Introduction

After World War II psychiatry in Germany carried a terrible burden. From 1933 onwards the ideology of national socialism had disastrous consequences for the mentally ill. The eugenic laws demanded the compulsory sterilisation of every individual suffering from functional psychoses, familial epilepsy and familial retardation. The inhumanity culminated in the programme of euthanasia. Between 80 000 and 100 000 mentally ill people were killed. Some of the leading German psychiatrists had been actively involved in this programme.

Understandably, psychiatrists and psychiatric institutions thereafter met with a fundamental distrust. It took a long time until the problems of mental health care could again be brought before the public. Therefore, until 1970, German psychiatry was comparatively little influenced by the community psychiatry movement initiated in the United States, Britain and other European countries. As a consequence, the maximum of occupation of psychiatric beds, indicating the culmination of custodial care, was reached in Germany approximately 15 years later than in Great Britain or the United States.

Mental health care in Germany in the early 1960s was characterised by a sharp demarcation between inpatient and outpatient care. Ninety-seven per cent of all psychiatric beds were in mostly remote, large public hospitals, four of them with more than 4000 beds. The majority were in an obsolete state. The average length of stay was 215 days, 26% of the patients staying in hospital for more than 10 years. Only 3% of the psychiatric beds were located in units of general hospitals with a bed ratio of 1:12.6 and an average length of stay as short as 35 days. Outpatient psychiatric care rested almost completely with psychiatrists and psychotherapists in private practice. Among their clientele patients with severe mental disorders and socially disabled chronically mentally ill individuals in particular, as well as psychogeriatric patients, were considerably underrepresented. Complementary services, such as day hospitals, supervised homes and apartments, and sheltered workshops, were lacking almost completely, and there was no prospect of a change in this system, especially in the rehabilitation of dischargeable long-stay patients.

Provision of care for mentally ill old people was extremely deficient. In the mostly isolated mental hospitals somatic care to modern standards was impossible.