Spanish National Research Council, Centre for Human and Social Sciences (CSIC), C/Albasanz 26-28, 28037, Madrid, Spain.
Health Care Anal. 2010 Sep;18(3):222-38. doi: 10.1007/s10728-009-0138-8.
This paper offers a panoramic assessment of the significant changes experienced by psychiatric care in Western Europe and North America in the course of the last decades of deinstitutionalization and reform. Drawing on different comparative studies and an own review of relevant data and reports, the main transformations in the mental health field are analyzed around seven major topics: the expanding scope of psychiatry; the decline and metamorphosis of the asylum; the introduction of alternative and diversified forms of care; the new challenges posed by chronic mental illness; the emergence of modern psychopharmacology; the deployment of subspecialization; and the new forms of coercion implemented with community mental health practices. Following a renewed diagnosis on the essential features of the reformed mental health systems based on the pattern of social inclusion inherent to the new devices and philosophies of care, some major challenges for the future such as the overburdening of services or the overt exclusion of a significant part of potential users are also identified and briefly discussed.
本文全景式评估了过去几十年去机构化和改革过程中，西欧和北美精神病学护理所经历的重大变化。本文借鉴了不同的比较研究以及对相关数据和报告的自主审查，围绕以下七个主要议题分析了精神卫生领域的主要转变：精神病学范围的扩大；庇护所的衰落和蜕变；替代和多样化护理形式的引入；慢性精神疾病带来的新挑战；现代精神药理学的出现；专科化的部署；以及随着社区精神卫生实践而实施的新形式的强制手段。在根据新的护理手段和理念所固有的社会包容模式，对改革后的精神卫生系统的基本特征进行重新诊断后，本文还确定并简要讨论了未来的一些重大挑战，例如服务负担过重或明显排斥一大部分潜在使用者。
