Toib Josef Assaf
Cardozo School of Law, Yeshiva University, New York, NY, USA.
Isr J Psychiatry Relat Sci. 2006;43(3):198-206; discussion 206-8.
There are two major forces currently impinging on Israeli Mental Health Law in the civil field. One derives from the shift in public funding for Mental Health. The other is driven by the conviction that neither patient rights nor public needs are well served by current arrangements. The challenge for the next decade is how to respond constructively to these somewhat different, yet coalescing demands. The U.S. was subject to the same pressures and adopted "deinstitutionalization." Its practice fell far short of its promise, and in turn prompted other innovations to be adopted, principally Assertive Community Treatment and Assisted Outpatient Treatment. For these to focus on the correct population new risk assessment techniques were required and an actuarial approach was adopted. When this experience is applied to the Israeli context, three main elements emerge as necessary for a successful response to the challenges of the decade: (i) an effective mechanism for risk assessment in mental health, (ii) substantially expanded research and professional training infrastructure in forensic mental health, and (iii) changes in the attitude towards the mentally ill and their treatment.
目前在民事领域有两大力量冲击着以色列精神卫生法。一是精神卫生公共资金的转移。另一个则源于一种信念,即当前的安排既未充分保障患者权利,也未满足公众需求。未来十年面临的挑战是如何建设性地应对这些虽有所不同但相互汇聚的需求。美国也曾面临同样的压力并采取了“去机构化”。其实际效果远未达到预期,进而促使人们采用其他创新举措,主要是积极社区治疗和辅助门诊治疗。为了使这些举措针对正确的人群,需要新的风险评估技术,并采用了精算方法。将这一经验应用于以色列的情况时,成功应对这十年挑战所需的三个主要要素便显现出来:(i) 精神卫生方面有效的风险评估机制,(ii) 大幅扩充法医精神卫生方面的研究和专业培训基础设施,以及(iii) 改变对精神病患者及其治疗的态度。