title: Integrated care in German mental health services as benefit for relatives--a qualitative study.
abstract: BACKGROUND
  As mental health services undergo the process of deinstitutionalization, this is resulting in a higher burden of care for relatives. Evidence suggests that interventions for carers have a beneficial impact on their psychological health. A reduction of responsibility for relatives is linked with a significantly improved outcome for the severely mentally ill. The aim of the study was to explore the relatives' experiences with severely mentally ill patients in different integrated care service providers.
  
  
  METHODS
  Semi-structured focus groups and interviews were conducted with 24 relatives of patients receiving community based integrated care for severe mental illness. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories.
  
  
  RESULTS
  Four main categories were found related to the structural aspects of the integrated care services and for the experiences of the relatives within these services. Relatives reported that the services offered significant relief and substantial support in daily life. In addition, relatives felt a reduced burden of carer responsibility and therefore that they were provided with more protection and stability. This resulted in a sense of encouragement and not feeling left alone to face challenges.
  
  
  CONCLUSIONS
  Relatives are a critical resource for patients suffering from mental health problems and benefit from formal structures and interventions to support them in carer role. An important need is to ensure continuity of care for patients and the bridging of gaps concerning information and support needs for relatives when providing integrated mental health services in the community.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany. jan.valentini@med.uni-heidelberg.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Valentini
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany. daniel2.ruppert@med.uni-heidelberg.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ruppert
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany. julia.magez@med.uni-heidelberg.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Magez
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073, Göttingen, Germany. constance.stegbauer@aqua-institut.de.
authors.forename: Constance
authors.initials: C
authors.lastname: Stegbauer
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care, Maschmühlenweg 8-10, 37073, Göttingen, Germany. anke.bramesfeld@aqua-institut.de.
authors.forename: Anke
authors.initials: A
authors.lastname: Bramesfeld
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany. katja.goetz@med.uni-heidelberg.de.|Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany. katja.goetz@med.uni-heidelberg.de.
authors.forename: Katja
authors.initials: K
authors.lastname: Goetz
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D008875:Middle Aged; D011368:Professional-Family Relations; D036301:Qualitative Research; D013315:Stress, Psychological / Q000523:psychology