Mechanic D
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, USA.
J Health Serv Res Policy. 1997 Apr;2(2):86-93. doi: 10.1177/135581969700200206.
People with serious and persistent mental illness require a range of community services typically provided by different specialized agencies. At the clinical level, assertive team case management is the strategy commonly used to achieve integration of services across specialized sectors. The USA also has used various financial and organizational approaches to reduce fragmentation and increase effectiveness, including development of stronger public mental health authorities, use of financial incentives to change professional and institutional behavior, requirements to allocate savings from hospital closures to community systems of care, and introduction of mental health managed care on a broad scale. These approaches have potential but also significant problems and there is often a large gap between theory and implementation. These US developments are discussed with attention to the implications for mental health services in the UK.
患有严重且持续性精神疾病的人需要一系列通常由不同专业机构提供的社区服务。在临床层面，积极团队病例管理是实现跨专业部门服务整合的常用策略。美国还采用了各种财政和组织方法来减少服务分散并提高效率，包括建立更强大的公共心理健康机构、利用财政激励措施改变专业人员和机构的行为、要求将医院关闭节省的资金分配给社区护理系统，以及广泛引入心理健康管理式医疗。这些方法有潜力，但也存在重大问题，而且理论与实施之间往往存在很大差距。本文将讨论美国的这些发展情况，并关注其对英国心理健康服务的影响。
