Chanoit P F
Institut Marcel Rivière.
Ann Med Psychol (Paris). 1988 May;146(5):405-19.
Changes in psychiatric practices derive from noticeable revision of conceptual framework and from the presence of different resources available to treat mental health problems. After an absolute priority given to the psychiatric hospital which in hand of an able doctor like Esquirol was certainly a splendid instrument of care, has followed the "Sector concept" (catchment area) which ideally insists on preventive and therapeutic measures directed toward the sick or presumably sick individual. But such evolutions are seldom linear and vicious genius tends to slow if not to reverse the process. The author retraces here the evolution of a psychiatric care system managed by himself for 25 years. Originally created by Sivadon in the context of relative freedom due to appurtenance to the private sector, this experience has been developed through addition of a variety of therapeutic structures to end up with a comprehensive System of social psychiatric deserving a catchment area. The author gives us his insights on the slowly made modifications to the functioning of this structure. He confirms the value of the catchment area framework but in the same time underlines his risks.
精神病学实践的变化源于概念框架的显著修订以及可用于治疗心理健康问题的不同资源的存在。在将绝对优先权赋予精神病院之后（在像埃斯基罗尔这样能干的医生手中，精神病院无疑是一种出色的护理工具），随之而来的是“区域概念”（服务范围），它理想地坚持针对患病或可能患病个体的预防和治疗措施。但这种演变很少是线性的，邪恶的天才往往会减缓甚至逆转这一进程。作者在此回顾了由他自己管理了25年的精神病护理系统的演变。最初由西瓦东在因属于私营部门而具有相对自由的背景下创建，这一经验通过增加各种治疗结构得以发展，最终形成了一个全面的社会精神病学体系，其服务范围涵盖一定区域。作者向我们阐述了对该结构运作进行的缓慢变革的见解。他肯定了服务范围框架的价值，但同时也强调了其风险。
