How do subjects with severe mental illness work and live in Germany?
Peter Brieger, MD, Professor at the University of Ulm, Director Bezirkskrankenhaus Kempten, Freudental 1, 87435 Kempten, Germany, peter.brieger@bkh-kempten.de
The German mental health system has several particularities. First there is intricate funding. Hospital and out-patient care is based on a complex system of finances, which includes several hundred insurance companies as well as institutions of the state, while residential care is financed by social welfare. Institutions which offer vocational rehabilitation or provide occupation for subjects with severe mental illnesses may receive money from pension funds, the government agency for work and social welfare. Obviously, coordination is difficult. Only recently have there been attempts to found local “steering associations”. Secondly, mental health hospital beds were only half-heartedly reduced during psychiatric reforms. Many large mental hospitals with several hundred beds have remained; at the same time there was a disquieting increase of beds in residential facilities. It is difficult to monitor the quality of care in such residential facilities. Thirdly, the importance of work, occupation and employment for subjects with severe mental illnesses has only become a focus of attention in the last few years. At present there are many positive examples in the field of residential care and occupation, while at the same time shortcomings and opportunities of the system are being discussed between health care professionals, government officials, users and their families. The lecture will present some examples as well as ideas for future developments.