Bramesfeld Anke, Holler Gerhard
Hannover Medical School, Department of Epidemiology, Social Medicine + Health System Research, Carl-Neuberg Strasse 1, 30625 Hannover, Germany.
Health Policy. 2005 Jun;72(3):359-66. doi: 10.1016/j.healthpol.2004.09.014. Epub 2004 Nov 5.
The integration of mentally ill and handicapped persons in the society requires the availability of various forms of sheltered housing in the community, most important ambulatory (supported) housing facilities. In Germany the administrative and financial responsibility for sheltered housing for mental ill and handicapped persons is usually assigned to two authorities: the welfare authorities at Lander (state) level are responsible for hostels, the welfare authorities on community and district level are responsible for ambulatory housing. However some Lander have distributed these responsibilities differently and other Lander offer subsidy programmes to promote the implementation of ambulatory housing.
To evaluate the different modes of distributing the responsibilities for administration and financing of sheltered housing for their impact on the supply with ambulatory and stationary housing in the 16 German Lander.
(1) Analysis of the practise of distributing the responsibilities for housing between Lander and community welfare-authorities in the 16 Lander. Analysis of the subsidy programmes in the Lander that aim to promote the implementation of ambulatory housing. (2) Assessment of the capacities in housing for mentally ill and handicapped persons in the Lander. (3) Comparing (1) and (2).
Lander that have the responsibilities for ambulatory housing and for hostels organised on the same authority-level, offer generally more housing in ambulatory facilities and less in hostels than Lander that do not. However, three Lander, despite having all responsibilities for housing at one authority level, provide accommodation for mentally ill and handicapped persons predominantly in hostels. There are so far no indications whether it would be more favourable to have a unique authority for housing based on Lander or on community level. Subsidy programmes to promote the implementation of supported housing are successful if they sponsor at least 50% of costs and if they exist for a considerable duration of time.
Organising the responsibilities for housing for mental ill and handicapped persons on one authority level and the availability of subsidy programmes have a positive impact on the supply with ambulatory housing. However other factors also have to be considered to influence the supply with ambulatory housing, such as political will, attitudes towards the mentally ill, interests of hostel operators, pre-existing hostel infrastructure, available funds. These factors need to be researched further.
精神疾病患者和残障人士融入社会需要社区提供各种形式的庇护性住房,其中最重要的是流动(支持性)住房设施。在德国,为精神疾病患者和残障人士提供庇护性住房的行政和财政责任通常由两个部门承担:州一级的福利部门负责宿舍,社区和地区一级的福利部门负责流动住房。然而,一些州对这些责任的分配有所不同,其他州则提供补贴计划以促进流动住房的实施。
评估为庇护性住房分配行政和财政责任的不同模式对德国16个州的流动和固定住房供应的影响。
(1)分析16个州在州和社区福利部门之间分配住房责任的做法。分析旨在促进流动住房实施的州补贴计划。(2)评估各州为精神疾病患者和残障人士提供住房的能力。(3)比较(1)和(2)。
在同一部门层面上负责流动住房和宿舍的州,与不这样做的州相比,通常在流动设施中提供的住房更多,而在宿舍中提供的住房更少。然而,有三个州尽管在一个部门层面上承担了所有住房责任,但主要在宿舍为精神疾病患者和残障人士提供住宿。到目前为止,尚无迹象表明基于州或社区层面设立单一住房部门是否更有利。促进支持性住房实施的补贴计划如果能资助至少50%的成本并且持续相当长的时间,就是成功的。
在一个部门层面上组织精神疾病患者和残障人士的住房责任以及提供补贴计划对流动住房供应有积极影响。然而,要影响流动住房供应还必须考虑其他因素,如政治意愿、对精神疾病患者的态度、宿舍经营者的利益、现有的宿舍基础设施、可用资金。这些因素需要进一步研究。