title: [Mental health care at the turn of the millennium--on the way toward two-class psychiatry].
abstract: Up to now the special position of psychiatry is determined by prejudices in connection with violence and dangerousness of the mentally ill. The reforms of mental health care since the fifties were directed not only at the improvement of the treatment and the situation of psychiatric patients, but also at the reduction of prejudices and stigmata--i.e. a normalisation of the aforementioned special position. However, in connection with the stepwise progress of the reforms one could notice an increasing neglect of a subgroup of severely mentally ill who are not able to accept the offers of modern mental health care, or whose care-requirements are not met by the current developments. This together with the withdrawal of psychiatry from all those aspects of treatment, dealing with aggressive behaviour of or coercion against mentally ill led to a stepwise removal of certain patients--recruited mainly from the aforementioned subgroup--from the general mental health care system. Initially this development could be observed only in the USA, but in the meantime several European countries are appearing to catch up. This reinforces the prejudices against mental patients in general which are present up to now, is counterproductive with regard to the intended aims of mental health reforms and increases the danger of undifferentiated and restrictive political reactions.
authors: H
authors: H
authors: Schanda
mesh_terms: D005060:Europe; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D011570:Psychiatry / Q000639:trends*