Haug H J, Rössler W
Psychiatrische Universitätsklinik Zürich, Switzerland.
Eur Arch Psychiatry Clin Neurosci. 1999;249(3):115-22. doi: 10.1007/s004060050075.
The central European countries Germany, Switzerland, Austria, and Luxemburg are confronted with a variety of individual problems concerning health care. After an analysis of problems which are shared by all the countries, these individual aspects are analyzed. In Germany there has been a rapid structural change of psychiatric care in the last 30 years. Although there was a broad movement to deinstitutionalize patients with chronic psychiatric disorders who need long-term care, there are still too many psychiatric beds in large psychiatric hospitals and still missing psychiatric departments in general hospitals in some areas. In Austria the process of deinstitutionalization has been delayed but a general survey of the health care system by the government led to an acceleration of this process in recent years. Due to historical reasons, the mental health care system in Switzerland is not easily comparable with the ones in the other two countries. Deinstitutionalization mainly means reduction of beds in the existing psychiatric hospitals rather than a structural change with a conversion to psychiatric departments in general hospitals. Luxemborg is a good example of the fact that economical factors are not the only aspects influencing development in psychiatric care. Psychiatric care is not community based, centralized, separated from medical care, and the supply system concerning complementary outpatients institutions is underrepresented. Thus, in all the countries the process of deinstitutionalization has still not come to a satisfying level. This is not only due to the economically difficult situation in the recent past. A change can only be expected when the opinions about modern principles of psychiatric care receive more weight in general society and with their political representatives.
中欧国家德国、瑞士、奥地利和卢森堡面临着各种与医疗保健相关的个别问题。在分析了所有国家共同存在的问题之后，对这些个别方面进行了分析。在德国，过去30年里精神科护理发生了迅速的结构变化。尽管有一场广泛的运动，旨在使需要长期护理的慢性精神疾病患者非机构化，但大型精神病医院的精神科床位仍然过多，而且在一些地区的综合医院中仍然缺少精神科部门。在奥地利，非机构化进程有所延迟，但政府对医疗保健系统进行的全面调查导致近年来这一进程加速。由于历史原因，瑞士的精神卫生保健系统不易与其他两个国家的系统相比较。非机构化主要意味着减少现有精神病医院的床位，而不是进行结构变革，将其转变为综合医院的精神科部门。卢森堡很好地说明了经济因素并非影响精神科护理发展的唯一方面。精神科护理不是基于社区的、集中的、与医疗护理分离的，而且关于补充门诊机构的供应系统代表性不足。因此，在所有这些国家，非机构化进程仍未达到令人满意的程度。这不仅是由于过去经济困难的状况。只有当关于现代精神科护理原则的观点在一般社会及其政治代表中得到更多重视时，才有望发生变化。
