Deinstitutionalization and schizophrenia in Finland: I. Discharged patients and their care.
Deinstitutionalization and schizophrenia in Finland: I. Discharged patients and their care.
复制标题
芬兰的去机构化和精神分裂症：I. 出院患者及其护理。
DOI：
10.1093/oxfordjournals.schbul.a033340
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发表时间：
1998
影响因子：
6.6
通讯作者：
S. Saarinen
中科院分区：
文献类型：
--
作者：
R. Salokangas;S. Saarinen
芬兰经历了世界上精神病院去机构化进程最快的国家之一。自 1980 年以来，精神科床位的使用量减少了约三分之一。国家出院精神分裂症患者项目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名具有代表性的精神分裂症患者样本，并对他们进行了为期3年的跟踪调查。与20世纪80年代初出院的精神分裂症患者相比，20世纪90年代初出院的精神分裂症患者年龄更大，精神更加紊乱，患病时间也更长。门诊护理的使用量增加，住院护理的使用量减少，但由于住院门诊护理的增加，研究期间住院护理的总量没有变化。然而，再次入院的人数有所增加。在病程较长的患者中，再入院率的增加特别高；这些患者似乎也失去了住院门诊服务的份额。总体而言，从精神科治疗体系的角度来看，去机构化似乎进展得相当成功。事实证明，该系统能够更有效地重新定向和利用可用资源，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院床位使用量减少的适应。
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.