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Poster Abstracts

Flexible and integrated treatment approaches in mental health – a comparison of model projects in Germany and Poland

Authors:

Martin Heinze ,

Brandenburg Medical University, Germany, DE
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Julian Schwarz,

Brandenburg Medical University, Germany, DE
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Andrzej Cechnicki

Medical College, Jagiellonian University, Poland, PL
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Abstract

Background: Psychiatric health services in Germany are well developed and, in general, usually also well financed. Nevertheless, according to OECD-data, health-related results in the field of mental health are worse than expected and coming with a lesser degree of the quality of services provided, given the financial resources used. The reason for this is that the health services are poorly coordinated between different providers and financiers. Furthermore, the German system is strongly shaped by its institution and a patient-centered approach often is not realized, being disadvantageous for patients. Until recently, similar problems were found in the chronically underfunded Polish psychiatric system.

Both countries reacted to this situation: in Germany model projects according to § 64b of the 5th German Social Insurance were introduced, bridging out- and inpatient services as well as Home Treatment. Up to the year 2021 Flexible Integrated Treatment approaches (FIT) were introduced in 22 German catchment areas. The Polish government, in 2008, started the National Mental Health Program (NMHP) which initiated the introduction numerous day wards and home treatment in Community Mental Health Teams (CMHT). In 2017-2021, in 33 selected catchment areas, Community Mental Health Centers (CMHC) with integrated program similar FIT-approaches, regional responsibility and capitalization model of financing was established

Since both models have the same aims and funding ideas, but are rather different in structure according the respective national laws, a comparison of the practice models between the two countries is helpful to understand the benefits of different ways of acting. The aim of our study is to compare both models in a sense of health systems comparison.

Methods: Prior research has identified 11 specific program components of FIT, suitable for representing the key components of FIT practice models.

The applicability for the Polish context was demonstrated using qualitative with the program managers of the Polish FIT models (n=19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared.

Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation showing only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components’ definition.

Conclusions: The specific program components of FIT, as first defined from the German experience, serve as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems. The future development of model projects for integrated mental health care should also increasingly undertake international, especially European comparisons in order to combine the best practical approaches.

How to Cite: Heinze M, Schwarz J, Cechnicki A. Flexible and integrated treatment approaches in mental health – a comparison of model projects in Germany and Poland. International Journal of Integrated Care. 2022;22(S3):397. DOI: http://doi.org/10.5334/ijic.ICIC22368
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Published on 04 Nov 2022.

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