LWL-Klinikum Gütersloh

Background: Treatment algorithms are considered as key to improve outcomes by enhancing the quality of care. This is the first randomized controlled study to evaluate the clinical effect of algorithm-guided treatment in inpatients with major depressive disorder. Methods: Inpatients, aged 18 to 70 years with major depressive disorder from 10 German psychiatric departments were randomized to 5 different treatment arms (from 2000 to 2005), 3 of which were standardized stepwise drug treatment algorithms (ALGO). The fourth arm proposed medications and provided less specific recommendations based on a computerized documentation and expert system (CDES), the fifth arm received treatment as usual (TAU). ALGO included 3 different second-step strategies: lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switch to a different antidepressant (ALGO SW). Time to remission (21-item Hamilton Depression Rating Scale ≤9) was the primary outcome. Results: Time to remission was significantly shorter for ALGO DE (n=91) compared with both TAU (n=84) (HR=1.67; P=.014) and CDES (n=79) (HR=1.59; P=.031) and ALGO SW (n=89) compared with both TAU (HR=1.64; P=.018) and CDES (HR=1.56; P=.038). For both ALGO LA (n=86) and ALGO DE, fewer antidepressant medications were needed to achieve remission than for CDES or TAU (P<.001). Remission rates at discharge differed across groups; ALGO DE had the highest (89.2%) and TAU the lowest rates (66.2%). Conclusions: A highly structured algorithm-guided treatment is associated with shorter times and fewer medication changes to achieve remission with depressed inpatients than treatment as usual or computerized medication choice guidance.

Subtyping depression is important in order to further delineate biological causes of depressive syndromes. The aim of this study was to evaluate clinical and outcome characteristics of distinct subtypes of depression and to assess proportion and features of patients fulfilling criteria for more than one subtype. Melancholic, atypical and anxious subtypes of depression were assessed in a naturalistic sample of 833 inpatients using DSM-IV specifiers based on operationalized criteria. Baseline characteristics and outcome criteria at discharge were compared between distinct subtypes and their overlap. A substantial proportion of patients (16%) were classified with more than one subtype of depression, 28% were of the distinct anxious, 7% of the distinct atypical and 5% of the distinct melancholic subtype. Distinct melancholic patients had shortest duration of episode, highest baseline depression severity, but were more often early improvers; distinct anxious patients had higher NEO-Five Factor Inventory (NEO-FFI) neuroticism scores compared with patients with unspecific subtype. Melancholic patients with overlap of anxious features had worse treatment outcome compared to distinct melancholic and distinct anxious subtype. Distinct subtypes differed in only few variables and patients with overlap of depression subtypes may have independent clinical and outcome characteristics. Studies investigating biological causes of subtypes of depression should take influence of features of other subtypes into account.

OBJECTIVE: Excessive internet use is being discussed as a non-substance-related addiction disorder. Estimations of its prevalence show that 1% of the German general population is affected by internet addiction. However, it is still unclear, whether internet addiction as a co-morbid disorder is also common among patients of the general health care system, especially in patients being treated in inpatient addiction rehabilitation centers. It seems plausible that these patients have a heightened proneness to co-morbid internet addiction. METHODS: In order to address this issue, a government-funded cooperation project was conducted. Within six months every new patient admitted to one of 15 rehabilitation facilities was screened for internet addiction. RESULTS: 4.2% of the patients fulfilled criteria for internet addiction. Male patients of younger age with main diagnosis of cannabis dependence or pathological gambling were found to be at higher risk. CONCLUSIONS: Internet addiction is more common among patients of the rehabilitation system than in the general population. Especially young, male patients in treatment for cannabis dependence or pathological gambling are at risk for co-morbid internet addiction. It is recommended that regular screening for internet addiction should be implemented in facilities with patients at risk in order to offer indicative treatment.

OBJECTIVE: To report the state of research about special observation and to develop implications for the German-speaking countries. METHODS: Systematic literature search. RESULTS: The literature consists mainly of descriptive studies. There are no standardized approaches. Use of assistants can have a negative impact on quality of the intervention and may result in an accumulation and change of measures. Nurses play a responsible role in special observation. There are different experiences and perceptions of patients and nurses. Special observation includes both therapeutic and non-therapeutic components. CONCLUSIONS: The focus should be on therapeutic aspects of observation; particularly involvement and development of hope. Observation might restrict personal freedom and should be used as rarely as possible. Strengthening nurses in decision-making is associated with increased quality. More research is needed regarding the effectiveness, the frequency of utilization and opportunities for prevention. The importance of observation is in contrast to the lack of relevant data.

Low-intensity cognitive behavioural therapy (LI-CBT) depicts interventions that aim at increasing access to evidence-based psychological therapies. This is achieved by (1) reducing the amount of time in which the practitioner is in contact with individual patients, (2) using practitioners that have been specifically trained to deliver low intensity interventions and without any prior formal health professional qualifications and (3) use of interventions with varying intensity. Stepped care and collaborative care constitute the organizational frame to deliver low-intensity interventions. Whereas large-scale research and health service projects abroad are focussing on LI-CBT, research in German is lagging far behind. Particularly in the light of the growing demands and utilization of mental health care as well as governmental claims to develop and evaluate new forms of providing mental health services, LI-CBT represents a promising approach.

BACKGROUND: Psychotherapy is an essential part of treating people with mental illness. However, the implementation of psychotherapeutic interventions in the field of inpatient psychiatric treatment remains well behind demand. At the same time, the use of psychotherapeutic interventions by other professional groups - such as social workers and nursing - is not a common practice in Germany. OBJECTIVE: What can we learn from the international research with regard to nursing for Germany in view of the insufficient supply of psychotherapeutic care. METHOD: Based on a literature analysis, the German situation of care is related to international developments and a German training curriculum is presented. RESULT: A look at the international literature shows that in other countries especially trained nurses perform psychotherapeutic Interventions. In addition, there are effective training curricula whose transferability to Germany appears to be possible after appropriate adjustments.An 18 months lasting training program for nurses is presented. In addition to disorder-specific competences, this curriculum also provides psychotherapeutic interventions with a general approach. CONCLUSION: Collaborative care in the collaboration of different health professionals has been repeatedly and stably proven to be effective and helpful in treating people with various mental disorders. In order to better meet the growing need for psychotherapeutic interventions in the population in the sense of a stepped care model, trained nurses need to be more involved in the provision of psychotherapeutic services.

Zusammenfassung Das Modellprojekt „Home Treatment (HT) – Behandlung zu Hause“ in Lengerich ist eine neue integrierte psychiatrische Versorgungsform von Menschen mit schweren schizophrenen oder schizo-affektiven Psychosen, die Elemente zweier Behandlungsansätzen kombiniert: Assertive Community Treatment und Home Treatment. Ziel dieser Studie ist eine Pilotevaluation nach 2 Jahren durch eine quantitative Bewertung im Prä-Post-Design und eine qualitative Evaluation des Projektes. Es wurden eine Reduktion der vollstationären Behandlungstage, eine signifikante Verbesserung der Psychopathologie, der Lebensqualität und des Funktionsniveaus sowie eine hohe Zufriedenheit mit dem Versorgungsangebot bei der untersuchten Stichprobe festgestellt. Die Ergebnisse stimmen mit denen anderer Untersuchungen zu integrierten Versorgungsmodellen in Deutschland überein. Das Projekt „HT – Behandlung zu Hause“ ist ein viel versprechendes Behandlungsmodell. Hinsichtlich einer zukünftigen Ausweitung des Modellprojektes müssen allerdings weitere Untersuchungen zur Stabilität der Behandlungsergebnisse, ihrer Übertragbarkeit auf die Gesamtpopulation von Patienten mit Psychosen und zur Kosteneffektivität des Behandlungsmodells erfolgen.

OBJECTIVE: The innovation fund project DemStepCare aimed to optimize multi-professional care through case management, risk stratification, and crisis outpatient clinic. Here, the evaluation results from the perspective of the general practitioners are presented. METHODS: A quantitative survey was carried out at three time points regarding acceptance, benefit assessment and sensitivity to dementia of the general practitioners. In addition, qualitative interviews were conducted. RESULTS: Satisfaction with the overall project was high. Added value and relief factors were perceived and more effective and stable dementia care was achieved through collaboration with case management. Physicians reported increased subjective competence in diagnostics and disease management. CONCLUSIONS: The results confirm the benefit and effectiveness of DemStepCare from general practitioner's perspective.

BACKGROUND: Mental healthcare users and patients were described as a particularly vulnerable group in the debate on the burdens of the COVID-19 pandemic. Just what this means and what normative conclusions can be derived from it depend to a large extent on the underlying concept of vulnerability. While a traditional understanding locates vulnerability in the characteristics of social groups, a situational and dynamic approach considers how social structures produce vulnerable social positions. The situation of users and patients in different psychosocial settings during the COVID-19 pandemic has not yet been comprehensively considered and ethically analyzed under the aspect of situational vulnerability. METHODS: We present the results of a retrospective qualitative analysis of a survey of ethical challenges in different mental healthcare facilities of a large regional mental healthcare provider in Germany. We evaluate them ethically using a dynamic and situational understanding of vulnerability. RESULTS: Difficulties in implementing infection prevention measures, restrictions of mental health services in favor of infection prevention, social isolation, negative health effects on mental healthcare users and patients, and challenges in implementing regulations on state and provider levels within the local specificities emerged across different mental healthcare settings as ethically salient topics. CONCLUSIONS: Applying a situational and dynamic understanding of vulnerability allows the identification of specific factors and conditions that have contributed to an increased context-dependent vulnerability for mental healthcare users and patients. These factors and conditions should be considered on the level of state and local regulations to reduce and address vulnerability.

OBJECTIVE: Psychological problems are highly prevalent in unemployed people and can lead to impairments in several areas of life. Programs to support and assist those affected, especially the long-term unemployed, are scarce. Reservations by those affected present an additional barrier with respect to health care utilisation. The authors designed a collaborative care cooperation project between a local job center and a psychiatric clinic with the aims of counselling unemployed people with psychological distress as well as offering continuing psychosocial care if required. METHOD: This paper presents the methodological design, clinical procedure as well as a preliminary evaluation of the pilot phase. RESULTS: Within the first 12 months of the pilot phase, 57 long-term unemployed were enrolled in the project. Subjective psychological distress in the sample was comparable with other studies reporting high rates of psychological problems in the unemployed. The psychosocial intervention was well accepted not only by the unemployed but also by case managers and led to high re-assignment rates (n=37) to complementary services within the psychosocial health care system. CONCLUSION: Unemployment and psychological distress should be addressed together within collaborative care projects that can positively affect the negative interaction between unemployment and psychological distress. Low-intensity psychological interventions are well suited to address barriers that hinder health care utilization and to offer person-centered, psychological assistance.

OBJECTIVE: 1:1 care is applied for patients requiring close psychiatric monitoring and care like patients with acute suicidality. The article describes the frequency of 1:1 care across different diagnoses and age groups in German psychiatric hospitals. METHODS: The analysis was based on the VIPP Project from the years 2011 and 2012. A total of 47 hospitals with more than 120,000 cases were included. Object of the analysis was the OPS code 9-640.0 1:1 care. The evaluation was performed on case level. RESULTS: Data of 47 hospitals were included. Of the 121,454 cases evaluated in 2011 3.8 % documented a 1:1 care within the meaning of OPS 9-640.0 additional code. Of the 66 245 male cases a 1:1 care was documented in 3.5 % and the 55 207 female cases was 4.1 %. Compared to 2011, the proportion of 1:1 care in 2012 rose to 4.8 %. CONCLUSION: The results show that 1:1 care is frequently applied in German psychiatric hospitals. The Data of the VIPP project have proven to be a useful tool to gain information on the frequency of cost-intensive interventions in German psychiatric hospitals. Further analyses should create the possibility of evaluation at the level of the individual codes.

INTRODUCTION: While lithium (Li) has been well established for the treatment of bipolar disorder, geriatric patients require special attention when it comes to issues of drug safety. Declining renal function, amongst other medical conditions, and polypharmacy may pose increased risks. Only a few previous studies have addressed the management of Li in geriatric patients. METHODS: Twenty-four German medical experts on geriatric medicine and Li treatment participated in a Delphi survey, consisting of two rounds of questionnaires and a final formulation of treatment recommendations. Three major issues of Li therapy were outlined: initiation of treatment, monitoring of ongoing therapy, and withdrawal due to medical reasons. Final recommendations were consented to at a threshold of at least 80% expert agreement. RESULTS: Final consensus was achieved on 21 clinical recommendations. The approved recommendations covered aspects of necessary laboratory checks, concomitant medication, and target Li serum concentration in geriatric patients. Concerning the termination of Li therapy, an agreement was reached on the appropriate time span for tapering and on potential alternatives to Li. No consensus was achieved on whether concomitant dementia or frailty should be considered contraindications for Li treatment and the appropriate threshold of the estimated glomerular function rate for withdrawing Li. CONCLUSION: According to the view of German experts, Li may be used in geriatric patients, but it should be monitored carefully. However, the lack of consent in several specific treatment situations underlines the need for research on specific issues of Li therapy.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

Summary Treatment clusters and personnel assessment in psychosomatic medicine and psychotherapy – results of a feasibility study of the platform model Objectives: In accordance with the legal requirements of the PsychVVG, it is necessary to develop criteria for inpatient and day-care psychosomatic psychotherapeutic care, which can be used to determine the appropriate staffing for different treatment areas and different care structures. For psychosomatic medicine and psychotherapy a model with four treatment clusters was developed, which is oriented on the one hand to the psychotherapeutic intensity and on the other hand to the medical expenditure. Method: In three consecutive rounds with up to 30 experts, representative selected from the three institution types university hospital, departmental psychosomatic medicine and specialized clinic, the minute values per patient required for a treatment according to the guidelines were determined using the Delphi method. Newly developed activity profiles for the six occupational groups were used, which allow the recording of all patient- and setting-related activities. Results: With the results of the feasibility study, an instrument has been developed for the first time to determine the requirements of staffing in psychosomatic medicine. Convergent minute values could be formulated for three of the four treatment clusters. Conclusions: The provision of care in psychosomatic medicine and psychotherapy is complex, so that a limitation to four treatment areas is only possible if significantly more generous equivalence rules are applied between the professional groups than those laid down in the PPP Directive.

Ziel der Studie: Darstellung der Evaluation eines Kooperationsprojektes für ein niedrigschwelliges, anonymes Beratungsangebot zwischen psychiatrischer Versorgung und dem Handlungsfeld der Kinder- und Jugendhilfe für Familien mit Kindern und psychisch erkrankten Eltern. Methodik: Auswertung der Leistungsdaten und der durch die Eltern beantworteten Evaluationsbögen zum Projekt. Ergebnisse: Im Zeitraum von 2011 bis 2014 haben 150 Familien im Rahmen des Projektes ein familienorientiertes Beratungsangebot mit bis zu 10 Gesprächsterminen erhalten. Die Ergebnisse der Befragung belegen eine hohe Zufriedenheit mit den Leistungen des Kooperationsprojektes. Der überwiegende Teil der Befragten würde das Angebot weiterempfehlen bzw. erneut in Anspruch nehmen. Schlussfolgerung: Eine Kooperation der Leistungserbringer aus den Bereichen Psychiatrie und Kinder- und Jugendhilfe und ein daraus hervorgehendes Brückenangebot mit gemeinsamer familienmedizinischer Perspektive stellt im Hinblick auf die Versorgung von Familien mit einem psychisch erkrankten Elternteil ein zukunftsweisendes Modell dar.

Hintergrund: Der Anstiege an Neuerkrankungen im gerontopsychiatrischen Bereich stellt eine nicht unerhebliche volkswirtschaftliche Dimension dar. Daher steht die Analyse des Leistungsgeschehens der akutpsychiatrischen stationären Versorgung von dementiell erkrankten Menschen vor großen Herausforderungen. Es steht die Frage im Vordergrund, wie sich mit Daten, die im Routineprozess laufend entstehen, das Leistungsgeschehen darstellen lässt. Ziel der Studie: Ziel der Untersuchung ist die Analyse der Abbildung therapeutischer Leistungseinheiten unterschiedlicher Berufsgruppencluster (Arzt/Psychologen, Pflege/Spezialtherapeuten) über dokumentierte Therapieeinheiten (TE) als OPS Kode in den ICD-10 Diagnosegruppen F00–F03 sowie G30 in den Jahren 2010 (ab Juli) und 2011. Wir gehen der Hauptfrage nach, wie viele Patientinnen und Patienten mit einer TE im Sinne des Operationen- und Prozedurenkataloges (OPS) erreicht werden konnten und ob es Gruppenunterschiede zwischen Regel- und Intensivbehandlung gibt. Datenbasis: Die Untersuchung basiert auf einer Analyse des §21 KHEntgG Datensatzes aus 35 akutstationären Einrichtungen. Die Sammlung der Daten erfolgte über das Projekt „Versorgungsindikatoren für die Psychiatrie und Psychosomatik (VIPP)“. Die verfügbaren Daten stammen von teilnehmenden Fachkrankenhäusern, Universitätskliniken und Abteilungspsychiatrien aus der gesamten Bundesrepublik. Methodik: Die Datensätze wurden durch die Firma GSG aufbereitet und in aggregierter Form zur Verfügung gestellt. Der Datensatz wurde mit der Software QlilkView und Excel 2007 explorativ analysiert. Ergebnisse: Insgesamt konnten wir 5 111 Fälle aus 18 Analysemonaten in die Untersuchung einschließen. Pflege- und Spezialtherapeuten konnten signifikant mehr Patienten in den analysierten Diagnosegruppen (F01, F03 und G30) und den unterschiedlichen Behandlungstypen (Regel-, und Intensivbehandlung) mit TE erreichen als Ärzte und Psychologen (p<0,05). Nicht alle Patientinnen und Patienten wurden durch eine TE erreicht (Erreichungsgrad: G30 78,8%, F01 83,4%, F03 81,2%). Der absolute Erreichungsgrad der Patienten in der Intensivbehandlung lag in beiden Berufsgruppencluster signifikant höher als in der Regelbehandlung (p<0,05). Schlussfolgerung: Wir konnten zeigen, dass die verpflichtende Dokumentation von TE über OPS-Kodes von den Einrichtungen umgesetzt wurde. Diese Untersuchung bietet einen ersten Überblick über das Leistungsgeschehen und die eingeschränkte Aussagekraft verschlüsselter TE in der stationären Behandlung von dementiell erkrankten Menschen. Weitere Studien sollten den Zusammenhang zwischen TE und konkreten Behandlungsleistungen darstellen.

BACKGROUND AND HYPOTHESIS: Non-affective psychoses (NAP) are associated with severe consequences with regard to social functioning, physical health, employment, and suicidality. Treatment guidelines recommend cognitive behavioral therapy for psychosis (CBTp) as an effective additional treatment strategy to psychopharmacology. We hypothesized that outpatient CBTp has an add-on effect in individuals with NAP who already receive comprehensive outpatient care (COC) in Germany. STUDY DESIGN: In a randomized-controlled effectiveness trial, 6 months of COC + CBTp were compared to COC. The primary outcomes were change of symptom severity as assessed by the Positive and Negative Symptom Scale (pre-/post-treatment and 6-month follow-up). Mixed linear models and effect sizes were used to compare changes across treatment groups. Additionally, the number of readmissions was compared. STUDY RESULTS: N = 130 individuals with chronic NAP were recruited (COC + CBTp: n = 64, COC: n = 66). COC + CBTp participants significantly improved more regarding positive symptom severity (estimated mean difference at follow-up: -2.33, 95% CI: -4.04 to -0.61, P = .0083, d = 0.32) and general psychopathology (estimated mean difference at follow-up: -4.55, 95% CI: -7.30 to -1.81, P = .0013, d = 0.44) than the COC group. In both groups, negative symptom severity did not change significantly over time nor did groups differ regarding readmissions. CONCLUSION: The results underline an add-on benefit of CBTp in chronically ill individuals with NAP. Superiority of CBTp was demonstrated in comparison with high-quality comprehensive care and may also be true in different comprehensive care settings. CLINICAL TRIALS REGISTRATION: DRKS00015627.

Zusammenfassung Hintergrund Die Gesundheitsförderung und präventive Krisenprophylaxe sind fundamentaler Bestandteil derzeitiger Mental-Health-Strukturen. Recovery-Colleges, als Institutionen zur Förderung seelischer Gesundheit, leisten in Deutschland bereits einen wesentlichen Beitrag zur mentalen Gesundheitsförderung und individuellen Recovery. Mittlerweile hat sich aus einzelnen Projektstrukturen ein deutschlandweites Netzwerk gebildet. Zielsetzung Die vorliegende Übersichtsarbeit beschäftigt sich mit dem bisher noch nicht abgebildeten, aktuellen Umsetzungsstand der Etablierung und primären Verortung von Recovery-College-Strukturen (RC/EC) im deutschsprachigen Raum. Es werden grundlegende Aspekte, Inhalte und Strukturen zum Recovery-College-Konzept und dessen Herkunft aufgezeigt. Dabei werden unterschiedliche Projektmodelle, deren Ausprägungen und Besonderheiten betrachtet. Material und Methoden Aufbauend auf eine Literaturrecherche über die Plattform PubMed zum Thema Recovery-Colleges konnten mittels Online-Befragung über das deutsche RC-Netzwerk (RCN) 11 verschiedene College-Einrichtungen rekrutiert und befragt werden. Ergebnisse Die Auswertung zeigt, dass die College-Einrichtungen nach gleichen Prinzipien strukturiert sind, aber sich z. B. in ihrem Standort, ihrer Refinanzierung und in ihrem Leistungsspektrum an Kursangeboten unterscheiden können. Des Weiteren stehen College-Einrichtungen oft in direkter oder indirekter Verbindung zu professionellen Akteuren des Gesundheitswesens, haben aber auch Anbindungen zu gemeindenahen Einrichtungen, Lehreinrichtungen und Selbsthilfegruppen. Schlussfolgerung Letztlich bedarf es einer verstärkten Aufmerksamkeit, einer kontinuierlichen finanziellen Rahmensubventionierung und weiterer Erforschung, um eine recovery-orientierte Praxis mit dem College-Konzept in Deutschland zu etablieren.

OBJECTIVE: Individuals suffering from mental illness have one to two decades reduced life expectancy. The increased morbidity and mortality is mainly due to cardiometabolic disorders. Despite these numbers, international studies give evidence that diagnoses and treatment of metabolic risk factors in psychiatric patients is insufficient. We assume that in Germany metabolic risk factors are also underdiagnosed and insufficiently treated. METHODS: We tested for the frequency of diagnoses of the metabolic risk factors obesity, nicotine dependence and abuse, disorders of lipid metabolism, hypertension and diabetes in 139 307 cases of residential treatment and semi-residential care in 47 psychiatric hospitals in Germany in the year 2012. Data were derived from the VIPP(indicators of treatment quality in psychiatry and psychosomatic medicine)-project, a project that comprises the routine data of psychiatric hospitals, that are sent to the InEK (institute for the lump sum payment system for hospitals). Frequencies were compared with prevalence of metabolic risk factors in the German population and prevalences of metabolic risk factors found in psychiatric patients in international studies. RESULTS: In particular obesity (2.8 %), disorders of lipid metabolism (2.8 %) and nicotin dependence (4.2 %) were underdiagnosed. We assume that also diabetes (6.8 %) and hypertension (17.7 %) were underdiagnosed. CONCLUSION: The results give evidence that metabolic risk factors are underdiagnosed and possibly insufficiently treated in German psychiatric hospitals. We cannot exclude that the results might also be due to poor documentation. It remains to be seen if the introduction of the PEPP (the new lump sum payment system in German psychiatry) will heighten the level of attention for metabolic risk factors and their treatment.

BACKGROUND: Youth mental health systems worldwide face increasing demand, workforce shortages, and fragmented pathways to care. Addressing these challenges requires approaches that extend beyond specialist clinical treatment to incorporate prevention, participation, education, and recovery-oriented support. While Recovery Colleges are increasingly established within adult mental health services, their youth-adapted counterparts commonly referred to as Discovery Colleges remain underexplored within youth mental health systems research. This narrative review synthesises emerging literature to examine the conceptual foundations, developmental adaptations, and potential system-level role of Discovery Colleges within youth mental health care. METHODS: A narrative review approach was employed to synthesise emerging literature on Discovery Colleges and related recovery-oriented educational initiatives. Peer-reviewed publications, programme descriptions, and implementation reports were analysed to examine the defining principles, developmental relevance, organisational characteristics, and system-level implications of Discovery Colleges within youth mental health contexts. RESULTS: The synthesis identified four interrelated conceptual domains characterising Discovery Colleges: (1) recovery-oriented learning models and developmental adaptation; (2) mechanisms of engagement and participation; (3) organisational and professional implications; and (4) cross-sector positioning within youth mental health ecosystems. The findings suggest that Discovery Colleges can be conceptualised as developmentally responsive and recovery-oriented learning environments operating at the intersection of education, community support, and mental health care. The review further highlights important tensions relating to implementation, safeguarding, fidelity, sustainability, and cross-sector integration. CONCLUSIONS: Discovery Colleges may represent a promising recovery-oriented innovation within youth mental health systems by reframing mental health support as a collaborative, participatory, and educational process rather than solely a clinical intervention. However, the current evidence base remains limited and largely exploratory. Further empirical, developmental, and implementation-focused research is required to evaluate their effectiveness, sustainability, and long-term contribution to integrated youth mental health systems.