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Paradigm shift in mental health care. Challenges and approaches for financing a community mental health care system in Austria.

By Ingrid Zechmeister

Abstract

The Austrian mental health care system has been characterized by reform initiatives since the 1970s. The reform strategies can be summarized under the term 'community mental health care'. The thesis focuses on an analysis of the reform (context) and the related challenges for mental health care financing with respect to its interdependencies with service provision in the process of change. In a qualitative research process, firstly, reform documents and transcripts of qualitative interviews have been analyzed via a discourse-analytical approach. Secondly, secondary data on mental health care financing in Austria and in western European countries have been collected. An analytical framework was, finally, applied to analyze the interrelations between mental health care financing and reform discourse with respect to its impact on the micro-level and on the macro-level of the mental health care system. The results show that the reform discourse reflects broader welfare state transformation processes. Yet, financing issues have hardly been addressed in reform discussions. Nevertheless, discursive elements are either explicitly or implicitly associated with financing issues or are even linked to specific financing models. A central impact from the restructuring processes on the micro-level is an increasing (financial) responsibility for people who are affected by a mental disorder and/or their relatives. On the macro-level, the processes of change are related to decreasing (financial) responsibility for the sector 'state' while responsibility for the sectors 'family' and 'voluntary/community' is rising. The international development shows similar characteristics. The thesis finishes with some recommendations for developing an alternative financing model and provides a guideline for a comprehensive discussion of alternative mental health care financing approaches. (author´s abstract

Topics: Austria / health care / community mental health care / reform / financing / mental health reform / discourse theory / welfare state /
Year: 2004
OAI identifier: oai:epub.wu-wien.ac.at:epub-wu-01_7a2

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