为慢性精神病患者提供的社区居住选择。
Community residential options for the chronically mentally ill.
作者信息
Cutler D L
出版信息
Community Ment Health J. 1986 Spring;22(1):61-73. doi: 10.1007/BF00752884.
We have discussed the problems of the new young chronic patients, deinstitutionalized old chronic patients now living in the community, and some of the groups of hard to place patients. We have talked about problems with community barriers, staff training, a spectrum of facilities, and we have looked at what new sorts of facilities may need to be developed. It seems clear that we have not yet developed a spectrum which can deal with all varieties of the chronically mentally ill. Pepper (1985) has suggested a different, more ideal spectrum of housing particularly suited to the young adult chronic patient. These include crisis residences, supervised 14-bed residences, growth house for 14 beds; support house for 14 beds; supervised apartments (satellite apartments), 14 beds; supportive apartments, 14 beds; (these have less intensive staffing than supervised ones); open community living; and residential congregate care for adults (RCCAs). These RCCAs are large facilities located either in old state hospitals or nursing homes which are primarily oriented towards the homeless mentally ill. According to Pepper, if a program can plan a spectrum of housing situations in the immediate catchment area, it can then actually meet the specific needs of each patient with a specific sort of residential facility. The challenge for community residences is certainly much greater than a decade ago and, with the homeless mentally ill population continuing to grow (Bachrach, 1985), one might be tempted to regard our present situation as one of crisis proportions. Clearly, there is little doubt that a need exists for a wide spectrum of living situations to be made available to the deinstitutionalized or never institutionalized young adult chronic patient. Yet very few incentives exist for those who would try to meet this challenge. To do this effectively will undoubtedly require the development of sizeable amounts of public funding through existing and new channels to provide support for a variety of new types of community living arrangements with varying degrees of structure and treatment. There is also a great need for continued educating of the community about the realities of treating chronic mental patients in tailored facilities who must be protected from harming themselves or others. Finally, we in the field need better continuing education for ourselves and for those staff working in the residential area. Most of us don't ever learn about how to operate outside of our offices.(ABSTRACT TRUNCATED AT 400 WORDS)
我们已经讨论了新的年轻慢性病患者、现在居住在社区的非机构化老年慢性病患者以及一些难以安置的患者群体所面临的问题。我们谈到了社区障碍、工作人员培训、一系列设施方面的问题,并且探讨了可能需要开发哪些新类型的设施。显然,我们尚未建立起一个能应对各类慢性精神病患者的体系。佩珀(1985年)提出了一种不同的、更理想的住房体系,特别适合年轻成年慢性病患者。这些包括危机住所、有14个床位的受监管住所、14个床位的成长之家;14个床位的支持性住所;14个床位的受监管公寓(卫星公寓);14个床位的支持性公寓(这些公寓的人员配备不如受监管的公寓密集);开放式社区生活;以及成人居住集体照料机构(RCCA)。这些RCCA是位于旧的州立医院或养老院的大型设施,主要面向无家可归的精神病患者。根据佩珀的说法,如果一个项目能够在直接服务区域规划一系列住房情况,那么它实际上就能用特定类型的居住设施满足每个患者的具体需求。社区住所面临的挑战肯定比十年前大得多,而且随着无家可归的精神病患者数量持续增加(巴赫拉赫,1985年),人们可能会倾向于认为我们目前的情况处于危机状态。显然,毫无疑问,需要为非机构化或从未机构化的年轻成年慢性病患者提供广泛的居住选择。然而,对于那些试图迎接这一挑战的人来说,几乎没有什么激励措施。要有效地做到这一点,无疑需要通过现有和新的渠道筹集大量公共资金,以支持各种具有不同程度结构和治疗的新型社区生活安排。还非常需要继续向社区宣传在量身定制的设施中治疗慢性精神病患者的实际情况,这些患者必须受到保护以免伤害自己或他人。最后,我们这个领域的人需要为自己以及居住区域的工作人员提供更好的继续教育。我们大多数人从未学习过如何在办公室之外开展工作。(摘要截断于400字)