[Evaluation of community care of psychiatric patients. Results of 4 years' scientific association with the building phase of the Mannheim model].

The implementation of a community mental health service in Mannheim (FRG), a city with 315,000 inhabitants, is being evaluated by means of the data of the Cumulative Psychiatric Case Register at the Central Institute of Mental Health. Within a four-year period of extending services for crisis intervention and emergency care, aftercare (sheltered apartments, homes, workshops) and of providing psychiatric beds in the city, the total number of treatment episodes has increased by more than 100% from about 1.1 to about 2.2 per 1000 inhabitants aged over 14, mainly at the out-patient level of care. Admissions to hospital showed an increase of about 40% whereas bed occupancy remained stable at a rate of about 1.7/1000-respectively 1.3/1000 if beds provided by a psychogeriatric nursing home are deducted. This development can be attributed to various factors: (1) A true increase of morbidity may occur mainly in diagnostic groups I.C.D. No.300, 301, 305-308, especially an increase in attempted suicides and in alcohol- and drug-related diseases. (2) The increased provision of help, mainly on the sector of crisis intervention and emergency care and - in diagnostic categories - mainly in minor neurotic disorders, crises, and affective psychoses, has resulted in a large rise in utilization. (3) The continuous decrease of long-term hospital stays, above all in schizophrenic patients, has led to increased utilization of out- and in-patient services in the community when crises and relapses occurred. A comparison of two cohorts of "old" and "new" patients, the latter having accumulated under the conditions of a community mental health service, has shown that these patients are admitted for a long-term hospital stay considerably later and less frequently than formerly, mostly only after several attempts for rehabilitation. In the group of schizophrenic patients, only about 5% of all first admissions stayed in a psychiatric hospital for more than one year in 1979/80. About the year 1900, this group had still amounted to between 60% and 70%. A comparison with evaluations of comprehensive community care systems in other countries shows that there are largely identical trends, although the initial rate for psychiatric beds was comparably lower in Mannheim.