We need more staff for a good treatment in psychiatry

“Save the medicine!” With this requirement in the star were 215 Doctors at the beginning of September for a nationwide stir. Your goal: for a radical Reform of the hospital sector. In many places it has been discussed: in hospitals, doctor’s offices and also in the television.

Three weeks after the appearance of the appeal, the number of its supporters is growing now at more than 130,000 – and it is growing every day.

The appeal of physicians in the printed star and stern.de big waves hit, that now other scientists, the claims connected as for example the German society for psychiatry and psychotherapy, psychosomatics and neurology (DGPPN). The star has spoken with the Chairman prof Andreas Heinz.

Professor Heinz, you worry about the quality of the supply of stationary patients. Even warn you before a “return to the Depositary psychiatry”. What is the Background?

We fear that the Situation in psychiatry is deteriorating significantly. From 2020 onwards, psychiatric clinics should be required to have a minimum staff of only 85 percent of the current staffing levels prove. Our demand was that the houses in compliance with the guidelines, so they can operate according to the current state of the research, and the staffing is increased. As the psychiatry personnel regulation of 1991 came into force, was, in substance, that severely mentally ill people are in need of inpatient medications, especially. Today is evidenced by many studies, the importance of human affection, social support and psychotherapy are. We were hoping for 10 to 20 percent more staff, so that, for example, for each patient, two hours of psychotherapy per week are possible. What we get now: a reduction of 85 percent as a lower limit.

You could understand this by the Joint Federal Committee-defined sub-limit of insurance for patients: A certain limit must not be at the staffing of a Station below.

And is not written, unfortunately, what is supposed to be, but only what may or may not be, so it is irresponsible. This is, as you would say: On a neonatal unit, there must be incubators; if that is missing, then the Station is closed. This absolute lower limit is now defined, but not what is a good and timely treatment is necessary. So it is the free play of market forces and the negotiating skills of individual hospital Directors with the funds to get anything beyond that. This is risky, it can always fail. A meaningful policy must be between the personnel requirements that align with the required good quality of care, and to ensure patient safety, the necessary personnel to distinguish lower limit.

What is likely to get worse, if the proposed regulation enters into force?

It means that the personal keys will not be increased, but even decreased it can be. This minimum staffing level must then be differentiated according to professional groups and at each Station at least monthly and be documented. If it falls below the lower limit of the sanctions – which the funds no longer want to pay then starting in 2021. So far, we have documented for the whole hospital each year. So we can demand, or even vacation – or disease-related, and Abs staff to compensate. For example, we can use time more social workers, if that is important. Here in Berlin-Mitte, the need for supervision by a social worker is particularly high, since patients often have no housing or no more work, when you are released. Because it can be useful to deal with the Budget more social end of the work at the expense of other professional groups. The clinics should have the leeway to do what is useful for the patients. The planned new rules would mean even more administrative and documentation work – so even less time for patients. For small hospitals, the threat of sanctions may even mean that – then we would have on the country, only large hospitals such as those 40 years ago.

What is the current supply?

For 18, on average, sick patients on our Station, the funds to pay in about a quarter of a psychotherapists office, a quarter of a top doctor and a psychiatrist in training, plus holiday cover. The psychotherapy session per week at present only guaranteed for about ten patients, and even that is very expected optimistic, because some time is needed to document the meetings, to supervise and discuss with the Team. This is far from sufficient.

The for the Charité and other University hospitals apply?

At the University clinics at the Charité, it looks better. Our professionals conduct studies and scientific work.

In Norway, in Tromso, works in a small psychiatric ward with six patients without medication. The patient should have the opportunity to receive only psychotherapy. So something in Germany, it is conceivable?

The Situation is in some respects better than its reputation, even in Germany, I have to say that again and again. For over 20 years, psychiatrists are trained always also a psychotherapist and as good as all of the not to treat people only with medication, but to speak with you to understand your problems and your needs. The law is in the States vary – but in Berlin, for example, no one may be the rejects, with drugs, forced treatment, unless he or she endangers himself massively. In the case of a foreign threat, or the data needs to be treated in any other way than with drugs, for example, by intensive care and monitoring. The staff needs. In individual cases the Situation can be very difficult and much suffering for the relatives and the Affected mean. But it is true: patients have the right on your treatment you receive.

We now know from studies that non-pharmacological psychotherapy is sometimes more helpful than medication.

In the case of all mental disorders, a thorough medical history is important – to have the talk time is essential. Sometimes it turns out on closer Inspection: nothing for a psychotherapy, but the thyroid is not working at this person, he needs a specific hormone. We also know: For minor depression, talking therapies help in the rule is best, to also support the end of talks with the family doctor. In the case of moderate depression psychotherapeutic interventions are a priority, the use of antidepressants may not help, but to make it work. In the case of severe depression drugs are, as a rule, in addition to psychotherapy. Of course you have to always pay attention to the duration of the medication administration and desired and undesired impacts. Basically, the human contact between a physician or psychological therapist and the patient is of great importance that we know today – even in patients with psychosis, by the way, the work is often very inaccessible. For this it needs time. The greater our disappointment is that taken by the G-BA little consideration was.

How it looks in the care sector?

Here, too, we would have liked that To be increased Numbers. We are in all other hospitals, the time is with the patient scarce, not least because documentation and administrative tasks take up so much space. A quality assurance, which is always expensive, is so absurd that is – at some point, especially at the expense of the quality of the treatment. If there are enough nurses, you can be each and every individual patient needs, so far locked station doors open, and often coercive measures, to avoid the experience. This is the key to a humane psychiatry.

You see, the Chance that the new psychiatry personnel regulation is now modified?

No. We ask, therefore, now the members of the Bundestag with all the emphasis of the law mandating that hospitals like to go so far with nationwide applicable quotas in the Fund negotiations. The need to be far above the minimum requirement of 85 per cent of the existing personnel standards and on the Status quo – so in 2020 at about 105 percent of the previous psychiatry personnel regulation. This no longer applies, starting in 2020 – when the legislature is not, I repeat, we have as a basis for our equipment, only the 85 percent minimum of the occupation and the danger of the race to the bottom.

The DGPPN has the doctors appeal of the star connected. The Doctors in normal hospitals fight back among other things, against flat rates, which induce, preferably interventions that bring money. In psychiatry this is regulated in the same way. There are Daily rates based on the severity of the disease. What made you decide to support the appeal?

Psychiatric patients may not be applicable to the unregulated “free” market is suspended. This is important to us. In psychiatric care there are a lot of emergencies. The people to be brought in by the police, the time of the fire. You can’t be choose the hospital most of the time, in which they are treated. In charge of the district in which they live. Houses in other districts, like the mentally Ill better, to be able to reject the emergency room. The Affected need, therefore, nationwide, valid, clear target specifications for a good treatment, apply to all psychiatric and psychosomatic houses. The patient and the Patient must be in the foreground. Administration and documentation is not allowed to steal more and more of the time of treatment due to the patient. It is important to us that the Welfare of the patient, with its many facets and individual needs in the centre of the political decisions.

The whole story to the Doctors appeal read in the star, edition 37.

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