Eikelmann B, Reker T
Westfälische Klinik für Psychiatrie Münster.
Gesundheitswesen. 1996 Jul;58(1 Suppl):72-8.
Since the early days in the 19th century, psychiatry has been dealing with chronic courses of illness and mental disabilities. The 1975 German "Psychiatry Enquete Report" has played a major role in achieving progress in the care system, allowing mentally ill patients with impending or established handicaps to be rehabilitated or to have long-term care of varying intensity and even at home. In particular, differentiated and graduated systems of sheltered accommodation, a sheltered labour market and leisure-time support have been created. Rehabilitation may induce a response in the disabled patient and improve his skills. It may, however, also be aimed at finding or structuring an adequate living environment to enable the patient to cope. A distinction must also be drawn between early and late rehabilitation: late rehabilitation applies primarily to those patients whose disabilities have become relatively irreversible after protracted illness. The objective in this case is to maintain social integration. Early rehabilitation is desirable today if functional deficits and impairments are found to occur in conjunction with a mental illness. If a substantial disability remains in spite of intensive efforts towards rehabilitation, adequate re-integration of the affected patient may be achieved by adapting the living environment. Although the practical state of development is promising, a large number of theoretical and scientific problems remains unsolved. The topic of psychiatric vocational rehabilitation in particular is raising more and more questions. There is a lack of information on the number of chronically mentally ill patients in the community and their needs, i.e. on the number of potential users. Further studies are needed to investigate the effects, the efficacy and the course of psychiatric rehabilitation.
自19世纪初以来，精神病学一直在应对慢性病程的疾病和精神残疾问题。1975年德国的《精神病学调查报告》在护理体系取得进展方面发挥了重要作用，使有即将出现或已确定残疾的精神病患者能够得到康复治疗，或获得不同强度的长期护理，甚至能在家中接受护理。特别是，已经建立了差异化和分级的庇护性住宿体系、庇护性劳动力市场和休闲支持体系。康复可能会促使残疾患者产生反应并提高其技能。然而，康复也可能旨在寻找或构建一个合适的生活环境，使患者能够应对。还必须区分早期康复和晚期康复：晚期康复主要适用于那些在长期患病后残疾已变得相对不可逆转的患者。在这种情况下，目标是维持社会融合。如果发现功能缺陷和损伤与精神疾病同时出现，如今早期康复是可取的。如果尽管进行了密集的康复努力仍存在严重残疾，那么通过调整生活环境，可以使受影响的患者实现充分的重新融入。尽管实际发展状况很有前景，但仍有大量理论和科学问题尚未解决。特别是精神病职业康复这一主题引发了越来越多的问题。缺乏关于社区中慢性精神病患者数量及其需求（即潜在使用者数量）的信息。需要进一步开展研究来调查精神病康复的效果、疗效和过程。
