Wolff Nancy
Bloustein School of Planning and Public Policy, Center for Mental Health Services and Criminal Justice Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, USA.
J Health Polit Policy Law. 2002 Oct;27(5):801-32. doi: 10.1215/03616878-27-5-801.
Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.
美国和英国的政策制定者认识到，患有精神疾病的罪犯给执法、心理健康、社会服务系统以及社区带来了特殊挑战。尽管在过去二十年里，为改善对患有精神疾病罪犯的管理已推进了各项政策举措，但在这两个国家，心理健康政策长期以来一直未能取得成效。由于随着心理健康系统的“去机构化”，安全问题日益凸显，关于社区护理方法对社区是否有效的争论也越来越多。本研究认为，心理健康政策之所以失败，是因为政策制定者关注了错误的风险，并设计出以增加不良临床和经济后果可能性的方式来管理这些风险的政策。此处所提出的论点以英国患有严重精神疾病的人群为例，阐述了民主治理中风险与政策制定之间的复杂关系。重点在于心理健康政策中风险的本质以及政府如何应对政策和政治风险。随后从英国心理健康政策对风险的应对和管理方面进行了分析。英国的心理健康政策在历史上对风险问题管理不善，因此引发了社区护理方面越来越强烈的反对。实现更好结果的途径在于对正确风险进行负责任的管理。英国的经验教训可有效地应用于许多工业民主国家的心理健康问题。
