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[社会福利政策对德国精神病患者去机构化的影响]

[The impact of social welfare policies on the deinstitutionalisation of the mentally ill in Germany].

作者信息

Bramesfeld Anke, Holler Gerhard

机构信息

Abteilung Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover.

出版信息

Psychiatr Prax. 2004 Nov;31(8):387-94. doi: 10.1055/s-2003-814856.

Abstract

OBJECTIVE

In Germany the competent institution for supported housing for mentally ill and handicapped persons is traditionally the regional welfare authority, while welfare authorities on state (Lander) level hold the competencies for accommodation in hostels and homes: Assessment of the impact of policies that try to overcome this separation of competencies.

METHOD

  1. Analysis of the practise of distributing the competencies for accommodation for mental ill and handicapped persons in the 16 German Lander. 2. Assessment of the supply with accommodation for mental ill and handicapped persons in the Lander. 3. Investigation of a possible relationship between distribution of competencies for accommodation and number of accommodation in supported housing and hostels/homes.

RESULTS

Data about available accommodation in supported housing and hostels are inconsistently limited and available. As far as this data can be interpreted, Lander that have the administrative and particularly financial competency for accommodation uniquely organised, generally offer more supported housing. At the same time they provide relatively less accommodation in hostels and homes. Despite having the competencies for accommodation uniquely organised, some Lander continue to provide accommodation for mentally ill persons predominantly in hostels and homes.

CONCLUSION

A comprehensive and between the Lander comparable system of documentation of accommodation for mentally ill and handicapped persons is highly needed. Unique organisation of competencies for accommodation of mental ill and handicapped persons is a necessary - however not commensurate precondition for the increase of the supply in supported housing. Beyond that, other factors seem to be influential, such as political will, attitudes towards the mentally ill, interests of hostel providers, pre-existing hostel infrastructure. In respect of these factors more research is needed.

摘要

目的

在德国,传统上负责为精神疾病患者和残疾人提供支持性住房的机构是地区福利部门,而州(联邦州)级的福利部门则负责提供青年旅社和疗养院的住宿:评估旨在克服这种职责分离的政策的影响。

方法

  1. 分析德国16个联邦州中为精神疾病患者和残疾人分配住宿职责的做法。2. 评估各联邦州为精神疾病患者和残疾人提供的住宿情况。3. 调查住宿职责分配与支持性住房及青年旅社/疗养院住宿数量之间可能存在的关系。

结果

关于支持性住房和青年旅社现有住宿情况的数据有限且不一致。就这些数据能够解读的情况而言,那些对住宿具有行政尤其是财政职责且组织方式独特的联邦州,通常提供更多的支持性住房。与此同时,它们在青年旅社和疗养院提供的住宿相对较少。尽管对住宿职责进行了独特的组织安排,但一些联邦州仍主要在青年旅社和疗养院为精神疾病患者提供住宿。

结论

迫切需要一个全面且在各联邦州具有可比性的精神疾病患者和残疾人住宿记录系统。对精神疾病患者和残疾人住宿职责进行独特的组织安排是增加支持性住房供应的必要条件——但并非充分条件。除此之外,其他因素似乎也有影响,如政治意愿、对精神疾病患者的态度、青年旅社提供者的利益、现有的青年旅社基础设施。针对这些因素,还需要开展更多研究。

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