Die Versorgung psychisch Kranker zur Jahrtausendwende - ein Weg in die 2-Klassen-Psychiatrie?

Zusammenfassung:

Bis zum heutigen Tage wird die Sonderstellung der Psychiatrie wesentlich durch das Vorurteil der besonderen Gefährlichkeit Kranker bestimmt. Die Entwicklung der psychiatrischen Versorgung seit Mitte der 50er Jahre hatte nicht nur die Verbesserung der Lebenssituation der Patienten, sondern auch den Abbau der Stigmatisierung - somit eine Normalisierung der erwähnten Sonderstellung - zum Ziel. Allerdings kam es im Rahmen der schrittweisen Umsetzung der Psychiatriereformen zu einer zunehmenden Vernachlässigung einer Gruppe schwer Kranker, die nicht imstande ist, die Angebote moderner psychiatrischer Versorgung zu nützen, bzw. werden die Bedürfnisse dieser Gruppe von der aktuellen Entwicklung nicht in ausreichendem Maße abgedeckt. Dies sowie der damit im Zusammenhang stehende Rückzug der Psychiatrie von jenen Aspekten der Behandlung, die mit aggressivem Verhalten Kranker oder Zwang gegen sie zu tun haben, führte zu einer Auslagerung eines Teils der erwähnten Subgruppe aus der regulären Versorgung. Diese anfangs nur in den USA zu beobachtende Entwicklung griff mit der Zeit auch auf Europa über. Sie verstärkt die nach wie vor bestehenden Vorurteile, ist kontraproduktiv im Hinblick auf die angestrebten Ziele der Reformen und erhöht die Gefahr undifferenzierter Reaktionen seitens der Politik.

Mental Health Care at the Turn of the Millennium - On the Way Towards Two-Class Psychiatry?

Up to now the special position of psychiatry is determined by prejudices in connection with violence and dangerousness of the mentally ill. The reforms of mental health care since the fifties were directed not only at the improvement of the treatment and the situation of psychiatric patients, but also at the reduction of prejudices and stigmata - i.e. a normalisation of the aforementioned special position. However, in connection with the stepwise progress of the reforms one could notice an increasing neglect of a subgroup of severely mentally ill who are not able to accept the offers of modern mental health care, or whose care-requirements are not met by the current developments. This together with the withdrawal of psychiatry from all those aspects of treatment, dealing with aggressive behaviour of or coercion against mentally ill led to a stepwise removal of certain patients - recruited mainly from the aforementioned subgroup - from the general mental health care system. Initially this development could be observed only in the USA, but in the meantime several European countries are appearing to catch up. This reinforces the prejudices against mental patients in general which are present up to now, is counterproductive with regard to the intended aims of mental health reforms and increases the danger of undifferentiated and restrictive political reactions.

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