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DOI: 10.1055/a-0646-4054
Wie Menschenrechte der Psychiatrie in Deutschland den Weg weisen:
Besorgnisse der UN – Daten – Evidenzen – VisionenHow human rights can guide german psychiatryPublication History
eingereicht 31 January 2018
akzeptiert 19 June 2018
Publication Date:
20 August 2018 (online)
![](https://www.thieme-connect.de/media/fdn/201808/lookinside/thumbnails/10.1055a-0646-4054-1.jpg)
Zusammenfassung
Die Besorgnisse und Empfehlungen der „Abschließenden Bemerkungen“ der UN ü̈ber den ersten Staatenbericht Deutschlands werden durch aktuelle Daten der Gesundheitsberichtserstattung konkretisiert. Ihre „Empfehlungen“ werden durch evidenzbasierte Versorgungsmodelle konkretisiert sowie durch weitere Inhalte aus dem Bericht des Sonderberichterstatter von 2017 als Visionen für die deutsche psychiatrische Versorgung ergänzt und so der Weg einer von der Wahrung der Menschenrechte und sozialer Inklusion bestimmten Psychiatrie aufgezeigt. Dabei stehen die Vermeidung von Zwang durch traumainformierte Behandlung und der Aufbau komplexer ambulanter Behandlungsstrukturen durch die Modelle des Offenen Dialogs und den Recovery-Ansatzes im Mittelpunkt eines Paradigmenwechsels. Das Bewusstsein, dass auch in der Psychiatrie von heute fortgesetzt vor allem durch mangelhafte Strukturen Menschenrechtsverletzungen begangen werden, die vermeidbar wären, sollte zur Entschiedenheit zu den erforderlichen Veränderungen beitragen.
Abstract
The concerns and recommendations of the UN “Final Remarks” on the first German State Report are substantiated by up-to-date health reporting data. Their “recommendations” are substantiated by evidence-based care models and supplemented by additional content from the Special Rapporteur’s report of 2017 as visions for German psychiatric care, thus demonstrating the path of psychiatry determined by respect for human rights and social inclusion. The avoidance of coercion through traumainformed treatment and the development of complex outpatient treatment structures through the models of open dialogue and the recovery approach are seen as the focus of a paradigm shift. The awareness that in today’s psychiatry, especially through deficient structures, human rights violations are committed that could be avoided, should contribute to the determination for the necessary changes.
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Literatur
- 1 Robert Koch Institut. DEGS-Studie; 2015 . Im Internet: https://www.degs-studie.de/deutsch/ergebnisse/literatur.html
- 2 Statistisches Bundesamt Gesundheit Krankheitskosten. 2015 , erschienen am 29. September 2017. Im Internet https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankheitskosten/KrankheitskostenJahr2120721159004.pdf?__blob=publicationFile
- 3 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde, Hrsg. S3-Leitlinie Psychosoziale Therapien bei schweren psychischen Erkrankungen S3-Praxisleitlinien in Psychiatrie und Psychotherapie. Berlin Heidelberg: Springer; 2012. Im Internet http://www.awmf.org/uploads/tx_szleitlinien/038-020l_S3_Psychosoziale_Therapien_10-2012.pdf
- 4 Vereinte Nationen CRPD / C/DEU / CO / 1. ( 2015 ) Im Internet: www.institut-fuer-menschenrechte.de/fileadmin/user_upload/PDF-Dateien/UN Dokumente / CRPD_Abschliessende_Bemerkungen_ueber_den_ersten_Staatenbericht_Deutschlands.pdf
- 5 Bundesamt für Justiz. Im Internet: https://www.bundesjustizamt.de/DE/SharedDocs/Publikationen/Justizstatistik/Betreuungsverfahren.pdf?__blob=publicationFile
- 6 Bruns H, Henking T. Unterbringung und Zwangsbehandlungen in Zahlen. . In: Henking T, Vollmann J. , Hrsg. Zwangsbehandlung psychisch kranker Menschen. Berlin Heidelberg: Springer; 2015: 19-28 . DOI 10.1007 / 978-3-662-47 042-8_1
- 7 Salize HJ, Dressing H. Epidemiology of involuntary placement of mentally ill people across the European Union. Br J Psychiatry 2004; 184: 163-168 . doi: 10.1192/bjp.184.2.163
- 8 de Jong MH, Kamperman AM, Oorschot M. , et al Interventions to Reduce Compulsory Psychiatric Admissions: A Systematic Review and Meta-analysis. JAMA Psychiatry 2016; 73: 657-64 . doi:10.1001/jamapsychiatry.2016.0501
- 9 Thornicroft G, Farrelly S, Szmukler G. , et al Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial. Lancet 2013; 381 (9878): 1634-41 . doi.org/10.1016/S0140-6736(13)60105-1
- 10 Angermeyer MC, Matschinger H, Schomerus G. Attitudes of the German public to restrictions on persons with mental illness in 1993 and 2011. Epidemiol Psychiatr Sci 2014; 23: 263-70 . doi: 10.1192/bjp.bp.112.122978
- 11 Croft B, İsvan N. Impact of the 2nd story peer respite program on use of inpatient and emergency services. Psychiatr Serv 2015; 66: 632-7 . doi: 10.1176/appi.ps.201400266
- 12 Corrigan PW. Impact of consumer-operated services on empowerment and recovery of people with psychiatric disorders. Psychiatr Serv 2006; 57: 1493-6 . doi:10.1176/ps.2006.57.10.1493
- 13 Choe JY, Teplin LA, Abram KM. Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns. Psychiatr Serv 2008; 59: 153-64 . doi: 10.1176/ps.2008.59.2.153.
- 14 Stat Bundesamt Gesundheit Grunddaten Krankenhäuser. 2016 ; Fachserie 12 Reihe 6.1.1 https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/GrunddatenKrankenhaeuser.html
- 15 Zinkler M. Freiheitsbeschränkung durch Fixierung - mündliche Stellungnahme zu den aktuellen Verhandlungen vor dem Bundesverfassungsgericht, Jan 2018 https://www.psychiatrie-verlag.de/fileadmin/storage/dokumente/Diverse/2018/Zinkler_BvG_R_P_3_.pdf
- 16 Sailas EES, Fenton M. Seclusion and restraint for people with serious mental illnesses. Cochrane Database of Systematic Reviews. 2000 Issue 1 . Art. No.: CD001163. DOI: 10.1002 / 14651858.CD001163.
- 17 Gaskin CJ, McVilly KR, McGillivray JA. Initiatives to reduce the use of seclusion and restraints on people with developmental disabilities: a systematic review and quantitative synthesis. Res Dev Disabil 2013; 34: 3946-61 . doi: 10.1016/j.ridd.2013.08.010
- 18 Scanlan JN. Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far a review of the literature. Int J Soc Psychiatry 2010; 56: 412-23 . doi: 10.1177/0020764009106630
- 19 Katsakou C, & Priebe S. Outcomes of involuntary hospital admission: A review. Acta Psychiatrica Scandinavica 2006; 114: 232-241 . doi: 10.1111/j.1600-0447.2006.00823.x
- 20 Frueh BC, Knapp RG, Cusack KJ. et al. Patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatr Serv 2005; 56: 1123-33 doi: 10.1176/appi.ps.56.9.1123
- 21 Melbourne Social Equity Institute. Seclusion and Restraint Project: Report, Melbourne: University of Melbourne; 2014 Im Internet. http://socialequity.unimelb.edu.au/__data/assets/pdf_file/0017/2004722/Seclusion-and-Restraint-report.PDF
- 22 Bonoldi I, Simeone E, Rocchetti M. et al Prevalence of self-reported childhood abuse in psychosis: a meta-analysis of retrospective studies. Psychiatry Res 2012; 210: 8-15 . doi: 10.1016/j.psychres.2013.05.003
- 23 Varese P, Smeets F, Drukker M. et al. Childhood adversities increase the risk of psychosis: a meta-ana lysis of patient-control, prospective- and cross-sectional cohort studies. Schizophr Bull 2012; 38: 661-671 . doi: 10.1093/schbul/sbs050
- 24 Steinert T, Bergbauer G, Schmid P. et al. Seclusion and restraint in patients with schizophrenia: clinical and biographical correlates. J Nerv Ment Dis 2007; 195: 492-6 . doi: 10.1097/NMD.0b013e3180302af6
- 25 Cusack K. J, Grubaugh A. L. , Knapp et al. Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness. Community Mental Health Journal 2006; 42: 487-50 . doi: 10.1007/s10597-006-9049-4
- 26 Muskett C. Trauma-informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing 2014; 23: 51-59 . doi: 10.1111/inm.12012
- 27 Elliot D, Fallot RD, Markoff LS. et al Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of community psychology 2005; 33: 461-477 . doi.org/10.1002/jcop.20063
- 28 Foxlewin B. What is Happening at the Seclusion Review that Makes a Difference? A Consumer Led Research Study; 2012 . Im Internet: http://www.actmhcn.org.au/images/documents/Research/2012-06_REPORT_SRRM_RESEARCH_incl_Executive_Summary.pdf (Stand 2018).
- 29 Chilvers R, Macdonald GM, Hayes AA. Supported housing for people with severe mental disorders. Cochrane Database of Systematic Reviews. 2002 Issue 4 . Art. No.: CD000453 . DOI: 10.1002 /14651858.CD000453.
- 30 Thomas EC, Despeaux KE, Drapalski AL. et al. Person-Oriented Recovery of Individuals With Serious Mental Illnesses: A Review and Meta-Analysis of Longitudinal Findings. Psychiatr Serv 2018; 69: 259-267 . doi: 10.1176/appi.ps.201700058
- 31 Davidson L, Bellamy C, Guy K. et al. Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry 2012; 11: 123-8 . doi.org/10.1016/j.wpsyc.2012.05.009
- 32 Pitt V, Lowe D, Hill S. et al Consumer-providers of care for adult clients of statutory mental health services. Cochrane Database of Systematic Reviews 2013 Issue 3. Art. No.: CD004807 . DOI: 10.1002 / 14651858.CD004807.pub2. doi: 10.1002/14651858
- 33 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, A / HR / 35 / 21, 28. März 2017 https://documents-dds.ny.un.org / doc / UNDOC / GEN / G17 / 076 / 04 / PDF / G1707604.pdf?OpenElement
- 34 Seikkula J, Trimble D. Healing elements of therapeutic conversation: Dialogue as an embodiment of love. Family Process 2005; 44: 461-475 . doi.org/10.1111/j.1545-5300.2005.00072.x
- 35 Olson M. Seikkula J. Ziedonis D. The key elements of dialogical practice in open dialogue: fidelity criteria;. 2014 ; Im Internet: http://umassmed.edu/psychiatry/globalinitiatives/opendialogue/
- 36 Lehtinen V, Aaltonen J. Koffert T. Two-year outcome in first episode psychosis treated according to an integrated model. Is immediate neuroleptisation always needed?. European Psychiatry 2000; 15: 312-320 . doi.org/10.1016/S0924-9338(00)00400-4
- 37 Seikkula J, Alakare B, Aaltonen J. The comprehensive open-dialogue approach (II). Long-term stability of acute psychosis outcomes in advanced community care: The Western Lapland Project. Psychosis 2011; 3: 192-204 . doi.org 10.1080/17522439.2011.595819
- 38 Tomi Bergström, Birgitta Alakare, Jukka Aaltonen. et al. The long-term use of psychiatric services within the Open Dialogue treatment system after first-episode psychosis. , Psychosis, 2017; 9: 310-321 . doi.org/10.1080/17522439.2017.1344295
- 39 Bond GR. An update on randomized controlled trials of evidence-based supported employment. Psychiatr Rehabil J 2008; 31: 280-90 . DOI: 10.2975/31.4.2008.280.290
- 40 Bond GR, Drake RE, Becker DR. Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US. World Psychiatry . 2012; 11 (01) : 32-9 . doi.org/10.1016/j.wpsyc.2012.01.005
- 41 Bond GR, Resnick SG, Drake RE. et al. Does competitive employment improve non-vocational outcomes for people with severe mental illness?. J Consult Clin Psychol 2001; 69: 489-501 . doi.org/10.1037/0022-006X.69.3.489