Mental health in Berlin

Berlin is a capital characterized by migration; about 40% of all adolescents have a migratory background. In recent years, mental health care for migrants has received increasing attention, although costs e.g. for translation in hospitals are still not covered by the insurances, and problems of inpatient care for migrants without a legal status remain. In Berlin, psychiatric hospital care is sectorized, and in each sector, a central conference tries to organize outpatient care and facilities. In spite of these efforts, transition between in- and outpatient care often remains complicated, and outpatient psychotherapy care offered by psychologists frequently does not reach the most severely affected patients. Patients suffering from addiction face additional problems, as detoxification is financed by health care insurances, while treatment of the addictive disorder itself is mainly financed by retirement funds, with pervasive problems characterizing the individual patient's shift from one system to the other. So-called “integrated” approaches that link specialized outpatient and inpatient care are currently established by different health care insurances and may help to bridge such gaps. However, the multitude of different offers from competing insurances threatens to fractionize health care, and multimorbid patients may have to select e.g. an insurance with an excellent program for schizophrenia but a badly structured offer for cancer treatment. Multimorbid patients will thus be forced to decide which of their health care problems is most pressing and to neglect other diseases. Research on the impact of these “integrated” health care programs therefore is urgently warranted.