Appelbaum Paul S, Redlich Allison
Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
J Nerv Ment Dis. 2006 Apr;194(4):294-302. doi: 10.1097/01.nmd.0000207368.14133.0c.
Persons who handle money for patients with mental disabilities often use access to funds as leverage to promote adherence to treatment. Drawing on data from a five-site study involving interviews of 1011 patients at community mental health centers, this paper explores who provides money assistance, the predictors of leverage use, and its impact on patients. A substantial minority of patients reported having experienced leverage. Substance abuse and frequent hospitalization were the strongest clinical predictors, suggesting that functional impairment is a key determinant. Patients experiencing money leverage were also likely to experience other forms of leverage, and although they were more likely to feel coerced, they were also more likely to believe that money leverage was effective. Family members seemed to provoke fewer negative feelings as money managers. The frequency with which money leverage is used suggests attention is needed to both the fairness of leverage and the means of minimizing negative effects.
为患有精神残疾的患者处理钱财的人常常利用资金控制权作为促使患者坚持治疗的手段。本文利用一项五地点研究的数据，该研究涉及对社区心理健康中心的1011名患者进行访谈，探讨了谁提供金钱援助、使用这种手段的预测因素及其对患者的影响。相当一部分患者报告称经历过这种手段。药物滥用和频繁住院是最强的临床预测因素，这表明功能损害是一个关键决定因素。经历过金钱手段的患者也可能经历其他形式的手段，尽管他们更可能感到被胁迫，但他们也更可能认为金钱手段是有效的。家庭成员作为资金管理者似乎引发的负面情绪较少。金钱手段的使用频率表明，需要关注手段的公平性以及将负面影响降至最低的方法。
