Germany has an approximate area of 357 000 km2. Its population is 82 526 million. The life expectancy at birth is 75.6 years for men and 81.6 years for women (World Health Organization, 2005). The proportion of gross domestic product allocated to the health budget is 10.8%. The per capita total expenditure on health is $2820 (international dollars here and below) and the per capita government expenditure on health is $2113 (World Health Organization, 2005). A major factor in recent German history was reunification, which had a pronounced effect on the German healthcare system.
The term ‘psychiatry’ was coined by Johann Christian Reil in 1808. In the 19th century, German psychiatry began to develop into a scientific discipline under the influence of Wilhelm Griesinger (1817–68), who focused on a holistic but differentiated approach, covering biological and psychological methods. At the beginning of the 20th century, psychiatrists like Emil Kraepelin, Alois Alzheimer, Kurt Schneider and Carl Wernicke founded the basis of current psychiatric classification systems.
In the period of the National Socialists (1933–45), German psychiatry was partially instrumentalised for political purposes, especially for the programme of ‘euthanasia’. This terrible period has been intensively analysed. The review by Seeman (2005) is a useful English introduction to this topic.
In the late 18th and early 19th century, large psychiatric institutions were founded, mainly outside the metropolitan areas. In the last part of the 20th century, the advent of psychopharmacotherapy and social psychiatry changed the picture of German psychiatry. Following the Psychiatrie Enquête report of 1975 (see under ‘Mental health policy’, below), many smaller psychiatric departments were set up in community hospitals but the total number of psychiatric hospital beds declined.
The lifetime prevalence for any psychiatric disorder in Germany is 42% and the 12-month prevalence rate is 31% for the adult population, not much different from the prevalence rate in the European Union (EU) as a whole, of 27% (Wittchen & Jacobi, 2005). In Germany, only about 25% of the population with a mental illness are in contact with mental health services, compared with 26% in the EU. Mental disorders are responsible for about 40% of all sick leave from work and 28% of all early retirements (Roth-Sackenheim, 2005).