挪威的社区心理健康服务。

Community-based Mental Health Services in Norway.

作者信息

Ruud Torleif, Friis Svein

机构信息

Division of Mental Health Services, Akershus University Hospital.

Clinic of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo.

出版信息

Consort Psychiatr. 2021 Mar 20;2(1):47-54. doi: 10.17816/CP43.

Abstract

Community-based mental healthcare in Norway consists of local community mental health centres (CMHCs) collaborating with general practitioners and primary mental healthcare in the municipalities, and with psychiatrists and psychologists working in private practices. The CMHCs were developed from the 1980s to give a broad range of comprehensive mental health services in local catchment areas. The CMHCs have outpatient clinics, mobile teams, and inpatient wards. They serve the larger group of patients needing specialized mental healthcare, and they also collaborate with the hospital-based mental health services. Both CMHCs and hospitals are operated by 19 health trusts with public funding. Increasing resources in community-based mental healthcare was a major aim in a national plan for mental health between 1999 and 2008. The number of beds has decreased in CMHCs the last decade, while there has been an increase in mobile teams including crisis resolution teams (CRTs), early intervention teams for psychosis and assertive community treatment teams (ACT teams). Team-based care for mental health problems is also part of primary care, including care for patients with severe mental illnesses. Involuntary inpatient admissions mainly take place at hospitals, but CMHCs may continue such admissions and give community treatment orders for involuntary treatment in the community. The increasing specialization of mental health services are considered to have improved services. However, this may also have resulted in more fragmented services and less continuity of care from service providers whom the patients know and trust. This can be a particular problem for patients with severe mental illnesses. As the outcomes of routine mental health services are usually not measured, the effects of community-based mental care for the patients and their families, are mostly unknown.

摘要

挪威基于社区的精神卫生保健由当地社区精神卫生中心(CMHC)组成,这些中心与市政当局的全科医生和初级精神卫生保健机构合作,并与私人执业的精神科医生和心理学家合作。CMHC自20世纪80年代发展而来,旨在为当地服务区域提供广泛的综合精神卫生服务。CMHC设有门诊诊所、流动团队和住院病房。它们为大量需要专业精神卫生保健的患者提供服务,还与医院的精神卫生服务机构合作。CMHC和医院均由19个接受公共资金资助的健康信托机构运营。增加基于社区的精神卫生保健资源是1999年至2008年国家精神卫生计划的主要目标。在过去十年中,CMHC的床位数量有所减少,而流动团队的数量有所增加,包括危机解决团队(CRT)、精神病早期干预团队和积极社区治疗团队(ACT团队)。针对精神健康问题的团队式护理也是初级保健的一部分,包括对严重精神疾病患者的护理。非自愿住院主要在医院进行,但CMHC可以继续此类住院治疗,并下达社区治疗令以便在社区进行非自愿治疗。精神卫生服务专业化程度的提高被认为改善了服务。然而,这也可能导致服务更加分散,患者认识和信任的服务提供者提供的护理连续性降低。这对于严重精神疾病患者可能是一个特别的问题。由于常规精神卫生服务的结果通常未得到衡量,基于社区的精神护理对患者及其家庭的影响大多未知。

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