Burnham John C
Department of History, Ohio State University, 230 West 17th Avenue, Columbus, 43210-1367, USA.
Perspect Biol Med. 2006 Spring;49(2):220-37. doi: 10.1353/pbm.2006.0021.
In the last half of the 20th century, the community mental health movement, based on a public health model, came to dominate patterns of care for mental patients. In the process, brutal deinstitutionalization of very ill patients took place, at least in the United States. These events were not inevitable. In 1949, the Menningers of Topeka, Kansas, began administering Topeka State Hospital, which was in deplorable condition. By concentrating expenditures on clinical personnel, the Menningers humanely deinstitutionalized many patients before chlorpromazine, before the entitlement programs of the U.S. federal government such as Medicaid (1965), and before the community psychiatry movement got under way. Topeka State Hospital furnished a model of mental health care that centered a whole system on a last-resort, large, specialized state mental hospital. This inadvertent social experiment suggests that a clinical approach to mental health care offers a hard-headed alternative to present arrangements.
在20世纪后半叶，基于公共卫生模式的社区心理健康运动开始主导精神病患者的护理模式。在此过程中，至少在美国，对重症患者进行了残酷的非机构化处理。这些事件并非不可避免。1949年，堪萨斯州托皮卡的门宁格家族开始管理状况糟糕的托皮卡州立医院。通过将支出集中在临床人员身上，门宁格家族在美国联邦政府的医疗补助计划（1965年）等福利项目实施之前、在社区精神病学运动兴起之前，就以人道的方式使许多患者非机构化。托皮卡州立医院提供了一种心理健康护理模式，该模式将整个系统围绕着一家作为最后手段的大型专业州立精神病医院展开。这项无心插柳的社会实验表明，心理健康护理的临床方法为当前的安排提供了一种务实的替代方案。
