[Alternatives to institutionalization in accordance with the Institutionalization Law: problems, recommendations for...

Police authorities, Public Health offices and Law Courts cooperate in solving the problem of psychiatric patients who have to be referred to a psychiatric hospital according to state mental health acts. Such referral, however, is only permissible as a last resort, i.e. if all other alternatives fail. The present study first presents this legal situation and points out that the alternatives are not always fully explored with the necessary energy. The importance of these alternatives is explained from a psychiatrist's point of view. A practical approach is suggested with the main burden resting with the relevant police authorities who (in West Germany) are responsible for arranging proper sociopsychiatric care of such persons. The problem is then discussed in accordance with a medico-anthropological system model demonstrating the typical characteristics of social, medical and legal attitudes and those of the pertaining "subcultures" to such problems.