Mechanic D
Hosp Community Psychiatry. 1986 Sep;37(9):891-6. doi: 10.1176/ps.37.9.891.
The challenge of chronic mental illness lies in developing effective service delivery systems that will preserve patients' functioning and limit their disability. The author uses a review of changes and excesses of the past 30 years--including deinstitutionalization, relocation of patients to nursing homes, the domination of psychodynamic concepts, and the naivety and partial successes of the community mental health movement--as a basis for outlining manageable ways to meet this challenge. Care for the chronic patient must be developed within a long-term rehabilitative context and with wiser use of available benefits and funds, including consolidation of funding sources. Mental health advocates should coordinate activities rather than compete with one another, and case management should be based on more sophisticated concepts and training.
慢性精神疾病的挑战在于建立有效的服务提供系统，以维持患者的功能并限制其残疾程度。作者回顾了过去30年的变化与过度之处——包括非机构化、患者转至疗养院、心理动力学概念的主导地位，以及社区心理健康运动的幼稚和部分成功——以此为基础概述应对这一挑战的可行方法。对慢性病患者的护理必须在长期康复背景下开展，并更明智地利用现有福利和资金，包括整合资金来源。心理健康倡导者应协调活动而非相互竞争，病例管理应基于更完善的理念和培训。
