Search

Objective: Characterization of medical emergencies of patients with psychiatric symptoms or in psychosocial crisis., Methods: Analysis of emergency medical services (EMS) mission logs from four German EMS stations of patients aged 12-65 from 2019 to 2020., Results: 23.4% of missions involved patients with psychiatric or psychosocial symptoms (1.6% psychotic, 3.0% suicidal, 7.1% psychosocial crisis, 15.7% intoxicated). On average, these patients were younger than those with other symptoms. 48.9% exhibited additional somatic complaints. The COVID-19 pandemic showed only little impact on the frequency of such emergencies., Conclusion: Psychiatric and psychosocial symptoms account for a significant proportion of rescue missions in our sample. Managing psychiatric and psychosocial emergencies should be an integral part of the training of medical and paramedical staff., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Subject: The article provides an overview on the current state of service provision for people with psychiatric illnesses, financed by health-insurance companies, the rehabilitation and participatory systems, and the German Federal States. Over the last 20 years, service capacities have continually improved. Three areas that are in need of further development are highlighted here: the coordination of services for mentally ill persons with complex needs; the long-term placement of persons with severe mental illness and challenging behavior; and a growing shortage of specialists., Conclusions: The mental health system in Germany is largely well to very well developed. Despite this, specific groups do not benefit from the available assistance, and these often end up as "long-term patients" in psychiatric clinics. Models for coordinated and outpatient-oriented service provision for persons with severe mental illness exist, but are only sporadic. Intensive and complex outreach services in particular are lacking, as are service concepts that are able to cross the boundaries of social security responsibilities. The shortage of specialists, which affects the whole mental health system, requires restructuring toward a more outpatient-care focus. The first tools for this exist within the health insurance-financed system. They should be used., (© 2023. The Author(s).)

Aim: To determine the effect of treatment volumes on the frequency and duration of special safety measures (SSM) such as seclusion or restraint., Method: Register Data of the Lower Saxony Ministry of Social Affairs, Health and Equal Opportunities is analysed for the number of cases hospitalised under State Mental Health Act, the proportion of cases experiencing SSM, and the frequency and cumulative duration of SSM per case., Results and Discussion: The larger the treatment volume of cases that are hospitalised under State Mental Health Act, the smaller the proportion of cases experiencing SSM. This result is robust, even if statistical outliers are exempted from analyses., Conclusions: In light of indications that also in mental health care treatment volumes may be related to the desired treatment outcome, discussion is need about the tension between hospital care that is provide., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: Definition of a standard for structures and processes of Centers for Community Psychiatry (CCP) that aim at providing mobile, multiprofessional, complex and intensive outpatient care to patients with severe mental illness., Methods: The standard was developed and consented using a mix-method approach and by involving all relevant stakeholders, including first hand experts and service providers of three CCP model-projects in Lower-Saxonia., Results: The standard comprises a checklist with 12 binary and obligatory CCP features as well as a model fidelity scale with 45 scaled items in 9 dimensions., Conclusion: For the first time, a CCP-standard is available that offers a quantifiable and verifiable catalogue of features essential for CCPs. The standard orients at the S3 guideline "Psychosocial Therapies"., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

In contrast to official mental health policy, psychiatric clinics accomodate long-term patients., Aim: To quantify this problem., Method: Cross-sectional assessment of the number of long-term patients in psychiatric clinics in Lower Saxony., Results: 13 clinics of adult psychiatry report 60 long-term patients and one clinic for child and adolescent psychiatry reports 2 patients. Median duration of stay 9.5, maximum 215 months. Reasons for long-term hospitalisation include patients' challenging behaviour and, consequently, difficulties to find an accommodating long-term facility., Discussion and Conclusion: Housing willing to accommodate mentally ill persons with challenging behaviour is lacking, as well as local responsibility for the placement of these persons. Systematic transfer management from hospital to residential homes does not exist., Competing Interests: AB leitet das Referat 404 im Niedersächsischen Ministerium für Soziales, Gesundheit und Gleichstellung und führt die Fachaufsicht über die nach dem NPschKG beliehenen psychiatrischen Krankenhäuser in Niedersachsen. CK, SR, DZW und FW sind Ärzte in Leitungsfunktionen in psychiatrischen Krankenhäusern in Niedersachsen, die der Fachaufsicht unterstehen., (Thieme. All rights reserved.)

Objective Multiple models of Integrated Care (IC) have been implemented in German mental health services in the last decade in order to improve cross-sectoral, interdisciplinary cooperation. This study investigates an IC network model providing home treatment, case management and a 24/7 hotline. The aim of the study was to explore how health professionals working in this service model perceive both cooperation within their facilities and with external stakeholders. Methods 5 focus groups with 39 health professionals working in an IC mental health network were conducted and analyzed with qualitative content analysis. Results Focus groups participants reported on excellent cooperation within their facilities. The cooperation with external stakeholders, i. e. physicians, psychotherapists and psychiatric clinics, leaves room for improvement. Conclusions Until now little consideration has been given to the perspectives of health professionals. Cooperation within IC mental health networks seems to be effective. Cooperation with stakeholders outside the networks needs to be enhanced., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To evaluate whether outcome measures in studies to evaluate outpatient mental health services reflect patients' priorities. Methods: Two systematic literature reviews were conducted to identify, 1) patients' priorities and 2) outcome measures that are used for evaluating outpatient mental health care. 3) The findings from the literature review for patients' priorities were contrasted with the findings from the literature review for outcome measures. Results: 19 patients' priorities and 48 outcome measures were identified. Only eight priorities were directly assessed by an outcome measure in evaluations of outpatient mental health care. Conclusion: The majority of studies that evaluate outpatient mental health care do not consider patients' priorities as an outcome., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: As mental health services undergo the process of deinstitutionalization, this is resulting in a higher burden of care for relatives. Evidence suggests that interventions for carers have a beneficial impact on their psychological health. A reduction of responsibility for relatives is linked with a significantly improved outcome for the severely mentally ill. The aim of the study was to explore the relatives' experiences with severely mentally ill patients in different integrated care service providers., Methods: Semi-structured focus groups and interviews were conducted with 24 relatives of patients receiving community based integrated care for severe mental illness. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories., Results: Four main categories were found related to the structural aspects of the integrated care services and for the experiences of the relatives within these services. Relatives reported that the services offered significant relief and substantial support in daily life. In addition, relatives felt a reduced burden of carer responsibility and therefore that they were provided with more protection and stability. This resulted in a sense of encouragement and not feeling left alone to face challenges., Conclusion: Relatives are a critical resource for patients suffering from mental health problems and benefit from formal structures and interventions to support them in carer role. An important need is to ensure continuity of care for patients and the bridging of gaps concerning information and support needs for relatives when providing integrated mental health services in the community.

Objective: The time of transfer between discharge from inpatient mental health care and first contact to the outpatient sector is considered to be an indicator for continuity of care., Methods: This indicator is assessed using health care claims data of one of the mayor health insurances in Baden-Wurttemberg, Germany., Results: About 80 % of cases with the diagnosis of a defined mental disorder sought outpatient care at general or mental health practitioners within six months from discharge. 50 % of them did so within six days, 75 % within three weeks. The majority sought outpatient care at general practitioners. Cases that sought care in outpatient clinics specialized for severe mental illness (SMI) could not be considered in the data. However, considering them by estimation, the rate of cases with SMI seeking outpatient care at mental health practitioners within six months from discharge estimated to be at least 70 %., Conclusions: General practitioners are an important source for aftercare of mentally ill people discharged from inpatient care. Time of transfer as an indicator can be predominantly assessed by using health claims data in Germany., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: While evidence is available that home treatment could be effective for treating severe mental illness, there is a lack of evidence on what exactly makes home treatment effective. The study presented here aims to develop recommendations for structures and processes in home treatment that are necessary for its effectiveness., Methods/design: 14 provider networks of home treatment for severe mental illness will be analyzed and compared according to their structures, processes and patient-related outcomes. Data will be drawn from health care claims data, routine assessments of psychosocial functioning, and from questionnaires on structures and processes. The primary outcome will be psychosocial functioning; secondary outcomes, quality of life and days spent in hospital. The relation between structures and processes on one hand side and outcomes on the other side will be identified by multilevel analysis. In addition, focus groups with patients, relatives and network staff will be held to add further insight into relevant processes. All networks will receive individual quality reports, providing them with feedback on the results of this research and benchmarking them against the average. Based on this research, recommendations for processes and structures of home treatment will be developed., Discussion: The research will use longitudinal data on outcomes routinely assessed since 2009 and claims data. Routine data is also used for the assessment of structures and processes. By way of additional questionnaires developed in discussion with providers, further relevant factors can be included. The approach of this study becomes more comprehensive by conducting focus groups with patients, relatives and providers and by having the chance to evaluate the results with the networks by providing feedback of results. Several factors such as outcomes related to regional availability of hospital beds or size of networks might limit this study.

Background: Health systems increasingly try to make their services more responsive to users' expectations. In the context of the World Health Report 2000, WHO developed the concept of health system responsiveness as a performance parameter. Responsiveness relates to the system's ability to respond to service users' legitimate expectations of non-medical aspects. We used this concept in an effort to evaluate the performance of mental health care in a catchment area in Germany., Methods: In accordance with the method WHO used for its responsiveness survey, responsiveness for inpatient and outpatient mental health care was evaluated by a standardised questionnaire. Responsiveness was assessed in the following domains: attention, dignity, clear communication, autonomy, confidentiality, basic amenities, choice of health care provider, continuity, and access to social support. Users with complex mental health care needs (i.e., requiring social and medical services or inpatient care) were recruited consecutively within the mental health services provided in the catchment area of the Hanover Medical School., Results: 221 persons were recruited in outpatient care and 91 in inpatient care. Inpatient service users reported poor responsiveness (22%) more often than outpatients did (15%); however this was significant only for the domains dignity and communication. The best performing domains were confidentiality and dignity; the worst performing were choice, autonomy and basic amenities (only inpatient care). Autonomy was rated as the most important domain, followed by attention and communication. Responsiveness within outpatient care was rated worse by people who had less money and were less well educated. Inpatient responsiveness was rated better by those with a higher level of education and also by those who were not so well educated. 23% of participants reported having been discriminated against in mental health care during the past 6 months. The results are similar to prior responsiveness surveys with regard to the overall better performance of outpatient care. Where results differ, this can best be explained by certain characteristics that are applicable to mental health care and also by the users with complex needs. The expectations of attention and autonomy, including participation in the treatment process, are not met satisfactorily in inpatient and outpatient care., Conclusion: Responsiveness as a health system performance parameter provides a refined picture of inpatient and outpatient mental health care. Reforms to the services provided should be orientated around domains that are high in importance, but low in performance. Measuring responsiveness could provide well-grounded guidance for further development of mental health care systems towards becoming better patient-orientated and providing patients with more respect.

Objective: In Germany the competent institution for supported housing for mentally ill and handicapped persons is traditionally the regional welfare authority, while welfare authorities on state (Lander) level hold the competencies for accommodation in hostels and homes: Assessment of the impact of policies that try to overcome this separation of competencies., Method: 1. Analysis of the practise of distributing the competencies for accommodation for mental ill and handicapped persons in the 16 German Lander. 2. Assessment of the supply with accommodation for mental ill and handicapped persons in the Lander. 3. Investigation of a possible relationship between distribution of competencies for accommodation and number of accommodation in supported housing and hostels/homes., Results: Data about available accommodation in supported housing and hostels are inconsistently limited and available. As far as this data can be interpreted, Lander that have the administrative and particularly financial competency for accommodation uniquely organised, generally offer more supported housing. At the same time they provide relatively less accommodation in hostels and homes. Despite having the competencies for accommodation uniquely organised, some Lander continue to provide accommodation for mentally ill persons predominantly in hostels and homes., Conclusion: A comprehensive and between the Lander comparable system of documentation of accommodation for mentally ill and handicapped persons is highly needed. Unique organisation of competencies for accommodation of mental ill and handicapped persons is a necessary - however not commensurate precondition for the increase of the supply in supported housing. Beyond that, other factors seem to be influential, such as political will, attitudes towards the mentally ill, interests of hostel providers, pre-existing hostel infrastructure. In respect of these factors more research is needed.

Objective: Coordination of all psychiatric services is essential for the successful implementation of community oriented services, particularly in a decentralised health system like the one in Germany. This study investigates which mechanisms are implemented for coordinating and planning psychiatric services throughout the 16 German States (Länder)., Method: Analysing mental health legislation and policy documents of the States. Guided expert interviews with the psychiatry departments of the State governments., Results: Coordinating and planning panels exist in all States on district level and in most States on State level for various tasks. Most of these mechanisms are implemented without legal obligation. 4 States have a mental health evaluation panel, which scrutinises all psychiatric services once a year and reports publicly to the government. 12 States have a mental health legislation and 13 States published a central psychiatric planning document., Conclusion: The continous implementation of mechanisms for coordinating and planning psychiatric services in the German States represent the dynamics of psychiatric reforms there. The effect of these mechanisms on the implementation of community oriented psychiatric care should be subject to further research.