Ravelli Dick P
Rivierduinen, Institute for mental health, P.O. Box 405, 2300 AK Leiden, The Netherlands.
Int J Integr Care. 2006;6:e04. doi: 10.5334/ijic.146. Epub 2006 Mar 15.
The objective of this policy paper is to put recent developments in Dutch mental health reform in an international perspective and draw conclusions for future directions in policy. CONTEXT OF THE CASE: The practice of Western psychiatry in the second half and particularly in the last decade of the 20th century has fundamentally changed. Dutch psychiatry has traditionally been prominently bed-based and various policies in the last ten years have been intended to reduce the influence of the mental hospitals. Until the mid-1990s, this had not resulted in reducing the psychiatric bed rate in comparison to other countries. Since then, there have been rapid, dramatic changes.
We summarised two recent national studies on this subject and placed them in a national and international context, using documents on psychiatric reforms, government and advisory board reports and reviews on deinstitutionalisation in different countries.
The practice of psychiatry in the second half, and particularly in the last decade, of the 20th century has fundamentally changed. This has resulted in a spectacular decline in the number of beds in mental hospitals, increased admissions, decreased length of stay, closure of the large asylums and in community treatment away from asylums and in society, although this is a reform process. This article examines how the Dutch mental health care system has developed at the national level. The main topics cover the size, nature, aims and effects of the process of deinstitutionalisation and how alternative facilities have been developed to replace the old-fashioned institutes.
There are two contrasting aspects of deinstitutionalisation in Dutch mental health care: the tendency towards rehospitalisation in relation to the sudden, late, but rapid reduction of the old mental hospitals and their premises; and a relatively large scale for community-based psychiatry in relation to building mental health care centres. Compared to other countries the bed rate in The Netherlands is still among the highest, although it is rapidly decreasing. Lessons from psychiatric reform in other countries emphasise the counterpart of deinstitutionalisation, especially issues such as the quality of alternative community treatment and increasing compulsory admission, while the closing down of old mental hospitals has caused a decrease in the availability of beds. In The Netherlands less attention has been paid to legislation, societal attitudes towards psychiatry, the roles of other care suppliers, the balancing and financing of care, the fate of psychiatric patients from old hospitals, the way to cope with the ever-increasing demand for psychiatric help and the actual quality of psychiatric help. A more integrative policy that includes all these aspects is desirable.
本政策文件的目标是从国际视角审视荷兰心理健康改革的最新进展，并为未来政策方向得出结论。
20世纪后半叶，尤其是最后十年，西方精神病学实践发生了根本性变化。荷兰精神病学传统上主要以住院治疗为主，过去十年的各项政策旨在减少精神病院的影响。直到20世纪90年代中期，与其他国家相比，这并未导致精神病床位率下降。从那时起，出现了迅速而巨大的变化。
我们总结了最近两项关于该主题的全国性研究，并将其置于国内和国际背景下，参考了精神病学改革文件、政府和咨询委员会报告以及不同国家去机构化的综述。
20世纪后半叶，尤其是最后十年，精神病学实践发生了根本性变化。这导致精神病院床位数量大幅下降、入院人数增加、住院时间缩短、大型精神病院关闭，以及从精神病院转向社区治疗并融入社会，尽管这是一个改革过程。本文探讨了荷兰心理健康护理系统在国家层面是如何发展的。主要主题包括去机构化过程的规模、性质、目标和影响，以及如何发展替代设施来取代老式机构。
荷兰心理健康护理中的去机构化有两个截然不同的方面：与旧精神病院及其设施突然、后期但迅速减少相关的重新住院趋势；以及与建设心理健康护理中心相关的相对大规模的社区精神病学。与其他国家相比，荷兰的床位率仍然是最高的之一，尽管它正在迅速下降。其他国家精神病学改革的经验教训强调了去机构化的对应方面，特别是替代社区治疗的质量和强制入院增加等问题，而旧精神病院的关闭导致了床位供应减少。在荷兰，对立法、社会对精神病学的态度、其他护理提供者的作用、护理的平衡和融资、旧医院精神病患者的命运、应对不断增长的精神病帮助需求的方式以及精神病帮助的实际质量关注较少。需要一项更综合的政策来涵盖所有这些方面。
