[Psychosocial care structures in urband and rural districts (author's transl)]

The present study is based on a complete institutional and personal coverage of psychosocial care institutions in nine local regions within the Federal Republic of Germany. The study was carried out by means of a short structured questionnaire and was supported by local psychosocial working groups. The following questions were considered on the basis of a sociodemographic differentiation, in urband and rural districts: 1. To what extent do differences appear between urban and rural districts with regard to outpatient-, inpatient- and complementary treatment facilities? 2. To what extent do differences appear in regard to the quantity and quality of specialized professional personel operating there? 3. In what way, and to what extent, compensatory care mechanism do exist? The results show important and systematic differences with regard to the outpatient, inpatient and complementary treatment facilities. Rural districts are characterised by an emphasis on inpatient facilities, including homes, as well as by a marked lack of outpatient facilties, especially of a psychotherapeutic nature. Psychosocial professions with high qualifications, especially in psychotherapeutic respect, are mainly found in regions characterised as urban, while they are nearly completely absent in rural districts. In addition the results point at a underprivileged treatment structure of rural district. However there are indications of compensatory care mechanisms. This means that persons without any specialized training are often engaged in treatment jobs requiring specialisation. This applies in particular to the complementary field of patient care. The article discusses overlapping problems of proper geographic distribution of psychosocial treatment facilities in accordance with actual requirements. Furthermore political conclusions resulting from this aiming at improvementsof the care structure for mentally ill persons are discussed.