Stoffels H
Psych. Klinik der Medizinischen Hochschule Hannover.
Psychiatr Prax. 1988 May;15(3):90-5.
Domiciliary visiting and follow-up care of mentally ill patients is one of the foci of treatment-and-care activities of a mobile outpatient care unit working in social psychiatry. Its self-declared aim is to either avoid or to cut down inpatient treatment or reference to a psychiatric hospital or asylum, and thus to enable the patient to lead a life of greater freedom and fewer restrictions. 217 home visits by members of two psychiatric mobile outpatient care units were evaluated and analysed via a descriptive and differentiated questionnaire study. The analysis revealed that patients themselves had requested a visit in only 12.4% of the cases. This seems to be a characteristic feature of psychiatric care. Another striking factor is the mediation by a "third person", for in almost 40% of all the cases the initiative came from relatives, neighbours, the family doctor, the police, the welfare office, the landlord and others, showing how closely follow-up care is interlinked with the patient's social environment. The style of working of the psychiatric care unit is reflected by the varied participation of representatives of different professions in the home visiting service. It is also remarkable that in 31 patients (i.e. 18% of the home visits) the home visit established the first contact between therapist and patient. Whenever such an initial contact was accomplished, the home visit always had a triadic structure. It is a direct consequence of our study that the members of a mobile psychiatric care service should boldly tackle the problems of basic concepts regarding the position and status of the individual within the system of psychiatric and welfare care.
对精神病患者的上门访视及后续护理是社会精神病学领域流动门诊护理单位治疗与护理活动的重点之一。其宣称的目标是避免或减少住院治疗或转诊至精神病院或收容所，从而使患者能够过上更自由、限制更少的生活。通过一项描述性且有区分度的问卷调查研究，对两个精神病流动门诊护理单位成员进行的217次上门访视进行了评估与分析。分析显示，仅12.4%的案例是患者本人要求进行访视的。这似乎是精神病护理的一个特征。另一个显著因素是由“第三方”进行调解，因为在几乎40%的所有案例中，主动发起访视的是亲属、邻居、家庭医生、警察、福利办公室、房东及其他人，这表明后续护理与患者的社会环境联系有多紧密。不同职业代表在上门访视服务中的不同参与情况反映了精神病护理单位的工作方式。同样值得注意的是，在31名患者中（即上门访视案例的18%），上门访视是治疗师与患者之间的首次接触。每当达成这样的首次接触时，上门访视总是具有三方结构。我们的研究直接得出的结论是，流动精神病护理服务的成员应大胆应对精神病和福利护理系统中关于个体地位和身份的基本概念问题。
