Brown P
Soc Sci Med. 1982;16(23):2025-39. doi: 10.1016/0277-9536(82)90159-9.
Recent changes in mental health policy and treatment have largely been attributed to a professional concern for patients' rights. This view is challenged by patients' rights organizations and their allies, such as legal advocacy groups. These parties argue that psychiatric planners and providers are trying to coopt a popular movement and to use patients' rights as a convenient explanation for the mental health system's limited self-reform and fiscal limitations. A key issue here is the gap between planned policy and implemented practice. Patients' rights activists maintain that rights are only very sparsely implemented, while the mental health system believes that it has progressed quite far. A study of patients' rights attitudes held by the various involved forces can illuminate the conflicts in patients' rights policy and provide understanding of the potential for resolving these conflicts. Such an analysis also touches on some general themes concerning the relationships between health providers and social movements in the health field. This paper examines attitudes towards mental patients' rights on the part of mental patients rights groups, state departments of mental health, state hospitals and statewide mental health associations. One hypothesis was borne out: that patients' rights groups do not believe as much as does the mental health establishment that concern for patients' rights has played a large role in mental health policy. Further, the activist groups are more favorable than are the other respondents to abolition or sharp curtailment of intrusive psychiatric treatments. And, mental health officials and their lay supporters are less prone to accept patients' rights groups' initiative in reform efforts. The second main hypothesis, that the mental health establishment would be more antagonistic to patients' rights in states where patients rights groups existed, was not supported. One possible explanation for this is that patients' rights groups have had a nationwide impact, and that mental health officials face common problems throughout the country. Alternatively, or in conjunction, an antecedent variable of political liberalism may operate in some states, creating both activist groups and more liberal psychiatric professionals. The significance of these findings is discussed and suggestions are offered for future research in this area.
近期心理健康政策和治疗方面的变化很大程度上归因于专业人士对患者权利的关注。这种观点受到了患者权利组织及其盟友（如法律倡导团体）的挑战。这些团体认为，精神病规划者和提供者试图拉拢一场民众运动，并将患者权利作为心理健康系统有限的自我改革和财政限制的便利托词。这里的一个关键问题是计划政策与实际实施之间的差距。患者权利活动家认为权利的实施非常稀少，而心理健康系统则认为自己已经取得了很大进展。对各相关力量所持的患者权利态度进行研究，可以阐明患者权利政策中的冲突，并有助于理解解决这些冲突的可能性。这样的分析还涉及到一些关于医疗服务提供者与健康领域社会运动之间关系的一般主题。本文考察了精神病患者权利团体、州心理健康部门、州立医院和全州心理健康协会对精神病患者权利的态度。一个假设得到了证实：患者权利团体不像心理健康机构那样认为对患者权利的关注在心理健康政策中发挥了很大作用。此外，与其他受访者相比，激进团体更倾向于废除或大幅缩减侵入性的精神病治疗方法。而且，心理健康官员及其外行支持者不太愿意接受患者权利团体在改革努力中的倡议。第二个主要假设，即心理健康机构在存在患者权利团体活动的州会更反对患者权利，没有得到支持。对此的一种可能解释是，患者权利团体在全国范围内产生了影响，而且心理健康官员在全国各地面临共同的问题。或者，也可能同时存在一个先行变量，即政治自由主义在一些州发挥作用，催生了激进团体和更开明的精神病学专业人员。本文讨论了这些研究结果的意义，并为该领域未来的研究提出了建议。
