[Guideline-adherent inpatient psychiatric psychotherapeutic treatment of borderline personality disorder : Normative definition of personnel requirements].
BACKGROUND
Borderline personality disorders (BPD) are severe mental diseases which place high pressure on the psychiatric healthcare system. Nowadays, well-tested, disorder-specific treatment concepts are available also for inpatient treatment in Germany. These show very good and long-term improvements in the psychopathology as well as posttreatment social participation; however, prerequisites for the implementation of these evidence-based inpatient psychotherapy programs are well-trained treatment teams and appropriate financing of resource expenditure.


OBJECTIVE
The aim was to formulate a definition of normative needs for treatment duration and intensity for a guideline-conform, empirically proven and effective inpatient treatment of borderline personality disorder as well as the derived personnel requirements in comparison to the currently available resources within the framework of the Psychiatry Personnel Act (Psych-PV).


METHODS
The resource requirements were established based on evaluated hospital ward models, the recommendations of the S2 guidelines and the criteria of specialist societies and compared with the personnel stipulations according to the Psych-PV.


RESULTS
The results for a normatively established treatment program showed a pronounced deficit in the financing of the evaluated resource requirements, even when the stipulations laid down in the Psych-PV were implemented to 100 %.


CONCLUSIONS
Disorder-specific inpatient treatment programs for borderline personality disorder have been scientifically proven to be highly effective; however, resource analyses show that the personnel requirements necessary for effective implementation of these programs are much higher than those allocated by the funding according to the Pysch-PV. The current underfunding leads to inadequate treatment outcomes with high readmission rates and as a result high direct and indirect costs of illness.
Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, J 5, 68156, Mannheim, Deutschland. martin.bohus@zi-mannheim.de.|Fakultät für Gesundheit, Universität Antwerpen, Antwerpen, Belgien. martin.bohus@zi-mannheim.de.
M
M
Bohus
Klinik für Psychosomatische Medizin und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Mannheim, Deutschland.
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C
Schmahl
Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland.
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SC
Herpertz
Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Mainz, Mainz, Deutschland.
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K
Lieb
Klinik für Psychiatrie und Psychotherapie, Universität Freiburg, Freiburg, Deutschland.
M
M
Berger
Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland.
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S
Roepke
Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland.
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A
Heinz
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
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J
Gallinat
Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, J 5, 68156, Mannheim, Deutschland.
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L
Lyssenko
D001883:Borderline Personality Disorder / Q000453:epidemiology / Q000628:therapy*; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000458:organization & administration; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D017146:Models, Organizational; D015233:Models, Statistical; D020380:Needs Assessment; D010561:Personnel Staffing and Scheduling / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011613:Psychotherapy / Q000592:standards* / Q000706:statistics & numerical data*; D016526:Workload / Q000592:standards / Q000706:statistics & numerical data
Dialectical Behavior therapy; Remuneration system in Psychiatric and Psychosomatic Health Care; Treatment costs