Herpertz-Dahlmann B, Borzikowsky C, Altdorf S, Heider K, Dempfle A, Dahmen B. In the future, more information on innovative treatment approaches should be actively provided. Baumgardt J, Schwarz J, Bechdolf A, Nikolaidis K, Heinze M, Hamann J, et al.. The Federal Association of Sickness Funds works with the Federal Association of Statutory Health Insurance Physicians and the German Hospital Federation to develop the ambulatory care fee schedule for sickness funds and the diagnosis-related group (DRG) catalog, which are then adopted by bilateral joint committees. Zahlen, Trends und Analysen. Long-term care and social supports: Statutory LTCI is mandatory. These fees tend to be higher than SHI fees. A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 1. Received: 26 January 2020; Accepted: 27 April 2020;Published: 25 May 2020. Knowledge of the current situation and the temporal development dynamics of mental health in Germany can contribute to actors from health promotion, prevention, care and relevant political departments . 20 Federal Ministry of Health, Gesetze und Verordnungen. doi:10.1136/bmj.h1258, 21. Furthermore, the law stipulates halving the reference amount used to calculate the minimum contribution for the self-employed insured. This equates to 17.8 million people. Todays system provides coverage for the entire population, along with a generous benefit package. Additional sociodemographic characteristics of the samples are reported in Table 1. Regional associations of SHI-contracted physicians are required by law to guarantee the local availability of ambulatory services for all specialties in urban and rural areas. Usually, the courts ordering forensic treatment or detention and treatment in general psychiatric units will set time limits for the respective legal measures, which may be extended following renewed expert testimony and court hearings. Mental health in Germany: services and support | Expatica Mental healthcare institutions developed in Germany in the late 19th century. Familiarity with and intentions to use Internet-delivered mental health treatments among older rural adults, Young students' use of the Internet for mental health information and support. official website and that any information you provide is encrypted In order to change this in the future, further studies are necessary, which examine the preferences of patients and the general population in a differentiated manner and explain which treatment would be accepted by whom. For sickness fund enrollees, private insurance plays a mixed complementary and supplementary role, covering minor benefits not covered by SHI, including some copayments (like for dental care) and private hospital rooms. Frontiers | Changes in German Mental Health Care by Implementing a Global Treatment BudgetA Mixed-Method Process Evaluation Study View Article Impact ORIGINAL RESEARCH article Front. 2020;21:1-11. Privacy Policy, Read the report to see how your state ranks, http://www.euro.who.int/__data/assets/pdf_file/0008/255932/HiT-Germany.pdf?ua=1, https://www.pkv.de/service/zahlen-und-fakten/, http://www.dhpv.de/tl_files/public/Service/statistik/20160411_Bericht_StatHospizePalliativ.pdf, http://www.bundesversicherungsamt.de/weiteres/disease-management-programme.html, http://www.hspm.org/countries/germany28082014/countrypage.aspx, Preventive services, including regular dental checkups, child checkups, basic immunizations, chronic disease checkups, and cancer screenings at certain ages, Prescription drugs, except for those explicitly excluded by law (mainly so-called lifestyle drugs like appetite suppressants) and those excluded following an unfavorable benefit-risk assessment, Dependent on an evaluation of individual care needs by the SHI Medical Review Board, which leads either to a denial of benefits or to an assignment to one of five levels of care. 21 Health Systems and Policy Monitor, Germany. Here's a collection of the Expath staff's favorite apps for mental health: Headspace offers several free introductory meditation sessions, then charges $12.99 per month. In Germany home treatment is not yet established in routine care. Available from: Deutsches Krankenhausinstitut,. Our Scorecard ranks every states health care system based on how well it provides high-quality, accessible, and equitable health care. In recent years, there have been efforts to initiate progress in the field of German digital healthcare through legal changes. Law compliance with human rights instruments self-rated 5 points checklist items: 1) Law promotes transition towards community-based mental health services (including mental health integrated into general hospitals and primary care); 2) Law promotes the rights of people with mental health conditions and psychosocial disabilities to exercise thei. Holger P, Schrappe M. Einfhrung in Konzept und Grundlagen der Versorgungsforschung,. 7 Association of Private Health Insurance Companies, Zahlen und Fakten. Normally, such rulings are based on expert testimonies by psychiatrists. Changes in Mental Health Care by a Regional Budget: Results of a Pilot Project in Schleswig-Holstein (Germany). Physicians may also earn income from privately insured patients. 15 Federal Association of Sickness Funds, Kennzahlen der GKV, 2018. Meanwhile about 10,000 patients have been enrolled. However, it should be noted that this refers to e-therapy interventions which include some level of support from a therapist and, in general, ratings of the therapeutic alliance are lower in unsupported interventions (60). We therefore wanted to examine the attitudes toward these innovative treatment approaches. Several studies reported earlier, that most people would prefer a face-to-face treatment (F2F) compared to e-mental health services (3840). This requires the provision of a legal custodian and, until the summer of 2012, the custodians agreement to treatment was sufficient. Bethesda, MD 20894, Web Policies E-therapy offers with the support of a therapist were preferred to unsupported e-therapy. http://www.kbv.de/html/gesundheitsdaten.php; accessed July 2, 2018. Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M. Intensive case management for severe mental illness. Basdekis-Jozsa, R., Mokros, A., Vohs, K., et al. 18 Company for Telematics Applications for the Electronic Health Card, Elektronische Gesundheitskarte. In a second step, multivariate binary, and multinomial logistic regressions for odds ratio with 95% confidence intervals were conducted to predict attitudes toward innovative treatment concepts. Limited to certain maximum amounts, depending on the level of care. In addition, copayment caps and exemptions (see table above) help reduce the out-of-pocket burden on Germans. 1st ed. The Chi2 tests showed the same results for sex, age-group, education and household income as in the first survey. Persons with previous mental health care experience reject e-therapy more strongly than persons without this experience. doi: 10.3109/09638230903469178, 43. With the exception of financial obstacles, barriers to mental health care in Germany are mostly identical compared to other countries. Flckiger C, Del Re AC, Wampold BE, Symonds D, Horvath AO. In the examined period, half of the existing DiGAs were developed for the treatment of mental disorders (28). Public Mental Health Volume 11 - 2020 | https://doi.org/10.3389/fpsyt.2020.00426 Read the report to see how your state ranks. After 1945, restructuring led to a strengthening of the German federal states and a weakening of the central legislature. Generally, if the need arises, the mental healthcare institution would then obtain a court ruling or initiate guardianship in order to continue with the detention. Technological advances and the increasingly ubiquitous Internet access (25) offer new treatment options and have led to increased research interest (26). Tremain H, McEnery C, Fletcher K, Murray G. The therapeutic alliance in digital mental health interventions for serious mental illnesses: narrative review. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. The federal government determines provider fees under substitutive, complementary, and supplementary private insurance through a fee schedule. Given the choice between different online-based treatment options, more than half of the subjects (63.9%) stated that they would not use online therapy at all. Available at: https://mrc.ukri.org/documents/pdf/mrc-phsrn-process-evaluation-guidance-final/. Mental health care: Acute psychiatric inpatient care is provided largely by psychiatric wards in general (acute) hospitals. Furthermore, to ensure greater safety in drug therapy, patients who use at least three prescribed drugs simultaneously will receive an individualized medication plan. This paper explores the attitudes toward these innovative treatment approaches. Wu T, Jia X, Shi H, Niu J, Yin X, Xie J, et al.. Psychiatric inpatient treatment, an important pillar of mental health care, is often of longer duration in Germany than in other countries. The COVID-19 pandemic called for infection prevention and control measures and thereby led to shifts in demand and inpatient capacities. There is no national mental health law in Germany: the 16 German states are responsible for legislation concerning forced admissions, while the German Civil Code covers non-acute care, in particular for those not able to care for themselves. Appleton R, Elahi F, Tuomainen H, Canaway A, Singh SP. In 2017, there were about 2,500 multispecialty clinics, where some 18,000 of Germanys ambulatory care physicians (11%) work. Happify ten modules free, then $14.95 per month. At the same time, participants were of the opinion that people with a drug addiction or schizophrenia should not be treated at home. Background: The Network for Mental Health (NWpG-IC) is an integrated mental health care program implemented in 2009 by cooperation between health insurance companies and community mental health providers in Germany. With regard to attitudes toward home treatment approaches, half of the sample stated that they would like to be treated by a team at home or in their community (50%). Organisation for Economic Co-operation and Development (OECD) (2018), Purchasing power parities (PPP) (indicator). The analysis is based on two surveys on physical and mental well-being, which were carried out in spring 2020 (S1) and winter 2020/2021 (S2) by an independent market and social research institute (USUMA, Berlin). Schrappe M, Pfaff H. Health services Research Faces New Challenges: Consequences for Definition and Concept. The continuing deinstitutionalisation process and the implementation of community mental health services was considerably affected by the reunification of East and West Germany in 1990, which required dramatic changes in the structure and quality of the mental health care system of the former German Democratic Republic (GDR). In home treatment approaches patients are treated in their everyday environment. As this type of involuntary admission is governed by state mental health laws, there are considerable differences in the details of the regulation of the process. If physicians exceed the quarterly thresholds, they are paid considerably less for any additional services provided. Transition is a crucial issue in mental health service (64). The number of hospitals providing care only for patients with psychiatric and/or neurological illnesses is low. Everybody with a physical or mental illness or disability (who has contributed for at least two years) can apply for LTCI benefits, which are: Beneficiaries can choose between free or discounted long-term care services and cash payments. 2014; 14:163. doi: 10.1186/1471-244X-14-163 . The detailed model is shown in Table 3. Alonso J, Codony M, Kovess V, Angermeyer MC, Katz SJ, Haro JM, et al.. Population level of unmet need for mental healthcare in Europe. (2021). Role of private health insurance: In 2017, private health insurance accounted for 8.4 percent of total health expenditures.5 This includes substitutive coverage purchased by individuals who are exempt from or can opt out of SHI (such as higher-income individuals) as well as supplementary policies bought by sickness fund enrollees. The physicians then bill the associations according to the SHI fee schedule. They triggered a change of attitude among the staff of psychiatric services and even influenced public opinion favourably. Federal government websites often end in .gov or .mil. BMC Complement Altern Med (2009) 9:18. doi:10.1186/1472-6882-9-18, 36. Lehrbuch Versorgungsforschung: Systematik - Methodik - Anwendung. 1906, only court-decided cases) for 2000 and 2011 (Table 1). Mental Health Resources for Expats in Germany | Expath doi:10.1176/appi.ps.201400178, 39. 2nd ed. Available from: At home or in hospital: home treatment and mental health stigma, Smartphone apps for schizophrenia: a systematic review, Wearable devices and smartphones for activity tracking among people with serious mental illness. 12 German Hospice and Palliative Association, Stationre Hospize fr Erwachsene, stationre Hospize fr Kinder, Jugendliche und junge Erwachsene sowie Palliativstationen in Deutschland Daten zur Entwicklung und zum aktuellen Stand. http://bmg.bund.de/; accessed July 16, 2018. Mohr DC, Siddique J, Ho J, Duffecy J, Jin L, Fokuo JK. Psychiatrie Barometer 2020/2021. Where a person with a mental disorder represents an extreme and acute danger, the Federal Penal Code allows acute help to be provided by any person, including of course staff members of mental healthcare units. The privately insured pay a risk-related premium, with separate premiums for dependents; risk is assessed only on entry, and contracts are based on lifetime underwriting. For the first dependent variable in S1, Chi2 tests and a Fisher-Freeman-Halton-Test showed an association between the preferred form of therapy and sex, age-group, education, income and home treatment. Consequently, the positive attitude seems to be highly dependent on personal experience (45). Mix of public and private nonprofit, some for-profit. One of the reasons is that after the federal elections in September 2017, it took six months of difficult talks and political insecurity to again form a grand coalition between political parties (Christian Democrats and Social Democrats). This indicates a high willingness to make unexpected, but necessary adjustments to treatment settings in the context of the pandemic (35). However, a therapeutic relationship currently seems easier to establish when some level of human support is involved. 6 Association of Private Health Insurance Companies, Zahlen und Fakten. Payment for ambulatory after-hours care is based on fee schedules, with differences in the amount of reimbursement by SHI and private health insurance. No subjects were excluded for S2, the final sample consisted of 2,519 subjects (52.5% female), aged 16 to 96 years (M = 50.33, SD = 18.06). According to current meta-analytical evidence, therapeutic alliance and outcome are significantly correlated not only in F2F-therapy (5355), but also in an e-therapy setting (56), indicating that fostering a stable alliance is important to promote efficacy of treatment across all therapy settings (53, 56). Physician education and workforce: About 35 public universities and five private ones offer degrees in medicine. In total, socio-demographic data were collected of 2,503 subjects in S1 and of 2,519 subjects in S2. COVID-19 government measures and their impact on mental health: a cross Ward-equivalent treatment (WeT) is a complex psychiatric-psychotherapeutic treatment in the patients' home environment in times of acute diseases and is, thus, an alternative to an in-patient stay. This is the first study evaluating the effectiveness of the program in comparison to standard mental health care in Germany. No statistically significant differences were found for age-group, education, income and urbanity. Given the increased number of downloads for mental health apps during the pandemic (33), it has even been described as a black swan moment, i.e., as an event permanently shifting mental health care toward online prevention, treatment and care (34). Benefits of e-mental health approaches lie in the opportunity to overcome attitudinal and socio-structural barriers (4, 5). Other aspects of home treatment may dominate these people's perceptions: they may be reluctant to open the own home to health care providers or fear stigmatization if neighbors notice that treatment teams visit them at home. Does one size really fit all? The effectiveness of a non-diagnosis Three indicators of mental health were observed in approximately 1,000 and later 3,000 randomly sampled participants monthly until June 2022: symptoms of depression (observed since April 2019 using the PHQ-2), symptoms of anxiety (observed since March 2021 using the GAD-2) and self-rated mental health (observed since March 2021 using a single it. Four out of five predictors remained significant in the final equation: sex [2(3) = 20.65, p < 0.001], age-group [2(15) = 262.34, p < 0.001], education [2(6) = 23.18, p = 0.001], and home treatment [2(3) = 109.26, p < 0.001]. People who were very satisfied with their internet access preferred significantly more often blended therapy (asr: 3.0) or online therapy (asr: 2.1). Most physicians working in multispecialty clinics are salaried employees. Deviations exceeding a value of 2 were considered significant. A Closer Look at Mental Health in Germany - The Borgen Project Rejecting toward outreach care was chosen as the reference category for the third dependent variable. Answer options were therapy with a therapist, therapy with a therapist, combined with online therapy (blended therapy) and pure online therapy. Role of public health insurance: In 2017, total health expenditures made up 11.5 percent of the gross domestic product (GDP). Binary and multinomial logistic regressions were performed to predict attitudes toward online-based treatment concepts and home treatment approaches. This population would therefore be a target group for e-mental health care, which is relevant for current projects dealing with the implementation of e-therapy interventions (e.g., DRKS00022420). The Health Monitor, which last conducted a study in 2016, ceased to exist after 15 years. 22 Federal Ministry of Health, Gesetze und Verordnungen. More than half of 95 German hospitals surveyed in the year 2020 stated that they definitely did not want to offer IEHT in the future (20). Collaborative mental health care program versus a general practitioner program and usual care for treatment of patients . An official website of the United States government. Mental health law in Germany - PMC - National Center for Biotechnology Spence J, Titov N, Solley K, Dear BF, Johnston L, Wootton B, et al.. Characteristics and treatment preferences of people with symptoms of posttraumatic stress disorder: an internet survey. Paterson C, Baarts C, Launs L, Verhoef MJ. Psychiatry 11:426. doi: 10.3389/fpsyt.2020.00426. Changes in German Mental Health Care by Implementing a Global Treatment The regulation went into effect January 2019. Germans earning more than $68,000 can opt out of SHI and choose private health insurance instead. Already Eichenberg et al. Due to its good accessibility, e-mental health approaches have the potential to increase services not only for people living in remote areas, but also for those who are faced with various other barriers to medical care, such as disability or scheduling conflicts. Preferences regarding the form of therapy were also assessed in the second survey (S2). In this way, specialized offers could be made accessible to transitioning patients who are not yet supported by adult mental health services. Krueger RA, Casey MA. The only regular financial incentive that GPs receive is a fixed annual bonus (EUR120, or USD154, in 2016) for patients enrolled in a disease management program, in which physicians provide patient training and document patient data. Additionally, e-therapy applications, such as mental health apps, may be prescribed by medical practitioners which lack the expertise to treat patients with mental disorders themselves (e.g., general practitioners), but nevertheless often have responsibility for the care of these young patients. http://bmg.bund.de/; accessed June 27, 2018. doi:10.1055/a-0942-2163, 14. von Peter S, Schwarz J, Bechdolf A, Birker T, Deister A, Ignatyev Y, et al. Nonbinding clinical guidelines are produced by the Physicians Agency for Quality in Medicine and other professional societies. People who had already experience with psychiatric treatment were underrepresented in terms of their preference for blended therapy (asr: 2.9) or online therapy (asr: 4.2) and preferred significantly more often a therapy with a therapist (asr: 5.1). 23. In fact, while participants in a previous study rated anonymity as a very important aspect, they still perceived it as the least important of 12 different areas of mental health treatment expectations (46).
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