[Two-class psychiatry? A psychiatric university clinic in the community]

The German psychiatric care system focuses on the person of the patient and on the treatment in which he or she lives. Basing on this principle, the advantages of integrating the inpatient department of a general hospital or a psychiatric hospital into the level of a single sector (a single-stage care system within the community framework) are described, where the sector includes disturbing groups, in the various stages of the course a psychiatric disease takes in a patient. Fundamentally, patients suffering from severe chronic psychosis should also be included in this mode of treatment. In some cases it is still unavoidable to hospitalize such patients in a psychiatric hospital until appropriate facilities have been developed within a framework of the community, especially with regard to adequate complementary facilities. Taking into consideration the human and scientific interpretation of disease, an overall picture is visualised in respect of community-centered concentration of inpatient, day-patient and complementary care on the one hand, and centralised forms or care involving a hospital or psychiatric institutions on the other.