Bulyáki Tünde, Wernigg Robert, Kéri Péter, Ács Andrea, Slezák Adrienn, Bodrogi Andrea, Harangozó Judit
Consort Psychiatr. 2024 Mar 26;5(1):49-56. doi: 10.17816/CP15483. eCollection 2024.
Psychiatric care has undergone several cycles of profound changes in the past centuries all over the world. In Hungary, community-based outpatient care has been showing signs of evolution since the 1950s. Initially, the system centered on assertive outreach and family involvement, especially for those with serious mental health problems. Such services remain available throughout the country, but the emphasis in the past decades has shifted towards mass care provision. In many places, community-based services are no longer provided, and where they are the approach is biomedical and less asuming of recovery. In other centers, the services provided are conceived with the eventuality of rehabilitation in mind and in close cooperation with community-based care providers. Community-based services providers, as part of the social fabric, offer as many psychiatric and rehabilitation services as possible for those with mental disorders within their communities. The main objective of community-based care is to achieve community re-integration and recovery from mental disorders. Today in Hungary, deinstitutionalisation and the introduction of community-based psychiatric care have been adopted even by large inpatient institutions. The replacement of institutional bed space and the provision of subsidised housing further underscore the importance of community-based psychiatric care provision. There is the opinion that, as a further course of development, the emphasis needs to now shift towards the nurturing of a community of experienced experts and creastion of user-led programs. In this new paradigm, the ability of a person with a mental disorder to make decisions and the bolstering of that ability are seen as vital. In order to achieve these objectives, it is essential that health and social seervices professionals cooperate. Hands-on experience is key in the provision and development of such services.
在过去几个世纪里，全球精神科护理经历了几个深刻变革的周期。在匈牙利，自20世纪50年代以来，社区门诊护理就已呈现出发展迹象。最初，该体系以积极外展和家庭参与为核心，尤其针对那些有严重心理健康问题的人。这类服务在全国范围内仍然可用，但在过去几十年里，重点已转向大规模护理服务的提供。在许多地方，不再提供社区服务，而在仍提供社区服务的地方，采用的是生物医学方法，对康复的期望较低。在其他中心，所提供的服务是在考虑到康复可能性的情况下构思的，并与社区护理提供者密切合作。作为社会结构的一部分，社区服务提供者为其社区内患有精神障碍的人提供尽可能多的精神科和康复服务。社区护理的主要目标是实现社区重新融入和从精神障碍中康复。如今在匈牙利，即使是大型住院机构也采用了去机构化和引入社区精神科护理的做法。机构床位的替代和补贴住房的提供进一步凸显了提供社区精神科护理的重要性。有一种观点认为，作为进一步的发展方向，现在需要将重点转向培养经验丰富的专家群体和创建用户主导的项目。在这种新范式中，患有精神障碍的人的决策能力以及对这种能力的增强被视为至关重要。为了实现这些目标，卫生和社会服务专业人员的合作至关重要。实践经验是提供和发展此类服务的关键。
