Rosen A
Royal North Shore Hospital and Community Mental Health Services, Sydney, NSW, Australia.
Acta Psychiatr Scand Suppl. 2006(429):81-9. doi: 10.1111/j.1600-0447.2005.00723.x.
To describe the Australian experience of deinstitutionalization of the Australian National Mental Health Strategy in the context of the history of mental health services in Australia, and of Australian culture.
The development of Australian Mental Health Services is described with reference to developments in both psychiatric intervention research and Australian culture. The effects and achievements of national mental health reforms are described and critically examined.
The relationship in Australia between the development of mental health services and the development of Australian society includes the stories of colonization, gold rush, suppression of indigenous peoples' rights, incarceration of mentally ill people, and incompatible state service systems. Mental health services required reform to provide consistent services and support for full citizenship and rights for such individuals who are still on the margins of society. Recent national developments in service models and service system research have been driven by the Australian National Mental Health Strategy. The translation of national policy into state/territory mental health service systems has led to a 'natural' experiment between states. Differing funding and implementation strategies between states have developed services with particular strengths and limitations.
The effects of competition for limited resources between core mental health service delivery and the shift to a population-based public health approach (to prevention of mental illness and promotion of mental health), leaves our services vulnerable to doing neither particularly well. The recent loss of momentum of these reforms, due to failure of governments to continue to drive and fund them adequately, is causing the erosion of their considerable achievements.
在澳大利亚精神卫生服务历史及澳大利亚文化背景下，描述澳大利亚国家精神卫生战略去机构化的经历。
参照精神病干预研究及澳大利亚文化的发展情况，描述澳大利亚精神卫生服务的发展历程。阐述并批判性审视国家精神卫生改革的效果及成就。
澳大利亚精神卫生服务发展与澳大利亚社会发展之间的关系包括殖民化、淘金热、对原住民权利的压制、精神病患者的监禁以及不相容的州服务体系等故事。精神卫生服务需要改革，以便为那些仍处于社会边缘的人提供一致的服务，并支持他们享有完全公民权和权利。近期服务模式和服务体系研究方面的国家发展是由澳大利亚国家精神卫生战略推动的。将国家政策转化为州/领地精神卫生服务体系引发了各州之间的“自然”试验。各州不同的资金和实施策略形成了具有特定优势和局限性的服务。
核心精神卫生服务提供与向基于人群的公共卫生方法（预防精神疾病和促进精神健康）转变之间对有限资源的竞争影响，使我们的服务面临两者都做得不够好的风险。由于政府未能继续充分推动和资助这些改革，近期这些改革势头减弱，正导致其巨大成就受到侵蚀。
