Cowan Sue
University of Abertay, Dundee, UK.
Health Soc Care Community. 2003 Sep;11(5):379-86. doi: 10.1046/j.1365-2524.2003.00439.x.
The relocation of mental health services from an institutional to community base in different parts of the UK has witnessed incidents of public opposition in relation to the establishment of community mental health projects. It has been argued that this not-in-my-backyard (NIMBY) syndrome is partly a result of the attitudes held by the public towards people with mental health problems. The present paper reports some findings from a study of community attitudes towards individuals with mental health problems in a Scottish community, and discusses their implications for the development of public consultation guidelines with respect to the establishment of community mental health facilities. Discourse analysis was used to explore people's views about individuals with mental health problems. The study examined the ways in which their views were expressed in letters to the local press, and in subsequent discussions and interviews, when arguing for or against a supported accommodation project in their neighbourhood. Participants formulated their arguments around a number of issues which they claimed were of public concern. One of these related to the way in which the project was set up. In particular, participants argued that it had been established without any prior consultation with local people and in circumstances of secrecy. The findings demonstrate that, while consultation is relatively unproblematically defined in terms of its function, the specific nature of consultation is more problematic. The implications of these findings for mental health policy and practice are considered in the light of current official guidelines on public consultation relating to the establishment of community mental health facilities. It is argued that existing guidelines fail to take account of the concerns of local people, and therefore, that any intervention based on such guidelines is likely to be ineffective. It is suggested that the findings of this study will be of interest to policy makers and practitioners seeking to devise future public consultation strategies.
在英国不同地区,心理健康服务从机构化向社区化转移的过程中,出现了公众反对社区心理健康项目设立的事件。有人认为,这种“不要建在我家后院”(NIMBY)综合征部分是公众对有心理健康问题者所持态度的结果。本文报告了一项关于苏格兰一个社区对有心理健康问题者的社区态度研究的一些发现,并讨论了这些发现对制定关于社区心理健康设施设立的公众咨询指南的影响。话语分析被用于探究人们对有心理健康问题者的看法。该研究考察了在支持或反对其社区内一个支持性住宿项目时,他们的观点在给当地报纸的信件以及后续讨论和访谈中的表达方式。参与者围绕一些他们声称是公众关切的问题阐述了自己的论点。其中一个问题与项目的设立方式有关。具体而言,参与者认为该项目在没有事先与当地人协商且处于保密状态的情况下就已设立。研究结果表明,虽然就其功能而言,咨询的定义相对没有问题,但咨询的具体性质则更具问题性。根据当前关于社区心理健康设施设立的公众咨询官方指南,考虑了这些发现对心理健康政策和实践的影响。有人认为现有指南没有考虑到当地人的关切,因此,基于此类指南的任何干预可能都是无效的。建议本研究的发现将对寻求制定未来公众咨询策略的政策制定者和从业者有参考价值。