Holt G, Costello H, Bouras N, Diareme S, Hillery J, Moss S, Rodriguez-Blazquez C, Salvador L, Tsiantis J, Weber G, Dimitrakaki C
Estia centre, South London and Maudsley NHS Trust, and King's College, London, UK.
J Intellect Disabil Res. 2000 Dec;44 ( Pt 6):685-96. doi: 10.1046/j.1365-2788.2000.00312.x.
The aim of the present paper is to describe and compare services for adults with intellectual disability (ID) and mental health needs in five European countries: Austria, England, Greece, Ireland and Spain. A framework and structure for collecting information about service provision was designed. This information was collected through a mixture of interviews with service providers, questionnaires and a review of the research literature within each country. Information was collected on historical context, policy, legislation, assessment, treatment and the structure of services for people with ID and mental health problems. Overall, the needs of those with additional mental health needs have not been specifically addressed at a national level with perhaps the exception of England and Ireland, although there are still gaps in services in these nations. Normalization has been adopted in each of the five countries, and there are moves toward deinstitutionalization, integration and inclusion. Families and self-advocacy groups have grown. The pace of this change varies between and even within countries. The main findings of the study include: unclear policy, trends for legislative changes, increased prevalence of mental health problems, inadequate generic service provision, a need for specialist mental health services, a need for improved interconnections of services, and a need for training developments. Policy and legislation in the five European countries under consideration tend to separate the disability aspects of people with ID from their mental health needs. Consequently, the service needs of this group remain largely invisible. This might be a direct reflection of policy clarity and legislation, or could be the result of a failure to implement existing guidelines. This has a detrimental effect on the lives of people with ID, and their families and carers.
本文旨在描述和比较五个欧洲国家（奥地利、英格兰、希腊、爱尔兰和西班牙）为有智力残疾（ID）和心理健康需求的成年人提供的服务。设计了一个收集服务提供信息的框架和结构。这些信息是通过与服务提供者访谈、问卷调查以及对每个国家研究文献的综述相结合的方式收集的。收集了有关历史背景、政策、立法、评估、治疗以及为有ID和心理健康问题的人提供的服务结构等方面的信息。总体而言，除了英格兰和爱尔兰之外，其他国家在国家层面尚未专门解决有额外心理健康需求者的需求问题，尽管这些国家的服务仍存在差距。五个国家均采用了正常化原则，并且有朝着去机构化、融合和包容发展的趋势。家庭和自我倡导团体不断壮大。这种变化的速度在不同国家之间甚至在同一国家内部都有所不同。该研究的主要发现包括：政策不明确、立法变化趋势、心理健康问题患病率上升、一般服务提供不足、需要专门的心理健康服务、需要改善服务之间的相互联系以及需要开展培训。所考虑的五个欧洲国家的政策和立法倾向于将有ID者的残疾方面与其心理健康需求分开。因此，这一群体的服务需求在很大程度上仍然不为人所见。这可能是政策清晰度和立法的直接反映，也可能是未能执行现有指导方针的结果。这对有ID者及其家庭和照顾者的生活产生了不利影响。
