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KMID : 0607419970020010101
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Mental Health Services
1997 Volume.2 No. 1 p.101 ~ p.114
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The Current State of Community Mental Health of Hamburg in Germany
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Kim Chul-Kwon
Lee Seung-Keun
Byun Won-Tan
Rhi Bou-Young
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Abstract
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In 1971, the West German parliament set up an expert committee to evaluate the state of psychiatric care in the country and the committee published a report about it in 1975. The major contents of a report were as follows. (1) Although chronic mental patients are also disabled persons, the financial supports for them were less from one fourth to one sixth than those for physical disabled patients. (2) In-patient care was provided almost exclusively by large state mental hospitals. Most of those hospitals with inadequately staffed and programs are located in the countryside. (3) There were almost no community-based psychiatric departments. (4) Psychiatric out-patient treatment and non-hospital rehabilitation care were insufficient. (5) Psychiatric care was separated from the general system of health care. The committee proposed reforms to the health care system that were in line with internationally accepted principles of modern psychiatry. The system should emphasize community-based in-patient and out-patient treatment destined to suit the individual needs of each patients. Since then, West Germany psychiatry has changed remarkably. The results of reforms were as follows. (1) The number of beds has been steadily reduced because of deinstitutionalization of chronic mental patients. (2) The mean length of stay in hospitalization was shortened considerably because of the reduction in hospital beds. (3) The admission rate was increased because of the decrease in psychiatric beds and the shortage of length of stay. (4) Many kinds of social recovery facilities such as sheltered homes or apartments, day care centers, social clubs, and vocational rehabilitation facilities were built and established in the community.
Hamburg city has also the same change like the West Germany since 1975. Now, many kinds of facilities which aim to facilitate social recovery of chronic mental patients were operating in Hamburg. Many chronic patients are living in community after discharged from state mental hospitals. Deinstitutionalization is still in process and does not lead the sequelae as was the case in the United States of America or Italy yet.
However, Hamburg’s mental health system has been faced several serious problems recently. The biggest problem is that of financing psychiatric care. Because of high unemployment rates, the Hamburg government has smaller financial resources and is correspondingly less able to provide adequate services for the chronic mentally ill. Most chronic mentally ill depend on social welfare and the government can not capable of the financial burden. The older chronic mentally ill who are living in the residential facilities also give a serious problem. The chance to get a job and home in the community is fewer and fewer after unification. Despite of these problems, the overall level of mental health and community-based are for chronic mental patients in Hamburg are considered satisfactory.
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KEYWORD
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Community Mental Health, Community Mental Health Care, Hamburg, Germany
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