Enthospitalisierungsprozesse in deutschen psychiatrischen Großkrankenhäusern

Abstract

The process of discharging previously long-term hospitalized patients from German state mental hospitals, and of transferring these patients to other forms of supported housing has meanwhile come to its end. Therefore, this paper presents an overview of the scientific evaluation of this process. By using clearly defined research methodological criteria, eight empirical studies from several German federal states are assessed focusing on the meaningfulness of their results. Because of the heterogeneity of the aims regarding contents of this transformation process, of the research methodological approaches, and of the characteristics of the assessed patient groups, only few general results could be identified. Chronically mentally ill patients (mostly suffering from schizophrenic disorders) who had been successfully discharged to the community were younger, and showed shorter periods of illness and hospitalization than control patients. After discharge they might have experienced positive changes of their objective and subjective quality of life and of their perceived needs of care. Referred to several other outcome domains, no homogeneous tendencies concerning clinically relevant improvement or deterioration were found. In particular, changes related to psychopathological symptoms and social competencies were generally small. However, mortality and re-hospitalization rates of de-hospitalized patients were considerably high, and ranged between 3-24 %, and 4-46 %, respectively. The assessed studies could not identify replicated predictors of successful de-hospitalization. Female sex and long-term last hospitalization seemed to be important for stable placement in forms of supported housing requiring a higher level of autonomy. From the generally unclear procedural quality of the German deinstitutionalization process, the authors deduce implications for the scientific evaluation of future projects of restructuring mental health care services. Besides the clear definition of empirically assessable aims which should be based on theoretical considerations, it is of utmost priority to guarantee high performance quality of research methodological standards.

Hospitalization of patients with schizophrenic and affective disorders in Israel in the aftermath of the structural and rehabilitation reforms

“…During the last half century, psychiatric reforms, intending to integrate the mentally ill into the community [1-4], as well as the development of new neuroleptic drugs [5] reduced significantly the importance of inpatient care for people with severe mental disorders [6,7]. …”

Psychiatrische Zentrale Funktionseinheit - Modellprojekt zur Optimierung der Versorgung psychiatrischer Patienten innerhalb von psychiatrischen Großkliniken

“…Here we present a model project to solve this problem: a new treatment unit has been created which not only ensures the psychiatric ambulatory care of three urban districts but is also the central psychiatric emergency admission as well as being the portal and pilot unit for over 560 hospital beds. Hier findet sich ein weiteres wichtiges Forschungsziel [14]. An evaluation of epidemiological, psychopathological and economical factors of the new concept will be established.…”

„Behandelt und gefördert oder verwahrt und vergessen”– Die psychiatrische Versorgung der Bewohner eines psychiatrischen Heimes im Längschnitt

“…Trotz allgemeiner Bekenntnisse zugunsten einer nichtinstitutionellen, gemeindenahen Versorgung von Menschen mit schweren psychischen Erkrankungen, ist in Deutschland die Anzahl an in psychiatrischen Heimen lebenden psychisch Kranken höher als die Anzahl der in psychiatrisch betreuten Wohngemeinschaften wohnenden Menschen; diese Schere hat sich in den letzten Jahrzehnten trotz Deinstitutionalisierung von psychiatrischen Krankenhäusern vergrößert [1][2][3][4][5][6][7][8]. In diesem Zusammenhang ist festzustellen, dass die Rate an vorgehaltenen Wohnheimplätzen in einzelnen Regionen Bayerns im deutschen Vergleich überdurchschnittlich hoch liegt [9].…”