Bramesfeld Anke
Institut für Epidemiologie Sozialmedizin und Gesundheitssystemforschung OE 5410, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2023 Apr;66(4):363-370. doi: 10.1007/s00103-023-03671-x. Epub 2023 Mar 3.
The article provides an overview on the current state of service provision for people with psychiatric illnesses, financed by health-insurance companies, the rehabilitation and participatory systems, and the German Federal States. Over the last 20 years, service capacities have continually improved. Three areas that are in need of further development are highlighted here: the coordination of services for mentally ill persons with complex needs; the long-term placement of persons with severe mental illness and challenging behavior; and a growing shortage of specialists.
The mental health system in Germany is largely well to very well developed. Despite this, specific groups do not benefit from the available assistance, and these often end up as "long-term patients" in psychiatric clinics. Models for coordinated and outpatient-oriented service provision for persons with severe mental illness exist, but are only sporadic. Intensive and complex outreach services in particular are lacking, as are service concepts that are able to cross the boundaries of social security responsibilities. The shortage of specialists, which affects the whole mental health system, requires restructuring toward a more outpatient-care focus. The first tools for this exist within the health insurance-financed system. They should be used.
本文概述了由健康保险公司、康复与参与体系以及德国联邦州资助的针对精神疾病患者的服务提供现状。在过去20年里，服务能力持续提升。这里突出了三个需要进一步发展的领域：为有复杂需求的精神疾病患者提供的服务协调；患有严重精神疾病且行为具有挑战性的患者的长期安置；以及专家日益短缺的问题。
德国的心理健康体系在很大程度上发展良好至极佳。尽管如此，特定群体并未从现有的援助中受益，这些群体往往最终成为精神病诊所的“长期患者”。存在针对严重精神疾病患者的协调且以门诊为导向的服务提供模式，但只是零星存在。尤其缺乏强化且复杂的外展服务，以及能够跨越社会保障责任界限的服务理念。影响整个心理健康体系的专家短缺问题，需要朝着更加注重门诊护理的方向进行重组。医疗保险资助体系中已存在为此所需的首批工具。应当加以利用。
