Williamson Toby
Strategies for Living (Adult Mental Health & User Empowerment), The Mental Health Foundation, 83 Victoria Street, London SW1H 0HW, UK.
Curr Opin Psychiatry. 2002 Sep;15(5):543-7. doi: 10.1097/00001504-200209000-00013.
Assertive outreach, also known as assertive community treatment, is a well established service model in several countries for people with severe and enduring mental health problems who do no engage with psychiatric services. However, it has been criticized for being coercive and paternalistic. The present review considers a number of recent contributions to the debate concerning the ethics of assertive outreach.
Assertive outreach brings into sharp focus a number of ethical issues that affect most mental health services, but it also generates new ones, primarily whether delivery of a service to people who are refusing it and are not legally bound to accept it can be justified. Several authors have grappled with these issues, mainly through using traditional principles of ethical treatment based on professional values, and this paper reviews such attempts at resolving those dilemmas. In so doing, it reveals the limitations of such approaches.
In conclusion, the present review suggests an alternative ethical basis for supporting delivery of assertive outreach services to a reluctant client group, which focuses more on the client's values and areas of assistance with which they express genuine appreciation and satisfaction.
积极外展服务，也称为积极社区治疗，在一些国家是一种成熟的服务模式，针对的是患有严重且持续性心理健康问题但不接受精神科服务的人群。然而，它因具有强制性和家长式作风而受到批评。本综述探讨了近期关于积极外展服务伦理辩论的一些观点。
积极外展服务使一些影响大多数心理健康服务的伦理问题凸显出来，但同时也产生了新的问题，主要是向拒绝接受服务且无法律义务接受服务的人群提供服务是否合理。几位作者主要通过运用基于专业价值观的传统伦理治疗原则来应对这些问题，本文回顾了他们解决这些困境的尝试。这样做揭示了这些方法的局限性。
总之，本综述提出了一种支持向不情愿的客户群体提供积极外展服务的替代伦理基础，该基础更多地关注客户的价值观以及他们真正表示赞赏和满意的帮助领域。
