A quarter of a century of rehabilitation of psychiatric patients in Germany
Häfner, H.
Gesundheitswesen ) 59(2): 69-78
1997
ISSN/ISBN: 0941-3790 PMID: 9156628 Document Number: 482228
The past quarter of a century marks the first and decisive phase of mental health care reform in Germany and of psychiatric rehabilitation throughout the world. During this great awakening, psychiatry passed beyond the custodial system of care, where potent therapy instruments were lacking and the connection to society, its living standard and progress in medicine had been lost. In Germany, the crucial step to modernity was taken with the creation of the Expert Commission on Mental Health Care in 1970 to 1975. The birth hour of rehabilitation followed the insight produced by Wing and Brown in 1970 and Wing and Bennett in 1972 that secondary impairments caused by social deprivation during long-term hospital stay can be favourably influenced by means of rehabilitation programmes. Inspired by the Expert Commission's report, and encouraged further by the recommendations of the Central Institute of Mental Health for the State of Baden-Württemberg (1987) and of an expert commission for the Federal Republic of Germany (1988), the Federal, State and Local governments as well as public welfare organizations supplied considerable funds for the development of services and programmes aimed at the reintegration of the chronically mentally ill and disabled. Job centres, health insurance schemes and retirement pension schemes as paying authorities had greater difficulties in contributing to the development of a functioning system of rehabilitation services for the severely socially disabled mentally ill. Not only the costs were involved but also the complexity of the needs for rehabilitation and confusion about the definition of the measures and about the distinction from basic needs. The needs, objectives and instruments of psychiatric rehabilitation are discussed within the context of the present financial situation. In view of the current perspectives of decreasing financial and human resources in our society, humanitarian and social responsibility for the particularly vulnerable and distressed group of the mentally ill and disabled is called for.