Lesage A D, Tansella M
Centre de Recherche, Hôpital Louis-H. Lafontaine, Montreal, Quebec.
Can J Psychiatry. 1993 Apr;38(3):187-94. doi: 10.1177/070674379303800307.
Despite the scientific evidence that long stays in mental hospitals are clinically deleterious, inhumane and probably not cost-effective, this practice still occurs in most Western countries. The continued use of long stay beds in mental hospitals is a policy decided by many authorities, including psychiatrists. Alternatives to the mental hospital exist and may limit the use of hospital beds through comprehensive community care that also includes proper residential provisions. Alternatives may also decrease, but not impede the tendency to chronicity in some patients, who become long term users of these community services. Italy passed a law in 1978 prohibiting admissions to mental hospitals and encouraging the development of community care. In South Verona, Italy, the policy has been properly implemented and evaluated. Data from the case register and intensive studies of a cohort of patients will be used to show that long stay hospitalization can be discontinued while meeting the needs of the most severely handicapped patients. Implications of South Verona's experience for future training of psychiatrists will also be discussed.
尽管有科学证据表明，长期住院在临床上有害、不人道且可能不具成本效益，但这种做法在大多数西方国家仍普遍存在。精神病院长期床位的持续使用是包括精神科医生在内的许多权威机构决定的一项政策。精神病院的替代方案是存在的，通过全面的社区护理，包括适当的住宿安排，可能会限制医院床位的使用。替代方案也可能减少，但不会阻碍一些患者发展为慢性病的趋势，这些患者会长期使用这些社区服务。意大利在1978年通过了一项法律，禁止收治精神病院，并鼓励发展社区护理。在意大利的南维罗纳，该政策已得到妥善实施和评估。将使用病例登记数据和对一组患者的深入研究数据，来表明在满足最严重残疾患者需求的同时，可以停止长期住院治疗。还将讨论南维罗纳的经验对未来精神科医生培训的启示。
