Psychiatric reform in Germany.

OBJECTIVE

To describe the ongoing process of German psychiatric reform and the structure and functioning of mental health services.

METHOD

Information sources used include official reports describing mental health services, relevant publications related to organization and functioning of services.

RESULTS

There has been far-reaching change in mental health care since the late 1960s: psychiatric hospitals have lost about 50% of their beds and one psychiatric hospital has been closed. One hundred and sixty-five general hospital psychiatric units have been built up. Out-patient, community and residential services have been developed. There is a lack of diversified residential and rehabilitation services, particularly for the most severely ill. Co-ordination of care is not always ensured, transfer of patients to remote nursing homes has occurred in some places. Carers and service users articulate their views to an increasing degree.

CONCLUSION

Political and professional enthusiasm have been important in implementation of the German reform. Evolving it further will require major efforts.