Burns Tom
Department of Psychiatry, University of Oxford, Warneford Hospital.
Consort Psychiatr. 2020 Dec 4;1(2):14-20. doi: 10.17650/2712-7672-2020-1-2-14-20.
Community mental health care in the UK was established by two influential mental health acts (MHAs). The 1930 MHA legislated for voluntary admissions and outpatient clinics. The 1959 MHA required hospitals to provide local follow- up after discharge, required them to work closely with local social services and obliged social services to help with accommodation and support. An effect of this was to establish highly sectorized services for populations of about 50,000. These were served by multidisciplinary teams (generic CMHTs), which accepted all local referrals from family doctors. Sector CMHTs evolved a pragmatic approach with an emphasis on skill-sharing and outreach, depending heavily on community psychiatric nurses. The NHS is funded by central taxation, with no distortion of clinical practice by per-item service fees. It is highly centrally regulated, with a strong emphasis on evidence-based treatments. Since 2000, generic sector teams have gradually been replaced or enhanced by Crisis Resolution Home Treatment teams, Assertive Outreach Teams and Early Intervention Teams. Assertive Outreach Teams were resorbed into CMHTs, based on outcome evidence. The last decade has seen a major expansion in outpatient psychotherapy (Improving Access to Psychological Treatments (IAPT) services) and in specialist teams for personality disorders and perinatal psychiatry. The traditional continuity of care across the inpatient-outpatient divide has recently been broken. During the last decade of austerity, day care services have been decimated, and (along with the reduction in availability of beds) compulsory admission rates have risen sharply. Mental health care is still disadvantaged, receiving 11% of the NHS spend while accounting for 23% of the burden of disease.
英国的社区精神卫生保健是由两部有影响力的精神卫生法案（MHA）确立的。1930年的《精神卫生法案》规定了自愿入院和门诊诊所事宜。1959年的《精神卫生法案》要求医院在患者出院后提供当地随访服务，要求它们与当地社会服务部门密切合作，并责成社会服务部门协助提供住宿和支持。此举的一个结果是为约5万人的群体建立了高度部门化的服务。这些服务由多学科团队（普通社区精神卫生团队）提供，该团队接受家庭医生的所有当地转诊。部门社区精神卫生团队形成了一种务实的方法，强调技能共享和外展服务，严重依赖社区精神科护士。英国国家医疗服务体系（NHS）由中央税收提供资金，单项服务费不会扭曲临床实践。它受到高度的中央监管，非常强调循证治疗。自2000年以来，普通部门团队逐渐被危机解决家庭治疗团队、积极外展团队和早期干预团队所取代或加强。基于结果证据，积极外展团队被并入社区精神卫生团队。过去十年见证了门诊心理治疗（改善心理治疗可及性（IAPT）服务）以及人格障碍和围产期精神病专科团队的大幅扩张。住院与门诊之间传统的连续护理最近被打破。在过去十年的紧缩时期，日间护理服务大幅减少，并且（随着床位可用性的降低）强制住院率急剧上升。精神卫生保健仍然处于劣势，在占国民健康服务支出11%的情况下，却承担了23%的疾病负担。
