Psychiatry reform

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The psychiatric reform is an ongoing process of restructuring psychiatric care and support in Germany that continues to this day. Its aim is to significantly improve the situation of mentally ill people. The psychiatry enquête published in 1975 ("Report on the situation of psychiatry in the Federal Republic of Germany") is seen today as the starting point for the psychiatry reform in Germany .

Since the early 1970s, forms of psychiatry have been tried in various European countries and North America. These reform efforts took on the most radical proportions in Italy, where Law 180 ("Legge centottanta") was passed in 1978 , which among other things prescribed the closure of all psychiatric institutions in Italy and called into question the psychiatric concepts of mental illness.

Accompanying or preceding reform processes

The introduction of neuroleptics in the 1950s brought an alternative to previous treatments such as ice baths and electric shocks. At the same time, the anti- psychiatry movement was formed, which fundamentally questioned traditional psychiatric treatment. It was not until the mid-1970s that the crimes against mentally ill patients in National Socialist Germany were dealt with in the psychiatry enquête. The forced sterilizations and the murder of mentally ill people in Action T4 are now particularly well known .

The formation of a lobby for those with experience in psychiatry begins. Organizations are formed by those affected and their families. The public exchange about illnesses and treatments begins in forums such as psychosis seminars , self-help groups for those affected and their families, as well as on the Internet and in newspapers. Targeted campaigns to educate and combat stigmatization and marginalization of mentally ill people are published. Under the motto “Experts from experience”, people with experience in psychiatry were employed as convalescent guides and lecturers.

Criticism of traditional psychiatry

The representatives of a psychiatric reform in Germany denounced the conditions in the large psychiatric hospitals of the time. Main points of criticism: It is a matter of “exclusion” and “custody psychiatry”, in which catastrophic, inhumane conditions prevailed. The patients would be socially isolated, incapacitated and merely kept in custody, sometimes for life, instead of being treated and rehabilitated.

Psychiatry inquiry (1975)

In the psychiatry inquiry of 1975 these points of criticism were confirmed and serious deficiencies in the psychiatric care of the time were identified. This included placing the patients in large, often overcrowded dormitories that did not allow privacy and had a negative impact on illness. In the large psychiatric hospitals there was a serious shortage of staff, both in the medical and nursing fields. There was hardly any use of social workers. In addition, there were qualification problems among the nursing staff with regard to the special tasks in the care of psychiatric patients.

The psychiatric clinics were mostly located in remote areas, which made pre- and post-operative care of inpatient stays, maintaining family ties and social integration of the patients difficult. The accessibility of the clinics by public transport was poor. The long periods of patient stay in the clinics were also among the points of criticism. In over 30% of the patients it was over 10 years. Structures for existing rehabilitation of the patients and their reintegration into everyday life after inpatient care were not available.

aims

Both medical and institutional changes and psychosocial improvements were formulated as goals of the psychiatry reform. One focus of the medical objectives was the reduction of long-term medications and the improvement of medication in the interest of increasing freedom from side effects .

The psychosocial objectives were the de- hospitalization of long-term patients, therapy and rehabilitation instead of the previous custody and equality of mentally ill with physically ill. For the needs-based care of all mentally ill, a community-based prior to inpatient care was sought, the avoidance or shortening of inpatient stays and the establishment and expansion of outpatient support services in the living environment of the patients and their families. In addition to the psychiatric clinics, more psychiatric departments should be set up at general hospitals. These measures should be supplemented by the expansion of self-help networks for mentally ill people and by better cooperation and coordination of all care services.

Achievements

The successes or achievements of the psychiatric reform include reducing the number of beds in psychiatric hospitals, improving staffing levels, which in addition to a higher level of care also includes the involvement of psychologists , social workers, occupational therapists and artistic therapists . The range of outpatient services such as social psychiatric services and day-structuring facilities was expanded. Legal framework conditions also contributed to the implementation of work rehabilitation measures such as B. Work opportunities with additional expense allowance , so-called additional earnings and integration projects .

There was a build-up of assisted living options , which can be differentiated into homes, assisted living communities and individually assisted living.

Through the establishment of psychiatric departments at general hospitals, a regionalization of inpatient care could be achieved and overall inpatient stays could be shortened.

Differentiation of the Enquête from antipsychiatry

The delimitation of the reform and the commission of inquiry from the antipsychiatry movement consists in the fundamental recognition of the reality of mental illness and the need for diagnoses , inpatient stays and drug treatment in certain cases.

Psychiatry is viewed as a service provider and as an instrument for treating and curing a disease, while antipsychiatry often sees psychiatry primarily as an authority that creates order, a social instrument for punishing or correcting social maladjustment.

literature

  • Manfred Bauer (Ed.): Psychiatry Reform in Europe , Bonn 1991.
  • Manfred Bauer: On the death of Walter Piccard In: Psychiatrische Praxis 27 (2000), p. 159.
  • Dorothea Buck : 70 years of coercion in German psychiatry - experienced and witnessed . (PDF; 52 kB). Main lecture on June 7, 2007 at the congress Coercive Treatment in Psychiatry: A Comprehensive Review , organized by the World Psychiatric Association (WPA) in Dresden
  • Anna Büchler: Psychiatry and psychiatry reform in the mirror of the Deutsches Ärzteblatt from 1949 to 1983 , Tübingen 2016.
  • Petra Bühring: Psychiatry history: turning point 1968. In: Deutsches Ärzteblatt 98 (51-52), 2001, pp. A-3435 / B-2893 / C-2689 ( aerzteblatt.de ).
  • Petra Bühring: Psychiatry reform: stuck halfway. In: Deutsches Ärzteblatt 98 (6), 2001, pp. A-301 / B-240 / C-227 ( aerzteblatt.de ).
  • German Bundestag : report on the situation of psychiatry in the Federal Republic of Germany (=  printed matter . No. 7/4200 ). Bonn 1975 ( dgppn.de [PDF]).
  • Asmus Finzen: The end of the institution. On the arduous everyday life of reform psychiatry , Bonn 1985.
  • W. Gaebel, J. Heinlein, K. Maas (Eds.): Well or bad? Medicines in psychiatry. In: Psychiatry through the ages. 125 years of 'Grafenberg' - Rheinische Kliniken Düsseldorf - Clinics of the Heinrich Heine University Düsseldorf. Rheinland Verlag, Cologne 2001, p. 137 f. ( lvr.de )
  • Heinz Häfner : Psychiatry Reform in Germany. Prehistory, implementation and aftermath of the psychiatry inquiry. An experience report. In: Heidelberger Jahrbücher Online, 2016, Volume 1, Article 8, pp. 119–145, PDF (accessed December 13, 2017).
  • Felicitas Söhner, Thomas Becker (eds.); Heiner Fangerau (Ed.): Psychiatry-Enquete: Understanding with contemporary witnesses. An oral history of the psychiatric reform in the FRG. Psychiatrie-Verlag, Cologne 2019. ISBN 978-3-88414-953-9 . ( Online )
  • Franz-Werner Kersting (Ed.): Psychiatry reform as social reform. The mortgage of National Socialism and the departure of the sixties. Schöningh, Paderborn 2003, ISBN 3-506-79619-4 .
  • Katrin Lange: Experienced people change psychiatry. European pilot project EX-IN creates models of user participation. In: Psychosoziale Umschau , 1/2008, p. 4, ex-in.info (PDF).
  • Peter Lehmann: Stattbuch 5 - A guide through the other Berlin. Stattbuch-Verlag, Berlin 1995, p. 128 ff., Antipsychiatrieverlag.de
  • Sabine Neukirch: 30 years of psychiatry reform in Italy. A look back at the reform process and its social and health policy influencing factors . In: Sozialpsychiatrische Informations , 4/2008, psychiatrie.de (PDF).
  • Heinz Schott, Rainer Tölle: History of Psychiatry. Diseases - wrong ways - forms of treatment. CHBeck, Munich 2006 ( online ).
  • Günther Wienberg: Community Psychiatry Today - Achievements, Current Challenges and Perspectives . In: Sozialpsychiatrische Informations , 1/2008, p. 2 f., Psychiatrie.de (PDF).

Individual evidence

  1. ↑ Heinz Schott, Rainer Tölle: History of Psychiatry. Diseases - wrong ways - forms of treatment. CH Beck, Munich 2006, p. 306 ( books.google.de ).
  2. ^ A b Petra Bühring: Psychiatry reform: Stuck halfway. In: Deutsches Ärzteblatt 98 (6), 2001: A-301 / B-240 / C-227 ( aerzteblatt.de ).
  3. ↑ Heinz Schott, Rainer Tölle: History of Psychiatry. Diseases - wrong ways - forms of treatment. CH Beck, Munich 2006, p. 306 ff. ( Books.google.de ).
  4. ^ Sabine Neukirch: 30 years of psychiatry reform in Italy. A look back at the reform process and its social and health policy influencing factors. In: Sozialpsychiatrische Informations , 4/2008, http://psychiatrie.de/data/pdf/f0/06/00/info_04_2008_02.pdf ( Memento from December 9, 2008 in the Internet Archive )
  5. ↑ W. Gaebel, J. Heinlein, K. Maas (Eds.): Wohl oder Übel? Medicines in psychiatry. In: Psychiatry through the ages. 125 years of 'Grafenberg' - Rheinische Kliniken Düsseldorf - Clinics of the Heinrich Heine University Düsseldorf. Rheinland Verlag, Cologne 2001, p. 137 f. ISBN 978-3-7927-1847-6
  6. ↑ Peter Lehmann: Instead of Book 5 - A Guide to the other Berlin. Stattbuch-Verlag, Berlin 1995, p. 128 ff. ( Antipsychiatrieverlag.de )
  7. ↑ Petra Bühring: Psychiatry history: turning point 1968. In: Deutsches Ärzteblatt 98 (51-52), 2001, pp. A-3435 / B-2893 / C-2689 ( aerzteblatt.de )
  8. ↑ for example Federal Association of Psychiatry Experienced , Federal Association of Relatives of Mentally Ill People , Irre Menschlich .
  9. ↑ for example psychosis forum
  10. ↑ for example Lichtblick ( Memento from January 31, 2009 in the Internet Archive )
  11. ↑ Errtu (r) m . Retrieved May 29, 2019
  12. ↑ for example Basta ( Memento from July 31, 2009 in the Internet Archive )
  13. ↑ Katrin Lange: Experienced people change psychiatry. European pilot project EX-IN creates models of user participation. In: Psychosoziale Umschau , 1/2008, p. 4, EX-IN (Experienced-Involvement) (PDF). Retrieved May 30, 2019
  14. ↑ Psychiatrie-Enquête (PDF file) ( Memento from February 19, 2010 in the Internet Archive ), p. 6 ff.
  15. ↑ Additional earnings in all its facets: What is additional earnings? For the history of the additional income offers BAG Inklusionsfirmen e. V., accessed on October 12, 2017
  16. ↑ Günther Wienberg: Community Psychiatry Today - Achievements, Current Challenges and Perspectives In: Sozialpsychiatrische Informations , 1/2008, S. 2 f., Psychiatrie.de ( Memento from December 22, 2009 in the Internet Archive ) (PDF).
  17. ↑ Heinz Schott, Rainer Tölle: History of Psychiatry. Diseases - wrong ways - forms of treatment. CH Beck, Munich 2006, p. 313 f. ( online ).
  18. ↑ Peter Lehmann: Instead of book 5. A Guide to the other Berlin. Stattbuch-Verlag, Berlin 1995, pp. 128–130 ( online )