Rationing in inpatient psychiatric care

OBJECTIVE: This study examined whether and in which services in psychiatric institutions implicit rationing takes place from the perspective of doctors and nurses. METHODS: From October 2013 to the middle of 2014 we conducted a written and standardized survey among physicians/psychologists (n = 256) and nurses (n = 796) from eight psychiatric hospitals in Germany. RESULTS: Out of 11 clinical activities 4 judged as necessary, namely communication and interaction with patients and relatives, coordination of treatment with other professionals and adequate documentation of the treatment, were not carried out sufficiently or implicitly rationed by 42-59% of the surveyed physicians/psychologists. Multivariate analysis identified a higher case load, poor relationships with superiors and an overall heavy workload as significant predictors of implicit rationing. DISCUSSION: The services which are particularly necessary for an effective treatment of mentally ill people, i.e. strong patient orientation and close cooperation with other professionals are jeopardized by the implicit rationing.