Lefley H P
Department of Psychiatry, University of Miami School of Medicine, Florida 33101.
Psychiatr Q. 1988 Summer;59(2):121-39. doi: 10.1007/BF01065101.
In sociocultural perspective, this paper traces the impact of deinstitutionalization and the community mental health movement on the mental health service delivery system and subsequent effects on psychiatric training. Examples are given of changes at the national, state, and local levels. The current need is for new initiatives to interest residents in public sector psychiatry and in work with the chronic patient. Issues discussed include new conceptions of the parameters and roles of psychiatric treatment, involvement of families and other support groups in patient care, comprehension and applications of cultural values, and new functions of the state hospital in the continuum of care as locus of specialized services and of professional training and research.
从社会文化角度来看，本文追溯了去机构化和社区心理健康运动对心理健康服务提供系统的影响以及对精神科培训的后续影响。文中给出了国家、州和地方层面变化的实例。当前需要新的举措来吸引住院医师投身公共部门精神病学领域以及与慢性病患者打交道的工作。讨论的问题包括精神病治疗的参数和角色的新观念、家庭及其他支持团体参与患者护理、文化价值观的理解与应用，以及州立医院在连续护理中作为专业服务、专业培训和研究场所的新功能。
