Rutz W
Int J Rehabil Res. 1983 Mar;6(1):29-42.
In recent years discussions about the development of psychiatric care internationally and in Scandinavia have been focused on principles of opening and sectorizing, sometimes at the cost of existing differentiated and effective psychiatric in-patient care-programs. During the last 6 years a process of strengthening and opening psychiatric care was started on the Swedish island of Gotland (55 000 inhabitants), based on an existing mental hospital, utilizing the existing personnel, maintaining existing effective structures of institutional care and developing new ones in out-patient care. The intention was to combine principles of subspecialized psychiatric in-patient are treatment with ideas of sectorization, accessibility and openness. Our results seem to show that it is well possible to reach positive results, optimizing and opening up an existing institution, using a basic psychodynamic, synoptic and eclectic ideology, offering differentiated treatment programs and without the immediate use of sectorizing principles. Sectorization and accessibility without qualified treatment programs of in-patient care may not be a sufficient solution to all the problems we find in psychiatric organisations. On the other hand, our achieved positive results have probably the naturally sectorized character of the island of Gotland as a presupposition. Principles of sectorization and differentiation seem in psychiatry not to be contrary but complementary. However, it seems to be legitimate, possible and effective to start a process of psychiatric evolution transforming an existing old-fashioned mental hospital.
近年来，国际上以及斯堪的纳维亚地区关于精神科护理发展的讨论主要集中在开放和部门化原则上，有时甚至以牺牲现有的差异化且有效的精神科住院护理项目为代价。在过去6年里，瑞典的哥特兰岛（有5.5万居民）启动了一项加强和开放精神科护理的进程，该进程以现有的一家精神病院为基础，利用现有的人员，维持现有的有效的机构护理结构，并在门诊护理方面发展新的结构。其目的是将专科化精神科住院治疗的原则与部门化、可及性和开放性的理念结合起来。我们的结果似乎表明，利用基本的精神动力学、综合和折衷的理念，在不立即采用部门化原则的情况下，优化并开放现有机构，很有可能取得积极成果，提供差异化的治疗方案。没有合格的住院护理治疗方案的部门化和可及性可能无法充分解决我们在精神科组织中发现的所有问题。另一方面，我们取得的积极成果可能是以哥特兰岛自然形成的部门化特点为前提的。在精神病学中，部门化和差异化原则似乎并非相互对立，而是相辅相成的。然而，启动一个改造现有老式精神病院的精神科发展进程似乎是合理、可行且有效的。
