[The legal basis for the work of the sociopsychiatric services in Germany]. / ÖGDG und PsychKG als Arbeitsgrundlage der Sozialpsychiatrischen Dienste in Deutschland.

INTRODUCTION: The legal basic principles of community mental health services or sociopsychiatric services (SpDi) in the Federal Republic of Germany are state, not federal laws, namely laws on help and protective measures for mentally disordered people (PsychKG) and laws on Public Health Services (ÖGDG) as SpDi are all integral parts of Community Public Health Authorities in most places. State laws of the 16 German states differ considerably. Earlier research on PsychKG focussed exclusively on involuntary hospitalisation, this work is the first to address PsychKG as related to the work of SpDi and to consider ÖGDG as well. METHODS: Based on an internet-based literature review the expedient laws of the 16 German states were systematically reviewed and compared. RESULTS: There is an ÖGDG in 15/16 states, a PsychKG in 12/16 and some laws concerning SpDi in 13/16. Where ÖGDG has health support to socially disadvantaged people, there is also a law on SpDi. SpDi are mainly part of the municipal or county health authorities except for 3 states without PsychKG. Where there is a legal basis, SpDi fulfills the 5 core tasks of counselling and support, crisis intervention, psychiatric expertise, coordination of mental health services and controlling of mental health institutions. CONCLUSION: In every day practice, the "Recommendations of the Board of Experts" of 1988 are more relevant than the actual state laws. However, where no such law has been passed, the impact of the "Recommendations" was much weaker. As PsychKG and ÖGDG do not warrant individual claims, but give only general indications of action, precise standards of practice are needed, as they were recently formulated in the state of Schleswig-Holstein. The UN Convention on the rights of disabled persons with its claim to more assistance may be facilitating the process of further development of state laws and to the work of the community mental health services based on them.

["Help Conference", a new social assistance for integration according to § 53 SGB XII--a two-year analysis]. / Hilfekonferenzen, das neue Verfahren zur Eingliederungshilfe psychisch Kranker nach dem SGB XII--eine Zweijahresuntersuchung.

OBJECTIVE: To deal with applications for social assistance for integration according to § 53 SGB XII, in the district of Hannover a so called "Help Conference" was introduced. Since implementation of "Help Conferences", the number of applications has increased by about 1,100% over the past five years. We analysed whether a change from the institutional help system to more individual "help" has already been realised. METHODS: "Help Conferences" recorded between 2005 and 2006 were evaluated in regard to demographic and medical data. 78 of 202 protocols (40%) had been filled in completely and thus could be included in our evaluation. RESULTS: 37 patients (47%) had F2 spectrum diagnoses according to ICD-10. More than one third of our patients (31 patients=40%) were male patients with a diagnosis of addiction, whereas in this study female patients were rarely affected by addiction (5 patients=6%). The first application was filed by the hospital social service in most cases. Applications submitted by the patients themselves were an exception. 46 applications (59%) were follow-ups, submitted by the institution responsible for the patient. CONCLUSIONS: The new system is focused on the individual interests of patients and implicates an improved and more predictable aftercare in patients with psychiatric diseases.

The impact of 'statutory duties' on mental health social workers in the UK.

In the UK, applications for involuntary admission to psychiatric units are made mainly by specially trained approved social workers (ASWs). Proposed changes in the legislation will permit other professionals to undertake these statutory duties. This study aimed to examine how ASW status impacts upon work pattern and workload stresses by comparing ASWs with other mental health social workers who did not carry statutory responsibilities. A multimethod design was adopted that included a cross-sectional national survey of mental health social workers (n=237, including 162 ASWs), and a telephone survey of mental health service managers (n=60). Data were collected using a semistructured questionnaire and diary, the content of which was derived from focus-group work and standard measures. Features of job content, working patterns and conditions were described and their association with stress, burnout and job satisfaction examined. ASWs were older and had been qualified longer than non-ASWs. The working patterns and conditions of the two groups did not differ, although ASWs did more hours on duty. ASWs received less support at work, particularly from supervisors and their role afforded less decision latitude than that of non-ASWs. ASW status was related to an elevated GHQ score, particularly among males. Emotional exhaustion was very high (over two-thirds in both groups) but ASWs and non-ASWs did not differ in this or any other feature of burnout, only 8% of the sample were actually 'burnt-out', being more common among ASWs. ASWs were more dissatisfied and were more likely than non-ASWs to want to leave their job. Given that ASW status increased stress and job dissatisfaction, especially for men, and was related to a desire to leave one's current job, it seems likely that extending statutory duties to other professionals will increase levels of stress, burnout and dissatisfaction in these groups also. In turn, this might have consequences for staff recruitment and retention.

Therapeutic case advocacy: a model for interagency collaboration in serving emotionally disturbed children and their families.

A model for the creation of a system of care for emotionally handicapped children and their families is presented. The model delineates a framework for modifying environments and for identifying the clinical skills necessary to do so. Coordination of the efforts of both formal organizations and natural support systems is seen as an essential component of the proposed system.

Application of the powers of compulsory admission to psychiatric hospital by general practitioners, social workers and psychiatrists.

Ways of extending or consolidating the powers of compulsory admission under the Mental Health Act 1983 have been discussed by the government and other organizations, including the Royal College of Psychiatrists. However there is little data on how existing legislation is applied. The authors examined the differential application of the Act between GPs, psychiatrists and social workers by means of an anonymous, confidential questionnaire. Fourteen case vignettes were interpreted by 20 social workers, 19 GPs and 28 Section 12 approved psychiatrists, who were asked to decide if they would detain the patient under the Act. Responses were analysed between and within the three groups. There was general agreement between groups on situations involving 'danger to self' and 'danger to others', but social workers were less likely to detain on health grounds and GPs tended to use the Act unpredictably, in areas not covered by the Act. The authors conclude that the Act may not be used to its fullest extent due to differences in interpretation or in knowledge, which may arise from differential constructs of mental illness and training. A national study of knowledge of mental health law is suggested.

Mental health policy in practice: lessons from the All Wales Strategy Mental Illness.

The ultimate objective of the All Wales Strategy--Mental Illness, is to produce a community based mental health service led by multidisciplinary community mental health teams. This paper is based upon a report commissioned by the Welsh Office Social Services Inspectorate based upon a review of progress in the implementation of the strategy through scrutiny of County Joint Plans and meetings with County Joint Planning Teams. In general, we found that community multidisciplinary teamwork was not well developed throughout Wales. Insufficient attention was being paid to issues of staff development and the capacity to monitor and evaluate service developments. The need for a baseline assessment of current performance by health and social services authorities seemed inescapable, if the impact of the strategy is to be reliably and validly assessed.

The 1983 Mental Health Act in five local authorities: a study of the practice of approved social workers.

This paper represents the first report of an ongoing collaborative project and charts the activities of social workers undertaking their duties within the framework of the 1983 Mental Health Act in five English Local Authorities for one year. Social workers are involved in a range of duties under the Act, but most commonly they are involved in assessments with a view to compulsory detention. The characteristics of people assessed are examined, and a profile emerges of vulnerable subgroups, typically younger men, older women, and people living in socially impoverished situations. Considerable variation between Authorities is found in terms of numbers of assessments, and in numbers of detentions. Low levels of 'diversion' into alternative care are identified. Comparisons are made with a major national study which took place four years earlier. Higher rates of detention are found on average, but lower rates of use of emergency provision (Section 4). An examination of the organisational context within which Approved Social Workers (ASWs) practice reveals a great deal of variation between authorities in terms of the ongoing experience of assessments available to ASWs. Social workers based in Emergency Duty Teams and Hospital Teams are compared, and a distinctive profile of their work emerges, the hospital-based ASWs being more likely to be assessing 'known' people, often already in hospital, and referred for assessment by consultants. The implications of these findings for the management and deployment of Approved Social Workers are briefly discussed. The emphasis is upon the role of the ASW in terms of balancing the rights and needs of people assessed under the Act.

The impact of vendorship legislation and interprofessional competition in the market for social workers' services.

The results of this article suggest that, in the short run, vendorship legislation will not result in a large shift of social workers from organized settings into private practice. However, vendorship legislation appears to increase the number of social workers in private practice in areas that have not attracted as many psychiatrists. Thus, vendorship may have a favorable impact on the geographic distribution of mental health providers. Vendorship legislation may result in increases in private practice social workers in underserved areas. The results also suggest that social workers and psychiatrists compete in the market for mental health services. In counties with higher psychiatrist-to-population ratios, fees for social workers' services are lower. Further, in counties with higher psychiatrist-to-population ratios, the number of social workers in private practice decreased after vendorship. Finally, there is a large range of optimal practice size for social workers. Social workers with 20 or more clients per month can provide mental health services at the lowest average cost per client. Thus social workers operating either full-time or part-time practices with more than 20 clients per month can provide mental health services efficiently.

The link between domestic violence and child abuse: assessment and treatment considerations.

This article discusses the existence of both spouse abuse and child abuse within families. Recent research suggests that practitioners have often missed the coexistence of these problems within their caseloads. Practice implications for both domestic violence service providers and child welfare professionals are outlined. Recommendations for changes in assessment procedures, treatment planning, and implementation are made.

[Social work in the child and adolescent psychiatric clinic--aspects of quality assurance within the scope of the psychiatric personnel regulation]. / Die Sozialarbeit in der kinder- und jugendpsychiatrischen Klinik-- Aspekte der Qualitätssicherung im Lichte der Psychiatrie-Personalverordnung.

After defining social work in child and adolescent psychiatry as social therapy, we present the development of our own concept and our experiences, referring to the Psych-PV's professional provisions (Psych-PV being a law ruling the staff: patient ratios in FRG). Social work in the multiprofessional team contributes independently to therapy, and it unquestionably adds to the institutional perspectives.

[Implementation of joint-crisis plans--a study of health care users and professionals]. / Einführung und Umsetzung einer Behandlungsvereinbarung--Eine empirische Studie unter Berücksichtigung von Betroffenen, Ärzten und Sozialarbeitern.

OBJECTIVE: To study effects of the implementation of joint-crisis plans (JCP) on health-care users and professionals. METHODS: The first 3 years of the implementation of JCP were followed with structured interviews with health-care users and professionals. Legal and administrative complications were documented. RESULTS: 36 of 44 subjects with JCP were assessed. Most of them had learned of JCP through other users or self-help. 55 % had prior experience with compulsory treatment. Better communication and self-determination were main goals of JCP. A relevant change in hospital treatment through JCP was not observed. Only few professionals had made direct experience with JCP. They valued JCP mildly positive. No legal and administrative complications were documented. CONCLUSIONS: Only a small minority of users signed JCP. JCP were easily employed and improved communication and self-determination.