[The process of deinstitutionalization in German State Mental Hospitals. Critical overview of empirical research studies].
The process of discharging previously long-term hospitalized patients from German state mental hospitals, and of transferring these patients to other forms of supported housing has meanwhile come to its end. Therefore, this paper presents an overview of the scientific evaluation of this process. By using clearly defined research methodological criteria, eight empirical studies from several German federal states are assessed focusing on the meaningfulness of their results. Because of the heterogeneity of the aims regarding contents of this transformation process, of the research methodological approaches, and of the characteristics of the assessed patient groups, only few general results could be identified. Chronically mentally ill patients (mostly suffering from schizophrenic disorders) who had been successfully discharged to the community were younger, and showed shorter periods of illness and hospitalization than control patients. After discharge they might have experienced positive changes of their objective and subjective quality of life and of their perceived needs of care. Referred to several other outcome domains, no homogeneous tendencies concerning clinically relevant improvement or deterioration were found. In particular, changes related to psychopathological symptoms and social competencies were generally small. However, mortality and re-hospitalization rates of de-hospitalized patients were considerably high, and ranged between 3-24 %, and 4-46 %, respectively. The assessed studies could not identify replicated predictors of successful de-hospitalization. Female sex and long-term last hospitalization seemed to be important for stable placement in forms of supported housing requiring a higher level of autonomy. From the generally unclear procedural quality of the German deinstitutionalization process, the authors deduce implications for the scientific evaluation of future projects of restructuring mental health care services. Besides the clear definition of empirically assessable aims which should be based on theoretical considerations, it is of utmost priority to guarantee high performance quality of research methodological standards.
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Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Fetscherstrasse 74, 01307 Dresden. Thomas.Kallert@mailbox.tu-dresden.de
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Leisse
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Hoffmann
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D000328:Adult; D015331:Cohort Studies; D003688:Deinstitutionalization / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006778:Hospitals, Psychiatric / Q000458:organization & administration* / Q000706:statistics & numerical data; D006783:Hospitals, State / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011786:Quality Control; D012107:Research Design; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors