Brooker C
Department of Nursing, University of Manchester, England.
J Adv Nurs. 1990 Sep;15(9):1092-8. doi: 10.1111/j.1365-2648.1990.tb01991.x.
Community care policies for the mentally ill rely, to a large extent, on the informal contribution that often seems to be made willingly by families. In financial terms alone, it has been calculated by the British Government that families caring for a relative with schizophrenia at home save the country 25 billion pounds a year. Nearly 15 years ago, it was argued that community mental health services were failing to monitor the relationships in homes where this situation prevailed and provide the support mechanisms that were required. Further, it has been noted that when there is an over-emphasis on community care, family crises can become severe and remain undetected. This paper reviews the literature relating to the needs of families caring for a schizophrenic relative at home. It concludes that a major service that should be offered to families is education about the illness, schizophrenia, itself. Strategies for undertaking this role are examined within the overall context of 'psychosocial interventions' and the literature on 'high expressed emotion'. Finally, an experimental course, funded by the Department of Health, and located in the Department of Nursing at Manchester University, is described. Here, community psychiatric nurses are being taught to recognize the value of health education for those living with a schizophrenic relative. As a consequence, a number of valuable initiatives have been developed and these are briefly outlined.
针对精神病患者的社区护理政策在很大程度上依赖于家庭的非正式贡献，而这种贡献似乎往往是家庭自愿做出的。仅从经济角度计算，英国政府得出结论，在家照顾精神分裂症亲属的家庭每年为国家节省250亿英镑。近15年前，有人认为社区精神卫生服务未能监测这种情况普遍存在的家庭中的关系，也未能提供所需的支持机制。此外，有人指出，当过度强调社区护理时，家庭危机可能会变得严重且未被察觉。本文回顾了有关在家照顾精神分裂症亲属的家庭需求的文献。结论是，应该向家庭提供的一项主要服务是关于精神分裂症这种疾病本身的教育。在“心理社会干预”的整体背景以及关于“高情感表达”的文献中，探讨了承担这一角色的策略。最后，描述了一门由卫生部资助、设在曼彻斯特大学护理系的实验课程。在这里，社区精神科护士正在学习认识到对与精神分裂症亲属共同生活的人进行健康教育的价值。因此，已经制定了一些有价值的举措，并在此简要概述。
