Alakeson Vidhya
Office of the Assistant Secretary, Department of Health and Human Services, Washington, DC 20201, USA.
Psychiatr Serv. 2008 Jul;59(7):792-4. doi: 10.1176/ps.2008.59.7.792.
The President's New Freedom Commission on Mental Health identified self-directed care as one service innovation that could create a more consumer- and family oriented mental health system. Four years later, there are still fewer than 400 consumers in five states accessing self-directed care in the public mental health system. This Open Forum identifies three main barriers to explain this lack of progress: the absence of a strong evidence base to support the effectiveness of self-directed care for serious mental illness, uncertainty over the appropriate scope of self-directed care, and the absence of a sustainable source of funding. The introduction of the 1915(i) provision of the Social Security Act in 2007 appears to partly address the funding barrier to self-directed care. There is also a strong case for a large-scale evaluation of self-directed care for persons with serious mental illness to address the two remaining barriers to progress.
总统心理健康新自由委员会将自主式照护确定为一项服务创新举措，有望打造一个更以消费者和家庭为导向的心理健康系统。四年后，五个州仍仅有不到400名消费者在公共心理健康系统中接受自主式照护。本次公开论坛确定了导致这一进展不足的三个主要障碍：缺乏有力的证据基础来支持自主式照护对严重精神疾病的有效性、自主式照护适当范围的不确定性，以及缺乏可持续的资金来源。2007年引入的《社会保障法》第1915(i)条规定似乎部分解决了自主式照护的资金障碍。此外，有充分理由对严重精神疾病患者的自主式照护进行大规模评估，以解决其余两个阻碍进展的障碍。
