Salokangas R K, Saarinen S
Dept. of Psychiatry, University of Turku, Turku University Central Hospital, Finland.
Schizophr Bull. 1998;24(3):457-67. doi: 10.1093/oxfordjournals.schbul.a033340.
Finland has experienced one of the most rapid psychiatric deinstitutionalization processes in the world. Since 1980, the use of psychiatric beds has decreased about one-third. The effects of this deinstitutionalization were studied in the national Discharged Schizophrenia Patient Project. The study used three representative samples of patients with schizophrenia who were discharged from mental hospitals in 1982, 1986, and 1990, and followed them for 3 years. Patients with schizophrenia discharged at the beginning of the 1990s were older and more disturbed, and had been ill for a longer time than patients discharged at the beginning of the 1980s. The use of outpatient care increased and that of hospital care decreased, but because of the increased residential outpatient care, the total amount of residential care did not change during the study period. However, readmissions to the hospital increased. In patients with a long duration of illness, the increase in readmissions was exceptionally high; these patients also seemed to be losing their share of the residential outpatient services. On the whole, from the point of view of the psychiatric treatment system, deinstitutionalization seemed to have proceeded fairly successfully. The system proved able to redirect and use the available resources more effectively and to modify the structure of services according to the changing needs of patients discharged from hospitals. The well-developed social services have also supported this adaptation to the decreasing use of mental hospital beds.
芬兰经历了世界上最迅速的精神科去机构化进程之一。自1980年以来，精神病床的使用量减少了约三分之一。在全国出院精神分裂症患者项目中研究了这种去机构化的影响。该研究使用了1982年、1986年和1990年从精神病院出院的三组具有代表性的精神分裂症患者样本，并对他们进行了3年的跟踪。20世纪90年代初出院的精神分裂症患者比80年代初出院的患者年龄更大、病情更严重，患病时间也更长。门诊护理的使用增加，住院护理的使用减少，但由于住院门诊护理的增加，在研究期间住院护理的总量没有变化。然而，再次住院的人数增加了。在病程较长的患者中，再次住院的增加尤为显著；这些患者似乎也在失去他们在住院门诊服务中的份额。总体而言，从精神科治疗系统的角度来看，去机构化似乎进展得相当成功。该系统证明能够更有效地重新分配和利用可用资源，并根据出院患者不断变化的需求调整服务结构。发达的社会服务也支持了这种对精神病床使用减少的适应。
