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Has the public taken notice of psychiatric reform? The image of psychiatric hospitals in Germany 1990–2011

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In the context of mental health care reform in Germany, psychiatric hospitals have been transformed in terms of their infrastructure, staffing levels and therapeutic culture. The question arises as to what extent these improvements had an impact on the public image of these institutions.


In 1990 and 2011, population surveys were conducted in the “old” states of Germany, using the same sampling procedure, interview mode and measures.


Over the last two decades, attitudes toward psychiatric hospitals have improved considerably. This improvement was particularly pronounced among those who had been in treatment for mental health problems. The public is now more inclined to regard psychiatric hospitals as similar to other hospitals, more ready to expect effective treatment in psychiatric hospitals, and less inclined to support the stereotype that psychiatric hospitals are primarily places where patients are locked away. However, there was a stronger tendency to agree with the notion that psychiatric hospitals are necessary to protect society from persons with mental illness.


The improvement of psychiatric care seems to pay off as regards the image of psychiatric hospitals among the general public. Further efforts are necessary to reduce the stigma attached to mentally ill people.

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  1. Deutscher Bundestag (1975) Bericht über die Lage der Psychiatrie in der Bundesrepublik Deutschland—Zur psychiatrischen und psychotherapeutischen/psychosomatischen Versorgung der Bevölkerung [Report on the state of psychiatry in the Federal Republic of Germany—Psychiatric and psychotherapeutic/psychosomatic care for the population]. Hans Herger, Bonn

  2. Arbeitsgruppe Psychiatrie der Obersten Landesgesundheitsbehörden (2003) Bestandsaufnahme zu den Entwicklungen der Psychiatrie in den letzten 25 Jahren [Assessment of developments in psychiatry over the last 25 years]. Chemnitz

  3. Arbeitsgruppe Psychiatrie der Obersten Landesgesundheitsbehörden (2007) Psychiatrie in Deutschland. Strukturen, Leistungen, Perspektiven [Psychiatry in Germany. Structures, services, perspectives]

  4. Salize HJ, Rössler W, Becker T (2007) Mental health care in Germany. Current state and trends. Eur Arch Psychiatry Clin Neurosci 257:92–103

    Article  PubMed  Google Scholar 

  5. Bauer M, Kunze H, von Cranach M, Fritze M, Becker T (2001) Psychiatric reform in Germany. Acta Psychiatr Scand 104(Suppl 410):27–34

    Article  Google Scholar 

  6. Angermeyer MC, Matschinger H (1991) Einstellung der Bevölkerung der BRD zu psychiatrischen Patienten und zu psychiatrischen Einrichtungen [Public attitudes in the Federal Republic of Germany towards psychiatric patients and psychiatric services]. Forum Gesundheitsw 1:9–24

    Google Scholar 

  7. Holzinger A, Matschinger H, Angermeyer MC (2011) What to do about depression? Help-seeking and treatment recommendations of the public. Epidemiol Psychiatr Sci 20:163–169

    Article  PubMed  CAS  Google Scholar 

  8. Matschinger H, Angermeyer MC (1996) Zur Bedeutung von “weiß nicht”-Antworten bei der Messung von Einstellungen und Vorstellungen [The meaning of “don’t know”responses in the assessment of attitudes and beliefs]. Z Different Diagn Psychol 17:18–39

    Google Scholar 

  9. Holzinger A, Matschinger H, Schomerus G, Carta MG, Angermeyer MC (2011) The loss of sadness: the public’s view. Acta Psychiatr Scand 123:307–313

    Article  PubMed  CAS  Google Scholar 

  10. Long SJ, Freese J (2006) Regression models for categorical dependent variable using Stata, 2nd edn. Stata Press, College Station

    Google Scholar 

  11. Xu J, Long SJ (2005) Confidence intervals for predicted outcomes in regression models for categorical outcomes. Stata J 5:537–559

    Google Scholar 

  12. Statacorp (2011) Stata Statistical Software. Release 12. Stata Press, College Station, TX

  13. WonPat-Borja AJ, Yang LH, Link BG, Phelan JC (2012) Eugenics, genetics, and mental illness stigma in Chinese Americans. Soc Psychiatry Psychiatr Epidemiol 47:145–156

    Article  PubMed  Google Scholar 

  14. Yang LH, Lo G (2012) Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: implications for reducing mental illness stigma in China. Soc Psychiatry Psychiatr Epidemiol 47:1459–1473

    Article  PubMed  Google Scholar 

  15. Barke A, Nyarko S, Klecha D (2011) The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients’ views. Soc Psychiatry Psychiatr Epidemiol 46:1191–1202

    Article  PubMed  Google Scholar 

  16. Leidermann EA, Vazquez G, Berizzo C, Bonifacio A, Bruscoli N et al (2011) Public knowledge, beliefs, and attitudes towards patients with schizophrenia: Buenos Aires. Soc Psychiatry Psychiatr Epidemiol 46:281–290

    Article  Google Scholar 

  17. Angermeyer MC, Dietrich S (2006) Public beliefs about and attitudes toward people with mental illness: a review of population studies. Acta Psychiatr Scand 113:163–179

    Article  PubMed  CAS  Google Scholar 

  18. Schomerus G, Schwahn C, Holzinger A, Corrigan PW, Grabe HJ, Carta MG, Angermeyer MC (2012) Evolution of public attitudes about mental illness. A systematic review and meta-analysis. Acta Psychiatr Scand 125:440–452

    Article  PubMed  CAS  Google Scholar 

  19. Angermeyer MC, Matschinger H, Schomerus G (2013) Public attitudes towards people with depression in times of uncertainty: results from three population surveys in Germany. Soc Psychiatry Psychiatr Epidemiol (Epub ahead of print)

  20. Kovess-Masfety V, Alonso J, Brugha TS, Angermeyer MC, Haro JM, Sevilla-Dedieu C (2007) Differences in lifetime use of services for mental health problems in six European countries. Psychiat Serv 58:213–220

    Article  Google Scholar 

  21. Schomerus G, Matschinger H, Angermeyer MC (2013) Do psychiatric units at general hospitals attract less stigmatizing attitudes compared with psychiatric hospitals? Epidemiol Psychiatr Sci (Epub ahead of print)

  22. Hübner-Liebermann B, Hajak G, Spiessl H (2008) Versorgungsepidemiologie: Entwicklung in der stationär-psychiatrischen Versorgung 1996–2006 [Mental health services research: Trends in psychiatric inpatient care from 1996 up to 2006]. Psychiat Prax 35:387–391

    Article  Google Scholar 

  23. Angermeyer MC, Matschinger H (2005) Causal beliefs and attitudes to people with schizophrenia. A trend analysis based on data from two population surveys in Germany. Br J Psychiatry 186:331–333

    Article  PubMed  Google Scholar 

  24. Üçok A, Brohan E, Rose D, Sartorius N, Leese M, Yoon CK, Plooy A, Ertekin BA, Milev R, Thornicroft G, INDIGO Study Group (2012) Anticipated discrimination among people with schizophrenia. Acta Psychiatr Scand 125:77–83

    Google Scholar 

  25. Gaebel W, Ahrens W, Schlamann P (2010) Konzeption und Umsetzung von Interventionen zur Entstigmatisierung seelischer Erkrankungen: Empfehlungen und Ergebnisse aus Forschung und Praxis [Concepts and application of interventions aimed at reducing the stigma of mental illnesses: Recommendations and results from research and practice]. Aktionsbündnis Seelische Gesundheit, Berlin

  26. Corrigan PW, Angermeyer MC (2012) Stigma blocks recovery from mental illness. World Psychiatry 11:61

    Article  PubMed  Google Scholar 

  27. Steinert T (2011) Nach 200 Jahren Psychiatrie: Sind Fixierungen in Deutschland unvermeidlich? [After 200 years of psychiatry: Are mechanical restraints in Germany still inevitable?] Psychiat Prax 38:348–351

    Google Scholar 

  28. Jordan W, Bleich S, Cohrs S, von Einsiedel R, Falkai P, Grosskopf V, Hauth I, Steinert J, Adler L (2011) Shortage of doctors in psychiatric hospitals—providing for the future by reorganizing medical services. Psychiat Prax 38:S16–S24

    Article  Google Scholar 

  29. Priebe S (2012) Wo ist der Fortschritt? [Where is the progress?] Psychiat Prax 39:55–56

    Google Scholar 

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This study was funded by the Fritz-Thyssen-Stiftung (Az.

Conflict of interest

M.C. Angermeyer has received lecturer fees from AstraZeneca, Janssen-Cilag, Eli Lilly, and Pfizer. He also has received research grants from GlaxoSmithKline and Lundbeck. The other authors have nothing to declare.

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Correspondence to Matthias C. Angermeyer.

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Angermeyer, M.C., Matschinger, H. & Schomerus, G. Has the public taken notice of psychiatric reform? The image of psychiatric hospitals in Germany 1990–2011. Soc Psychiatry Psychiatr Epidemiol 48, 1629–1635 (2013).

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