Smith W G
Community Ment Health J. 1975 Spring;11(1):47-57. doi: 10.1007/BF01420464.
A large midwest community-oriented regional mental health center reports a detailed methodology for evaluating the outcome effectiveness of clinical care for seriously disturbed mental patients. A controlled study of a 10% systematic sample of all public patients from a 10-county area compares the results obtained by traditional state hospitals with those of a new regional mental health center. The cohorts were followed for 3 full years. Outcomes were assessed in terms of social competence and economic cost to the patients and society. Although increased funds and staffing clearly improved the level of humanitarian care in all public institutions, no objective evidence was found that the community-oriented approach was superior in decreasing disability due to serious mental disorder. The study corroborated impressions that a relatively small proportion of persons entering mental hospitals tend to become chronically disabled and require large quantities of care-giving services. It is concluded that a period of consolidation and replanning is necessary in community psychiatry. It is suggested that early identification of potentially chronic patients, intensive social training, and specialized community living arrangements focused on this group might provide a break-through in rehabilitation of the mentally ill.
中西部一个大型的以社区为导向的区域心理健康中心报告了一种详细的方法，用于评估对严重精神障碍患者临床护理的疗效。一项对来自10个县地区所有公立患者的10%系统样本的对照研究，比较了传统州立医院与新的区域心理健康中心所取得的结果。对这些队列进行了整整3年的跟踪。从患者和社会的社会能力和经济成本方面评估结果。虽然增加资金和人员配置显然提高了所有公立机构的人道主义护理水平，但没有发现客观证据表明以社区为导向的方法在减少严重精神障碍导致的残疾方面更具优势。该研究证实了这样的印象，即进入精神病院的人中相对较小比例的人往往会长期残疾，并需要大量的护理服务。结论是社区精神病学需要一段巩固和重新规划的时期。建议对潜在的慢性病患者进行早期识别、强化社会培训以及针对该群体的专门社区生活安排，可能会为精神病患者的康复带来突破。
