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Zusammenfassung

Anliegen Die Ausgliederung chronisch psychisch Kranker aus Langzeitstationen wurde hinreichend evaluiert und gilt mittlerweile in der westlichen Welt als abgeschlossen. Methode In einer Literaturrecherche über „pubmed” wurden alle deutsch- und englischsprachigen Arbeiten der Jahre 1997–2007 ausgehoben, welche sich mit dem Thema der Deinstitutionalisierung auseinandersetzten. Ergebnisse Beinahe alle entlassenen Patienten wurden in Betreuungsformen mit 24-h-Betreuung transferiert; dieser Umstand änderte sich auch im längerfristigen Verlauf nicht. Schlussfolgerung Angesichts des auf die Entlassung folgenden Verlaufs muss auf die Gefahr der Trans-Institutionalisierung hingewiesen werden. Der Stand des Wissens zu bedürfnisgerechter Integration mit möglichst niederschwelligen Hilfsangeboten ist bisher sehr gering, woraus sich gegebener Forschungsbedarf ableiten lässt.

Abstract

Objectives In the last decades, long-time patients were systematically discharged from psychiatric hospitals in order to integrate this disadvantaged population into the community. This procedures where adequately evaluated and are regarded to be completed in the western world today. However, few evidence has been presented regarding the further course of integration following discharge from mental hospitals: was integration into community really successful or were patients permanently placed in sheltered housing staffed 24 hours 7 days a week. This review focuses on the question whether papers describing large deinstitutionalisation projects mention the level of institutional support in the years following discharge from hospital. Furthermore we tried to find out which parameters are dealt with when describing successful community integration. Methods „Pubmed” was searched for studies on deinstitutionalisation projects published between 1997 and 2007. Results The discharge from the mental hospital wards was in all studies described as successful, positive effects like an increased quality of life were found. However, studies describing the years following discharge mentioned that patients continuously stayed in sheltered housing with care offered 24 hours a day. Conclusion Reviewing the available data about the level of support regarding accommodation of former long time patients, the danger of „transinstitutionalisation” has to be pointed out. Evidence is lacking concerning support models tailored to the individual needs of the patients. Similarly, possible side effects of long-term stays in sheltered housing staffed 24 hours a day have not yet been established. Therefore, we see a need for further evaluation of different models of supported housing for former long-term hospitalised patients, as well as for new chronic mentally ill patients.

Literatur

• 1 Lamb H R, Bachrach L L. Some Perspectives on Deinstitutionalization.  Psychiatr Serv. 2001;  52 1039-1045
  CrossrefPubMedGoogle Scholar
• 2 Priebe S, Gruyters T. The role of the helping alliance in psychiatric community care. A prospective study.  J Nerv Ment Dis. 1993;  181 552-557
  PubMedGoogle Scholar
• 3 Kaiser W, Priebe S, Hoffmann K. et al . Subjektive Lebensqualität bei Patienten mit chronischer Schizophrenie.  Nervenarzt. 1996;  67 572-582
  PubMedGoogle Scholar
• 4 Kaiser W, Priebe S, Barr W. Profiles of subjective quality of life in schizophrenic in- and out-patient samples.  Psychiatry Res. 1997;  66 153-166
  CrossrefPubMedGoogle Scholar
• 5 Zerssen D von, León C A, Möller H J. et al . Care Strategies for Schizophrenic Patients in a Transcultural Comparison.  Compr Psychiatry. 1990;  31 398-408
  CrossrefPubMedGoogle Scholar
• 6 Svensson B, Hansson L. Patient satisfaction with inpatient psychiatric care. The influence of personality traits, diagnosis and perceived coercion.  Acta Psychiatr Scand. 1994;  90 379-384
  CrossrefPubMedGoogle Scholar
• 7 Barry M M, Crosby C. Qualtity of life as an evaluative measure in assessing the impact of community care on people with long-term psychiatric disorders.  Br J Psychiatry. 1996;  168 210-216
  CrossrefPubMedGoogle Scholar
• 8 Knudsen H C, Krasnik A, Jessen-Petersen B. et al . Patients in the care of private psychiatric practitioners. Comparison with public hospital patients and the background districts' population.  Soc Psychiatry Psychiatr Epidemiol. 1992;  27 156-160
  PubMedGoogle Scholar
• 9 Holley L H, Jeffers B, Hodges P. Potential for community relocation among residents of Alberta's psychiatric facilities: a needs assessment.  Can J Psychiatry. 1997;  42 750-757
  PubMedGoogle Scholar
• 10 Holley H L, Hodges P, Jeffers B. Moving psychiatric patients from hospital to community: views of patients, providers, and families.  Psychiatr Serv. 1998;  49 513-517
  PubMedGoogle Scholar
• 11 Steinkamp G, Netz P, Werner B. Ambulante Versorgung psychisch gestörter älterer Menschen – Eine vergleichende empirische Untersuchung von zwei Versorgungsregionen.  Gesundheitswesen. 1996;  58, Sonderheft 2 132-138
  PubMedGoogle Scholar
• 12 Francis V M, Vesey P, Lowe G. The closure of a long-stay psychiatric hospital: a longitudinal study of patients' behaviour.  Soc Psychiatry Psychiatr Epidemiol. 1994;  29 184-189
  PubMedGoogle Scholar
• 13 Thornicroft G, Bebbington P, Leff J. Outcomes for long-term patients one year after discharge from a psychiatric hospital.  Psychatr Serv. 2005;  56 1416-1422
  PubMedGoogle Scholar
• 14 Lesage A D, Morissette R, Fortier L. et al . Downsizing psychiatric hospitals: needs for care and services of current and discharged long- stay inpatients.  Can J Psychiatry. 2000;  45 526-531
  PubMedGoogle Scholar
• 15 Shipley K, Hilborn B, Hanselt A. et al . Patient satisfaction: a valid index of quality of care in a psychiatric service.  Acta Psychiatr Scand. 2000;  101 330-333
  CrossrefPubMedGoogle Scholar
• 16 Räsänen S, Hakko H, Herva A. et al . Community placement of long-stay psychiatric patients in northern Finland.  Psychiatr Serv. 2000;  51 383-385
  CrossrefPubMedGoogle Scholar
• 17 Rothbard A B, Schinnar A P, Hadley T P. et al . Cost comparison of state hospital and community-based care for seriously mentally ill adults.  Am J Psychiatry. 1998;  155 523-529
  PubMedGoogle Scholar
• 18 Rothbard A B, Kuno F, Schinnar A P. et al . Service utilization and cost of community care for discharged state hospital patients: A 3-year follow-up study.  Am J Psychiatry. 1999;  156 920-927
  PubMedGoogle Scholar
• 19 Sytema S, Burgess P, Tansella M. Does community care decrease length of stay and risk of rehospitalization in new patients with schizophrenia disorders? A comparative case registers study in Groningen, the Netherlands; Victoria, Australia; and South Verona, Italy.  Sizophr Bull. 2002;  28 273-281
  PubMedGoogle Scholar
• 20 Tansella M, Amaddeo F, Burti L. et al . Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience.  Acta Psychiatr Scand. 2006;  113 (Suppl. 429) 90-94
  CrossrefPubMedGoogle Scholar
• 21 Trieman N, Leff J, Glover G. Outcome of long stay psychiatric patients resettled in the community: prospective cohort study.  BMJ. 1999;  319 13-16
  PubMedGoogle Scholar
• 22 Salokangas R K, Saarinen S. Deinstitutionalization and schizophrenia in Finland: I. discharged patients and their care.  Schizophr Bull. 1998;  24 457-467
  PubMedGoogle Scholar
• 23 Honkonen T, Saarinen S, Salokangas R K. Deinstitutionalization and schizophrenia in Finland: II. discharged patients and their psychosocial functioning.  Schizophr Bull. 1999;  25 543-551
  PubMedGoogle Scholar
• 24 Leff J, Szmidla A. Evaluation of a special rehabilitation programme for patients who are difficult to place.  Soc Psychiatry Psychiatr Epidemiol. 2002;  37 532-536
  CrossrefPubMedGoogle Scholar
• 25 Hansson L, Björkman T, Priebe S. Are important patient-rated outcomes in community mental health care explained by only one factor?.  Acta Psychiatr Scand. 2007;  116 113-118
  CrossrefPubMedGoogle Scholar
• 26 Leiße M, Kallert T W. Social integration and the quality of life of schizophrenic patients in different types of complementary care.  Eur Psychiatry. 2000;  15 450-460
  CrossrefPubMedGoogle Scholar
• 27 Spancken E. Rheinische Kliniken Bedburg-Hau: Auswertung eines Enthospitalisierungsprogramms unter besonderer Berücksichtigung der schwierigen bzw. neuen chronisch Kranken.  Krankenhauspsychiatrie. 2001;  12, Sonderheft 2 79-84
  Article in Thieme ConnectPubMedGoogle Scholar
• 28 Konrad M. Enthospitalisierung als Aufgabe eines kliniknahen Pflegeheims.  Krankenhauspsychiatrie. 2001;  12, Sonderheft 2 85-89
  Article in Thieme ConnectPubMedGoogle Scholar
• 29 Heilemann H. Enthospitalisierung in den neuen Bundesländern am Beispiel des Sächsischen Krankenhauses für Psychiatrie und Neurologie Arnsdorf. Eine Zwischenbilanz nach 10 Jahren.  Krankenhauspsychiatrie. 2001;  12, Sonderheft 2 90-94
  Article in Thieme ConnectPubMedGoogle Scholar
• 30 Stich J. Enthospitalisierung älterer psychisch kranker Menschen am Beispiel einer ehemaligen Langzeitstation des Bezirkskrankenhauses Bayreuth. 1989–1993
  Google Scholar
• 31 Moos M, Stich J, Rossow D. et al . Enthospitalisierung am BKH Bayreuth – Aktuelle Situation schwer chronisch psychisch kranker Menschen.  Krankenhauspsychiatrie. 2001;  12, Sonderheft 2 110-115
  Article in Thieme ConnectPubMedGoogle Scholar
• 32 Arvidsson H. Met an unmet needs of severely mentally ill persons. The psychiatric care reform in Sweden.  Soc Psychiatry Psychiatr Epidemiol. 2003;  38 373-379
  PubMedGoogle Scholar
• 33 Thornicroft G, Strathdee G, Phelan M. et al . Rationale and design. PRiSM Psychosis Study I.  Br J Psychiatry. 1998;  173 363-370
  CrossrefPubMedGoogle Scholar
• 34 Becker T, Holloway F, McCrone P. et al . Evolving service interventions in Nunhead and Norwood. PRiSM Psychosis Study 2.  Br J Psychiatry. 1998;  173 371-375
  CrossrefPubMedGoogle Scholar
• 35 Johnson S, Leese M, Brooks L. et al . Frequency and predictors of adverse events. PRiSM Psychosis Study 3.  Br J Psychiatry. 1998;  173 376-384
  CrossrefPubMedGoogle Scholar
• 36 McCrone P, Thornicroft G, Phelan M. et al . Utilisation and costs of community mental health services. PRiSM Psychosis Study 5.  Br J Psychiatry. 1998;  173 391-398
  CrossrefPubMedGoogle Scholar
• 37 Becker T, Leese M, McCrone P. et al . Impact of community mental health services on users' social networks. PRiSM Psychosis Study 7.  Br J Psychiatry. 1998;  173 404-409
  CrossrefPubMedGoogle Scholar
• 38 Leese M, Johnson S, Slade M. et al . User perspective on needs and satisfaction with mental health services. PRiSM Psychosis Study 8.  Br J Psychiatry. 1998;  173 409-415
  CrossrefPubMedGoogle Scholar
• 39 Taylor R E, Leese M, Clarkson P. et al . Quality of life outcomes for intensive versus standard community mental health services. PRiSM Psychosis Study 9.  Br J Psychiatry. 1998;  173 416-422
  CrossrefPubMedGoogle Scholar
• 40 Thornicroft G, Wykes T, Holloway F. et al . From efficacy to effectiveness in community mental health services. PRiSM Psychosis Study 10.  Br J Psychiatry. 1998;  173 423-427
  CrossrefPubMedGoogle Scholar
• 41 Ruggeri M, Biggeri A, Rucci P. et al . Multivariate analysis of outcome of mental health care using graphical chain models. The South-Verona Outcome Project 1.  Psychol Med. 1998;  28 1421-1431
  CrossrefPubMedGoogle Scholar
• 42 Lasalvia A, Ruggeri M, Mazzi M A. et al . The perception of needs for care in staff and patients in community-based mental health services. The South-Verona Outcome Project 3.  Acta Psychiatr Scand. 2000;  102 366-375
  CrossrefPubMedGoogle Scholar
• 43 Ruggeri M, Warner R, Bisoffi G. et al . Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach. The South Verona Outcome Project 4.  Br J Psychiatry. 2001;  178 268-275
  CrossrefPubMedGoogle Scholar
• 44 Ruggeri M, Gater R, Bisoffi G. et al . Determinants of subjective quality of life in patients attending community-based mental health services. The South-Verona Outcome Project 5.  Acta Psychiatr Scand. 2002;  105 131-140
  CrossrefPubMedGoogle Scholar
• 45 Lasalvia A, Ruggeri M, Santolini N. Subjective quality of life: its relationship with clinician-rated and patient-rated psychopathology. The South-Verona Outcome Project 6.  Psychother Psychosom. 2002;  71 275-284
  CrossrefPubMedGoogle Scholar
• 46 Ruggeri M, Pacati P, Goldberg D. Neurotics are dissatisfied with life, but not with services. The South Verona Outcome Project 7.  Gen Hosp Psychiat. 2003;  25 338-344
  PubMedGoogle Scholar
• 47 Ruggeri M, Leese M, Slade M. et al . Demographic, clinical, social and service variables associated with higher needs for care in community psychiatric service patients. The South Verona Outcome Project 8.  Soc Psychiatry Psychiatr Epidemiol. 2004;  39 60-68
  CrossrefPubMedGoogle Scholar
• 48 Ruggeri M, Bisoffi G, Lasalvia A. et al . A longitudinal evaluation of two-year outcome in a community-bades mental health service using graphical chain models. The South-Verona Outcome Project 9.  Int J Methods Psychiatr Res. 2004;  13 10-23
  CrossrefPubMedGoogle Scholar
• 49 Hansson L, Middelboe T, Merinder L. et al . Predictors of subjective Quality of Life in Schizophrenic Patients living in the Community. A Nordic Multicentre Study.  Int J Soc Psychiatry. 1999;  45 247-258
  CrossrefPubMedGoogle Scholar
• 50 Sörgaard K W, Hansson L, Heikkilä J. et al . Predictors of social relations in persons with schizophrenia living in the community: a Nordic multicentre study.  Soc Psychiatry Psychiatr Epidemiol. 2001;  36 13-19
  CrossrefPubMedGoogle Scholar
• 51 Levy E, Shefler G, Loewenthal U. et al . Characteristics of schizophrenia residents and staff rejection in community mental health hostels.  Isr J Psychiatry Relat Sci. 2005;  42 23-32
  PubMedGoogle Scholar
• 52 de Souza L A, Coutinho E S. The quality of life of people with schizophrenia living in the community in Rio de Janeiro.  Brazil Soc Psychiatry Psychiatr Epidemiol. 2006;  41 347-356
  PubMedGoogle Scholar
• 53 Leiße M, Kallert T W. Normative needs for community-based psychiatric care of patients with schizophrenia in different residential settings.  Psychiatr Res. 2003;  118 223-233
  CrossrefPubMedGoogle Scholar
• 54 Henderson C, Phelan M, Loftus L. et al . Comparison of patient satisfaction with community-based vs. hospital psychiatric services.  Acta Psychiatr Scand. 1999;  99 188-195
  CrossrefPubMedGoogle Scholar
• 55 Harrison-Read P, Lucas B, Tyrer P. et al . Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough.  Psychol Med. 2002;  32 403-416
  PubMedGoogle Scholar
• 56 Petersen L, Nordentoft M, Jeppesen P. et al . Improving 1-year outcome in first-episode psychsis. OPUS trial.  Br J Psychiatry. 2005;  187 (Suppl. 48) 98-103
  CrossrefPubMedGoogle Scholar
• 57 Killaspy H, Bebbington P, Bilzard R. et al . The REACT study: randomised evaluation of assertive community treatment in north London.  Br Med J. 2006;  332 815-820
  Google Scholar
• 58 Sytema S, Wunderink L, Bloemers W. et al . Assertive community treatment in the Netherlands: a randomized controlled trial.  Acta Psychiatr Scand. 2007;  116 105-112
  CrossrefPubMedGoogle Scholar
• 59 Essock S M, Mueser K T, Drake R E. et al . Comparison of ACT and standard case management for delivering integrated treatment for co-coccurring disorders.  Psychiatr Serv. 2006;  57 185-196
  CrossrefPubMedGoogle Scholar
• 60 Ryu Y, Mizuno M, Sakuma K. et al . Deinstitutionalization of long-stay patients with schizophrenia: the 2-year social and clinical outcome of a comprehensive intervention program in Japan.  Aust N Z J Psychiatry. 2006;  40 462-470
  CrossrefPubMedGoogle Scholar
• 61 Priebe S, Hoffmann K, Isermann M. et al . Klinische Merkmale langzeithospitalisierter Patienten. Teil 1 der Berliner Enthospitalisierungsstudie.  Psychiat Prax. 1996;  23 15-20
  PubMedGoogle Scholar
• 62 Hoffmann K, Priebe S, Isermann M. et al . Lebensqualität, Bedürfnisse und Behandlungsbewertung langzeithospitalisierter Patienten. Teil II der Berliner Enthospitalisierungsstudie.  Psychiat Prax. 1997;  24 221-226
  PubMedGoogle Scholar
• 63 Kaiser W, Hoffmann K, Isermann M. et al . Behandlerprognosen und Entlassungen nach zwei Jahren. Teil III der Berliner Enthospitalisierungsstudie.  Psychiat Prax. 1998;  25 67-71
  PubMedGoogle Scholar
• 64 Hoffmann K, Isermann M, Kaiser W. et al . Lebensqualität im Verlauf der Enthospitalisierung. Teil IV der Berliner Enthospitalisierungsstudie.  Psychiat Prax. 2000;  27 183-188
  PubMedGoogle Scholar
• 65 Kaiser W, Hoffmann K, Isermann M. et al . Langzeitpatienten im Betreuten Wohnen nach der Enthospitalisierung. Teil V der Berliner Enthospitalisierungsstudie.  Psychiat Prax. 2001;  28 235-243
  Google Scholar
• 66 Priebe S, Hoffmann K, Isermann M. et al . Do long-term hospitalised patients benefit from discharge into the community?.  Soc Psychiatry Epidemiol. 2002;  37 387-392
  CrossrefPubMedGoogle Scholar
• 67 Haberfellner E M, Grausgruber A, Grausgruber-Berner R. et al . Die Enthospitalisierung psychiatrischer Langzeitpatienten in Oberösterrreich – soziodemografische und klinische Daten.  Psychiat Prax. 2004;  31 192-197
  Article in Thieme ConnectPubMedGoogle Scholar
• 68 Haberfellner E M, Grausgruber A, Grausgruber-Berner R. et al . Der Versorgungsbedarf ehemaliger psychiatrischer Langzeitpatienten.  Psychiat Prax. 2006;  33 23-29
  Article in Thieme ConnectPubMedGoogle Scholar
• 69 Haberfellner E M, Grausgruber A, Grausgruber-Berner R. et al . Die Enthospitalisierung ehemaliger psychiatrischer Langzeitpatienten in Oberösterreich – Inanspruchnahme von Versorgungsleistungen und Kosten der außerstationären Versorgung.  Psychiat Prax. 2006;  33 74-80
  Article in Thieme ConnectPubMedGoogle Scholar
• 70 Franz M, Meyer T, Ehlers F. et al . Schizophrene Patienten, die trotz Dekaden der Enthospitalisierung in den psychiatrischen Krankenhäusern verblieben sind. Teil 1 der Hessischen Enthospitalisierungsstudie.  Psychiat Prax. 2002;  29 245-250
  Article in Thieme ConnectPubMedGoogle Scholar
• 71 Meyer T, Franz M, Gallhofer B. Subgruppen und Prognose besonders schwer zu enthospitalisierender schizophrener Langzeitpatienten: Eine Differenzierung des „harten Kerns”. Teil 2 der Hessischen Enthospitalisierungsstudie.  Psychiat Prax. 2002;  29 301-305
  Article in Thieme ConnectPubMedGoogle Scholar
• 72 Franz M, Meyer T, Gallhofer B. Subjektive Lebensqualität schwer chronifizierter schizophrener Langzeitpatienten. Teil 3 der Hessischen Enthospitalisierungsstudie.  Psychiat Prax. 2002;  29 306-310
  Article in Thieme ConnectPubMedGoogle Scholar
• 73 Franz M, Meyer T, Ehlers F. et al . Schwer chronisch kranke schizophrene Langzeitpatienten. Welche Merkmale beeinflussen den Prozess der Enthospitalisierung? Teil 4 der Hessischen Enthospitalisierungsstudie.  Krankenhauspsychiatrie. 2001;  12, Sonderheft 2 95-100
  Article in Thieme ConnectPubMedGoogle Scholar
• 74 Kallert T W, Stoll A, Leiße M. et al . Der Enthospitalisierungsprozess des psychiatrischen Heimbereichs eines ehemaligen Großkrankenhauses aus Patienten- und Mitarbeitersicht.  Fortschr Neurol Psychiat. 2004;  72 446-459
  Article in Thieme ConnectPubMedGoogle Scholar
• 75 Rössler W, Salize H J, Cucciaro G. et al . Does the place of treatment influence the quality of life of schizophrenics?.  Acta Psychiatr Scand. 1999;  100 142-148
  PubMedGoogle Scholar
• 76 Zissi A, Barry M M. From Leros asylum to community-based facilities: levels of functioning and quality of life among hostel residents in Greece.  Int J Soc Psychiatry. 1997;  43 104-115
  CrossrefPubMedGoogle Scholar
• 77 Leff J, Trieman N. Long stay patients discharged from psychiatric hospitals. Social and clinical outcomes after five years in the community: the TAPS Project 46.  Br J Psychiatry. 2000;  176 217-223
  CrossrefPubMedGoogle Scholar
• 78 Trieman N, Leff J. The TAPS Project. 36: The Most Difficult to Place Long-Stay Psychiatric In-patients. Outcome One Year After Relocation.  Br J Psychiatry. 1996;  169 289-292
  CrossrefPubMedGoogle Scholar
• 79 Trieman N, Smith H E, Kendal R. et al . The TAPS Project 41: Homes for life? Residential stability five years after hospital discharge.  Community Ment Hlt J. 1998;  34 407-417
  CrossrefPubMedGoogle Scholar
• 80 Trieman N, Hughes J, Leff J. The TAPS Project 42: the last to leave hospital – a profile of residual long-stay populations and plans for their resettlement.  Acta Psychiatr Scand. 1998;  98 354-359
  PubMedGoogle Scholar
• 81 Trieman N, Leff J. Long-term outcome of long-stay psychiatric in-patients considered unsuitable to live in the community. TAPS Project 44.  Br J Psychiatry. 2002;  181 428-432
  CrossrefPubMedGoogle Scholar
• 82 Leff J, Triemann N. Long-stay patients discharged form psychiatric hospitals. Social and clinical outcomes after five years in the community. The TAPS Project 46.  Br J Psychiatry. 2000;  176 217-223
  CrossrefPubMedGoogle Scholar
• 83 Hobbs C, Tennant C, Rosen A. et al . Deinstitutionalisation for long-term mental illness: a 2-year clinical evaluation.  Aust N Z J Psychiatry. 2000;  34 476-483
  CrossrefPubMedGoogle Scholar
• 84 Hobbs C, Newton L, Tennant C. et al . Deinstitutionalization for long-term mental illness: a 6-year evaluation.  Australian and New Zealand Journal of Psychiatry. 2002;  36 60-66
  CrossrefPubMedGoogle Scholar
• 85 Trauer T, Farhall J, Newton R. et al . From long-stay psychiatric hospital to Community Care Unit: evaluation at 1 year.  Soc Psychiatry Psychiatr Epidemiol. 2001;  36 416-419
  CrossrefPubMedGoogle Scholar
• 86 Barbato A, D'Avanzo B, Rocca G. et al . A study of long-stay patients resettled in the community after closure of a psychiatric hospital in Italy.  Psychiatr Serv. 2004;  55 67-70
  CrossrefPubMedGoogle Scholar
• 87 Katschnig H, Angermeyer M C. Quality of life in depression. In: Katschnig H et al., Hrsg Quality of life in mental disorders. Chichester; John Wiley & Sons 1997: 137-147
  Google Scholar
• 88 Holley H L, Hodges P, Jeffers B. Moving Psychiatric Patients From Hospital to Community: Views of Patients, Providers, and Families.  Psychiatr Serv. 1998;  49 513-517
  PubMedGoogle Scholar
• 89 Eikelmann B. Grenzen der Deinstitutionalisierung? – Die Sicht der Fachklinik.  Psychiat Prax. 2000;  27, Sonderheft 2 53-58
  PubMedGoogle Scholar
• 90 Priebe S, Turner T. Reinstitutionalisation in mental health care.  Br Med J. 2003;  326 173-176
  CrossrefPubMedGoogle Scholar
• 91 Priebe S. Institutionalisation revisited – with and without walls.  Acta Psychiatr Scand. 2004;  110 81-82
  CrossrefPubMedGoogle Scholar
• 92 Killaspy H. From the asylum to community care: learning from experience.  Br Med Bull. 2006;  79 and 80 245-258
  CrossrefPubMedGoogle Scholar
• 93 Jähnel M, Rehm S, Pausch S. et al . Untersuchungen zur Lebensqualität im heimangebundenen betreuten Wohnen für chronisch psychisch Kranke.  Psychiat Prax. 2007;  34, Supplement 1 S136-S137
  Article in Thieme ConnectPubMedGoogle Scholar
• 94 Priebe S, Frottier P, Gaddini A. et al . Mental health care institutions in nine European countries, 2002 to 2006.  Psychiatr Serv. 2008;  59 570-573
  CrossrefPubMedGoogle Scholar
• 95 Priebe S, Badeconyi A, Fioritti A. et al . Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries.  BMJ. 2005;  330 123-126
  CrossrefPubMedGoogle Scholar
• 96 Hoffmann C. Enthospitalisierung oder Umhospitalisierung? – am Beispiel der Neuen Länder. In: Theunissen G Enthospitalisierung – ein Etikettenschwindel? Neue Studien, Erkenntnisse und Perspektiven der Behindertenhilfe. Bad Heilbrunn; Klinkhardt 1998: 109-153
  Google Scholar
• 97 Hambrecht M. Gemeindepsychiatrie im 21. Jahrhundert.  Psychiat Prax. 2007;  34 263-265
  PubMedGoogle Scholar

Univ.-Doz. Dr. Stefan Frühwald

Psychosozialer Dienst der Caritas St. Pölten

Dr. Karl Renner Prom. 12

3100 St. Pölten, Österreich

Email: psd.fruehwald@stpoelten.caritas.at