Expectations of medical care as performed by the social psychiatry services in the State of Saxony

被引:3
|
作者
Kallert, TW [1 ]
Leisse, M [1 ]
Kreiner, B [1 ]
Bach, O [1 ]
机构
[1] TU DRESDEN,KLINIKUM CARL GUSTAV CARUS,KLIN & POLIKLIN KINDER & JUGENDPSYCHIAT & PSYCHOT,DRESDEN,GERMANY
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D O I
10.1055/s-2007-996352
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
After the ''Policlinic system'' that had predominated in the GDR had been dismanted, a far-reaching restructuring of the complementary psychiatric care sector became necessary. In the State of Saxony, comprehensive establishment of a homogeneous home-visit outpatient service is the first building block in an interlinked system of regionalised community psychiatry. Based on about 20 yea rs of experience in the Federal States of the FRG, this function is fulfilled by social psychiatry services (SPS). The present study investigates the expectations of free-practising psychiatrists (n = 165), doctors in psychiatric hospitals (n = 95) and staff of social psychiatry services (0 = 138) throughout the State of Saxony in respect of available care and the way these new care structures work. The results are approximately representative owing to the high rate of responses in an anonymous postal survey of three specified groups (48.5%, 67.4%, 84.0%). All the groups surveyed expected that the clientel to be looked after by SPS will chiefly consist of the group of chronically mentally ill persons. Moreover, the consistently expressed expectations as to the central care/therapy to be provided by SPS can be summarised as the core of directly client-oriented SPS work. This consists of the elements ''welfare work'', ''individual and institutionalised social therapy'', and ''help in administrative measures''. The main differences between the two groups of doctors is that free-practising psychiatrists more often expect a large SPS involvement with regard to social therapy provided at an institutional level, wereas hospital doctors expert this with regard to medical therapies in the strict sense. Hospital doctors have greater expectations that SPS will also fulfil further functions: work with relatives, public relations, establishment of a crisis service and running self-help groups. The expectations of SPS staff with regard to the therapy they should provide themselves exceed what has already been currently achieved in all sectors. A detailed analysis of contents is also presented in this article. Besides improved staffing, SPS employees state that eliminating internal organisational and postgraduate training deficits are two major requirements for stabilization of their work. Appraisals of the quality of care for the chronically mentally ill in the outpatient complementary sector requested by hospital doctors and SPS staff in comparison with former provision structures in the GDR, show deterioration in the economic security of patients as well as of possibilities available in occupational rehabilitation. On the other hand, there are some improvements in the training of specialist staff whereas protection of the personality rights of patients as well as care measures are now free from ideological bias. These are crucial prerequisites for an update individualised, need-orientated therapeutic procedure. To counteract overburdening of the SPS with expectations of care and to enable a more unequivocal positioning of its structure in a complex system of psychosocial care, further need-orientated development and establishment of psychiatric facilities close to the community concerned, are urgently required, a least as far as the State of Saxony is concerned.
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页码:461 / 472
页数:14
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