LVR Psychiatric Report 2016 Focus: Migration and Integration Contents
1. The LVR Clinic Association ...... 6 1.1. Treatment Goals of the LVR Clinic Association ...... 10 2ϑHULQJ6WUXFWXUHIRU3V\FKLDWU\ 3V\FKRWKHUDS\DQG3V\FKRVRPDWLF0HGLFLQH...... 12 2ϑHULQJ6WUXFWXUHIRU&KLOGUHQ¶VDQG$GROHVFHQW3V\FKLDWU\3V\FKRWKHUDS\DQG 3V\FKRVRPDWLFV...... 15 /95,QVWLWXWHIRU&DUH5HVHDUFK ...... 18 /95$FDGHP\IRU0HQWDO+HDOWK ...... 20
2. Migration and Integration ...... 22 ,QWHUYLHZRQWKH7RSLFRID&XOWXUDOO\6HQVLWLYH+RVSLWDO ...... 26 /DQJXDJHDQG,QWHJUDWLRQ0HGLDWRUV...... 31 +HOSIRU7UDXPDWLVHG5HIXJHHVDWWKH'VVHOGRUI/95&OLQLF...... 34 $UW7KHUDS\2ϑHUVDWWKH'UHQ/95&OLQLF ...... 39
3. The LVR Clinics ...... 42 %HGEXUJ+DX/95&OLQLF ...... 44 Bonn LVR Clinic ...... 46 'UHQ/95&OLQLF ...... 42 'VVHOGRUI/95&OLQLF ...... 50 Essen LVR Clinic...... 52 &RORJQH/95&OLQLF ...... 54 /DQJHQIHOG/95&OLQLF ...... 56 0|QFKHQJODGEDFK/95&OLQLF ...... 58 Viersen LVR Clinic...... 60 9LHUVHQ/95&OLQLFIRU2UWKRSDHGLFV ...... 62
4. Facts and Figures ...... 64 3HUIRUPDQFH'DWDIRU3330DQG.-333 ...... 66 ,QWHJUDWHG&DUH3LORW6FKHPHVDQG3URMHFWV ...... 72 6WDϑ2ULHQWDWLRQ ...... 74 3DWLHQW2ULHQWDWLRQ ...... 76 $VVHWV)LQDQFHDQG,QFRPH6LWXDWLRQ...... 82
5. Appendix ...... 84
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6 LVR Clinic Association
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Psychiatry, Psychotherapy and WR DQ LQFUHDVH RI RYHU 7KLV JURZWK Psychosomatic Medicine (PP/PM) FRUUHVSRQGVWRDIDOOLQWKHDYHUDJHOHQJWKRI VWD\ IURP RYHU RQH GD\ WR DURXQG GD\V )LJXUHVKRZVWKHGHYHORSPHQWRILQSDWLHQW ZLWKLQSDWLHQWFDSDFLWLHVZKLFKKDYHUHPDLQHG DQG GD\ FDVHV URXJKO\WKHVDPH “Around 42% of DQG WKH GHYHORS patients treated as ment of the aver 'D\FDVHVDSSHDUVLPLODUO\ WKHVHDOVRVKRZ DJH OHQJWK RI VWD\ DULVHLQWKHQXPEHURIFDVHVLQFRQMXQFWLRQ inpatients are female, LQ WKH SV\FKLDWULF ZLWK D IDOO LQ WKH DYHUDJH OHQJWK RI VWD\ while over 59% of DQGSV\FKRVRPDWLF 7KXV RYHU PRUH FDVHV ZHUH WUHDWHG DV day case patients are GLVFLSOLQHV GD\ FDVHV LQ FRPSDUHG WR 7KLV A rise to almost GHYHORSPHQW FDQ PDLQO\ EH WUDFHG EDFN WR female.” WUHDWHG WKHLQFUHDVHGQXPEHURIGD\FDVHWUHDWPHQWV FDVHV FDQ EH EHLQJRϑHUHG$URXQGRISDWLHQWVWUHDWHG VHHQ LQ WKH LQSDWLHQW DUHD LQ WKH SHULRG DV LQSDWLHQWV DUH IHPDOH ZKLOH RYHU RI EHWZHHQ DQG 7KLV LV HTXLYDOHQW GD\FDVHSDWLHQWVDUHIHPDOH Fig. 4: Inpatient and Day Cases, and Progression of Length of Stay in PP / PM Inpatient Outpatient 50,000 50 10,000 100 Number of cases 40,000 40 8,000 80 Number of cases 30,000 30 6,000 60 20,000 Length of stay (in days) 20 4,000 40 Length of stay (in days) 10,000 10 2,000 20 0 0 0 0 2009 2011 2013 2015 2009 2011 2013 2015 66 Fig. 5: Outpatients in PP / PM Male Female 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 2009 2011 2013 2015 $Q LQFUHDVHG XVH FDQ DOVR EH VHHQ LQ WKH IDOOHQ IURP DURXQG WR DURXQG %\ RXWSDWLHQWVHFWRU)LJXUHVKRZVWKHQXPEHU FRQWUDVW WKH SHUFHQWDJH RI SHRSOH UHFHLYLQJ RISDWLHQWVWUHDWHGRYHUDSHULRGRIWLPH7KH WUHDWPHQW IRU Dϑ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able 4: Diagnosis Distribution of Inpatient Treatment Cases in PP / PM F0+G30: Organic, including symptomatic psychological 8,5% 8,3% 8,6% 8,6% disorders and Alzheimer's F1: Psychological and behavioural disorders due to 37,3% 35,1% 34,1% 34,5% psychotropic substances F2: Schizophrenia, schizotypal and delusional disorders 20,4% 19,5% 20,1% 20,3% F3: Affective disorders 24,9% 28,9% 29,3% 27,2% F4: Neurotic, stress and somatic disorders 4,3% 3,5% 3,4% 4,7% F6: Personality and behavioural disorders 3,2% 3,5% 3,3% 3,5% 1RWH 0LVVLQJIURPWKHDUHRWKHUGLDJQRVHVZKLFKLQGLYLGXDOO\PDNHXSOHVVWKDQHDFK 67 Farbe ambulant geändert und 2015er Zahlen teilstationär und vollstationär ergänzt Table/95&OLQLFV 5: Diagnosis Distribution of Day Treatment Cases in PP / PM F0+G30: Organic, including symptomatic psychological 4,3% 2,6% 2,5% 2,7% disorders and Alzheimer's F1: Psychological and behavioural disorders due to 6,8% 4,6% 4,1% 4,4% psychotropic substances F2: Schizophrenia, schizotypal and delusional disorders 11,9% 10,0% 9,3% 8,9% F3: Affective disorders 63,3% 70,7% 72,6% 71,5% F4: Neurotic, stress and somatic disorders 7,5% 6,6% 6,6% 7,0% F6: Personality and behavioural disorders 4,9% 4,5% 4,1% 4,7% 1RWH 0LVVLQJIURPWKHDUHRWKHUGLDJQRVHVZKLFKLQGLYLGXDOO\PDNHXSOHVVWKDQHDFK ,Q WKH GD\ FDVH DUHD WKH SHUFHQWDJH RI 30VKRZDPDUNHGULVHLQWKHSHUFHQWDJHV SDWLHQWV ZLWK DϑHFWLYH GLVRUGHUV ) KDV RISDWLHQWVZLWKDϑHFWLYHGLVRUGHU 7DEOH ULVHQ 7DEOH 7KLV JURXS PDNHV XS RYHU 7KHSHUFHQWDJHKDVULVHQIURPLQ LQWRWDOZKLFKLVHTXDOWRDULVHRIRYHU WRLQ$VOLJKWGURSFDQEHVHHQ HLJKW SHUFHQWDJH SRLQWV LQ WKLV SDUWLFXODU IRUWKHRWKHUGLDJQRVLVJURXSV WLPH SHULRG $OO RWKHU GLDJQRVHV GHSLFWHG VKRZHGRQO\VOLJKWSHUFHQWDJHFKDQJHV%RWK LQSDWLHQW DQG RXWSDWLHQW GHSDUWPHQWV IRU 33 /95&OLQLFV Table 6: Diagnosis Distribution of Outpatients in PP / PM F0+G30: Organic, including symptomatic 13,5% 13,6% 13,2% 12,8% psychological disorders and Alzheimer's F1: Psychological and behavioural disorders due 18,0% 16,6% 16,7% 16,0% to psychotropic substances F2: Schizophrenia, schizotypal and delusional 14,0% 13,7% 13,2% 13,2% disorders F3: Affective disorders 26,0% 30,3% 31,5% 33,5% F4: Neurotic, stress and somatic disorders 12,8% 12,1% 12,9% 12,6% F6: Personality and behavioural disorders 4,6% 4,6% 4,5% 4,2% F7: Learning difficulties 2,6% 2,4% 2,3% 2,3% 2WKHU 1RWH 0LVVLQJIURPWKHDUHRWKHUGLDJQRVHVZKLFKLQGLYLGXDOO\PDNHXSOHVVWKDQHDFK select fk_fall_hauptdiagruppe(f.fallnr), fbd_fall_fachbereich (b.fallnr,b.bewdat), count(distinct f.fallnr) as "Fälle", 68 4.1.2. Child and Adolescent Psychiatry, ULVHRIRYHU'D\FDVHWUHDWPHQWRϑHUV Psychotherapy and Psychosomatics KDYH DOVR EHHQ KHDYLO\ LQFUHDVHG KHUH $W (Kinder- und Jugendpsychiatrie, WKH VDPH WLPH -psychotherapie und -psychosomatik, there was a fall in “The percentage or KJPPP) WKH DYHUDJH OHQJWK of female KJPPP RI VWD\ WR RYHU inpatients is 58%, 6LPLODU GHYHORSPHQWV FDQ EH VHHQ IRU &KLOG GD\V LQSDWLHQWV and 50% in a DQG $GROHVFHQW 3V\FKLDWU\ 3V\FKRWKHUDS\ DQGDURXQGGD\V DQG 3V\FKRVRPDWLFV .-333 WR WKRVH LQ WKH GD\FDVHV day case setting.” VDPH¿HOGVIRUDGXOWV )LJ ,QWKHLQSDWLHQW &RPSDUHG WR DGXOW UHJLRQ FDVH QXPEHUV KDYH ULVHQ E\ DURXQG SV\FKLDWU\ WKH SHUFHQWDJH RI IHPDOH .-333 WRRYHUFDVHVDQGRYHUFDVHV LQSDWLHQWVLVVRPHZKDWKLJKHUDWZKLOH LQ WKH GD\ FDVH UHJLRQ ZKLFK UHSUHVHQWV D WKH SHUFHQWDJHV RI JLUOV DQG ER\V LQ D GD\ Fig. 6: Inpatient and Day Cases, and Progression of Length of Stay in KJPPP Inpatient Day case 5000 100 1500 100 Number of cases Number of cases 4000 80 1200 80 3000 60 900 60 2000 40 600 40 Length of stay (in days) Length of stay (in days) 1000 20 300 20 0 0 0 0 2009 2011 2013 2015 2009 2011 2013 2015 69 Fig. 7: Outpatients in KJPPP Male Female 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 2009 2011 2013 2015 FDVHVHWWLQJLVPRUHEDODQFHGDWDURXQG SUHGRPLQDQWSRUWLRQRIWKLVJURZWKFRQFHUQV each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able 7: Diagnosis Distribution of Inpatient Treatment Cases in KJPPP F1: Psychological and behavioural disorders due to 0,08 0,06 0,06 0,05 psychotropic substances F2: Schizophrenia, schizotypal and delusional disorders 2,9% 2,6% 2,3% 2,5% F3: Affective disorders 19,9% 23,9% 30,4% 36,4% F4: Neurotic, stress and somatic disorders 13,0% 13,7% 15,1% 14,6% F5: Behavioural disorders with physical disorders and factors 2,5% 3,6% 4,2% 4,8% F8: Developmental disorders 2,7% 2,2% 3,5% 2,9% F9: Behavioural and emotional disorders beginning in 48,6% 44,3% 36,2% 32,1% childhood and adolescence 1RWH 0LVVLQJIURPWKHDUHRWKHUGLDJQRVHVZKLFKLQGLYLGXDOO\PDNHXSOHVVWKDQHDFK 70 87,5% 87,7% /95&OLQLFV Table 8: Diagnosis Distribution of Day Treatment Cases in KJPPP F1: Psychological and behavioural disorders due to 0,3% 0,1% 0,2% 0,2% psychotropic substances F3: Affective disorders 12,2% 14,4% 22,2% 25,1% F4: Neurotic, stress and somatic disorders 14,8% 15,6% 15,4% 19,2% F5: Behavioural disorders with physical disorders and factors 2,1% 2,6% 3,9% 4,0% F7: Learning difficulties 0,2% 0,1% 0,3% 0,0% F8: Developmental disorders 2,7% 2,4% 4,4% 3,4% F9: Behavioural and emotional disorders beginning in 66,0% 62,4% 51,9% 46,3% childhood and adolescence 2WKHU 1RWH 0LVVLQJIURPWKHDUHRWKHUGLDJQRVHVZKLFKLQGLYLGXDOO\PDNHXSOHVVWKDQHDFK 7KHSHUFHQWDJHRI) GLDJQRVHV EHKDYLRXUDO SUREOHPV ) PDNH XS DQG DQG HPRWLRQDO GLVRUGHUV KDV IDOOHQ E\ UHVSHFWLYHO\LQ SHUFHQWDJH SRLQWV LQ WKH SHULRG LQ TXHVWLRQ ZKLOH DϑHFWLYH GLVRUGHUV ) KDYH ULVHQ E\ 7KH SHUFHQWDJH RI FKLOGUHQ ZLWK DQ ) DERXWWKHVDPHQXPEHU GLDJQRVLVKDVIDOOHQE\WHQSHUFHQWDJHSRLQWV LQRXWSDWLHQWFKLOGDQGDGROHVFHQWSV\FKLDWU\ 7KHUH ZDV DOVR D IDOO LQ ) GLDJQRVHV LQ WKH 7DEOH 7KHUH ZDV DOVR D ULVH KHUH IRU GD\ FDVH VHFWRU E\ DURXQG SHUFHQWDJH DϑHFWLYHGLVRUGHUV ) EXWWKH)GLDJQRVHV SRLQWV 7DEOH $ϑHFWLYHGLVRUGHUVKDYHDOVR KDYHDKLJKHUSHUFHQWDJHLQWKDQLQWKH FOHDUO\ULVHQKHUHWRRYHU&KLOGUHQZLWK FRPSDULVRQ\HDURI GHYHORSPHQWDOGLVRUGHUV ) DQGEHKDYLRXUDO /95&OLQLFV Table 9: Diagnosis Distribution of Outpatients in KJPPP F1: Psychological and behavioural disorders due to 3,4% 3,2% 3,0% 3,4% psychotropic substances F3: Affective disorders 6,7% 8,2% 10,8% 12,7% F4: Neurotic, stress and somatic disorders 19,7% 20,5% 23,7% 24,6% F5: Behavioural disorders with physical disorders and factors 1,8% 2,2% 2,8% 2,8% F7: Learning difficulties 2,1% 2,3% 2,7% 2,1% F8: Developmental disorders 7,7% 7,9% 8,1% 8,1% F9: Behavioural and emotional disorders beginning in 52,4% 50,7% 44,8% 42,4% childhood and adolescence 2WKHU 1RWH 0LVVLQJIURPWKHDUHRWKHUGLDJQRVHVZKLFKLQGLYLGXDOO\PDNHXSOHVVWKDQHDFK 71 ,QWHJUDWHG&DUH3LORW6FKHPHVDQG3URMHFWV Innovation in treatment 3LORW VFKHPHV FUHDWH DQ LPSRUWDQW EDVLV IRU 7RJHWKHUZLWKWKH5KLQHODQG+DPEXUJ$2. 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Association and LVR Hospital Central Laundry (Condensed Balance Sheet) LVR Clinic Association 2014 2013 (Condensed Balance Sheet) 7(85 7(85 )L[HGDVVHWV 70.1 71.2 &XUUHQWDVVHWV 29.7 28.8 $FFUXDOVDQGGHIHUUHGLQFRPH 1262 0.2 289 0.0 Total assets 700,376 100.0 678,605 100.0 (TXLW\ 15.7 16.1 6SHFLDOLWHPVIURPFRQWULEXWLRQWR¿QDQFLQJ 46.0 48.4 3URYLVLRQV 19.4 19.3 /LDELOLWLHV 18.9 16.1 $FFUXDOVDQGGHIHUUHGLQFRPH 298 0.0 402 0.1 Total liabilities 700,376 100.0 678,605 100.0 82 Table 12: Sales Revenue in LVR Clinic Association by Service Sector 2014 2013 LVR Clinic Association 7(85 7(85 %3À9 52.8 51.6 )RUHQVLF3V\FKLDWU\ 19.6 19.5 .+(QWJ* 3.9 3.9 2UWKRSDHGLFV 2.6 2.5 6RFUHKDE 4.2 4.1 2XWSDWLHQWV 5.3 5.4 0LVFHOODQHRXV 11.6 13.0 Total 642,648 100.0 628,540 100.0 IXQG ELOOLQJ LV FDUULHG RXW ZLWK D FHUWDLQ 6OLJKW JURZWKV LQ UHYHQXH FRXOG DOVR EH WLPH GHOD\ ,Q IXWXUH WKLV HϑHFW ZLOO DJDLQ UHFRUGHGLQWKHRWKHUDUHDV RQO\PLVFHOODQHRXV EH UHGXFHG RQFH WKH QHZ ELOOLQJ PRGDOLWLHV VDOHV UHYHQXHV GHFOLQHG FRPSDUHG 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