Lamb H R
University of Southern California School of Medicine, USC Department of Psychiatry, Los Angeles 90033.
Br J Psychiatry. 1993 May;162:587-92. doi: 10.1192/bjp.162.5.587.
Deinstitutionalisation is at an advanced stage in the US, both in duration, and in reduction in state hospital beds. The new generation of chronically and severely mentally ill persons has posed the greatest problems. They no longer receive life-long hospital admission and thus permanent asylum from the demands of the world. Resistance to treatment and substance abuse are problems. Early proponents of deinstitutionalisation believed it would be cheaper, better, and give the mentally ill their freedom. In reality, good community care does not cost less. While a number of community programmes in the US have been impressive, they have served only a small proportion of the total population of severely mentally ill persons. More freedom has been of benefit for many, but has proved difficult for some patients. Some patients have been deinstitutionalised who cannot be effectively treated in the community. The homeless mentally ill epitomise all these problems.
在美国，去机构化在时间跨度和州立医院病床减少方面都处于高级阶段。新一代慢性和重度精神疾病患者带来了最大的问题。他们不再能获得终身住院治疗，从而无法再从外界的要求中获得永久庇护。抗拒治疗和药物滥用都是问题。去机构化的早期支持者认为这会更便宜、更好，还能给予精神疾病患者自由。但实际上，良好的社区护理成本并不低。虽然美国的一些社区项目令人印象深刻，但它们服务的重度精神疾病患者总数比例很小。更多的自由对许多人有益，但对一些患者来说却很困难。一些患者被去机构化后无法在社区得到有效治疗。无家可归的精神疾病患者集中体现了所有这些问题。
