title: [Caring for psychiatric patients in proximity to their domicile or, more than one approach may be feasible (author's transl)].
abstract: The arguments in favour of caring for psychiatric patients in locations which are close to their domicile, are by no means new. Practically all of these arguments had already been brought forward by Griesinger, and we can also read them up in the minutes of the meetings of the Federal Germany Parliamentary Committee for Youth, Family and Health Problems. A frequent argument against the decentralisation of psychiatric care by setting up psychiatric departments in general hospitals is that this would eventually lead to a kind of two-class psychiatry. In simplified language, this would imply that those patients who are acutely diseased, are admitted to a general hospital, whereas the chronically diseased persons remain in the large-scale psychiatric Land hospital. However, this is not necessarily so, if such psychiatric departments of regional competence are compulsorily allocated to a certain area, which means they are compelled to admit patients residing in their area, while being prohibited from transferring these patients to another, far-away hospital. The departments in Rheydt and Hanover, for example, show that relevant experience collected outside Germany applies likewise to the Federal Republic. In fact, the reports published by these two hospitals show that psychiatry conducted close to the domicile of the patients improves outpatient follow-up of patients with chronic disturbances, whereas the number of compulsory admissions is dramatically reduced. On the other hand, the rate of admission is increased, and the period of hospitalisation reduced. In the long run, this results in a pattern of psychiatric care in which long-term outpatient therapy predominates. We can sum up by saving that community-centered and population oriented working is by no means a panacea for all problems of psychiatric care which have remained unsolved to data. However, experience has shown that the method is feasible and, on the whole a promising one. It is precisely the return of psychiatry to the communal level which opens up non-professional resources which would otherwise remain untapped. It must be borne in mind, however, that the physician's own psychiatric practice is exposed to the public eye to greater extent than before. This offers a real chance. The psychiatrist can take advantage of this chance only if he develops a kind of sixth sense for social processes and requirements within the community, for the best way to influence them, and to make use of them for translating one's own goals into reality. Of course, this will always involve the risk of overstepping one's own area of jurisdiction, but this need not be dramatised.
mesh_terms: D000208:Acute Disease; D000359:Aftercare / Q000523:psychology; D003155:Community Mental Health Centers / Q000458:organization & administration*; D005860:Germany, West; D006301:Health Services Needs and Demand; D006769:Hospitals, General; D006778:Hospitals, Psychiatric; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation*; D011567:Psychiatric Department, Hospital
vernacular_title: Gemeindenahe Versorgung oder Es geht auch anders, aber so geht es auch.