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Mental health care in Germany

Current state and trends

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Abstract

Germany turned towards community-based mental health care in the mid seventies, during a general climate of social and political reform. The continuing deinstitutionalisation process and the implementation of community mental health services was considerably affected by the reunification of East and West Germany in 1990, which required dramatic changes in the structure and quality of the mental health care system of the former German Democratic Republic (GDR). Overall, German mental health care is organised as a subsidiary system, where planning and regulating mental health care is the responsibility of the 16 federal states. So German mental health care provision is spread among many sectors and characterised by considerable regional differences. A key characteristic is the particularly wide gap between inpatient and outpatient services, which are funded separately and staffed by different teams. In 2003 the total number of psychiatric beds was a mere two thirds of the overall bed capacity in 1991, the first year as a re-unified Germany, when psychiatric beds in East and West Germany totalled 80,275. From 1970 onwards the number of psychiatric beds was cut by roughly half. So the momentum of the reform has been strong enough to assimilate the completely different mental health care system of the former German Democratic Republic and, in the course of a decade, to re-structure mental health services for an additional 17–18 million new inhabitants. In an ongoing struggle to adapt to changing administrative set-ups, legal frameworks, and financial constraints, psychiatry in Germany in currently facing specific problems and is seriously challenged to defend to considerable achievements of the past. A major obstacle to achieving this aim lies in the fragmented system of mental health care provision and mental health care funding.

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References

  • Aktion Psychisch Kranke (2005) Der personenzentrierte Ansatz in der psychiatrischen Versorgung. Psychiatrie-Verlag, Bonn

    Google Scholar 

  • Angermeyer MC, Holzinger A (2005) Erlebt die Psychiatrie zurzeit einen Boom der Stigmaforschung? [Is there currently a boom of stigma research in psychiatry?] Psychiatr Prax 32:399–407

    Article  PubMed  Google Scholar 

  • Angermeyer MC, Holzinger A, Kilian R, Matschinger H (2001) Quality of life—as defined by schizophrenic patients and psychiatrists. Int J Soc Psychiatry 47:34–42

    PubMed  CAS  Google Scholar 

  • Angermeyer MC, Matschinger H (2004) Public attitudes to people with depression: have there been any changes over the last decade? J Affect Disord 83:177–182

    Article  PubMed  Google Scholar 

  • Angermeyer MC, Matschinger H (2005) The stigma of mental illness in Germany: a trend analysis. Int J Soc Psychiatry 51:276–284

    Article  PubMed  Google Scholar 

  • Angermeyer MC, Matschinger H, Corrigan PW (2004) Familiarity with mental illness and social distance from people with schizophrenia and major depression: testing a model using data from a representative population survey. Schizophr Res 69:175–182

    Article  PubMed  Google Scholar 

  • Arbeitsgruppe Psychiatrie der obersten Landesgesundheits- behörden (2003) Bestandsaufnahme zu den Entwicklungen der Psychiatrie in den letzten 25 Jahren. Vorgelegt der 76. Gesundheitsministerkonferenz

  • Bauer M (1994) Psychiatry in former East and West Germany since reunification. Psychiatr Bull 18:637–639

    Google Scholar 

  • Bauer M, Kunze H, von Cranach M, Fritze J, Becker T (2001) Psychiatric reform in Germany. Acta Psychiatr Scand 104:S27–S34

    Article  Google Scholar 

  • Bell K, Deutsche Gesellschaft für Psychosomatische Medizin und Psychotherapie (2004) The specialty of psychosomatic medicine and its share in the evolution of ambulatory care. Z Psychosom Med Psychother 50:226–230

    Article  PubMed  CAS  Google Scholar 

  • Berger H, Fritz U (2004) Die Akutbehandlung mit Psychopharmaka in den Jahren 1990–2000 Ergebnisse einer Umfrage zu den Verordnungsgewohnheiten psychiatrischer Kliniken [Medication in acute psychiatric treatment results of a survey of routine medication practice in psychiatric hospitals]. Psychiatr Prax 31:68–73

    PubMed  Google Scholar 

  • Berger M (2005) Die Versorgung psychisch Kranker in Deutschland – Unter besonderer Berücksichtigung des Faches Psychiatrie und Psychotherapie. In: Berger M, Fritze J, Roth-Sackenheim C, Voderholzer U (eds.) Die Versorgung psychischer Erkrankungen in Deutschland – Aktuelle Stellungnahmen der DGPPN. Springer, Heidelberg, pp. 3–18

    Chapter  Google Scholar 

  • Berger M, Weig W, Becker T (2005) Die Rolle der Rehabilitation im VersorgunGspektrum psychischer Erkrankungen. In: Berger M, Fritze J, Roth-Sackenheim C, Voderholzer U (eds.) Die Versorgung psychischer Erkrankungen in Deutschland – Aktuelle Stellungnahmen der DGPPN. Springer, Heidelberg, pp 61–69

    Chapter  Google Scholar 

  • Bundesärztekammer (2003) Tätigkeitsbericht 2003. Deutscher Ärzteverlag, Köln

    Google Scholar 

  • Cording C, Gastpar M (1997) Stellungnahmen—DGPPN-Empfehlung zur psychiatrischen Basisdokumentation (BADO). Nervenarzt 68:930–931

    PubMed  CAS  Google Scholar 

  • Deutscher Bundestag (1975) Bericht über die Lage der Psychiatrie in der Bundesrepublik Deutschland—zur psychiatrischen und psychotherapeutischen/psychosoma-Tischen Versorgung der Bevölkerung. Drucksache 7/4200. Deutscher Bundestag, Bonn

  • Diefenbacher A (2005) Psychiatry and psychosomatic medicine in Germany: lessons to be learned? Aust N Z J Psychiatry 39:782–794

    Article  PubMed  Google Scholar 

  • Dressing H, Salize HJ (2004) Compulsory admission of mentally ill patients in European Union member states. Soc Psychiatry Psychiatr Epidemiol 39:797–803

    PubMed  Google Scholar 

  • Faulstich H (1990) Neben den Morden noch ein geplantes Hungersterben? Ein Aufruf zum (Nach-)forschen. Spektrum der Psychiatrie und Nervenheilkunde 4:158–162

    Google Scholar 

  • Friemel S, Bernert S, Angermeyer MC, König HH (2005) Die direkten Kosten von depressiven Erkrankungen in Deutschland [The direct costs of depressive disorders in Germany]. Psychiatr Prax 32:113–121

    Article  PubMed  Google Scholar 

  • Fritze J, Saß H, Schmauß M (2005) Befragung der Fachgesellschaften durch den Sachverständigenrat für die Konzertierte Aktion im Gesundheitswesen zur Frage von Über-, Unter- und Fehlversorgung. In: Berger M, Fritze J, Roth-Sackenheim C, Voderholzer U (eds.) Die Versorgung psychischer Erkrankungen in Deutschland – Aktuelle Stellungnahmen der DGPPN. Springer, Heidelberg, pp 83–176

    Google Scholar 

  • Gaebel W, Baumann A, Witte AM, Zaeske H (2002) Public attitudes towards people with mental illness in six German cities: results of a public survey under special consideration of schizophrenia. Eur Arch Psychiatry Clin Neurosci 252:278–287

    Article  PubMed  CAS  Google Scholar 

  • Gaebel W, Baumann A (2003) Interventions to reduce the stigma associated with severe mental illness: experiences from the open the doors program in Germany. Can J Psychiatry 48:657–662

    PubMed  Google Scholar 

  • Härter M, Schneider F, Gaebel, W, Berger M (eds) (2003) Versorgungsleitlinien für depressive Störungen in der ambulanten Praxis. Zeitschrift für ärztliche Fortbildung und Qualitätssicherung 97:1–92

  • Hölling I (2001) About the impossibility of a single (ex-)user and survivor of psychiatry position. Acta Psychiatrica Scandinavica 104:S102–S106

    Article  Google Scholar 

  • Hoffmann KM (2004) Der Patient, das (un-)bekannte Wesen—die subjektive Sicht der Nutzer [The patient, an (un-) known being–the subjective view of users]. Psychiatr Prax 31:263–268

    Article  Google Scholar 

  • Holzinger A, Angermeyer MC (2002) Sozialpsychiatrische Forschung im Deutschen Sprachraum [Social-psychiatric research in German-speaking countries]. Psychiatr Prax 29: 397–410

    Article  PubMed  Google Scholar 

  • Kallert T (2005) Braucht psychiatrische Versorgungsforschung randomisierte kontrollierte Studien? [Is mental health services research in need of randomised controlled trials]. Psychiatr Prax 32:375–377

    Article  PubMed  Google Scholar 

  • Kallert T, Becker T (2001) Basisdokumentation in der Gemeindepsychiatrie. Psychiatrie-Verlag, Bonn

    Google Scholar 

  • Kallert TW, Leisse M (2001) Schizophrenic patients’ normative needs for community-based psychiatric care: an evaluative study throughout the year following hospital release in the Dresden region. Soc Psychiatry Psychiatr Epidemiol 36:1–12

    Article  PubMed  CAS  Google Scholar 

  • Kallert TW, Leisse M, Winiecki P (2004) Needs for care of chronic schizophrenic patients in long-term community treatment. Soc Psychiatry Psychiatr Epidemiol 39:386–396

    Article  PubMed  Google Scholar 

  • KBV (Kassenärztliche Bundesvereinigung) (2005) Ärztestatistik 2003

  • Kilian R, Angermeyer MC (2004) Der Einfluss der Neuroleptikabehandlung auf die Inzidenz und die Kosten stationärer psychiatrischer Behandlungen bei schizophren Erkrankten: Ergebnisse einer prospektiven Beobachtungsstudie [The impact of antipsychotic medication on the incidence and the costs of inpatient treatment in people with schizophrenia: results from a prospective observational study]. Psychiatr Prax 31:138–146

    Article  PubMed  Google Scholar 

  • Kilian R, Matschinger H, Becker T, Angermeyer MC (2003) A longitudinal analysis of the impact of social and clinical characteristics on the costs of schizophrenia treatment. Acta Psychiatr Scand 107:351–360

    Article  PubMed  CAS  Google Scholar 

  • Kissling W, Höffler J, Seemann U, Muller P, Ruther E, Trenckmann U, Uber A, Graf von der Schulenburg JM, Glaser P, Glaser T, Mast O, Schmidt D (1999) Die direkten und indirekten Kosten der Schizophrenie [Direct and indirect costs of schizophrenia]. Fortschr Neurol Psychiatr 67:29–36

    PubMed  CAS  Google Scholar 

  • Kunze H (2004) Reform of psychiatric services in Germany: hospital staffing directive and commissioning of community care. Psychiatric Bull 28:218–221

    Article  Google Scholar 

  • Linden M, Mayer W, Achberger M, Herr R, Helmchen H, Benkert O (1996) Psychische Erkrankungen und ihre Behandlung in Allgemeinarztpraxen in Deutschland. Ergebnisse aus einer Studie der Weltgesundheitsorganisation. Nervenarzt 67:205–215

    PubMed  CAS  Google Scholar 

  • Melchinger H, Machleidt W, Roessler W (2003) Ausgaben auf dem Prüfstand Dtsch Arztebl 100:A2850–A2852 [was bedeutet “A”]

    Google Scholar 

  • Meyer T, Franz M (2005) Vorstellungen von schizophren Erkrankten über Lebensqualität [Perceptions of quality-of-life in schizophrenic persons]. Gesundheitswesen 67:120–123

    Article  PubMed  CAS  Google Scholar 

  • Mory C, Jungbauer J, Angermeyer MC (2002) Finanzielle Belastungen von Eltern und Partner schizophrener Patienten im Vergleich [Financial burden on caregivers of schizophrenic patients: a comparison between parents and spouses]. Psychiatr Prax 29:175–180

    Article  PubMed  Google Scholar 

  • Richter RA, Nollau M (2000) Perspectives of psychiatric care in Leipzig–deinstitutionalization from the viewpoint of neurologist/psychiatrist in private practice and the work of consortium of community psychiatric services. Psychiatr Prax 27(Suppl 2):95–99

    Google Scholar 

  • Rodewischer Thesen (1965) Internationales Symposium über psychiatrische Rehabilitation. Zeitschrift ges. Hygenie 9:61–65

    Google Scholar 

  • Osterheider M, Dimmek B (2005) Germany. In: Salize HJ, Dressing H (eds) Placement and treatment of mentally disordered offenders—legislation and practice in the European Union. Pabst Science Publishers, Lengerich Berlin Bremen Miami Riga Viernheim Wien Zagreb, pp 225–235

    Google Scholar 

  • Priebe S, Badesconyi A, Fioritti A, Hansson L, Kilian R, Torres-Gonzales F, Turner T, Wiersma D (2005) Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. BMJ 330:123–126

    Article  PubMed  Google Scholar 

  • Roick C (2004) How effective is managed care in psychiatry? Implications for integrated care approaches in Germany. Psychiatr Prax 31:170

    Article  PubMed  Google Scholar 

  • Roick C, König HH (2005) Quo Vadis? Gesundheitspolitische Entscheidungen und deren Konsequenz für die Psychiatire [Quo vadis? Health policy decisions and their consequences for mental health care]. Psychiatr Prax 32:109–112

    Article  PubMed  Google Scholar 

  • Rössler W, Salize HJ, Riecher-Rössler A (1996) Changing patterns of mental health care in Germany. Int J Law Psychiatry 19:391–411

    Article  PubMed  Google Scholar 

  • Salize HJ, Rössler W (1996) The cost of comprehensive care of people with schizophrenia living in the community. A cost evaluation from a German catchment area. Br J Psychiatry 169:42–48

    Article  PubMed  CAS  Google Scholar 

  • Salize HJ, Rössler W (1999) Steigen die Kosten der Versorgung von Patienten mit Schizophrenie überproportional? Is there a disproportional increase in health care costs for schizophrenic patients? Nervenarzt 70:817–822

    Article  PubMed  CAS  Google Scholar 

  • Salize HJ, Moreno Küstner B, Torres González F, Reinhard I, Jiménez Estévez J, Rössler W (1999) Needs for care and effectiveness of mental health care provision for schizophrenic patients in two european regions—a comparison of Granada (Spain) and Mannheim (Germany). Acta Psychiatr Scand 100:328–334

    Article  PubMed  CAS  Google Scholar 

  • Salize HJ, Bullenkamp J, Alscher I, Wolf I (2000) Qualitätssicherung und Dokumentation im gemeindepsychiatrischen Verbund (GPV)—ein standardisiertes Verfahren für die regionale Versorgungsdokumentation und—steuerung. Psychiatr Praxis 27:92–98

    CAS  Google Scholar 

  • Salize HJ, Stamm K, Schubert M, Bergmann F, Härter M, Berger M, Gaebel W, Schneider F (2004) Behandlungskosten von Patienten mit Depressionsdiagnose in haus- und fachärztlicher Versorgung in Deutschland. Psychiatr Praxis 31:147–156

    Google Scholar 

  • Salize HJ, Dressing H (2005) Service provision. In: Salize HJ, Dressing H (eds) Placement and treatment of mentally disordered offenders—legislation and practice in the European Union. Pabst Science Publishers, Lengerich Berlin Bremen Miami Riga Viernheim Wien Zagreb, pp 98–113

    Google Scholar 

  • Schwabe U, Paffrath D (2004) Arzneiverordnungsreport 2004. Springer, Berlin

    Google Scholar 

  • Spengler A, Dressing H, Koller H, Salize HJ (2005) Zwangseinweisungen—bundesweite Basidaten und Trends. Der Nervenarzt 76:363–370

    Article  Google Scholar 

  • Statistisches Bundesamt (ed) (2004) Kosten nach Krankheitsarten—Kurzfassung. Statistisches Bundesamt, Wiesbaden

  • Statistisches Bundesamt (ed) (2005) Grunddaten der Krankenhäuser und Vorsorge oder Rehabilitationseinrichtungen. Fachserie 12 Reihe 6.1. Statistisches Bundesamt, Wiesbaden

  • Üstün TB, Sartorius N (1995) Mental illness in general health care: an international study. John Wiley on behalf of the WHO, Chichester

    Google Scholar 

  • Wittchen HU, Winter S, Höfler M, Spiegel B, Ormel H, Müller N, Pfister H (2000a) Häufigkeit und Erkennensrate von Depressionen in der hausärztlichen Praxis. Fortschritte der Medizin 118:22–30

    Google Scholar 

  • Wittchen HU, Müller N, Schmidtkunz B, Winter S, Pfister H (2000b) Erscheinungsformen, Häufigkeit und Versorgung von Depressionen. Fortschritte der Medizin 118:4–10

    Google Scholar 

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Authors and Affiliations

  1. Central Institute of Mental Health, J5, 68159, Mannheim, Germany

    Hans Joachim Salize

  2. Psychiatric University Hospital, Zürich, Switzerland

    Wulf Rössler

  3. Department of Psychiatry II, University of Ulm, Bezirkskrankenhaus Günzburg, Germany

    Thomas Becker

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  1. Hans Joachim Salize
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  2. Wulf Rössler
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  3. Thomas Becker
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Correspondence to Hans Joachim Salize.

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Salize, H., Rössler, W. & Becker, T. Mental health care in Germany. Eur Arch Psychiatry Clin Neurosci 257, 92–103 (2007). https://doi.org/10.1007/s00406-006-0696-9

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