[Community mental health approaches for avoidance of patient placement in closed psychiatric facilities-a positioning].

backgroundIn many cases the placement of people with mental disorders in closed residential homes is an expression of the lack of alternative care options. In the area of tension between the need for security in the case of chronically self-endangering behavior, recurrent acute psychiatric crisis interventions and a lack of perspective to establish a permanent therapy, in many places a placement in a closed facility approved under care law is carried out.

objectiveWhat alternatives are there to closed institutional care in the psychiatric care system in Germany?

methodsA trialogical discussion process was carried out in an expert panel taking the relevant literature into consideration and with the participation of organizations of those affected and their relatives.

resultsThe community psychiatric care system in Germany is extremely heterogeneous. The fragmented sociolegal and financing systems makes cross-sectoral and continuous care planning and service provision difficult. Precisely tailored and individualized services that could prevent the persons concerned from being placed in a closed home exist in Germany only at a few locations and in the form of individual model projects.

conclusionThe structural and sociolegal deficits addressed require a reform of the institutional framework and a redirection of all actors involved, including the clinics. Alternative approaches to the care of people with severe mental disorders are outlined. These include the Wedding model, binding community psychiatric structures, the basic functional model and assistance services under the German Social Code IX following the revision of the Federal Participation Act.