[How community oriented is psychiatric care in Germany?].
OBJECTIVE
Following 25 years of psychiatric reform in West and 12 years in East Germany the status of community orientation of German psychiatry is investigated.


METHODS
Analysis of secondary data.


RESULTS
Community orientation in hospital care is better realised in the smaller western states and in the eastern German states. In the large western states inpatient care is still dominated by the structures of the large regional hospitals. Outpatient care, dominated by psychiatrists and psychotherapists in private practise, is less densely provided in East Germany. Sheltered accommodation is provided predominantly in hostels. The states with better community orientation in hospital care offer fewer sheltered accommodation.


CONCLUSIONS
The process of psychiatric reform is not accomplished yet, particularly concerning hospital care in the large western states and sheltered accommodation in general. A possible cause for the weak implementation of community orientation in hospital services in the large western states might be the strong position of hospital responsables that oppose the closing down of hospitals. Incentives for implementing supported housing are weak. The under-serving with sheltered accommodation might pose risks to the persons concerned.
Bramesfeld
Anke
A
Abteilung für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover. bramesfeld.anke@mh-hannover.de
D003156:Community Mental Health Services / Q000600:supply & distribution*; D005544:Forecasting; D005858:Germany; D018166:Health Care Reform / Q000639:trends*; D006297:Health Services Accessibility / Q000639:trends*; D006301:Health Services Needs and Demand / Q000639:trends; D006764:Hospitals, Community / Q000600:supply & distribution*; D006778:Hospitals, Psychiatric / Q000600:supply & distribution*; D006801:Humans; D011570:Psychiatry; D011613:Psychotherapy; D000078329:Workforce