Oberlaender,
F.A., Platz, W.E., Mengering, F. (1995): German mental health
legislation and alcoholism treatment: results of a retrospective
long-term study in a Berlin state mental health hospital, in: Drug
and Alcohol Dependence, 40: 165-171.

Abstract

In 1985 German mental health legislation underwent a transformation. In accordance with an international trend, the State of Berlin, a pacesetter in this field, introduced a Law for Mentally Diseased Patients (Gesetz für psychisch Kranke). In contrast to the former Law for the Committal of the Mentally Ill and Substance Abusers(Gesetz über die Unterbringung von Geisteskranken und Süchtigen) healing and recovery are the main aims which the legislation focuses on with the intention of avoiding committal by excluding patients with mild disorders from involuntary admission.

The Karl-Bonhoeffer-Mental-Health Hospital as Department for Dependency Disorders conducted a study on 3,014 alcohol-dependent patients who were discharged between 1984-90. The focus of the study was to determine predictors for involuntarily committal; patients were explored in respect to age, sex, length of stay, psychiatric disorders, their living situation and how they had been admitted. Moreover, attempts were made to discover whether the 1985 law had changed the patient profile or the frequency or length of treatment in comparison to the previously valid law.

Historical Background: Over two-hundred years have now passed since modern nations were formed, catalysed by the United States, with Constitutions incorporating the right of self-determination for their citizens as the highest goal and the basis of legitimacy for the establishment of government. Not only did the "Spirit of 76" influence many nations but it beat it path through to the various groups and sub-groups of the individual societies of the world.

In the 1980's the "Spirit of 76" reached the "Mental Health Legislation in Europe". The issue of compulsive treatment of people with mental disorders became a socio-political and ethical challenge for legislators and psychiatry in almost every Western country. As far as treatment of alcoholism is concerned, it seems not only that many countries have moved from the "moral" to an "illness" model but also that the concept of alcoholism as a disease is being replaced by that of "alcohol-related problems" (Morawski, 1983; Takaka, Klingemann and Hunt, 1992; Oberlaender, 1994; Wiener, 1981).

Knud Jensen (1993) of Odense University in Denmark defined three "Basic requirements" for the treatment of people with mental disorders:
"1. respect of basic human rights of all people including the mentally ill and in specially defined situations acknowledgement of the need for committal and treatment of the mentally ill;
2. legal provision for a mental health care system that is so explicit it ensures that treatment of a mentally ill person is carried out with respect for human rights;
3. respect for the patient' s cultural, religious, political and social orientation when extending treatment."

In many respects mental health legislation varies from one nation to another. Legislation reflects differences in culture and in social and family structures. Generally speaking the situation in European countries is such that the jurisdiction for committal lies either with the physicians and psychiatrists or the judiciary.

The criteria for committal to psychiatric treatment are the following:
1. In order to commit compulsorily a person, legislators use terms like mental illness, mental disease, mental disorder, serious mental disturbance, severe mental impairment, psychopathic disorder and mental impairment. Most legislation lacks precise definition of diagnostic criteria for committal. Only a few countries define terms.
2. Moreover, all European countries apart from Italy permit committal of patients with severe mental disorders when they are a danger either to themselves or others. Russian legislation also states "helplessness" as a factor.

Criminal Law in Germany is a federal responsibility, while civil law such as that for mental illness committal is the responsibility of the States (Länder). In general, German legislation stresses that it is the patient's duty to submit to psychiatric examination and accept that a report be passed on to the authorities who then decide whether a committal shall take place.

In most federal states committal of a person with mental disorders is based on a judge's decision as to whether the person is of danger to self or others. In Bremen the opinion of a psychiatrist is decisive in instituting treatment. In urgent cases non-legal, usually medical, authorities may decide on committal. The initial committal is of relatively short duration but can be extended for longer periods. Only a judge may decide on discharge from the hospital but the patient may appeal against that decision. Some features of current mental health legislation in Germany are similar to those of The Netherlands and Belgium. In these countries committal is the responsibility of a judge, the major criterion being endangerment.

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