“去机构化”过程中精神卫生服务的社区建构:四国比较研究

A Comparative Study of the Development of Community Mental Health Systems in Four Countries

精神卫生服务已呈现出社区化发展趋势。但如何在社区构建高效而专业的精神卫生服务体系,仍然是摆在中国精神残障人事业发展面前的重要课题。本文以精神病学理论和技术发展为轴线,通过回溯法、美、英、意大利四国自二战后参照不同精神病学理论构建社区精神卫生服务体系的历程,分析总结了欧美四国在“去机构化”运动中所取得的经验与教训,并对各国社区精神卫生服务模式及其成效做了综合比较,发现良好的精神卫生服务体系得益于各要素之间的最优组合,包括适合本国社区环境的精神病学理论与技术、对包含医疗和社会支持的服务内容做科学有效的管理与规划、充足的财政支持、积极的福利政策、质量和数量兼具的专业人才。

The delivery of mental health services has shown a development trend of community engagement.However,how to construct an efficient and professional community mental health service system is still an essential issue for the development of China's cause of persons with mental disabilities.While reviewing the development of psychiatric theories and therapeutic techniques,we reviewed the community mental health service systems in France,the United States,Britain and Italy established by referring to different contemporary psychiatric theories since World War II,then analyzed and summarized the successful experiences and failures that the four countries gained from the“deinstitutionalization”movement,and comprehensively compared community mental health models and their effectiveness in the countries.We found that a good mental health service system depends on the optimal combination of the factors as follows:psychiatric theories and techniques applicable to the community environment of a country;scientific and effective organization and management of services including psychiatric treatment and social support;adequate financial support;proactive welfare policies;enough qualified mental health workers.