S11.03 - Re-institutionalisation of the severely mentally ill - who or what is to blame?

Abstract

The prejudice of the outstanding dangerousness of individuals with severe mental illness is one of the major reasons for the special position of psychiatry among the several medical disciplines. The mental health reforms initiated during the second half of the 20th century had the principal aim to move the locus of treatment and care from the big mental hospitals into the community and to strengthen the patients’ civil rights - so reducing stigmatization and ‘normalizing’ the aforementioned special position of psychiatry. Despite all doubtless improvements for the majority of mental patients every European country is reporting on rapidly growing admission rates of mentally ill offenders to forensic hospitals. A possible association with the introduction of mental health reforms is under continuous discussion.

It will be shown that not single details of the reforms but, rather, the changed attitude towards a subgroup of severely mentally ill subjects being at higher risk of violence could be the crucial issue. These patients hamper the desired ‘normalization’ of the position of psychiatry, and, in fact, modern community care hardly offers sufficient treatment options for them.

The basis for this development may lie in the societal changes of the last decades. Today, we do dispose of the ‘technical’ (financial, pharmacological) preconditions for the treatment of severely mentally ill patients. However, the emotional preconditions of society and its representatives seem to be only insufficiently developed. Therefore, forensic hospitals are in danger to take over the role of the old psychiatric asylums.