Niedersächsisches Landesarchiv

An overview of compulsory admission and civil commitment in Germany is presented. Legal, administrative, and methodological aspects are described, to allow interpretation of long-term trends. The official court proceedings in all German federal states from 1992 to 2003 were statistically investigated. Admission data from psychiatric hospitals are reported. Total civil commitment rates, excluding those allowing physical restraint, increased from 24 to 55 per 100 000 inhabitants, being rarely applied in East Germany. Public commitment rates increased from 64 to 75. They remained stable in the old West German states with 80 (range 76 to 89), and increased in the new states (15 to 26). The total of all commitments increased by 38 %. Independent of compulsory admission, court decision rates with regard to physical restraint, which have been obligatory since 1992, increased markedly from 12 to 90. Taking into account the limitations of assessing court proceedings, there is no evidence for a strong rise of compulsory admissions in Germany. The actual number of compulsory admissions shows a tendency to stabilize on a high level, reflecting an increasing legal orientation and changing clinical practice with shorter treatments and more placements in hostels.

In a previous study the effectiveness of vocational therapy was evaluated using the Osnabrück Profile of Working Abilities (O-AFP). No or only minor effects were detected. The goal of this reanalysis is to identify distinct responder groups. Hierarchical cluster analysis of O-AFP-scores before and after treatment, anovas, t-statistics as well as regression and discriminant analyses were applied to specify the clusters. For each of the O-AFP-scales (Learning Ability, Social Communication Ability, Adaptation) three subgroups different in level and slope of abilities could be identified. Improvements with medium to high effect sizes were detected for Social Communication Ability (34 %) and Learning Ability (14 % of the patients), deterioration was found in 30 % of the patients for Adaptation. Subgroups could be described with the help of symptomatology. Further variables and subgroup membership could be predicted above chance by discriminant and regression analysis. Targeted and more appropriate design of vocational therapy seems necessary.

Personen, die an einer psychischen Erkrankung leiden, werden nicht nur durch die Symptome ihrer Erkrankung beeintrachtigt, hinzu kommt die Belastung durch die gesellschaftliche Stigmatisierung und Diskriminierung aufgrund der Erkrankung. In Kap. 66 werden Definitionen von »Stigmatisierung« und »Diskriminierung« vorgestellt und Stigmakonzepte, wie sie Programmen und Kampagnen zur Bekampfung dieser Stigmatisierung zugrunde liegen, beschrieben. In diesem Kapitel wird der Zusammenhang zwischen Erkrankung, Stigma und psychiatrisch-psychotherapeutischer Versorgung unter besonderer Berucksichtigung der Rehabilitation psychisch Kranker dargestellt und Strategien, Stigmatisierung zu begegnen, vorgestellt und diskutiert. Internationale und nationale Programme und Kampagnen zur Bekampfung der Stigmatisierung aufgrund von psychischer Erkrankung werden vorgestellt und Methoden und Ergebnisse von Messungen ihrer Effekte und ihrer Effektivitat thematisiert.

The large-scale "Psychiatry Inquiry", or inquest, held in the Federal Republic of Germany in the 'seventies, represented a great step forward in the reformation of psychiatric patient care. However, the general consensus of opinion about the future development crumbled and fell apart by the end of the 'seventies. On the one hand, there was the demand for dissolving the psychiatric large-scale hospital whereas on the other hand the ancient type of lunatic asylum or mental hospital re-entered through the backdoor: therapy wards were separated spatially from care wards without the slightest regard for the modern concepts of mental illness, its treatment and its course. This article tries to point out that both tendencies are an expression of today's "postmodernistic thinking". They offer illusions of solutions, i.e. they simulate solutions in the sense of the postmodern technique of "as though" and do not pay any heed to the interests of the mental patient himself.