Administrative and financial responsibilities for sheltered housing for mentally ill and handicapped persons in Germany and its impact on housing supply.
BACKGROUND
The integration of mentally ill and handicapped persons in the society requires the availability of various forms of sheltered housing in the community, most important ambulatory (supported) housing facilities. In Germany the administrative and financial responsibility for sheltered housing for mental ill and handicapped persons is usually assigned to two authorities: the welfare authorities at Lander (state) level are responsible for hostels, the welfare authorities on community and district level are responsible for ambulatory housing. However some Lander have distributed these responsibilities differently and other Lander offer subsidy programmes to promote the implementation of ambulatory housing.


OBJECTIVE
To evaluate the different modes of distributing the responsibilities for administration and financing of sheltered housing for their impact on the supply with ambulatory and stationary housing in the 16 German Lander.


METHODS
(1) Analysis of the practise of distributing the responsibilities for housing between Lander and community welfare-authorities in the 16 Lander. Analysis of the subsidy programmes in the Lander that aim to promote the implementation of ambulatory housing. (2) Assessment of the capacities in housing for mentally ill and handicapped persons in the Lander. (3) Comparing (1) and (2).


CONCLUSIONS
Lander that have the responsibilities for ambulatory housing and for hostels organised on the same authority-level, offer generally more housing in ambulatory facilities and less in hostels than Lander that do not. However, three Lander, despite having all responsibilities for housing at one authority level, provide accommodation for mentally ill and handicapped persons predominantly in hostels. There are so far no indications whether it would be more favourable to have a unique authority for housing based on Lander or on community level. Subsidy programmes to promote the implementation of supported housing are successful if they sponsor at least 50% of costs and if they exist for a considerable duration of time.


CONCLUSIONS
Organising the responsibilities for housing for mental ill and handicapped persons on one authority level and the availability of subsidy programmes have a positive impact on the supply with ambulatory housing. However other factors also have to be considered to influence the supply with ambulatory housing, such as political will, attitudes towards the mentally ill, interests of hostel operators, pre-existing hostel infrastructure, available funds. These factors need to be researched further.
Bramesfeld
Anke
A
Hannover Medical School, Department of Epidemiology, Social Medicine + Health System Research, Carl-Neuberg Strasse 1, 30625 Hannover, Germany. bramesfeld.anke@gmx.de
Holler
Gerhard
G
D003156:Community Mental Health Services / Q000191:economics / Q000458:organization & administration*; D017598:Efficiency, Organizational; D005380:Financing, Government; D005858:Germany; D016352:Group Homes / Q000191:economics / Q000458:organization & administration* / Q000600:supply & distribution; D006208:Halfway Houses / Q000191:economics / Q000458:organization & administration* / Q000600:supply & distribution; D006284:Health Plan Implementation; D006801:Humans; D028642:Persons with Psychiatric Disorders; D017146:Models, Organizational; D020380:Needs Assessment; D019989:Persons with Intellectual Disabilities; D011635:Public Health Administration; D012941:Social Responsibility; D012946:Social Welfare