know that for themselves.” (E) “You must allow room for chance opportunities.” (E) in many interviews the phrase “let them do it themselves” was articulated This includes encouraging others and oneself to relinquish control and to rely on autonomy and self-responsibility: for me that was the beginning of it all […]” (E) “It is important that you believe in people And that you do not leave them alone.” (E) This “let them do it themselves” attitude is common in Gesthaacht This attitude is important for pragmatic reasons when some of the services in Geesthacht could not have been run without the support of peers involved either due to a shortage of employees or because only employees with lived experience have the necessary expertise: “We had no choice but to ask our patients to support us and take over tasks.” (E) “This used to be some kind of a self-help ward There were some employees but sometimes not enough so service users sometimes had to organize themselves somehow.” (ELE) we used them purposefully to enter into contact with particular patients when we thought we were not able to reach the person.” (E) employees with lived experience often take over unpopular jobs like bureaucracy the jobs that [they] are happy to hand over [to the peers].” (ELE) “There is no additional pay for working on Saturdays That means employees are happy when other people can take over this shift it is give and take and has advantages for everyone.” (ELE) This section reviews the evaluations and experiences of the persons that used the opportunity to participate in the fields of work and activities We primarily present citations by operative employees (vs executive staff reported on in section Philosophy and Mindset above) Although the experiences and evaluations of both groups coincide to some extent fundamental discrepancies became apparent as well which merit description questions related to their role and the changes to their role were central The following citations illustrate how they felt about the position they have within the team the forms of knowledge they were expected to have or were able to apply and the significance of their experience within the teams or the institution: “What is the position of peers within the team This all remains part of an ongoing discussion and debatable.” (ELE) no clear description of the role or expectations of employees with lived experience has been established no well-defined concept of experiential knowledge or expertise has been formalized: a clear role description for peer support is lacking.” (E) what is the unique characteristic of the activities and contributions of people with lived experience And what is the impact when these practices become institutionalized?” (ELE) Given the high level of ambivalence and many role changes the lack of distinct role descriptions was problematic for some of the interviewees: it was really difficult for me to distinguish - am I the patient now or do I work as part of the staff […] It was too much.” (ELE) “It went so far that my boss was simultaneously my therapist […] we framed this with the famous hat trick: ‘Well now I'm wearing the hat of the therapist or of the employee.’” (ELE) “…being both at the same time I lived but also worked in this housing project […] But that's the way it is in real life - I can feel deathly ill and at the same time I can still help you if people with lived experience gain power this naturalness of giving and taking will be restored.” (ELE) As described in section Forms of Employment and Compensation flexible and person-centered funding system is lacking in Germany that would allow for participation of service users in the life of the community The Geesthacht model tries to bridge this gap through creative ways of providing compensation we are aware of the risk that the Geesthacht model could lead to exploitation of employees with lived experience They do important work but are paid only partially or not at all for it: “By now I think that it should be paid […] you'll get [money] at some point when you are really a part of it’.” (ELE) a number of employees with lived experience complained that the financial compensation for their work was insufficient payments varied significantly from person to person “You have to know that peers are far from being able to make a living [with that activity].” (ELE) “Everyone at this table receives a different amount or no payment at all for the same amount of work […] People have totally different arrangements.” (ELE) Connected to the issue of a lack of financial compensation the issue of a lack of respect for their work was brought up by some of the employees with lived experience Some interviewees mentioned that the contributions of people with lived experience were not taken seriously by the other employees the lack of appreciation was shown by the insufficient provision of infrastructures necessary: “We are probably seen as patients who play around a bit and do their own thing without any real value.” (ELE) That is why I sometimes continue to work at home and write there […] You cannot work properly in this office.” (ELE) Some interviewees saw a correlation between the lack of respect and institutional hierarchies others felt a lack of respect on the side of service users: I do not think that we have a good reputation.” (ELE) “Because some people look at me as if I were still a patient the way they talk to me is different than the way they speak with their therapist for example […] less on the same eye-level.” (ELE) The opinions of employees with lived experience varied in terms of their perception of the level and quality of collaboration between employees with and without lived experience Some employees with lived experience described the collaboration as smooth as they were allowed to make choices by themselves giving them space to work independently and autonomously: “Everyone was very much on eye level I never had the feeling that she was the boss or that she ordered me to do anything.” (ELE) there are some situations when you are being told to do something […].” (ELE) Other issues were voiced as well: power struggles controversies regarding competencies required or responsibilities between employees with and without lived experience were reported The fear of being replaced or giving up responsibilities was mentioned as a reason for this phenomenon: Is he allowed to have a key?” (ELE) “Only 10% of the working hours may be done by peers […] This shows that the [employees] are simply afraid of losing their jobs And that could be prevented with new rules.” (ELE) employees with lived experience repeatedly felt that they were obliged to assert their own perspectives forcefully: “I often face the problem that when I get a certain impression of a patient and I mention this to the team […] And then I have to find a way […] to still assert myself.” (ELE) many employees with lived experience reported that they did benefit from the opportunity to work: I could not imagine sitting at home all the time.” (ELE) “My self-image became more positive And I am not that sad any more about the fact that I'm not employable or cannot be placed on the regular job market.” (ELE) employees with lived experience felt they were perceived more positively by the other employees than if they had simply remained a patient This is seen as a helpful development in the process to break down the rigid boundaries between employees without lived experience on the one hand and employees with lived experience on the other hand: “I am really happy that I am not just perceived in my role as a patient but also as someone who is engaged as a peer Now I don't feel like I'm walking around being stigmatized as a patient.” (ELE) work was experienced as a burden and as demanding: “You hear a lot about the problems [with peer support] […] you will still be confronted with this.” (ELE) Patients in occupational therapy usually have drug issues We even asked for help from the ward sometimes difficulties setting boundaries were mentioned: “Setting boundaries is a big topic for me because I am very sensitive I learned to turn my sensitivity into a strength it is difficult for me to set boundaries.” (ELE) There is not a systematic network among the employees with lived experience Some of the interviewees mentioned that the other employees without lived experience did not want this kind of exchange to occur: “The institutions do not want this they don't want peers to sit together across the entire institution they are working in Because they think that this automatically means that the institutions would be discredited.” (ELE) some networks have been established independently or at a limited scale: The whole system will collapse.” (ELE) some employees with lived experience perceive support among themselves as good: “It is a nice way of being together Connected to this lack of networking is the criticism that the participation model in Geesthacht has not been planned systematically enough and needs further development Defined structures with a clear and sufficient place for employees with lived experience have not been established yet: “That is the biggest mistake we have made […] We did not structure the program there are too many loose ends.” (E) I do see peers as set parts of the teams who can participate in supervision or in the planning of processes of change just as everyone else can.” (E) this lack of systematization requires a systematic evaluation of what has (and has not) been achieved: “That we look at it: what was good “Organic growth” t in Geesthacht over the last 13 years has led to the development of a care model that enables and promotes the participation of people with lived experience of crises and disabilities in the fields of work and activities This care model aims at supporting people by fostering an active and autonomous life in their primary care setting right from the start with the objective of making them less and less dependent on institutional support and in a sustainable way These goals and principles regard the activities in Geesthacht in the field of work and employment but also the different forms of assisted housing that have been established over years combining aid from community services and volunteers with forms of home treatment thereby enabling support in the services user's own environment and social interaction of people who are isolated The labor market still holds enormous barriers and access restrictions for people with psychosocial disabilities the unemployment rate of this group of people is disproportionately high as are their possibilities for societal participation allowing for gradual and often peer-based support for people with mental health crises and psychosocial disabilities this paper focusing on the gradual development of the Geesthacht model over years as a response to the German-specific historical or contemporary health service and political developments a detailed comparison will be deliberately omitted in favor of a comprehensive discussion of its conditions of development as well as its inherent tensions and ambivalences The model of participation in Geesthacht was developed through a stepwise process leading to changes in institutional culture and its characteristics which thus vary depending on the institutions involved and the time The fact that there was no central management of this process led to many instances of chaos and temporary (or long-lasting) solutions that are both satisfying as an achievement the chaos involved can also be interpreted as a driving force and a necessary condition to enable a flexible daily-life and person-centered model of support in Geesthacht we believe that the model can be seen as a constructive attempt to further de-institutionalize mental health care with the focus on adapting psychiatric care to the lives of the people in care instead of subordinating them to a rigid set of institutional rules The stated aim is to strengthen the autonomy and self-determination of the people who need support when experiencing mental crises and disabilities which is certainly not always the case in Geesthacht The development of the Geesthacht model started at a time when the principles enshrined in the CRPD as well as the various critical approaches to the existing psychiatric care system were neither formulated nor well-known it inheres conceptual tensions that will be further elaborated upon in the next subchapter of this discussion The change of paradigmatic embedding of the psychiatric care system over the past 40 years has led to a progressive enrichment of concepts initially drawing on ideas of the era of de-institutionalization and gradually turning into more human rights-oriented models over the years This evolution has resulted into a variety of co-existing work and support models that consequently draw on a wide spectrum of rationales is of contemporary importance as most people who experience mental crises and disabilities are still employed in sheltered workplaces (rather than supported employment) continue to live in asylums or residential care homes (instead receiving supported housing) or remain hospitalized (instead of receiving home treatment) Fundamental to the changes in Geesthacht were adjustments to the budget allocation system for public hospitals. Care budgets previously based on either the number of days of care or the intensity of care were first supplemented with a regional mental health care budget in 2007, which was then encompassed in a global treatment budget from 2013 to 2019 (9) Thanks to flexibility allowed in terms of how the global budget was applied it has been possible to establish a complex network of opportunities for participation and activities for people with lived experience a certain mindset and certain principles of the people involved were equally important: leaving room for spontaneity and serendipity and for processes to develop as well as the deep-seated conviction that participation and activities are important existentially to all people are only a few examples of an overall strongly ideological and value-based approach in Geesthacht the project would not have evolved in this way some of the benefits of the Geesthacht model of participation can be explained by the variety of tensions we found ourselves in varying emotional states that were subject to rapid change on several occasions and sometimes discontent occurred in rapid succession the divergence of perspectives of the different actors interviewed became apparent While the statements made by those who were operational employees (with and without lived experience) were mainly related to their work tasks and the project which they evaluated critically the executive staff (all without lived experience) tended to focus on the values and principles of this project This difference represents one part of the enormous complexity and the contradictions that are characteristic of the Geesthacht model Geesthacht is characterized by a high willingness to take risks to dare to try new things and to see that they are done Employees with lived experience are trusted and given space to find their own way and shape their own lives Instead of pre-planning or over-regulating participation and involvement in detail opportunities for activities and work can grow organically between the parties involved from concrete situations as well as from relationships that have grown over time this approach has led to a lack of clear structures and responsibilities to date Responsibilities often remain vague and there are no fixed formats for networking or supervision leaving employees with lived experience sometimes alone with the question whom to approach Another area of conflict concerns the lack of a clear separation between therapy and work It is possible for the service users in Geesthacht to participate early on during their hospital care by taking over tasks The same or other activities may be continued after discharge and at times Many problematic situations are possible along the way it remains a fact that for some of the employees with lived experience no other avenue of participation or work would have been possible the employees with lived experience are involved as much as possible during these transitions between therapy and work: in each case they make decisions themselves or at least say they are ready to go along with them A third example of the many forms of ambivalence felt toward the Geesthacht model is the way in which the different roles change into another which can be very challenging for all participants The citation above from one of the employees with lived experience who continued her paid employment even at a time when she was experiencing a crisis illustrates these tensions often it is impossible for persons to differentiate between their identity of service user and employee a fact that involves both opportunities and risks We were surprised that only a few persons interviewed evaluated these tensions negatively suggesting that the demarcation between (“ill”) patients and (“healthy”) employees—a demarcation common in mental health care—played a minor role in Geesthacht the question is whether more regulation in Geesthacht would have led to a better model Clear rules and structures always involve the risk of establishing rigid roles and opportunities and open character of the Geesthacht model of participation was possible primarily because local structures and processes evolved in their own ways with the responsibility to manage the various projects being left up to the participants themselves Due to a variety of regulations and laws that have been implemented in recent years in Germany such an approach has become less feasible in the inpatient sector in spite of the fact that it has positive effects as demonstrated which is possible in Geesthacht right from the beginning of treatment tolerating risks and the willingness to take responsibility are substantial parts of the relationship and finding new methods with unknown outcomes is explicitly permitted The application of “mental health care as an on-going project” entails risks as well If people are not able to communicate their needs if power relations and dependencies are not dealt with transparently then those people who already have little influence in the care system may be the ones who continue to suffer There is significant room for improvement regarding these issues remaining in Geesthacht as well To what extent the openness and vibrancy of the project could be lost when dealing with these issues remains to be seen As described, the Geesthacht model also works well because many of the roles and opportunities for participation are not well-defined or clearly established. Therefore, it remains uncertain to what extent the employees with lived experience are actually working in accordance with the principles and methods of peer support (42) some of these employees have received prior no conclusions could be drawn from the interviews despite the fact that the issue was addressed frequently the danger of employees with lived experience being instrumentalized and asked to “toe the line,” but on the other hand this loose framework also constitutes part of the spirit behind the project Whether this ambiguity also represents added value in developing the field of peer support could be the subject of further research the scope of this contribution allows us to cover in detail only those opportunities to participate in the fields of work and activities in Geesthacht We have not reported here the significant results that we believe have also been achieved in the areas of participation in housing and treatment In relation to the earlier question of whether the model described meets the standards of the CRPD we will therefore only consider this area of participation in the areas of work and activity it depends on the individual case to what extent equal rights are applied in Geesthacht and how power imbalances play a role accessibility of the various options for participation and to what extent work is compensated appropriately Maybe it is precisely here that there is a clear need to catch up if the concepts of the CRPD are to be applied across the board Geesthacht is a place where the boundaries between employees and service users are drawn less strictly relationships have been built up for years that transcend the traditional therapist and patient roles which in many places continue to exist strongly and are very separate from one another a common sense of belonging in work and life and not only of analytical value and should serve as a model for the implementation of projects elsewhere In terms of compliance with the principles of the CRPD the situation of (former) service users in Geesthacht regarding participation in work has improved considerably This model has allowed them to become a substantial part of an activity-related and social network and the model in Geesthacht reveals the existing barriers to implementation of equal opportunities even in the presence of strong motivation and the intense commitment of all participants Many things remain to be done that must be initiated and managed structurally The datasets underlying the current study are not publicly available due to the used data protection declaration and the nature of qualitative interviews where individual participants could be possibly identified. Parts of the dataset are available from the research group on reasonable request. Requests to access the datasets should be directed at Sebastian von Peter, c2ViYXN0aWFuLnZvbnBldGVyQG1oYi1mb250YW5lLmRl The studies involving human participants were reviewed and approved by Ethics Commission of Medical School Brandenburg Theodor Fontane; Institutional Ethics Committee of the Carl Gustav Carus University Dresden The patients/participants provided their written informed consent to participate in this study SP and JS drafted the first version of the manuscript. SP was responsible for the background, result, and discussion section. JS drafted material and methods and developed tables, figures, and Supplementary Material All authors were involved in preparing and conducting the present part of the PsychCare study critically reviewed and commented on the manuscript and read and approved the final version of the manuscript This study was funded by the Federal Joint Committee (G-BA) Innovation Fund in Germany (grant reference no The funder had no role in the design of the study and is not involved in its execution The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2021.634080/full#supplementary-material 1. ^Beeker T Conducting a process evaluation coproduced by people with lived experience of mental distress – a metareflection and methodological concept 2. ^Additional income is a capped amount that a person receiving a disability pension is allowed to receive for short-term or marginal employment 3. ^A mini-job is a marginal job with a maximum income of 450 Euros per month or short-term employment for a few weeks or months 1. 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Penny D. Defining “Peer Support”: Implications for Policy, Practice, and Research. (2018). Available online at: https://www.ahpnet.com/AHPNet/media/AHPNetMediaLibrary/White%20Papers/DPenney_Defining_peer_support_2018_Final.pdf (accessed April 11 Google Scholar Habicht J and Schwarz J (2021) Supported Employment Participatory Case Study Report of the Geesthacht Model Received: 26 November 2020; Accepted: 23 March 2021; Published: 23 April 2021 Copyright © 2021 von Peter, Göppert, Ziegenhagen, Beeker, Glück, Groth, Groß, Reinholdt, Boerma, Heißler, Habicht and Schwarz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) distribution or reproduction in other forums is permitted provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited in accordance with accepted academic practice distribution or reproduction is permitted which does not comply with these terms *Correspondence: Sebastian von Peter, c2ViYXN0aWFuLnZvbnBldGVyQG1oYi1mb250YW5lLmRl Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish The news: Pathology services provider Sonic Healthcare has signed binding agreements to acquire Germany’s Laboratory Group Dr Kramer & Colleagues (LADR) for an enterprise value of €423 million ($698.6 million) The numbers: Sonic said it would issue shares in the company to the sellers worth a maximum of €222 million which would be funded from Sonic’s existing cash and debt facilities The transaction is expected to be immediately earnings per share (EPS) accretive reaching high single-digit percentage accretion after three years Sonic said the return on invested capital (ROIC) will significantly exceed its cost of capital once synergies are achieved The context: Sonic said there is strong cultural and operational alignment between its German business and LADR with significant synergy potential in multiple areas of operations LADR is one of the top five medical laboratory groups in Germany with more than 2,800 full-time equivalent staff with its central laboratory located in Geesthacht providing high-quality testing services delivered through a network of stand-alone and hospital-based laboratories throughout Germany LADR also has a presence in Poland and a small joint-venture interest in Finland The Polish laboratory is majority owned by LADR and operates under the brand ‘badaj.to’ and is believed to be the fourth largest laboratory group in Poland with annual revenue of €30 million Sonic will also get a 15% interest in a separate German medical laboratory business Sonic will inherit a put/call structure for the remaining 85% of equity in this group with expected cash outflow for this transaction to be €55 million by calendar year 2027 The source: ASX announcement is to build a new silicones plant at its Geesthacht site in Northern Germany multi-purpose silicones manufacturing facility (expected to be operational by the end of 2019) will be a “double-digit million-euro” investment for the company though it declined to give an exact figure at this stage The facility will provide additional capacity for Evonik’s range of silicones and silane-terminated polymers which the company sells under the brand names Polymer VS and Polymer ST head of the interface and performance business line at Evonik said: "The planned investment at the Geesthacht site has an important strategic significance by helping us to further strengthen our focus on innovative specialty chemical products" In addition to the silicones build the company is building a facility for filling tank trucks at the Geesthacht location head of the polymer and construction specialties product line: “this will simplify the delivery and storage process for our customers and in doing so increases efficiency “The additional production capacity will also create room for us to develop new products…and to react to future demands in the adhesives and sealants market.” The Geesthacht site will focus on silicones and nanotechnology Addition- and condensation-curing silicones along with silane-terminated polymers are used as binders in adhesives and sealants and have applications in electronics and medicine Silica-based nanomaterials also have a range of applications including use as property-enhancing additives in fibre composites in the automotive and aerospace industry Evonik acquired the Geesthacht site when it bought Hanse Chemie in 2011 which became fully integrated into the Evonik Group in 2016 The upgrades to the facilities and capabilities of the site represent the next phase of Evonik’s investment Article by Amanda Jasi Covestro to build world-scale MDI plant Johnson Matthey set targets to lower waste and improve safety on journey to net zero UK sets up centre to advise on critical minerals, amid warnings of supply risks US aims to create semiconductor manufacturing clusters by 2030 Singapore "model factory" to help SMEs Process Engineer - 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Take part in our reader survey By 2021-03-01T14:27:00+00:00 Scientists in Germany have created an alloy with an exceptionally low corrosion rate – lower than ultra high-purity magnesium – that they say approaches stainless magnesium by alloying pure magnesium with tiny amounts of calcium abundance in the Earth’s crust and excellent electrochemical properties biomedical and energy-storage applications magnesium’s weight makes it attractive from a sustainable perspective – it is significantly lighter than aluminium so replacing aluminium with stainless magnesium in cars and aeroplanes could reduce fuel consumption and carbon dioxide emissions using magnesium on an industrial scale is limited because it corrodes in aqueous environments Source: © Daniel Höche/Helmholtz-Zentrum Geesthacht The team tested their new alloy alongside two commercial alloys by immersing them in 3.5wt% NaCl solution for 6 months ‘Our magnesium–calcium alloys were prepared by conventional casting processes,’ explains Min Deng from the Helmholtz Centre for Materials and Coastal Research in Geesthacht ‘Pure magnesium and pure calcium were melted at high temperatures in a steel crucible the new alloy retains the properties of pure magnesium it can resist corrosion because the calcium reduces the cathodic water reduction kinetics allows the development of a protective surface film and stabilises impurities (such as iron and silicon) within the alloy the processing route for [our] magnesium–calcium alloy with [its] superior performance is quite simple The alloy could have ‘biomedical applications, such as scaffolds and implants, because it seems to reduce significantly the formation of hydrogen bubbles, [which are] common in existing magnesium implant materials, [and] the formed corrosion products are not expected to be toxic,’ comments Polina Volovitch who studies corrosion at Chimie ParisTech in France ‘Application in aqueous batteries could also be [possible].’ ‘Practical applications of stainless magnesium are many and varied. Certainly portable electronics come to mind, but as a wonder material, the world is magnesium’s oyster,’ adds Nick Birbilis who specialises in material sustainability and corrosion science at the Australian National University so let’s see what magnesium will bring us.’ This article is free to access until 12 April 2021 M Deng et al, Mater. Horiz., 2021, 8, 589 (DOI: 10.1039/d0mh01380c) Site powered by Webvision Cloud Scientists of the Geesthacht GKSS Research Centre have developed a radar system with which it is possible to study the behaviour of sea waves This technology will be used immediately on the North Sea on the FINO3 research platform in order to determine the interactions between offshore wind power machines and swells The location of the FINO3 research platforms is located approximately 80 kilometres to the west of Sylt where up to 80 wind power plants will be located in just a few years FINO3 is used by researchers to estimate the environmental consequences and technical risks of offshore wind energy parks Changes in the sea swell are also of great interest in addition to the observations of bird migration or the measurement of lightening frequencies on the sea To determine how much of an effect large waves and what is known as 'breakers' have on wind power plants and to what extent the structures can change the surrounding swell the coastal researchers of the Geesthacht GKSS Research Centre installed a Doppler radar approximately 50 metres above sea level on the FINO3 lattice mast we can even track the individual waves for the first time" GKSS Department Manager of Radar Hydrology Ziemer and his team have studied the swell and the behaviour of large breakers The information is transmitted by FINO3 to Geesthacht via satellite The frequency of large breakers and the force which creates the steep giant waves are of particular interest not only to researchers but also the designers and operators of offshore wind power plants or oil platforms Each individual wind rotor creates turbulent air flows in its "tow" and periodical movements which can have an effect on other structures This can result in undesired or even dangerous vibrations If there is an interaction between the waves and the individual wind power plants This means in a wave field which is harmless without a windmill park very high waves can be created by these interferences which could possibly have a critical effect on these plants "I am sure that we will soon be able to better assess the swells and the force of the breakers," says Friedwart Ziemer This means that the breaker behaviour could be taken into account better in planning and the stability of the systems can be more predictable Solid position on the COSYNA North Sea monitoring system The FINO3 research platform will be an important component in the new COSYNA measurement network initiated by GKSS A comprehensive monitoring system will be created in the German North Sea area to record predict and provide scientific analysis of the current state and development of the coastal waters with the major COSYNA project (Coastal Observation System for Northern and Arctic Seas) FINO3 will provide the Geesthacht coast researchers information on seafaring and the wind The Doppler radar technology was developed by the GKSS employees in unison with the Technical University of Saint Petersburg The initial test readings with the new wave radar from the shore have already been carried out successfully are not responsible for the accuracy of news releases posted to EurekAlert by contributing institutions or for the use of any information through the EurekAlert system Copyright © 2025 by the American Association for the Advancement of Science (AAAS) There is a potential for solar power of up to five megawatts in total at Vattenfall’s pumped storage plants in Germany and the first project has now been launched at the pumped storage plant in Geesthacht near Hamburg Aerial photo of Geesthacht pumped storage plant with solar plant to the left of the water pipes Vattenfall is further expanding its solar electricity generation and is currently checking the extent to which areas at the company's German pumped storage plants are suitable Vattenfall experts are currently determining the potential for around five megawatts of new solar power generation in total This includes free space at the pumped storage dams photovoltaic systems on the roofs of operating buildings as well as free space on previously unused areas The pv@hydro project has started at the Geesthacht pumped storage plant on the Elbe in Schleswig-Holstein The existing solar modules have been replaced with new higher-performance modules as part of a repowering scheme and on top of that the plan is to install further photovoltaic modules with an output of close to 2 MW at the upper reservoir dam in Geesthacht Additional photovoltaic systems may later be added to the pumped storage plants in Wendefurth (Saxony-Anhalt) Hohenwarte (Thuringia) and Markersbach (Saxony).Peter Apel CEO of Vattenfall Wasserkraft GmbH: "Vattenfall aims to be fossil free within one generation That's why it makes sense for us as a company to further promote the expansion of renewable energies particularly in regions where we have already been a firm part of the local energy infrastructure for decades through our pumped storage plants." the solar energy is thus not used to operate the pumps at the pumped storage plant but fed into the grid through the pumped storage plant’s existing grid connection Head of the Solar & Batteries unit at Vattenfall adds: "We find very good conditions for the construction of photovoltaic systems at the pumped storage plants The use of the existing technologies leads to synergies that can also benefit the profitability of such projects PV@hydro is an excellent example of how the existing and new energy worlds can be combined within the scope of the energy transition in Germany." Vattenfall has further solar projects in the pipeline or already underway the company is building around 30 MW of new photovoltaic facilities in 2018 Vattenfall plans to invest some €100 million in expanding solar energy in 2018 and 2019 excess electricity generated in the electricity system can be used to pump large amounts of water from a lower reservoir to an upper reservoir where it is stored as potential energy When additional electricity is needed in the system water can be released from the upper reservoir through the huge water pipes that also brought it up to the upper reservoir and used to propel the turbines installed at the lower reservoir In contrast to hydro power plants located in rivers there is no natural inflow to the upper reservoirs of pumped storage plants The capacity of the wind power plants and solar plant installed in Germany is continuously increasing Thanks to the further expansion of the renewable energy sources there will be an increasing need for storage capacity as well as the short-term availability of balancing energy to stabilise transmission networks in future Hydro in Germany operates eight pumped storage power plants Vattenfall’s market share in total installed pumped storage plant capacity in Germany is roughly 40 % (3,000 MW of 7,000 MW in total) Vattenfall’s power plants Cement currently accounts for 8 per cent of the world's carbon dioxide emissions – but if you look at the research and the progress in the industry Researcher Josie Harrison is developing an AI-model  to facilitate the reuse of already extracted materials As the operating life of existing Swedish nuclear reactors is being extended to 80 years the availability of spare parts will be crucial Contact us LinkedIn YouTube Instagram Facebook Vattenfall is a European energy company with approximately 21,000 employees For more than 100 years we have electrified industries supplied energy to people's homes and modernised our way of living through innovation and cooperation More about Vattenfall Das Helmholtz-Zentrum Hereon in Geesthacht betreibt internationale Spitzenforschung für eine Welt im Wandel: Rund 1.000 Beschäftigte erschaffen Wissen und Innovationen für mehr Resilienz und Nachhaltigkeit – zum Wohle von Klima Das wissenschaftliche Spektrum des Hereons umfasst Hochleistungswerkstoffe Verfahren und umweltschonende Technologien für die Mobilität und neue Energiesysteme Darüber hinaus werden Biomaterialien für die Medizin und zur Steigerung der Lebensqualität erforscht Mithilfe von Forschung und Beratung begegnet das Hereon den Herausforderungen des Klimawandels lösungsorientiert und ermöglicht über ein umfassendes wissenschaftliches Verständnis ein nachhaltiges Management und den Schutz der Küsten- und Meeresumwelt Der Weg von der Idee zur Innovation führt über Experimentalstudien, Modellierungen und künstliche Intelligenz bis hin zum Digitalen Zwilling Damit wird interdisziplinär der Bogen vom grundlegenden wissenschaftlichen Verständnis komplexer Systeme hin zu Szenarien und praxisnahen Anwendungen geschlagen In Schleswig-Holstein ist das 1956 gegründete Zentrum die größte außeruniversitäre Forschungseinrichtung Neben dem Hauptsitz in Geesthacht und dem Campus Teltow bei Berlin hat das Hereon Außenstellen in Hamburg Prozent beträgt der Frauenanteil bei Hereon Die Küstengebiete im globalen Wandel Küstenschutz an Nord- und Ostsee bei Meeresspiegelanstieg Künstliche Muskeln für Roboter Die Entwicklung von Biomaterialien für die Regeneration des Körpers Küsten als Lebens- und Wirtschaftsraum bewahren Leichtere Autos und Flugzeuge bauen, um das Klima zu schonen Ein weltweit einzigartiges Forschungsschiff bauen Mit KI neuartige, ressourcenschonende Materialien schneidern Die Stadt der Zukunft auf das Klima der Zukunft vorbereiten Das Welt-Klimawissen in regionale Modelle übertragen Die Entwicklung einer ultrastarken Bio-Faser als Ersatz für Kunststoffe Die Konstruktionspläne der Natur verwenden ein Ziel: Wasserstoffexperte Thomas Klassen und der Batteriewissenschaftler Martin Winter im Gespräch über die Autos der Zukunft die Chancen der Antriebstechnologien – und die größten… Max-Planck-Straße 1 21502 Geesthacht