Bülow Pia H, Finkel Deborah, Allgurin Monika, Torgé Cristina Joy, Jegermalm Magnus, Ernsth-Bravell Marie, Bülow Per
Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
Research Fellow in Department of Social Work, University of the Free State, Bloemfontein, South Africa.
Int J Ment Health Syst. 2022 Jul 13;16(1):35. doi: 10.1186/s13033-022-00544-9.
The concept of deinstitutionalization started in the 1960s in the US to describe closing down or reducing the number of beds in mental hospitals. The same process has been going on in many countries but with different names and in various forms. In Europe, countries like Italy prescribed by law an immediate ban on admitting patients to mental hospitals while in some other European countries psychiatric care was reorganized into a sectorized psychiatry characterized by open psychiatric care. This sectorization has not been studied to the same extent as the radical closures of mental hospitals, even though it entailed major changes in the organization of care. The deinstitutionalization in Sweden is connected to the sectorization of psychiatric care, a protracted process taking years to implement.
Older people, with their first admission to psychiatric care before or after the sectorization process, were followed using three different time metrics: (a) year of first entry into a mental hospital, (b) total years of institutionalization, and (c) changes resulting from aging. Data from surveys in 1996, 2001, 2006, and 2011 were used, together with National registers.
Examination of date of first institutionalization and length of stay indicates a clear break in 1985, the year when the sectorization was completed in the studied municipality. The results show that the two groups, despite belonging to the same age group (birthyears 1910-1951, mean birthyear 1937), represented two different patient generations. The pre-sectorization group was institutionalized at an earlier age and accumulated more time in institutions than the post-sectorization group. Compared to the post-sectorization group, the pre-sectorization group were found to be disadvantaged in that their level of functioning was lower, and they had more unmet needs, even when diagnosis was taken into account.
Sectorization is an important divide which explains differences in two groups of the same age but with different institutional history: "modern" and "traditional" patient generations that received radically different types of care. The results indicate that the sectorization of psychiatric care might be as important as the Mental Health Care Reform of 1995, although a relatively quiet revolution.
去机构化的概念始于20世纪60年代的美国，用于描述关闭精神病院或减少其床位数量。许多国家都在进行同样的过程，但名称不同，形式各异。在欧洲，像意大利这样的国家依法立即禁止收治患者进入精神病院，而在其他一些欧洲国家，精神科护理被重新组织成以开放式精神科护理为特征的分区精神病学。尽管这种分区涉及护理组织的重大变化，但对其研究的程度不如对精神病院的彻底关闭。瑞典的去机构化与精神科护理的分区有关，这是一个需要数年时间实施的漫长过程。
对在分区过程之前或之后首次接受精神科护理的老年人，使用三种不同的时间指标进行跟踪：（a）首次进入精神病院的年份，（b）住院总年数，以及（c）因衰老导致的变化。使用了1996年、2001年、2006年和2011年的调查数据以及国家登记册。
对首次住院日期和住院时间的检查表明，1985年有明显的变化，这一年在所研究的市镇分区完成。结果表明，尽管两组属于同一年龄组（出生年份为1910 - 1951年，平均出生年份为1937年），但代表了两代不同的患者。分区前的组住院年龄更早，在机构中积累的时间比分区后的组更多。与分区后的组相比，分区前的组在功能水平较低且未满足的需求更多方面处于劣势，即使考虑到诊断也是如此。
分区是一个重要的分水岭，它解释了同一年龄但有不同住院历史的两组之间的差异：接受了截然不同类型护理的“现代”和“传统”患者代际。结果表明，精神科护理的分区可能与1995年的精神卫生保健改革同样重要，尽管这是一场相对平静的革命。
