Development and function of the psychiatric crisis and emergency service in Mannheim

Abstract

The setting up of a psychiatric emergency and crisis service during the years 1974 to 1980 in Mannheim forms part of the evolvement of a central psychiatric overall care programme with emphasis on patients residing in the same region, that is to say, close to the psychiatric facilities; within this framework, the role played by the emergency service is preferably of an auxiliary and additional nature, over and above the already existing regular care facilities. Since the emergency and crisis service forms a part of a regular psychiatric care network, its principal functions are: 1. First diagnosis and, in connection therewith, the decision whether 2. acute intervention in an existing crisis should be effected within the emergency service, or 3. whether further treatment must be instituted with a psychiatric or internistic or social partner of the emergency service. The emergency service has to look after an increasing proportion of patients with severe mental disturbances who are seen by the emergency service in moments of extreme crisis (high rate of attempted suicides) or in acute severe relapses, and who are normally also looked after by the regular psychiatric services. Over and above, the emergency service has to look after a special small group of patients not covered by any other psychiatric service on account of their social disorganisation , frequently also because they are addicts. As should be expected, there is an almost continuous drop in the referral to the psychiatric service, the farther away the patients live from the seat of the emergency service. This, however, applies in a very similar manner to the regular outpatient services and also to the entire psychiatric care available to the residents of Mannheim.