Workshop: Angst, Einsamkeit und unsichtbare Kämpfe; Frauen und Männer in der Obdachlosigkeit: Workshop: Fear, Loneliness, and Invisible Struggles; Women and Men experiencing Houselessness and how Psychiatrists may reach them

deutsch: Workshop 1: Angst, Einsamkeit und unsichtbare Kämpfe; Frauen und Männer in der Obdachlosigkeit Luisa Schneider hat die Lebensrealität von obdachlosen Frauen beforscht und stellt Forschungsergebnisse vor, die auch konkrete Einzelbeispiele beinhalten. Akteure aus der gemeindepsychiatrischen Versorgung Leipzigs berichten von den Schwierigkeiten der Obdachlosenhilfe und diskutieren mögliche Unterstützungswege sowie gemeinsame Projekte mit der Wohnungslosenhilfe der Stadt Leipzig. English: Referent:innen: Luisa T. Schneider, Karola Seidler, Dyrk Zedlick Workshop 1: Fear, Loneliness and Invisible Struggles; Women and Men in Homelessness. Luisa Schneider has researched the experiences of houseless women's lives and presents research findings that include specific individual examples. Stakeholders from Leipzig's community mental health services will report on the difficulties of helping the houseless and discuss possible avenues of support as well as joint projects with the City of Leipzig's houseless services. Speakers: Luisa T. Schneider, Karola Seidler, Dyrk Zedlic

Changes in German Mental Health Care by Implementing a Global Treatment Budget-A Mixed-Method Process Evaluation Study

Background Internationally, there is a broad spectrum of outreach and integrative care models, whereas in Germany acute psychiatric treatment is still mostly provided in inpatient settings. To overcome this, a new legal framework (64b Social Code V) has been introduced, promoting Flexible and Integrative Treatment Models (FIT64b), based on a Global Treatment Budget (GTB) financing approach. 23 hospitals have implemented the framework according to local needs and concepts. Prior research has already identified specific components of FIT64b. Based on this, our paper aims to examine the implementation process and underpinning change mechanisms of GTB-based FIT64b models from a staff, service user and caregiver perspective. Method 31 focus groups and 15 semi-structured interviews were conducted with hospital staff (n = 138), service users (n = 63), and caregivers (n = 35) in 10 psychiatric hospitals implementing FIT64b. Using qualitative analysis, we identified 5 core themes describing the implementation process, which were theoretically modeled into a logical diagram. The core mechanisms of change were thus identified across themes. Additional structural and semi-quantitative performance data was collected from all study departments. Results The qualitative analysis showed that the shift from a daily- and performance-based payment to a lump-sum GTB and the shift of resources from in- to outpatient settings were of crucial importance for the process of change. Saved budget shares could be reinvested to integrate in-, out-, and day-patient units and to set up outreach home care. Clinicians reported feeling relieved by the increase of treatment options. They also emphasized a stronger relationship with and a better understanding of service users and a simplification of bureaucracy. Finally, service users and caregivers experienced higher need-adaptedness of treatment, a feeling of deeper understanding and safety, and the possibility to maintain everyday life during treatment. Finally, two FIT64b implementation prototypes were classified according to the semi-quantitative performance data. Conclusion Based on the results, we developed 3 core mechanisms of change of FIT64b models: (1) Need-adaptedness and flexibility; (2) Continuity of care; (3) Maintaining everyday life. Our findings outline and emphasize the potential a GTB approach may have for improving psychiatric hospital services

Evaluation of Flexible and Integrative Psychiatric Treatment Models in Germany - A Mixed-Method Patient and Staff-Oriented Exploratory Study

Contrary to the practice in some countries, access to flexible and integrated forms of psychiatric care (FIT models) is limited in Germany. Several legislations have been introduced to improve this situation, notably the recent 64b (flexible and integrative treatment model; FIT64b) of the German Social Code, which allows for a capitation-based accounting of fees for services. The aim of this study was to explore the effects of FIT64b implementation on various stakeholders (patients, informal caregivers and staff) in 12 psychiatric hospital departments across Germany. Structural as well as quantitative and qualitative data are included, with integration of different methodological approaches. In all departments, the implementation of the new accounting system resulted into a relatively stable set of structural and processual changes where rigid forms of mainly inpatient care shifted to more flexible and integrated types of outpatient and outreach treatments. These changes were more likely to be perceived by patients and staff, and likewise received better evaluations, in those departments showing higher level or longer duration of implementation. Patients' evaluations, furthermore, were largely influenced by the advent of continuous forms of care, better accessibility, and by their degree of autonomy in steering of their services