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H Häfner

Publications and source records attributed to H Häfner.

At least 127 records · Page 7Linked to original sources
PubMed1986

[Psychiatric care in the past, present and future].

The changes in psychiatric service concern the realm of psychiatric hospitals, the ambulant services, and the complementary services for chronic patients. Influencing factors are the number of patients and the incidence of illnesses and their fluctuations, the available possibilities of therapy and provision and their changes, social changes, influences of the spirit of the age, and political and financial factors. The change in all these areas is briefly presented. There exist relevant figures in the literature. They are critically discussed. The quality of psychiatric services has been altered several times. The change concerns also the patients, in which general factors are to be mentioned like higher longevity, an increased number of chronic patients, aging of the population and the resulting increase in the incidence of psychiatric disturbances.

Community Mental Health Services↗
PubMed1986

[Psychiatric emergency care and crisis intervention--concepts, experiences and results].

Psychiatric emergencies and life crises are located at opposite ends of a broad scale of stages requiring acute help: Emergency cases need immediate medical care in order to prevent danger to life. For the same reason, immediate hospital admission and additional treatment of risks of internal medicine have to be provided, if necessary. Crises often have not only mental but also social aspects. The immediate urgency of treatment is determined by the psychiatric (suicidal) or the physical risk. Emergency cases and severe crises require a 24-hour medical service. Social aspects cannot be settled in the night-time, even if they are urgent. Emergency and crisis intervention services with a multidisciplinary staff therefore ascribe different roles to physicians, nurses and social workers. Since 1976, the Central Institute of Mental Health provides a 24-hour crisis intervention and emergency service both at the Institute and at the emergency ward of the Mannheim University General Hospital. Within few years, the number of treated episodes has increased to 1,800-1,900 per year. The distance between the place of work or residence is a decisive factor of service utilization. Over 50% of the users of the emergency and crisis intervention service are mentally ill. Only a small part are contacts for crises without psychiatric disorder. Suicidal attempts or intentions account for about 30% of the service users, marriage crises for about 25% and alcohol problems also for about 25%. The development of complementary care in Mannheim has led to a parallel increase in the proportion of chronically mentally ill living in complementary facilities. This clearly indicates that a 24-hour emergency and crisis intervention service is a compulsory prerequisite for the implementation of an efficient system of complementary care for the mentally ill.

Adaptation, Psychological↗
PubMed1985

[Schizophrenia research using psychiatric case registries].

Almost 60 years after the establishment of the National Register of Psychoses in Norway psychiatric case registers have become an indispensable instrument of psychiatric research. By enabling a consecutive, person-related registration of contacts with the health care services of a geographically circumscribed region over long periods they have opened up new perspectives for epidemiological and followup studies and the evaluation of the care provided for schizophrenics. The severity of the illness and the fact that it frequently takes a long-term course are highly likely to lead to contacts with psychiatric services in areas with well-developed service structures. In this way case registers permit relatively reliable estimates of the treatment prevalence and first contacts, providing indicators of the true incidence. In the Federal Republic of Germany, however, as the only country in the world, cumulative psychiatric case registers have become illegal. An examination of long-term ecological, social and individual distribution processes among persons fallen ill with schizophrenia shows that the uneven distribution becomes effective even prior to the first onset. This is reflected in the marriage rates--the more so among males than females--, in the choice of occupation and the social chances of the schizophrenics to-be. In contrast, there is no reliable evidence for an increased risk of falling ill with schizophrenia after exposure to severe stress over a longer period of time. The age at first onset is some 10 years lower for males than females. Neither for this finding nor for the deviating birth season distribution, exhibited by approximately 10% of the schizophrenics, has any conclusive explanation been found. Even after the successful combat against tuberculosis falling ill with schizophrenia clearly reduces further life expectancy. The linkage of data from psychiatric case registers with twin, adoption and birth registers confirms the assumption that the probability of falling ill with schizophrenia is increased by genetic factors, thus refuting the alternative hypothesis of an environment-related transmission of the illness. Case registers are an indispensable means for the evaluation and cost analysis of the care provided for schizophrenics, above all in the establishment of new programmes of community-based complementary care for the chronically ill. Furthermore, they provide a solid basis for methodological studies on questions such as the stability of or transitions in the diagnosis over time.

Cross-Cultural Comparison↗
PubMed1985

Changing patterns of mental health care.

The evaluation of intra- and extramural psychiatric care nowadays calls for new models and methods of services research as the transition from custodial to community mental health care results in patterns of utilization of high complexity. Not only the capacity and the components of the care system has changed considerably but also the composition of the cared patient groups. In Mannheim 3/4 of the schizophrenic patients requiring institutioned care for one year or more are admitted to sheltered homes and apartments due to the establishment of complementary services in the last 15 years. Data of a representation cohort of 148 schizophrenics observed over a period of 18 months show that corresponding to the multiple needs of the patients multiple utilization prevails. The effectiveness of extramural care can be demonstrated by a reduced probability of readmission to inpatient treatment. The economic efficiency of the provision of complementary care was evaluated by analyzing costs of service use by the cohort. The direct costs per case of all the services utilized over one year averaged 43% compared with an uninterrupted stay in a mental state hospital. Also in community mental health care almost 80% of the total costs accrue from hospital readmission due to relapses.

Adolescent↗
PubMed1985

Are mental disorders increasing over time?

The impression that the prevalence of mental disorder has been increasing during the last decades is only partially justified. The considerable increase in the demand for psychiatric and psychotherapeutic help is influenced by quite a number of factors that vary in nature and direction. The most essential contribution was made by changes in the age composition of the population - and here primarily by the growing number of mentally ill elderly persons - and by the enormous increase in life expectancy. In milder psychiatric disorder the increase in the utilization of medical help is mainly due to new ways of treatment and to the great enlargement of psychiatric and psychotherapeutic services in most industrial countries, for which the zeitgeist of transition from a predominance of natural science to a more psychological understanding of life forms the background. Civilizational factors in a closer sense, like the raising of the achievement level for school beginners or alterations in the threshold of tolerance between mental illness needing medical intervention and mental suffering to be borne with submission to God's will, play an essential role particularly for the widening of the disease concept and thus for changes in the frequency of certain deficits of achievement and feeling, such as 'reading disorder' or depressive states. The fact that the age-corrected risk of falling ill with schizophrenia has remained stable over many decades - wherever it could be investigated - does not point to a relation with variable environmental factors like industrialization, civilization or social order. In contrast with this disease in a closer sense, the rates of psychiatrically relevant forms of deviant behaviour - suicidal attempts, drug- and alcohol-related disorders - show rapidly changing upward and downward variations. Thus, they are more comparable to criminality rates that vary over time and culture. There is obviously a relation between changes in the frequency of deviant behaviour and changing patterns of values in society, such as the reduction of educational intensity and the commitment of adolescents to norms and convictions of their parents. This is why the most distinct changes in these rates occur at the age most accessible to contemporary or fashionable influences: in youth and younger adult age. Except for age-related changes, we do not seem to have become more ill than the generation of our parents, but more pessimistic.

Adolescent↗
PubMed1983

[Attempted suicide and depressive disorders].

211 persons consecutively seen for parasuicidal behavior by the various services of the CIMH (Central Institute of Mental Health) in Mannheim were investigated with regard to the seriousness of intention and the real risk to die. Seriousness and real risk to die were measured by a scale which was divided into two parts - the interviewer rating scale and the self-rating scale. The highest suicide risk was found in depressed patients. This group showed higher scores on the self- and interviewer rating scale than the non-depressed patients. It could be shown that the high risk of suicidal attempts of depressed patients cannot be explained by the older age of this group. However, it can be assumed that psychological factors, influencing the intention to die, are more important.

Adolescent↗