Pulice R T, McCormick L L, Dewees M
Center for Human Service Research, School of Social Welfare, State University of New York at Albany 12222, USA.
Psychiatr Serv. 1995 Jun;46(6):575-9. doi: 10.1176/ps.46.6.575.
In 1988 Vermont implemented a policy designed to reduce the state hospital census and expand community-based services. This qualitative study assessed perceptions of the policy's impact among mental health consumers, family members, and providers.
Eleven focus groups were convened, which included 94 participants from across the state. Separate groups were held for consumers, family members, and providers. Trained facilitators guided discussion of the policy's effect on quality of life, housing and vocational status, community integration, and social networks. Audiotapes of the discussion were transcribed, and content was analyzed.
Several universal themes were noted. All participants reported that stigma was still a substantial barrier to integration and that community education to reduce stigma had not been effective. Tension between families and providers was a problem; family members felt that although providers depended on their supporting the consumer, they were not included in treatment planning. All participants noted that urban areas were better served by the policy's service packages. A lack of coordination of community services was reported to be a continuing problem across the state. In contrast to findings of previous studies, consumers in this study preferred not to live alone, which led to feelings of isolation.
Service delivery in rural areas and system coordination throughout the state must be improved. Families' conflicting feelings of burden and isolation must be addressed. Further research should determine more clearly the range of housing preferences among consumers.
1988年，佛蒙特州实施了一项旨在减少州立医院住院人数并扩大社区服务的政策。这项定性研究评估了心理健康消费者、家庭成员和服务提供者对该政策影响的看法。
召集了11个焦点小组，其中包括来自全州的94名参与者。分别为消费者、家庭成员和服务提供者设立了小组。训练有素的主持人引导讨论该政策对生活质量、住房和职业状况、社区融入及社会网络的影响。讨论的录音被转录，并对内容进行了分析。
发现了几个普遍的主题。所有参与者都表示，耻辱感仍然是融入社会的重大障碍，而且减少耻辱感的社区教育并未奏效。家庭与服务提供者之间的紧张关系是个问题；家庭成员觉得，尽管服务提供者依赖他们对消费者的支持，但他们并未被纳入治疗计划。所有参与者都指出，该政策的服务套餐在城市地区的服务效果更好。据报告，社区服务缺乏协调在全州仍是一个持续存在的问题。与之前的研究结果相反，本研究中的消费者不喜欢独居，这导致了孤独感。
必须改善农村地区的服务提供以及全州的系统协调。必须解决家庭在负担和孤立感方面的矛盾情绪。进一步的研究应更明确地确定消费者对住房偏好的范围。
