[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.

[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.

Educational collaboration in psychiatric disability, rehabilitation, and recovery: developing transformative solutions.

This article describes an innovative statewide collaboration between schools of social work and public mental health departments to transform social work curriculum and address the workforce crisis in public mental health service systems. The collaborative partnership has fostered the development of a Mental Health Initiative that has developed a set of mental health competencies offered in each of the participating master's in social work (MSW) programs in California. These competencies identify critical skills and knowledge necessary to support recovery, resiliency, evidence-based practice, and psychosocial rehabilitation principles. A statewide stipend program to support final-year MSW students in their graduate study and a requirement for a year of employment payback in the public mental health system is also presented, as well as a brief discussion of the organizational and structural principles supporting the collaborative organization. Current successes, future challenges, and strategies for the partnership collaborative in their task of developing a workforce are addressed.

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.

[The impact of social welfare policies on the deinstitutionalisation of the mentally ill in Germany]. / Der Einfluss der Ausführungspraxis des Bundessozialhilfegesetzes auf die Deinstitutionalisierung psychisch Kranker.

OBJECTIVE: In Germany the competent institution for supported housing for mentally ill and handicapped persons is traditionally the regional welfare authority, while welfare authorities on state (Lander) level hold the competencies for accommodation in hostels and homes: Assessment of the impact of policies that try to overcome this separation of competencies. METHOD: 1. Analysis of the practise of distributing the competencies for accommodation for mental ill and handicapped persons in the 16 German Lander. 2. Assessment of the supply with accommodation for mental ill and handicapped persons in the Lander. 3. Investigation of a possible relationship between distribution of competencies for accommodation and number of accommodation in supported housing and hostels/homes. RESULTS: Data about available accommodation in supported housing and hostels are inconsistently limited and available. As far as this data can be interpreted, Lander that have the administrative and particularly financial competency for accommodation uniquely organised, generally offer more supported housing. At the same time they provide relatively less accommodation in hostels and homes. Despite having the competencies for accommodation uniquely organised, some Lander continue to provide accommodation for mentally ill persons predominantly in hostels and homes. CONCLUSION: A comprehensive and between the Lander comparable system of documentation of accommodation for mentally ill and handicapped persons is highly needed. Unique organisation of competencies for accommodation of mental ill and handicapped persons is a necessary - however not commensurate precondition for the increase of the supply in supported housing. Beyond that, other factors seem to be influential, such as political will, attitudes towards the mentally ill, interests of hostel providers, pre-existing hostel infrastructure. In respect of these factors more research is needed.

Social work and the law: a therapeutic jurisprudence perspective.

Social workers in all practice areas are affected by interactions with the law and legal systems. Unfortunately, the profession has paid inadequate attention to education, scholarship, and practice in legal environments. This article introduces a new perspective for examining social work and the law called "therapeutic jurisprudence," which emanates from psychology/mental health law. Therapeutic jurisprudence focuses on the therapeutic and antitherapeutic consequences of laws, legal rules, and legal actions. It provides a framework for assessing legal issues, applying social science research to legal questions, and structuring interventions in the legal environment. The authors argue that this perspective has the potential to serve as a lens through which social workers can view the law and, ultimately, use the knowledge gained to achieve better outcomes for clients.

[Sociotherapy in German social law. Indication, contents, and aspects of public health]. / Soziotherapie gemäss Paragraph 37a SGB V. Psychiatrische Indikation, Leistungsbeschreibung und sozialrechtlicher Hintergrund.

In German mental health services, the ill-defined term "sociotherapy" has been used to designate nonmedical, social, and work-related components of the care process. Recently, a new component of outpatient/community mental health care called "sociotherapy" (according to Paragraph 37a of the Fifth German Social Code) which is funded by the public health insurance system has been introduced and is now in the process of being implemented. The paper describes (a) patients eligible for the service and (b) the aims and scope of this case management module. The key objectives are to motivate patients with schizophrenia to utilise mental health services and antipsychotic medication and to liaise with psychosocial services. Therefore, sociotherapy is distinct from (a) multidisciplinary inpatient care for people with severe mental illness, (b) assertive community treatment, (c) community care provided by social workers or community psychiatric nurses, and (d) family interventions. So far there has been little evaluation of sociotherapy.

The child-centered social worker and the sexually abused child: pathway to healing.

The prosecution of child sexual abuse cases continues to be an area in which there is a strain between the judicial system and the social work profession; the former is predominately interested in the conviction of the accused and the later is primarily interested in the protection of the child's emotional well-being. In an effort to assist the sexually abused child throughout the court process, the authors propose the concept of a child-centered social worker committed to minimizing the potential for system-induced trauma by assisting the sexually abused child through the judicial process and providing clinical treatment as well.

Social work practice in the donation of human tissue for transplantation: utilising social work values and competencies to achieve effective outcomes for transplant patients and donor families.

In Queensland, Australia, senior social workers have pioneered the coordination of tissue donation at coronial autopsies, seeking consent for the donation of heart valve, bone and eye tissue after sudden deaths which have been reported to the coroner. The urgent need for tissue for transplantation is balanced with the counselling, information and practical needs of potential donor families in their shock and grief. Social work assessment, advocacy, liaison, counselling, crisis intervention and particularly communication skills have been utilised, both as an integral component of obtaining informed consent and in working with families' experience of grief and loss in sudden, traumatic bereavement. This tissue donation program, over a period of eight years, has maximised the availability of tissue with its high donation rates, while upholding the rights and needs of potential donor families through provision of an effective social work service. The paper will reflect upon key social work knowledge and processes which have respected the subjective experience of client and worker while working within a medical model.

[Sociopsychiatric care as a municipal problem]. / Sozialpsychiatrische Leistungserbringung als kommunale Aufgabe.

Because of their disease mentally ill persons are often unable to request and receive necessary help on their own. Hence, local authorities have the legal duty to offer support in subsidiary or complementary ways or to organize help together with other participants concerned with psychiatric care. If the transition from community care to the differently structured regular health care system is too fast there is a danger of worsening of the symptoms. In the city of Bochum health insurance bodies agreed to take over the costs of therapy for mentally ill people via the sociopsychiatric services within the scope of crisis intervention. Background information on the sociopsychiatric services of the city of Bochum is given.

Plan moderno de asistencia a los alienados (1926)

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