Joint Agreement: "The relationship between relatives and professionals – regulation of contractual quality assurance in the field of psychiatric care"

In the system for psychiatric help and treatment, despite many improvements since introduction of the Enquiry into the State of Psychiatry (1976), there is still a major discrepancy between the care of all patients requiring treatment and the specific care of each individual.

If we want to further improve the quality of care then it will also be necessary to consider the quality of the relationship between relatives and the professionals and the patients themselves. Effective help also requires a dialogue with the relatives, whilst respecting the will of the patient.

In everyday psychiatric practice the role of relatives, unlike that of patients, can often be unclear and tends to depend on the goodwill of the directors of hospitals and outpatient facilities. But at the same time the work of relatives is very important because the patient generally remains part of a family despite the strain on relationships. This is true even if the family does not (any longer) live together.

A minimum requirement to be stated is a discussion after hospital admission and before release between the doctor, the mentally ill person and the relatives in the sense of a trialogue. This should be recognised as a basic professional standard.

However the relationship between relatives and professionals is not always easy. Despite hospital relatives’ groups and consultation hours for relatives and the trialogue, some relatives still wish for more cooperation and understanding for their situation. This is around the issue of relatives’ involvement in the quality assurance of hospitals, i.e. specific standards for treatment procedures, including the involvement of relatives in treatments and department concepts, the release of professionals from their duty of confidentiality (possibly only concerning certain aspects) in respect of specifically named relatives on subjects such as release from hospital, the medical condition and status of the patient, exchange of information on treatment plans and goal setting and the medical and/or nursing contact person within the hospital who conducts a joint discussion with the patient and relatives upon admission and upon release. The content of discussions with regard to planned and implemented measures, regulations on statutory carers, release procedures, links to outpatient supplementary structures, living circumstances and work situation after release, and provision of information for relatives by hospitals.

Close cooperation with relatives’ associations and self-help groups, who could perhaps be permitted to arrange information events in the hospital and distribute flyers, would be desirable.

It should be standard practice that the homepage of psychiatric hospitals or outpatient facilities always includes links to relatives’ groups and associations. But in the future this should be a regulated procedure which becomes more or less part of the sociotherapeutic services.

But how often will such a concept actually be implemented? Why and under what circumstances would hospitals sign up to such a concept with relatives and local or federal associations? What would be the effect of specific guidelines or a cooperation agreement?

General statements on the situation in Germany are difficult. There is no systematic collection of data on this. Also, “contracts” or agreements between hospitals and associations have been practically unheard of up to now. One excellent example that must be mentioned is the cooperation agreement between the Lohr district hospital und the relatives’ self-help association for Aschaffenburg and the surrounding areas. There is a documented cooperation agreement, but there is no information to date on the success of the agreement. A similar agreement exists between the centre for mental health at Ingolstadt hospital and the association for relatives and friends of the mentally ill in region 10 (in and around Ingolstadt).

The aim of the current project “The relationship between relatives and professionals – regulation of contractual quality assurance in the field of psychiatric care,” intended to last two years, is to gather new knowledge on optimising communication between relatives and professionals and possibilities for contractual regulation in the context of quality assurance (within and outside the hospital). Existing local and non-systematic developments in this direction are to be amalgamated. This knowledge is to be used to implement and ensure partial improvements in psychiatric care by incorporating relatives’ perspectives, i.e. the viewpoint of the family. Suggestions are to be formulated on how specialist associations and healthcare policymakers can use the knowledge to establish a structured set of instruments for quality assurance.