Integrated Working Group "Mental Health

Psychiatric care often focuses the dyadic doctor-user relationship, which makes caregivers a largely disregarded group in the treatment situation. Their systematic exclusion is often seen as a requirement and/or therapeutic necessity. Recently, there has been a renewed interest in the group of caregivers: On the one hand, there is a clear tendency to pathologize this group (as "co-sufferers"), on the other hand, psychiatry increasingly demands the inclusion of caregivers as so-called "co-therapists".

In a collaborative-participative cooperation, a proposal was formulated that aims to investigate the possibilities for participation of caregivers in psychiatric treatment, beyond this dichotomy. The application was submitted to the German Research Foundation. Members of the Berlin Association of Caregivers of Mentally Ill People (ApK e.V.), employees of the University Clinic for Psychiatry and Psychotherapy Leipzig and employees of the MHB participated in the development of the application. The project aims to develop an intervention to improve the integration of caregivers into the psychiatric treatment situation.

Contact person at the MHB is Sebastian von Peter.

Participation in Health Policy Institutions

In addition to the institutions that are obligated to involve patient representatives according to § 140 f of the German Social Code V, there are other institutions that infrequently involve patients without a formalized legal basis. There is a multitude of possibilities for participation, but the access and type of participation are difficult to recognise (not only) for those affected who want to get involved.

The project aims at an inventory and needs analysis of patient participation in health policy institutions in Germany at the federal level. For this purpose, different methods of analysis are combined (legal analysis, systematic literature research, document analysis, qualitative survey). In the area of the qualitative survey, semi-structured, guideline-supported individual interviews with representatives of health policy institutions and with patient representatives, as well as focus groups will be conducted. The aim of the study is to gain insights into the group of people involved, the recruitment of patient representatives, the institutional participation formats and the factors that constitute them. In this context, the perspectives of patient and other representatives will be investigated and how they experience the implementation of patient participation in institutions and which concrete needs for further development are seen.

The project is carried out in cooperation with the Center for Health Services Research Brandenburg (ZVF-BB) of the MHB (link), the duration is from 2020 to 2021. Contact person is Eva Buchholz.

SiSi Study/Subproject Mad Studies

The project investigates the interplay of thing-meanings and agency in extreme mental crises, in madness experiences and psychiatric reactions to them. It is assumed that the boundaries be-tween man and thing are renegotiated precisely when we leave the territory of self-evident routines and the everyday. Following the method of "photo-elicitation", "object-elicited inter-views" are conducted. Things - either materially available or described from memory - are a third party between the interviewer and the interviewee. The preoccupation with their materi-ality, with the actions and meanings associated with them, allows a joint exploration of the sub-ject matter. The result is a scientific work and a website as a digital museum. This wants to make the knowledge of psychiatry-experienced about crises and their overcoming more publicly known.

It is a stakeholder-controlled project in which (a) the people who make the decisions and (al-most) all those who collaborate in it are relevantly experienced; b) interpretations are based on a hermeneutic circle of "mad wisdom": different texts of psychiatry-experiencers open up new horizons of understanding for each other; c) The "digital museum" will be designed with the participation of the "donors".

The project is funded by the BMBF (duration 2018-2021). It was conceived by Elena Demke and is being implemented by her together with other collaborators. Martin Heinze is in charge of the application.

In this research project, the crisis support of the Bochum Crisis Respite, an peer-organized sup-port by the Landesverband Psychiatrieerfahrener NRW (North Rhine-Westphalia Association of People Experiencing Psychiatric Disorders), was examined. The main research interest was to evaluate the specificities of a self-help-organized crisis support, the investigation of its central components, effective factors and effects. Methods of qualitative health research were used and the approach was strictly collaborative-participative, meaning that the research team consisted of employees with and without experiential expertise (collaboration), and that employees and, in some cases, former users of the Bochum crisis support were involved in central decisions in all phases of the research process (participation).

The project was funded by Stiftung Wohlfahrtspflege and lasted from 2017 to 2020.

The term Recovery originates from the critical self-help and historically turned against the pessimism of employees in psychiatric institutions. Followingly, the term was adopted by reform-oriented professionals, gradually incorporating into various health policy concepts and demands, which also led to a major change in the concept.

Since 2014, participatory-collaborative work has been underway on a group concept for the implementation of Recovery-oriented principles for people with psychosis experiences. This concept has also been published in the meantime. Based on this, researchers with and without psychiatric experience are currently have been working on a brochure, which will present different recovery groups and discuss the underlying concepts in comparison.

The current project is funded by Aktion Mensch and lastet from 2020 to 2021.

Open Dialogue and its predecessors have been practiced and developed in some Scandinavian countries since the early 1980s. A number of principles have been described (such as immediate and mostly outreach help; team-based work; systemic orientation; presence of users during dis-cussion of all concerns; continuity of care; flexible treatment design; mediation of individual psychotherapy when needed; low-dose neuroleptics), not all of which can be easily translated to the German care situation. Nevertheless, Open Dialogue is now being implemented at about 42 locations in Germany, both in clinics and outpatient facilities. So far, there has been no system-atic evaluation of these services.

Based on a study with high methodological requirements in Great Britain (ODESSSI - link), an international cohort study has been in preparation since 2018, which will systematically investi-gate the effects of care through Open Dialogue in more than 10 countries over the long term. The research design for this international study is currently being implemented in the Nether-lands and in three locations in Germany. At the MHB, the study activities for the sites in Germa-ny are being coordinated.

The overall study receives funding from the Foundation for Excellence in Mental Health Care. It is planned to last for 7 years, 2019-2026. Contact person is Kolja Heumann.

Children and adolescents who witness parents in mental health crisis are statistically at increased risk of experiencing a mental health crisis themselves at some point. Currently, there is a lack of low-threshold, family-oriented care services to respond to this need.

With the new form of care "CHIMPs-Net", a family-therapeutic offer is to be established in Germany, which is designed between therapy and prevention, depending on the needs of the family. Within the framework of a qualitative process and outcome evaluation, the MHB caries out the implementation process at various centres in Germany. This project also includes a critical examination of the concept of medical-psychiatric prevention of mental crises.

The project is implemented within the framework of the Innovation Fund. Duration: 2019-2022. Contact persons is Timo Beeker.

The project investigates the interplay of thing-meanings and agency in extreme mental crises, in madness experiences and psychiatric reactions to them. It is assumed that the boundaries be-tween man and thing are renegotiated precisely when we leave the territory of self-evident routines and the everyday. Following the method of "photo-elicitation", "object-elicited inter-views" are conducted. Things - either materially available or described from memory - are a third party between the interviewer and the interviewee. The preoccupation with their materi-ality, with the actions and meanings associated with them, allows a joint exploration of the sub-ject matter. The result is a scientific work and a website as a digital museum. This wants to make the knowledge of psychiatry-experienced about crises and their overcoming more publicly known.

It is a stakeholder-controlled project in which (a) the people who make the decisions and (al-most) all those who collaborate in it are relevantly experienced; b) interpretations are based on a hermeneutic circle of "mad wisdom": different texts of psychiatry-experiencers open up new horizons of understanding for each other; c) The "digital museum" will be designed with the participation of the "donors".

The project is funded by the BMBF (duration 2018-2021). It was conceived by Elena Demke and is being implemented by her together with other collaborators. Martin Heinze is in charge of the application.

Users and related associations have long criticized the strong reliance on psychopharmacothera-py as a primary means of treatment. They cite side effects and long-term consequences of taking both antipsychotics and antidepressants. Long-term and high-dose use of antipsychotics and an-tidepressants can lead to significant side effects, tolerance development and irreversible late effects. What is desired instead is a structured approach to reducing and/or discontinuing psy-chotropic medications. To date, there is little substantiated knowledge on this.

Thus, in 2018, a trialogue was founded in Berlin, in which psychiatric patients, their relatives and staff, exchange knowledge about the reduction and discontinuation of psychotropic drugs. In addition, the current procedures and attitudes of prescribing physicians with regard to the reduction and discontinuation of antidepressants and antipsychotics in Berlin and Brandenburg will be investigated within the framework of a doctoral project and an online survey.

The project is being implemented as part of a doctoral project. Duration: 2018-2021. Contact person is Sebastian von Peter.

Over the last decades, psychiatry as an institution, science and practice has continuously gained importance in society. More and more people have received a psychiatric diagnosis, have been prescribed psychotropic drugs or have taken advantage of other psychiatric or psychotherapeutic treatment. In complex interactions with this development, psychiatrically influenced thinking in concepts and language is increasingly permeating our everyday life and various areas of life. Whether learning difficulties in elementary school or aggressiveness in a nursing home: problems are increasingly interpreted psychiatrically and are then primarily to be solved psychiatrically.

The project critically examines these phenomena and understands them as part of an overarching development process towards an increasing psychiatrization of society. It focuses on possible risks and damages for individuals (e.g. by low-threshold diagnoses and ineffective treatments) and society (e.g. if social grievances are not to be solved politically but medically-psychiatrically). The approach to the object of research is both empirical, using the methods of mental health care research, and conceptual, through continuous theory development along the lines of philosophy and the critical social sciences. Because of this theoretical reference, there is a close cooperation with the WG Paradigms of Psychiatry and Psychotherapy (Head: Prof. Heinze).

Project duration: open. Contact person: Timo Beeker.

Internationally, there is a broad spectrum of team-based and inpatient care models, while in Germany many users are treated exclusively in the full inpatient setting. Since 2013, the possi-bilities for integrative forms of treatment according to §64b SGB V have been expanded: Through a clinic-related total budget across all treatment settings (inpatient, day-care, outpa-tient) these model projects aim to provide more flexible, needs-based care. As a result of the framework conditions of § 64b, the health insurance associations issued a Europe-wide invita-tion to tender for accompanying research in 2015. This is based on the analysis of routine data available from the health insurance funds.

This study design cannot answer qualitative questions, in particular the assessment of the model care by users, relatives and employees. It is also not possible to investigate how the individual clinics structure the model care. For these reasons, a group of model clinics decided to conduct their own study (Akronym EvaMod64b). Data collection has already been completed. The study results will be published starting in 2018.

The project was supported by funding from the consortium of participating clinics and lasted from 2016 to 2018.