Hewitt J L
Centre for Mental Health Studies, University of Wales Swansea, Singleton Park, Swansea, South Wales, UK.
J Psychiatr Ment Health Nurs. 2008 Apr;15(3):186-94. doi: 10.1111/j.1365-2850.2007.01188.x.
Mental health policy development in the UK has become increasingly dominated by the assumed need to prevent violence and alleviate public concerns about the dangers of the mentally ill living in the community. Risk management has become the expected focus of contemporary mental health services, and responsibility has increasingly been devolved to individual service professionals when systems fail to prevent violence. This paper analyses the development of mental health legislation and its impact on services users and mental health professionals at the micro level of service delivery. Historical precedence, media influence and public opinion are explored, and the reification of risk is questioned in practical and ethical terms. The government's newest proposals for compulsory treatment in the community are discussed in terms of practical efficacy and therapeutic impact. Dangerousness is far from being an objectively observable phenomenon arising from clinical pathology, but is a formulation of what is partially knowable through social analysis and unknowable by virtue of its situation in individual psychic motivation. Risk assessment can therefore never be completely accurate, and the solution of a 'better safe than sorry' approach to mental health policy is ethically and pragmatically flawed.
英国心理健康政策的制定越来越受到一种假定需求的主导，即预防暴力行为并减轻公众对社区中患有精神疾病者危险性的担忧。风险管理已成为当代心理健康服务预期的重点，当系统未能预防暴力行为时，责任越来越多地被下放给个体服务专业人员。本文分析了心理健康立法的发展及其在服务提供微观层面上对服务使用者和心理健康专业人员的影响。探讨了历史先例、媒体影响和公众舆论，并从实际和伦理角度对风险的具体化提出了质疑。从实际效果和治疗影响方面讨论了政府关于社区强制治疗的最新提议。危险性远非临床病理学产生的客观可观察现象，而是一种通过社会分析部分可知、因其在个体心理动机中的情况而不可知的表述。因此，风险评估永远不可能完全准确，“宁可错杀一千，不可放过一个”的心理健康政策解决方案在伦理和实际操作上都存在缺陷。
