How do subjects with mental illness work and live in Germany
Prof. Dr. Peter Brieger, Bezirkskrankenhaus Kempten & Medizinische Fakultät, Universität Ulm, peter.brieger@bkh-kempten.de
Principles psychiatric care
- Housing
- Work
- Conclusion
3 Periods of Psychiatric Care: Period 1: Rise of asylums
Psychiatric care - then
3 Periods of Psychiatric Care: Period 2: Decline of asylums
Byberry State Mental Hospital, PA, USA 
3 Periods of Psychiatric Care: Period 3: Balanced Care
82,000,000 inhabitants, 16 federal states
The historical guilt of psychiatric care in Germany
Psychiatric hospitals
- 404 hospitals
- 53,000 beds
- average length of stay 24.2 days
- 91.4 % occupancy
Number of hospital beds 2006
Out-patient care
- Registered psychiatrists
- Registered psychotherapists
- Psychiatric out-patient units at hospitals
Housing
Allgäu:
Re-institutionalization? Germany 1990 - 2002
Re-institutionalization? England 1990 - 2002
Re-institutionalization? Holland 1990 - 2002
Residential facilities
Number of beds for subjects with mental health problems
Positive options
- Assisted housing (single or shared appartment)
- „Familienpflege“: „family care“
Work
How many subjects with severe mental illness have work?
The function of work
- to earn money
- to fulfil a social role
- to overcome the „sick role“
- criteria for recovery
- social status
- social contacts
- day structure
- …
Problem: In many societies there is not even enough work for people w/o disabilities
To bring people with mental disorders into work is problematic in societies with an unemployment rate >2%, it is almost impossible with unemployment rates > 6%. (Morgan & Cheadle 1972)
Early disability payments
Diagnosis for disability payments
Early disability payments: affective disorders
Specializied forms of work
Workshops for disabled persons
Integration projects
Additional earning
Work rehab (vocational training etc.)
Effect after 9 months
Social functioning
Subjective QOL
Is Supported Employment superior?
- IPS: Individual placement and support
- first place, then train
- EQOLISE study: 312 Patienten, 6 countries, RCT
- 55% (IPS) vs. 28% (Standard Reha) success
but…
We must never forget that subjects with a severe mental illness are more often..
- poor
- unemployed
- less educated
- isolated
- physically ill
