Hadley T R, Goldman H
Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia 19104-2648, USA.
BMJ. 1995 Dec 9;311(7019):1556-8. doi: 10.1136/bmj.311.7019.1556.
The introduction of new policies in health and social services in Britain has changed the way community care is provided to seriously mentally ill people. Britain is creating the same problems that have existed in the United States, whereby clinicians struggle to provide services in an environment with multiple payers and perverse incentives. A simple system in Britain has been replaced with complicated organisational and financial structures that require almost impossible feats by local health and social service staff to coordinate care for patients for whom continuity of care is critical for their survival in the community and their wellbeing. Seriously mentally ill people are in the middle of these complicated problems. The creation of a local mental health authority that could be held responsible for community care, as exists in some American states, may be one solution.
英国卫生与社会服务新政策的出台改变了为严重精神疾病患者提供社区护理的方式。英国正在制造美国曾出现过的同样问题，即临床医生在一个存在多个付费方和不当激励措施的环境中努力提供服务。英国原本简单的体系已被复杂的组织和财务结构所取代，这要求当地卫生和社会服务人员完成几乎不可能的任务，以便为那些护理连续性对其在社区生存和福祉至关重要的患者协调护理。严重精神疾病患者置身于这些复杂问题之中。设立一个像美国一些州那样可对社区护理负责的地方心理健康管理机构或许是一个解决办法。
