Individual needs and allocation of home-based community psychiatric services. Analysis of an example for ambulatory care living

In the Federal Republic of Germany, rebuilding the structures of complementary care in the newly formed eastern states created the opportunity to provide at-home care in the community as a low-threshold flanking measure for chronically mentally ill individuals generally capable of living independently. For a group of patients with chronic schizophrenic disorders (ICD-10: F20) living on their own in the community with at-home mental health care ( n=83), a study of data focusing on psychopathology, social disability, need for psychiatric care, and (subjective) quality of life demonstrates that the principle of need-oriented care has not yet been realized consistently. This applies especially to the provision of community services of varying treatment intensity based on the differing severities of psychopathological symptoms and social disabilities of individual clients. Furthermore, the results of the study show that the severity of psychosocial impairments is associated with a rather negative assessment of the subjective quality of life, whereas the living arrangement has no influence on satisfaction with life. The conclusion for organizing community mental health care is to establish flexible provision of services oriented to standardized individual analyses of needs for care.