Taylor Tatiana L, Killaspy Helen, Wright Christine, Turton Penny, White Sarah, Kallert Thomas W, Schuster Mirjam, Cervilla Jorge A, Brangier Paulette, Raboch Jiri, Kalisová Lucie, Onchev Georgi, Dimitrov Hristo, Mezzina Roberto, Wolf Kinou, Wiersma Durk, Visser Ellen, Kiejna Andrzej, Piotrowski Patryk, Ploumpidis Dimitri, Gonidakis Fragiskos, Caldas-de-Almeida José, Cardoso Graça, King Michael B
Research Department of Mental Health Sciences, UCL Medical School, London, UK.
BMC Psychiatry. 2009 Sep 7;9:55. doi: 10.1186/1471-244X-9-55.
A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components.
We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery.
We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation).
Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.
一部分有心理健康问题的人需要在精神病院或社会护理机构接受长期护理。然而，目前尚无国际公认的机构护理质量标准，也没有评估各国通用护理标准的方法。我们旨在确定针对有长期心理健康问题的人的机构护理的关键组成部分及其有效性。
我们使用全面的检索词对11个电子数据库中的文献进行了系统综述，共识别出12182个标题。我们查看了550篇摘要，审阅了223篇论文，其中110篇被纳入。通过对证据进行“批判性解释性综合分析”，以确定对服务使用者康复至关重要的机构护理领域。
我们确定了对服务使用者康复至关重要的八个机构护理领域：生活条件；精神分裂症干预措施；身体健康；约束和隔离；工作人员培训与支持；治疗关系；自主权和服务使用者参与度；以及临床治理。关于精神分裂症特定治疗干预措施（家庭心理教育、认知行为疗法（CBT）和职业康复）的证据最为充分。
理想情况下，机构应基于社区，实行灵活的管理制度，保持较低的居民密度，并最大限度地保障居民隐私。对于被诊断患有精神分裂症的服务使用者，应通过综合方案提供特定干预措施（CBT、涉及心理教育的家庭干预措施和支持性就业）。应尽可能避免约束和隔离，工作人员应接受足够的降级技术培训。应定期对工作人员进行监督，这应支持服务使用者参与决策以及工作人员与服务使用者之间建立积极的治疗关系。应有明确的临床治理线路，以确保遵循循证指南，并应通过定期筛查关注服务使用者的身体健康。
