Contrary to the practice in some countries, access to flexible and integrated forms of psychiatric care (FIT models) is limited in Germany. Several legislations have been introduced to improve this situation, notably the recent §64b (flexible and integrative treatment model; FIT64b) of the German Social Code, which allows for a capitation-based accounting of fees for services. The aim of this study was to explore the effects of FIT64b implementation on various stakeholders (patients, informal caregivers and staff) in 12 psychiatric hospital departments across Germany. Structural as well as quantitative and qualitative data are included, with integration of different methodological approaches. In all departments, the implementation of the new accounting system resulted into a relatively stable set of structural and processual changes where rigid forms of mainly inpatient care shifted to more flexible and integrated types of outpatient and outreach treatments. These changes were more likely to be perceived by patients and staff, and likewise received better evaluations, in those departments showing higher level or longer duration of implementation. Patients' evaluations, furthermore, were largely influenced by the advent of continuous forms of care, better accessibility, and by their degree of autonomy in steering of their services.

BackgroundFlexible and integrative treatment (FIT) models are rather novel in German mental health care. This study aimed at identifying and evaluating empirically based, practicable, and quantifiable program components that describe the specific treatment structures and processes of German FIT models.MethodsA multi-step, iterative research process, based on Grounded Theory Methodology (GTM), was used to identify and operationalise components. A complex algorithm and expert-interviews were applied to quantify the relative weight of each component and to develop a sum score. Face and content validity were examined and internal consistency was tested by Cronbach’s α coefficient.ResultsTen of eleven FIT components could be operationalised, quantified and united in the total score. All operationalised components showed sufficient face and content validity and eight components had a good reliability.ConclusionsThe components are a first step in the process of operationally defining German FIT models. They considerably overlap with various critical ingredients of international FIT models and may serve as a theoretical basis for constructing fidelity tools and research guides to enable process and outcome evaluation of German FIT models.

BackgroundGeneral psychiatric and forensic psychiatric beds, supported housing and the prison population have been suggested as indicators of institutionalized mental health care. According to the Penrose hypothesis, decreasing psychiatric bed numbers may lead to increasing prison populations. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change, and to explore whether the data are consistent with the Penrose hypothesis in that historical context.Methodology/Principal FindingsGeneral psychiatric and forensic psychiatric bed numbers, supported housing capacities and the prison population rates were collected in Azerbaijan, Belarus, Croatia, Czech Republic, East Germany, Hungary, Kazakhstan, Latvia, Poland, Romania, Russia and Slovenia. Percentage change of indicators over the decades 1989–1999, 1999–2009 and the whole period of 1989–2009 and correlations between changes of different indicators were calculated. Between 1989 and 2009, the number of general psychiatric beds was reduced in all countries. The decrease ranged from −11% in Croatia to −51% in East Germany. In 2009, the bed numbers per 100,000 population ranged from 44.7 in Azerbaijan to 134.4 in Latvia. Forensic psychiatric bed numbers and supported housing capacities increased in most countries. From 1989–2009, trends in the prison population ranged from a decrease of −58% in East Germany to an increase of 43% in Belarus and Poland. Trends in different indicators of institutionalised care did not show statistically significant associations.Conclusions/SignificanceAfter the political changes in 1989, post-communist countries experienced a substantial reduction in general psychiatric hospital beds, which in some countries may have partly been compensated by an increase in supported housing capacities and more forensic psychiatric beds. Changes in the prison population are inconsistent. The findings do not support the Penrose hypothesis in that historical context as a general rule for most of the countries.

These components can be used for implementation, quality management and evaluation of projects for treatment models according to § 64b SGB V.

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Zusammenfassung Ziel Untersuchung des Implementierungsstands und der Erfahrungen der Stakeholder mit der Zuhause-Behandlung (=ZHB) in der Modellversorgung nach §64b SGB V (=MV). Methodik Standardisierte Befragung von 381 Patienten aus 8 Kliniken der MV und inhaltsanalytische Auswertung von Fokusgruppen und Interviews mit Patienten, Angehörigen und Mitarbeitern (n=37). Struktur-, prozess- und leistungsbezogene Daten wurden ergänzend abgefragt. Ergebnisse Die ZHB der MV ist äußerst heterogen implementiert, insbesondere zwischen ländlichen und städtischen Regionen. Aus Sicht der Stakeholder wird eine längerfristige, flexible und settingübergreifende Versorgung geboten, die alltagsintegrativ wirkt und häufig erst mit zunehmender Inanspruchnahme als hilfreich bewertet wird. Schlussfolgerung Eine starke Orientierung an den Bedürfnissen der Patienten und regionalen Besonderheiten zeichnet die ZHB aus. Es lassen sich Implikationen zur Weiterentwicklung von stationsäquivalenter Behandlung ableiten.

Background: The 28-item General Health Questionnaire (GHQ-28) is a scaled version of the General Health Questionnaire that has been used internationally to screen for mental disorders in nonpsychiatric populations. There is great need to validate international screening instruments in the Russian language for their use in post-Soviet countries. Methods: 200 persons were surveyed in a deprived area of Almaty, Kazakhstan using the Russian version of the GHQ-28 and socioeconomic measures (income level, employment situation and education). We calculated the median and the mean GHQ-28 scores for different socioeconomic subgroups. The internal reliability was tested using Cronbach’s α coefficient and intersubscale correlations. We conducted an exploratory factor analysis using varimax rotation. Results: The median score of the GHQ-28 was 2 (mean = 3.56; SD = 5.09) for the total sample. Higher age, unemployment and female gender were significantly associated with high mean GHQ-28 scores. Cronbach’s α coefficient was 0.92 for the total scale. Exploratory factor analysis revealed four factors explaining 50.07% of the variance. The factor Anxiety/Insomnia accounted for 14.87%, Severe Depression for 13.74%, Social Dysfunction for 13.47% and Somatic Symptoms for 8.81% of the variance. Conclusions: The test showed good internal consistency. The median GHQ-28 score was relatively low compared to other countries. The subscale Severe Depression including items on suicidal ideation may have a lower acceptance than the other subscales Somatic Symptoms, Anxiety/Insomnia and Social Dysfunction.

Zusammenfassung Ziel Bundesweit gibt es 19 Modellvorhaben nach §64b SGB V (MV), die eine settingübergreifende und flexible psychiatrische Behandlung anbieten. In Schleswig-Holstein (SH) haben sich fünf dieser Modelle gebildet. In einer vergleichenden Analyse wird die Implementierung der MV in SH gegenüber dem Bundesgebiet untersucht. Methodik Standardisierte Befragung von 383 Patienten aus sieben Kliniken, davon drei aus SH, zur Beurteilung der Modellversorgung. Es wurden Struktur-, Leistungs- sowie Daten zum Implementierungsstand von MV in SH und den übrigen Bundesländern analysiert. Ergebnisse MV in SH weisen eine stärkere Ausprägung modellspezifischer Merkmale und einen höheren Implementierungsgrad gegenüber der Vergleichsgruppe auf. Sie befinden sich in öffentlicher Trägerschaft und sind mit allen Krankenkassen verhandelt. Patienten dieser MV werden häufiger ambulant oder aufsuchend behandelt, verfügen über mehr Erfahrung mit spezifischen Aspekten der MV und bewerten diese besser. Schlussfolgerung Die Implementierung der MV in SH kann als besonders erfolgreich angesehen werden. Unter anderem scheint die Unterstützung der Landespolitik eine entscheidende Triebkraft hierfür zu sein.