Oshima Iwao, Mino Yoshio, Inomata Yoshimasa
Department of Mental Health, Tokyo University Graduate School of Medicine, Tokyo, Japan.
Psychiatry Clin Neurosci. 2007 Feb;61(1):71-7. doi: 10.1111/j.1440-1819.2007.01613.x.
The mental health-care system in Japan remains hospital-based, and has the largest number of psychiatric beds per capita in the world. However, serious discussion about deinstitutionalization has recently begun. This study attempts to determine the proportion of inpatients that would benefit from community-based programs, as judged by hospital psychiatrists, and to evaluate the need for community resources for their community placement. Inpatients with schizophrenia from 139 hospitals were randomly selected. Data on the psychiatrists' judgment of discharge and required resources for community placement were obtained for 2758 subjects. Among the subjects, 1097 (39.8%) were judged to have the possibility of being discharged using community resources (possible discharge group; PDG). Provided that the proportion of PDG was 40%, controlling for the hospital background variables, the number of schizophrenia inpatients with a hospital stay of > or = 1 year who could be discharged from psychiatric hospitals in Japan was estimated to be 66,000. For the PDG, the required community resources, including accommodation, daytime activity, and daily living support services, were calculated. The numbers of governmental targets for community resources, including community accommodation, daytime activities, and daily living support services may have been underestimated.
日本的精神卫生保健系统仍然以医院为基础，且人均拥有的精神病床位数量位居世界第一。然而，最近关于非机构化的严肃讨论已经开始。本研究试图确定经医院精神科医生判断，能从社区项目中受益的住院患者比例，并评估将他们安置到社区所需的社区资源。从139家医院中随机选取了患有精神分裂症的住院患者。获取了2758名受试者的精神科医生关于出院判断及社区安置所需资源的数据。在这些受试者中，1097名（39.8%）被判定有可能利用社区资源出院（可能出院组；PDG）。假设PDG的比例为40%，在控制医院背景变量的情况下，估计在日本住院时间≥1年的精神分裂症住院患者中，能够从精神病医院出院的人数为66000人。对于PDG，计算了所需的社区资源，包括住宿、日间活动和日常生活支持服务。包括社区住宿、日间活动和日常生活支持服务在内的社区资源的政府目标数量可能被低估了。
