Pinfold V
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, Kings College London, Denmark Hill, SE5 8AF, London, UK.
Health Place. 2000 Sep;6(3):201-12. doi: 10.1016/s1353-8292(00)00023-x.
Deinstitutionalization moved the focus of psychiatric care away from hospital institutions to community settings. Mental health services are no longer driven by a policy of illness containment, although detention and coercion retain legislative and cultural legitimacy, because the conceptual and practical focus of caring for people in the 1990s is built around journeys to(wards) ordinary 'independent' living. This paper draws upon the experiences of people with enduring mental health problems to explore the positions, roles and therapeutic benefits established by socio-spatial networking in the community. Social isolation and community integration are polar extremes, two very different 'locations' on a 'theoretical' rehabilitation pathway shaping mental health policy and community care practices. The paper assesses these two locations and searches for the middle-ground in practice. It draws on the concept of normality to compare service user and professional perspectives on the rehabilitation process. The paper argues, with optimism, that spaces of rehabilitation are being found 'in the community' but notes that until mental illness is de-stigmatised and society celebrates difference, creating space for 'Mad Pride', the post-asylum landscape must continue to evolve in search of models of good community care practice and potential landscapes of caring. The research presented in the paper was carried out with Rehabilitation and Community Care Services (RCCS) in Nottingham (1994-1997), and is based upon fieldwork observations and in-depth interviews with RCCS staff and 25 service users.
非机构化将精神科护理的重点从医院机构转移到了社区环境。心理健康服务不再受疾病控制政策的驱动，尽管拘留和强制手段仍具有立法和文化上的合法性，因为20世纪90年代照顾患者的概念和实际重点是围绕走向普通“独立”生活的旅程构建的。本文借鉴了患有持久性心理健康问题者的经历，以探讨社区中社会空间网络所确立的地位、角色和治疗益处。社会隔离和社区融合是两个极端，是塑造心理健康政策和社区护理实践的“理论”康复途径上两个截然不同的“位置”。本文评估了这两个位置，并在实践中寻找中间地带。它借鉴了正常性的概念，比较了服务使用者和专业人员对康复过程的看法。本文乐观地认为，正在“社区中”找到康复空间，但指出，在精神疾病消除污名化且社会崇尚差异、为“疯癫自豪”创造空间之前，后收容时代的格局必须继续演变，以寻找良好社区护理实践的模式和潜在的护理格局。本文所呈现的研究是与诺丁汉的康复与社区护理服务机构（1994 - 1997年）合作开展的，基于实地观察以及对该机构工作人员和25名服务使用者的深入访谈。
