in Berlin) does not allow forced treatment in such situations, leaving forced detention without treatment as the only legal option. In this regard, our analysis showed that people who prefer pure online therapy to F2F therapy are also less open to home treatment. Although anonymity is seen as an advantage when searching for information, the lack of human contact was mainly seen as a disadvantage when coping with and treating a mental problem or mental illness (36). Several studies reported earlier, that most people would prefer a face-to-face treatment (F2F) compared to e-mental health services (3840). However, a therapeutic relationship currently seems easier to establish when some level of human support is involved. Within the first dependent variable, the first (therapy with a therapist) and within the second dependant variable, the last category (I would not use online therapy) were used as reference categories. Mental health law in Germany - PMC - National Center for Biotechnology We calculated these figures for the numbers of cases admitted following court orders under state legislation (Fig. Does one size really fit all? The effectiveness of a non-diagnosis Although home treatment is strongly recommended in the German guideline for the treatment of severe mental illnesses (16), only a small number of projects provide home treatment (17). Despite the advanced development of evidence-based treatments for a broad range of mental health problems (1), still a high proportion of people in need of treatment do not receive professional help (2). Ambulatory psychiatrists also coordinate a set of SHI-financed benefits called sociotherapeutic care (which requires referral by a GP), intended to encourage the chronically mentally ill to access needed care and to avoid unnecessary hospitalizations. Most physicians working in multispecialty clinics are salaried employees. The site is secure. 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. If longer treatment periods are necessary, new court rulings must be applied for. Abbreviations: BW = Baden-Wrttemberg; BRA = Brandenburg; MV = Mecklenburg-West Pommerania; NIE = Lower Saxony; NRW = North Rhine-Westphalia; RPF = Rhineland-Palatinate; SAAR = Saarland; SAX = Saxony; SAXA = Saxony-Anhalt; THUR = Thuringia. Integrated care in German mental health services as benefit for Recently, there has been a shift away from reliance on overall budgets for ambulatory physicians and hospitals and collective regional prescription caps for physicians, toward an emphasis on quality and efficiency. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Once they reach an upper age limit (typically at age 18, 1821 years in Germany), young patients can no longer be treated by child and adolescent mental health services and need to be transferred into adult services. without therapeutic support. With regard to the influence of the COVID-19 pandemic, it would be interesting to investigate long-term effects. Mix of public and private nonprofit, some for-profit. Currently, there are around 1,300 DRG categories. In this way, specialized offers could be made accessible to transitioning patients who are not yet supported by adult mental health services. Basdekis-Jozsa, R., Mokros, A., Vohs, K., et al. In cases of acute mental illnesses or acute exacerbations of chronic mental illness, a person may be forcibly admitted to a closed mental healthcare service under state mental health laws. While almost half of the participants expressed openness toward home treatment approaches, the majority were skeptical about e-therapy. Organisation for Economic Co-operation and Development (OECD) (2018), Purchasing power parities (PPP) (indicator). 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. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Federal government websites often end in .gov or .mil. Therapists in action'-Home treatment in adolescent anorexia nervosa: a stepped care approach to shorten inpatient treatment, https://webarchive.nationalarchives.gov.uk/ukgwa/+/www.dh.gov.uk/en/ publicationsandstatistics/publications/publicationspolicyandguidance/ dh_4002960, https://www.dki.de/sites/default/files/2020-12/Psych-Barometer_2019_2020_final_1.pdf, https://www.dki.de/sites/default/files/2021-07/202106_Final_Psych- Barometer _komprimiert.pdf, https://diga.bfarm.de/de/verzeichnis?category=%5B%2277%22%5D, Online-progr. 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. Schrappe M, Pfaff H. Health services Research Faces New Challenges: Consequences for Definition and Concept. 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. 27. Thousand Oaks, California: Sage publications (2014). SHI physicians receive additional fees for sharing electronic medical reports with other providers (since 20162017), collecting and documenting emergency records (since 2018), and managing and reviewing basic insurance claims data online. Burns T, Fioritti A, Holloway F, Malm U, Rssler W. Case management and assertive community treatment in Europe, Vereinbarung zur stationsquivalenten psychiatrischen Behandlung nach 115d Abs. These measures must be necessary to avoid imminent and considerable damage to the health of the affected person. Private providers paid through regionally negotiated FFS payments up to maximum number of services per quarter. Long-term care services are covered separately under Germanys mandatory, statutory long-term care insurance (LTCI). Zahlen, Trends und Analysen. Long-term care services are covered separately under Germany's mandatory, statutory long-term care insurance (LTCI). http://bmg.bund.de/; accessed June 27, 2018. Two major new developments within mental health care in Germany are (i) home treatment approaches to prevent inpatient treatment and (ii) e-mental health approaches to intensify treatment or to lower barriers for treatment. http://bmg.bund.de/; accessed July 16, 2018. The fact that younger people show higher acceptance for e-therapy is an opportunity for child and adolescent psychiatric and psychotherapeutic services: especially low threshold offers for service could reach a high number of youths and young adults. Keywords: global budget, capitation, block grant, integrated care, cross-sectoral mental health care, process evaluation, mixed method, complex intervention. Federal government websites often end in .gov or .mil. Source of state PsychKG data: http://www.bundesanzeiger-verlag.de/fileadmin/BT-Prax/downloads/Statistik_Betreungszahlen/Betreuungsstatistik2011.pdf, Source of population data: http://www.statistik-portal.de/Statistik-Portal/de_jb01_jahrtab1.asp, National Library of Medicine official website and that any information you provide is encrypted The detailed model is shown in Table 3. Process evaluation of complex interventions UK Medical Research Council (MRC) guidance (full version) (2015). Transition age youth mental health: addressing the gap with telemedicine, Addressing the needs of youth in transition to adulthood, Public Acceptability of E-mental health treatment services for psychological problems: a scoping review. Integrated care in German mental health services as benefit for 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. doi:10.1007/s00115-017-0459-z, 20. Apolinrio-Hagen J, Fritsche L, Bierhals C, Salewski C. Improving attitudes toward e-mental health services in the general population, Intensive treatments in adolescent anorexia nervosa. A binary logit model predicting attitudes toward the acceptance of home treatment using sex, preferred form of therapy, and preferred type of online therapy as predictors was significant. Medical services or palliative care in a hospice are covered by SHI. Sickness funds are financed through general wage contributions (14.6%) and a dedicated, supplementary contribution (1% of wages, on average), both shared by employers and workers. However, based on the data, no conclusions can be drawn as to what caused this rejection. Preferences regarding the form of therapy were also assessed in the second survey (S2). Zahlen, Trends und Analysen. Limited to certain maximum amounts, depending on the level of care. 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. After-hours care: After-hours care is organized by the regional associations to ensure access to ambulatory care around the clock. There are three major issues (Gaebel & Zielasek, 2012): Source of data: Statistisches Bundesamt: Strafvollzugsstatistik. Compared to percentages in other European countries, the share of population reporting an unmet need for medical care is very low (0.3%), ranging between 0.8 percent in the lowest income quintile and 0.1 percent in the highest income quintile in 2017.13 This suggests good access with few disparities. The average SHI reimbursement for a family physician is more than EUR 200,000 (USD 256,739) per year. With regard to attitudes toward online-based treatment concepts, <20% of the participants of S1 preferred an online therapy setting compared to the traditional F2F therapy. Frequency of responses of participants distributed on the three dependent variables. government site. In acute cases, the process can be shortened. Eur J Health Econ. E-therapy offers with the support of a therapist were preferred to unsupported e-therapy. Overall, German mental health care is organised as a subsidiary system, where planning and regulating mental health care is the responsibility of the 16 federal states. However, knowledge about the procedure or the setting of online therapy increases its acceptance (62, 73). 30. Factors associated with attitudes toward online-therapy: multinomial logistic regressions. Results underline the high need for informational campaigns about treatment options, especially for groups with high skepticism, like older people and people with lower education. Klagenfurt: SSOAR Open Access Repository (2014). Private insurance: individual premiums. Torous J, Firth J, Huckvale K, Larsen ME, Cosco TD, Carney R, et al.. FOIA 29. 1Department of Psychiatry and Psychotherapy, Medical Faculty, Kliniken der Heinrich-Heine Universitt, Dsseldorf, Germany, 2LVR-Klinikum Dsseldorf, Kliniken der Heinrich-Heine Universitt, Dsseldorf, Germany, email ed.frodlesseud-inu@lebeag.gnagflow. Front. Our Scorecard ranks every states health care system based on how well it provides high-quality, accessible, and equitable health care. Long-term care and social supports: Statutory LTCI is mandatory. BMJ (2015) 350:h1258. (2021). The metric variable age was divided into meaningful age categories, which are described in Table 1. The emerging imperative for a consensus approach toward the rating and clinical recommendation of mental health apps, Bericht des GKV-Spitzenverbandes ber die Inanspruchnahme und Entwicklung der Versorgung mit Digitalen Gesundheitsanwendungen, DiGA-Verzeichnis [Directory of Digital Health Applications]. Depression treatment in Germany - BMC Psychiatry However, representatives of patient organizations have the right to participate in other decision-making bodies, including subcommittees of the Federal Joint Committee. In a qualitative survey of a large German health insurance company on user satisfaction with DiGAs, some of the users complained about the lack of personal contact with their doctors and therapists (29). Results may not only apply to the German health care system but may be transferred on different mental health . Mental health law in Germany | BJPsych International | Cambridge Core Therefore, information on e-mental health and home-treatment may help to increase acceptance, which would be beneficial if these forms of therapy are to be implemented more extensively in the German healthcare system. After-hours care assistance is available mainly through a nationwide telephone hotline. Montagni I, Tzourio C, Cousin T, Sagara JA, Bada-Alonzi J, Horgan A. I'm just a long history of people rejecting referrals experiences of young people who fell through the gap between child and adult mental health services.