Deinstitutionalization of psychiatric patients in central Europe

The central European countries Germany, Switzerland, Austria, and Luxemburg are confronted with a variety of individual problems concerning health car e. After an analysis of problems which are shared by all the countries, the se individual aspects are analyzed. In Germany there has been a rapid struc tural change of psychiatric care in the last 30 years. Although there was a broad movement to deinstitutionalize patients with chronic psychiatric dis orders who need long-term care, there are still too many psychiatric beds i n large psychiatric hospitals and still missing psychiatric departments in general hospitals in some areas. In Austria the process of deinstitutionali zation has been delayed but a general survey of the health care system by t he government led to an acceleration of this process in recent years. Due t o historical reasons, the mental health care system in Switzerland is not e asily comparable with the ones in the other two countries. Deinstitutionali zation mainly means reduction of beds in the existing psychiatric hospitals rather than a structural change with a conversion to psychiatric departmen ts in general hospitals. Luxemborg is a good example of the fact that econo mical factors are not the only aspects influencing development in psychiatr ic care. Psychiatric care is not community based, centralized, separated fr om medical care, and the supply system concerning complementary outpatients institutions is underrepresented, Thus, in all the countries the process o f deinstitutionalization has still not come to a satisfying level. This is not only due to the economically difficult situation in the recent past. A change can only be expected when the opinions about modem principles of psy chiatric care receive more weight in general society and with their politic al representatives.