The Enquête Commission: ZI Mannheim

1975

The Enquête Commission presents its report on the state of psychiatry in the Federal Republic of Germany, commissioned by the Bundestag. It calls for a fundamental reorganisation of psychiatric care in Germany and recommends

The equalisation of mentally and somatically ill patients
Separate care for mentally ill and mentally disabled people
Care for the mentally ill and people with a disability within the framework of general health care
The reorganisation of large psychiatric hospitals
Community-based care
The promotion of counselling services and self-help groups
The promotion of training and further education

MP Walter Picard, an important driving force behind the Psychiatry Enquiry, during a speech in the German Bundestag © Deutscher Bundestag/Presse-Service Steponaitis.

The equalisation of mentally and somatically ill patients was of great urgency, as the statutory health insurance funds only had to pay half of the costs of hospitalisation exceeding acute treatment. The other half - if the person concerned was unable to pay themselves - was borne by the social benefit provider and later recovered from the sick person or their family through recourse.

In 2015, Heinz Häfner stated: ‘Since the publication of the Enquête Report, the fate of mentally ill people, psychiatric institutions and the face of psychiatry have changed fundamentally in Germany. However, one of the most significant successes of the Enquête was of an immaterial nature: a profound change in mentality among the majority of those working in psychiatric care and, in connection with this, a fundamental change in the way the mentally ill are treated. I just hope that this will not be lost again with the growing bureaucratisation and monetisation of healthcare in Germany.’

Herr you can read more about the Enquête commission and the psychiatric reform:
Psychiatric reform in Germany. Prehistory, implementation and aftermath of the Psychiatry Enquête. A field report (a review by Heinz Häfner)
On the road to psychiatric reform

Looking at psychiatric-psychotherapeutic care in Germany today, it must be recognised that the goals formulated in the Commission's report have so far only been achieved in part and to varying degrees. Psychiatry has - mainly thanks to the discovery and introduction of effective medication - changed from a preservative to a therapeutic discipline. Effective psychotherapy and rehabilitation methods have been and continue to be developed, researched and applied. The community psychiatric model has been established in a number of areas. Inpatient stays are now much shorter, outpatient and day-clinic treatments have become standard and tracks enable individually customised long-term care.

As part of inpatient treatment, seriously ill people can also be treated at home. Psychiatry has become an integral part of the medical disciplines. However, a stronger presence in general medical training is still desirable. Certain mental illnesses, especially depression, have lost some of their stigma thanks to media awareness. Other serious illnesses such as schizophrenia and psychoses are still associated with fears, insecurities and prejudices that place a heavy burden on those affected and their environment. Neuropsychiatric research has gained immense knowledge since 1975 and, thanks to technologies such as imaging, genetics, stem cell research, machine learning and artificial intelligence, is on the verge of a further, enormous increase in knowledge. The complexity of the human brain and its processes continues to present a fascinating challenge.

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