[Treatment of disorders of emotion regulation in the Adolescents Center at the Central Intitute of Mental Health]. / Behandlung von Störungen der Emotionsregulation im Adoleszentenzentrum am Zentralinstitut für Seelische Gesundheit.

Severe disorders of emotion regulation, e.g. in the context of mental illnesses, such as borderline disorders, attention deficit hyperactivity disorder (ADHD) and complex posttraumatic stress disorder (PTSD), often begin in childhood and adolescence and influence the psychosocial development of those affected, often into adulthood. Professional treatment therefore often requires longer term planning, if possible from a single source. The sectorized structure of the current psychiatric healthcare system, however, makes this process more difficult or is even a hindrance and promotes high hospitalization rates and chronification. The concept of the Adolescents Center for Disorders of Emotion Regulation at the Central Institute of Mental Health functions as a model concept for long-term, cross-sectoral treatment structures. A constant treatment team from child, adolescent and adult psychiatry and psychotherapy provides evidence-based psychotherapy according to the guidelines of dialectical behavior therapy (DBT) for those affected between the ages of 16 and 24 years. Conceptually, inpatient, day care and staged outpatient treatment modules complement each other in order to not only provide psychotherapy to the young patients in this important phase of life but also to accompany and support them in completing school and training, in partnership and independent living.

[Track treatment in psychiatry: the CIMH track model to overcome sector boundaries]. / Track-Behandlung in der Psychiatrie: das ZI-Track-Modell zur Überwindung von Sektorengrenzen.

The overall conditions for the treatment of patients with psychiatric disorders have changed and place new demands on therapy concepts and procedures. This concerns both the legal conditions of the treatment as well as the content and economic conditions for a patient-oriented diagnostic work-up and therapy. The Central Institute for Mental Health (CIMH) in Mannheim is currently implementing a track concept that takes these changes into account and aims to overcome sectoral boundaries in favor of treatment continuity.

[The CIMH track concept in the treatment of psychotic disorders]. / Das ZI-Track-Konzept in der Behandlung psychotischer Störungen.

The treatment of psychotic disorders and illnesses is a challenge for therapists and institutions due to the heterogeneity of the cause and course, refractory symptoms, lack of therapy adherence and high rates of relapse. These circumstances can be effectively counteracted by the flexibility of therapeutic approaches and settings. A useful but rarely used concept is the treatment of psychoses within the so-called track unit. A track unit is defined as a syndrome-oriented, decentralized, modular unit, adjusted to the patient's individual stage-specific needs across both inpatient and outpatient sectors. The track concept offers a fully integrated sector-spanning model of treatment at all stages of psychotic illnesses as well as a continuity of treatment. Another important goal is the early availability of timely treatment for as many psychotic patients as possible so that the symptoms can be alleviated as soon as possible and the quality of life can be sustainably improved or preserved. The track concept not only improves the current situation of treatment for acutely or chronically psychotic patients but also represents a necessary investment in the future. This treatment model aims to ensure that the good but complex and costly treatment options are available to patients even if inpatient treatment is not favored by the patient.

[The CIMH Track Concept in Psychiatry: Syndrome-specific Treatment across Modalities - Part 1 - Theoretical background]. / Das ZI-Track-Konzept in der modernen Psychiatrie: Eine syndromspezifische sektorenübergreifende Behandlung.

During the past decades, important progress was made in the treatment of patients with mental disorders. Nevertheless, the guideline-based treatment still represents a significant challenge that must take into account novel diagnostic and therapeutic possibilities as well as recent social development and the economic framework. Therefore, there is a need for further improvement of care in inpatient, day-care and outpatient hospital units. An effective and economic over-arching treatment setting may be the so called "Track-unit". This is a symptom- and syndrome-based, decentralised, and modular constructed unit adjusted to the patient's individual stage-specific needs for his / her treatment across in- and outpatient sectors. This concept allows a team of clinicians to accompany a patient from acute (even coercive) admission through to discharge and outpatient department in order to ensure the best-fitted treatment providing a maximum continuity of care without break-points in responsibilities and information flow. The Track-unit may improve the quality of mental health care while at the same time meeting economic and social interests. However, its implementation is challenging for both staff and internal processes. Here, we focus on underlying principles of the Track-concept in a German psychiatric department emphasizing ethical, therapeutic, personnel, and educational benefits of this alternative and promising setting in modern psychiatry.

[The CIMH Track Concept in Psychiatry: Syndrome-specific Treatment across Modalities - Part 2 - Practical implementation]. / Das ZI-Track-Konzept in der modernen Psychiatrie: Eine syndromspezifische sektorenübergreifende Behandlung.

Modern psychiatry needs to implement novel mental health care systems in order to address recent developments in diagnostics and treatment of psychiatric patients. In this context, it is necessary to take into account recent ethical and certain legal aspects which explicitly seek to reduce coercive treatment. The so-called "track-unit" is a promising strategy in order to achieve these goals. The "track-unit" seeks to enhance and improve patients' autonomy, setting-overlapping team continuity, compliance and adherence to treatment as well as to reduce time of patients in hospital as inpatients by more flexible intervention. Although there are many interfaces between normal wards and the "track-unit", implementation into daily routine should be done gradually. The first part of this paper will focus on required changes taking as an example the Department of Psychiatry and Psychotherapy at the Central Institute of Mental Health in Mannheim. In the second part, we will describe corresponding helpful constructional measures. In part three, we will discuss the socio-economic aspects and benefits of "track-units". In conclusion, the implementation of "track-units" in a German psychiatric department is a personnel and economic endeavor to improve the link and coordination between diagnostics and treatment throughout all stages of mental illness.