[Follow-up options in institutional protection--"patient careers" in a comprehensive community psychiatric care...

The recommendations for the reorganization of German psychiatry were associated with the expectation that institutional protection can be reduced in a comprehensive community care system on the longterm basis and that a stabilization can be achieved during treatment with a minimum share in full and partial hospitalization. To test this assumption we studied the institutional pathways of 136 chronic, mainly schizophrenic patients within the comprehensive care system of the Department of Social Psychiatry over two years. A cluster analysis of sequence and intensity of institutional care showed three major types of use of the system: as a rehabilitation system, as an alternative and flexible care system, and as a traditional "dual-care-system". These patterns of institutional pathways were analyzed regarding predictors from patient's history. Consequences are discussed concerning further development of community mental health, coordination of services and continuity of care.