[The process of establishing social psychiatry services in the state of Saxony--a critical analysis based on existing urban-rural differences].Gesundheitswesen. 1998 Nov; 60(11):649-55.G
In accordance with the intentions of the Saxonian planning for restructuring mental health services the establishment of social psychiatry services (SPS) was evaluated. The results presented here originate from one part of a public health research project. In 8 selected SPS a client-centred documentation of care episodes (n = 825) was conducted during the period 8/1995-1/1997 using a specifically designed instrument. In the whole group (54% women; mean age women (49.6 years) > men (43.2 years); 39% schizophrenic, 13% affective disorders, 21% alcoholism) significant differences in the distribution of diagnoses could be found on comparing urban and rural regions: 50% schizophrenic disorders (urban) vs. 20% (rural); 34.5% dependency disorders (rural) vs. 12% (urban). Concerning the chronicity of mental disorders (whole group: first contact with psychiatric institution for 30% of the clientele < 1985; 67% formerly hospitalised) there are considerable variations between SPS in urban and rural areas. Cooperative contacts with other complementary psychiatric institutions as well as the spectrum of items of care also differ significantly between the investigated SPS. Related to the diagnoses some impressive concentrations of care/therapeutical activities could be identified: e.g. home visits (37.2% of the activities) are very important especially for schizophrenic patients, consultations focusing on practical issues (35%) are of eminent significance for dependency disorders. The results lead to the conclusion that the Saxonian SPS already realise an extensive and time-consuming spectrum of social psychiatric activities. However, strengthening these institutions on a professional and personal level as well as the further establishment of psychiatric facilities close to the community seem necessary to achieve concentration on main diagnostic groups, establishment of more homogeneous care strategies, and implementation of coordinative SPS-activities.