The phenomenon of mentally ill physicians is hardly noticed in Germany today-a fact that possibly indicates a taboo. This investigation is to reveal the importance of the subject by referring to the findings of several major studies. Epidemiological data turn out to be of little reliability regarding for instance the number of impaired physicians with a range between 0.5-46%. Addiction and substance abuse can be found in 90% of all cases of mental illness. Increased suicide (3-4x), divorce (20x) and addiction rates (according to some authors 30-100x) in comparison with the average population emphasise the necessity of further investigation. These facts imply the question whether doctors are mentally more vulnerable than their patients. Special difficulties in treating doctor-patients deserve attention as only little is known how appropriate "iatrotropic" (psycho-)therapy can be carried out effectively.
The mental health care structures and practice in lIaly Hmnenthal Mandelli,Ina (Cologne! Germany), Munizza, Carmme (Turinolltaly), Schmidt,Roger(Konstanz/Germany) italian Psychiatry got famous in 1978 as consequence of the radical Basaglian Psychratnc reform by the law/legge 180 Before thrs reform the old psychiatric insutunonszmamcomi m Italy have been m a bad condiuon and highlyovercrowded. That time the bed-to inhabitants-rate was In lIaly approximately three limes higher than m the most other Western European countries. These facts made the reforms more urgent All obligatory structural changes were mtroduced together With the new organl7.allon of the whole health system based in sectonzanon in U S LI Unila Samtana Locale(one for 80 000-130000 inhabnants) The psychiatric bospuahzatron facilities wereextremelyreduced to small units of max 15 beds per U S L , which got integrated into general hospitals The importance of out pallent servicesincreased definitely. Out patient services and the 15bed units were led by the same learn In those years of structural changes the discussron about psychiatry was mamly political, but it is changmgnow. getnng more professional and scientifically based. The present state of experiences wtth the renewed Italian mental health care system will be reported With the strikingadvantages as well as with some possible disadvantage.
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