Rössler W, Drake R E
Psychiatric University Hospital,Zürich University,Zürich,Switzerland.
Dartmouth Psychiatric Research Center,The Geisel School of Medicine at Dartmouth,Lebanon,New Hampshire,USA.
Epidemiol Psychiatr Sci. 2017 Jan 19;26(3):1-7. doi: 10.1017/S2045796016000858.
To describe the core elements of modern psychiatric rehabilitation. Based on selected examples we describe the discussion about values in mental health care with focus on Europe. We present outcome data from studies, which have tried to implement care structures based on this value discussion. In the second half of the 20th century, mental health care in all European and other high-income countries changed conceptually and structurally. Deinstitutionalisation reduced the number of psychiatric beds and transferred priority to outpatient care and community-based services, but community mental health programs developed differently across and within these countries. High-income countries in Europe continued to invest in costly traditional services that were neither evidence-based nor person-centered by emphasising inpatient services, sheltered group homes and sheltered workshops. We argue that evidence-based, person-centred, recovery-oriented psychiatric rehabilitation offers a parsimonious solution to developing a consensus plan for community-based care in Europe. The challenges to scaling up effective psychiatric rehabilitation services in high-income countries are not primarily a lack of resources, but rather a lack of political will and inefficient use and dysfunctional allocation of resources.
描述现代精神科康复的核心要素。基于选定的示例，我们描述了以欧洲为重点的精神卫生保健中的价值观讨论。我们展示了一些研究的结果数据，这些研究试图基于这种价值观讨论来实施护理结构。在20世纪下半叶，所有欧洲国家和其他高收入国家的精神卫生保健在概念和结构上都发生了变化。去机构化减少了精神病床位数量，并将重点转移到门诊护理和社区服务上，但这些国家之间以及国家内部的社区精神卫生项目发展情况各不相同。欧洲的高收入国家继续投资于既无循证依据又非以人为本的昂贵传统服务，重点是住院服务、庇护性集体之家和庇护性工场。我们认为，循证、以人为本、以康复为导向的精神科康复为制定欧洲社区护理共识计划提供了一个简洁的解决方案。在高收入国家扩大有效的精神科康复服务面临的挑战，主要不是缺乏资源，而是缺乏政治意愿以及资源利用效率低下和分配不当。
