小组工作对精神病患者康复的介入研究——以天津市南开区某医院精神科患者为例

本文以天津市南开区某医院精神科精神病患者为例,对其五名精神病患者进行了“精神康复小组活动”的介入研究。介入结果表明：小组工作在巩固药物治疗的基础上,为精神病患者提供了心理和社会的支持,缩短了精神病患者回归社会的路程,为精神病患者的康复提供了新的途径和方法。     

“反精神医学”的谱系： 精神卫生公共性的历史及其启示

基于对上世纪后半叶以来“反精神医学”历史的考察,本文试图提出反精神医学运动如何影响精神卫生公共性建设的问题。文章结合当时欧美社会民权运动的背景,从“反精神医学”诸种思潮中梳理出其指涉公共性的各个面向,探讨其历史经验与启示。在传统精神医学陷入危机之时,反精神医学的精神卫生观转向以精神病患为主体,其中对“全控机构”的批判和标签论颠覆了传统精神医学的神话,成为“去机构化”意识形态的合力;同时,草根组织的援助改变了被收容者的社会处置方式;巴扎利阿的精神医疗改革则进一步解放了被收容者,其提出的废除精神病院、通过立法保障患者权益的案例,进一步彰显出精神卫生的公共性何以可能的历史经验。在此基础上,文章对精神卫生的公共性所指涉的目标和价值取向、精神卫生改革中的公众参与以及争取合法保障精神卫生相关权益的经验进行了讨论。     

No longer a one-man job?: On day activities in mental health care in Sweden

Swedish psychiatry is organizationally in line with the international development of closing down the old large mental hospitals. As in other countries, problems of provision of care for severely mentally ill people can be observed. An organizationally new field focusing on the activities of daily living is developing, however. This was surveyed nationally (spring 1991) and parts of these results are presented and discussed. The field is characterized by profound uncertainty manifested in the fact that psychiatry is no longer doing the work alone. Local social services take on a growing responsibility trying to make claims on how to define the work even if psychiatry is dominant, both in organizational and discursive power. Promising characteristics in joint venture units set up between psychiatry and local social services opens up for discussions on who, in what ways and with what means these new forms of care are going to be pursued.     

The Psychiatric Hospital in the Light of Modern Theoretical Trends in Psychiatry

The Soviet public health system is justifiably proud of its system of psychiatric care. Revolutionary demolition of the old society has led to extensive transformations in all fields of activity and to improvement in theoretical thinking and creative work. Preventive measures and the creation of a system of treatment and restoration of the ability of patients with various mental illnesses to work in any region of the country has resulted in a radical change in the history of psychiatry. We should emphasize that the creation of a system of psychiatric care through institutions differing in type and functions was a new feature. In order to understand the importance of this change, it is enough to recall that foreign psychiatry began thinking about the need to create a unified system encompassing both in- and out-patient care only several decades later, but in practice such a system has still not been established in a single developed, capitalist country.     

Adoptive Families in Distress

In this study, features of 22 adoptive families were examined in the light of some possible explanations of the reported over-representation of adoptive families among child psychiatry referrals. Themes which emerged included problems with bonding, motivations for adoption and psychiatric illness of parents. Implications for adoption workers are discussed.¹     

Mental Health Policy in South Australia: A Job Half Done

Though the emphasis in South Australian mental health policy on deinstitutionalisation is based on sound principles of civil liberties and psychiatric treatment, serious social problems have followed in the wake of the new initiatives. This paper attributes many of the problems to the simultaneous pursuit of deinstitutionalisation and centralisation of resources within psychiatric hospitals. It is argued that the policy of deinstitutionalisation demands a commensurate decentralisation of resources to enable the development of community-based residential and nonresidential alternatives to hospital.     

A Spate of Suicide by Jumping

Since 1980 eleven patients of a psychiatric hospital have committed suicide by jumping from high buildings. Possible contributing factors to this spate of suicides include the effect of suggestion, the continued attempt to de-institutionalise patients with chronic illness, and administrative difficulties with a shortage of trained psychiatrists. Comment is also made on the wisdom of making potential sites for such suicides less accessible, and the medico-legal responsibilities of psychiatric hospitals.     

To be or to be trained to be: On emerging and diverging ideological traditions in organizing day care activities for people with severe mental disorders in Sweden

Organized activities for people with severe mental disorders have until recently been the societal task of one human service organization, the medical speciality of psychiatry. With former psychiatric impatients moving out into the local community and with heavier dependence on outpatient polyclinic care, the situation is slowly changing. Day care activities for people with severe mental disorder are organized with an increasing involvement of the social services. The aim of this article is, using data from a national survey carried out in 1991 in Sweden, to describe and categorize how day care units interpret their task. Results show that claims-making activities still adhere largely to a therapeutic paradigm in spite of the outspoken social character of the work of organizing everyday life activities.     

SLOF: a behavioral rating scale for assessing the mentally ill

Rating scales for assessing the mentally ill usually focus on the role functioning of clients and their psychiatric symptomatology. This article introduces a rating scale to measure more directly observable behavioral functioning and daily living skills of clients in mental hospitals and in the community. Results are presented from a series of studies designed to test the instrument's psychometric properties.     

Psychiatric nursing in the Netherlands and Great Britain: class,status and gender in the making of a profession

ABSTRACT

In most Western countries psychiatric nursing, from the late nineteenth century onwards, developed as a specialization under medical supervision and within one general training scheme for all nurses. In the Netherlands as well as in the United Kingdom (UK), this occupation, initiated by psychiatrists, more or less distanced itself from somatic nursing. A comparison of the twentieth-century development of psychiatric nursing in these two countries shows similarities in its basic conditions and some of the problems it faced, but also some remarkable differences, which are largely of a social nature. We argue that Dutch mental health nurses, in cooperation with asylum doctors rather than in opposition to them, succeeded in establishing a stronger professional identity than their British colleagues: earlier in time and to a greater extent they had opportunities to voice their views on their work and to define the social and didactic nature of their vocation. Our explanation of these national contrasts focuses on gender, class and social status, which had dissimilar effects in the two countries because of some fundamental differences in the hierarchies and religious affiliations of institutional psychiatry as well as in the more general class structure of the Netherlands and the UK.     

User Involvement in Services--Incorporation or Challenge?

Correspondence to Joan Forbes at The School of Social Work, The University of Leicester, 107 Princess Road East, Leicester, LE1 7LA Summary In recent years, users of social work, like those of psychiatry,have been increasingly drawn into the organization and deliveryof social work and mental health services. This has been largelywelcomed as a desirable development by planners, academics andpractitioners in the field. In this article, we reappraise thebroad issues raised by user involvement and consider the implicationsof this trend. Despite the attractiveness of the user perspectivein the policy and delivery of social work and psychiatric services,we point to the dangers of incorporation and moderation of anoppositional position, from which, we argue, users can bestchallenge existing practices and connect with wider politicalstruggles.     

Exploring perceptions of mental health clients and professionals about Buddhism‐based therapies at mental health hospitals in Vietnam

With 80% of Vietnamese people holding key Buddhist beliefs, Buddhism has great impact on the thoughts, emotions, and behavior of Vietnamese people. However, almost no Buddhism‐based psychosocial interventions are offered at formal psychiatric hospitals across Vietnam, nor is there any plan to incorporate these interventions into mental health care. This exploratory study examines the perceptions of mental health clients and staff regarding the effectiveness of Buddhism‐based therapies (BBTs) in mental health treatment in Vietnam, using ethnographic observation and in‐depth interviews with 24 patients and eight professionals at the only psychiatric hospital employing BBT. Participants strongly believed in the positive impact of BBT to help clients manage or improve their symptoms. However, clients and staff advised that BBT should not be used alone; rather it should be used in combination with medication and was best employed for stress‐related disorders. They unanimously supported incorporating BBT into the formal mental health system, especially if the therapies were well developed through collaboration between Buddhist monastics and mental health professionals. Results of the paper suggest that Vietnam should think strategically about developing and incorporating BBT into the formal mental health care system.     

A house divided: deinstitutionalization, medicare and the Canadian Mental Health Association in Saskatchewan, 1944-1964

Defined as a set of distinct processes that included the declining use of large psychiatric institutions and the increasing use of outpatient services and general hospitals, deinstitutionalization occurred earlier in Saskatchewan than other provinces in Canada. It was led by a CCF government dedicated to major change across a number of sectors including mental health, assisted by one of the most influential and well-organized social movement organizations of the 1950s, the Saskatchewan Division of the Canadian Mental Health Association (SCMHA). However, by the late 1950s and early 1960s, the SCMHA opposed the CCF government's policy priority on medicare which it felt came at the expense of mental health care, in particular the implementation of a regional psychiatric hospital system called the Saskatchewan Plan. As a consequence, the SCMHA, once such a powerful ally of the CCF government in health reform, formed a strategic and temporary coalition with the anti-medicare forces in the province. Given the fact that a number of medical staff within the government's department of public health were prominent members of the SCMHA, the CCF government found that it occupied an increasingly divided house at the very time it was struggling to introduce medicare in the midst of civil unrest and a doctors' strike.     

The State of Care Management in Learning Disability and Mental Health Services 12 Years into Community Care

This paper reports on the organization of care management froma longitudinal study of community care for people resettledfrom long-stay learning disability and psychiatric hospitals.The findings from a 12-year follow-up of care management arrangementsin 12 learning disability and eight mental health study siteservices are described. The diversity of care management arrangementsfound at earlier points in the evaluation remained evident.Also, many of the former ‘care in the community’service users were excluded from mainstream care managementarrangements in their localities. The difficulty of developingperson-centred arrangements in learning disability and the lackof integration of the Care Programme Approach and care managementwere evident. The findings and observations are placed in thewider policy and practice context, with suggestions for takingcare management forward nationally and locally.     

Forms of ignorance and their role in the joint planning process

The Care in the Community initiative has given a new lease of life to joint planning between health and local authorities. The planned closures of psychiatric and mental handicap hospitals offer a new opportunity for these agencies to collaborate in the planning of alternative provision. All too often, though, considerable ignorance impedes their joint efforts. This ignorance relates to the scope of the exercize, the precise nature of the required services, and agencies’ knowledge of their different organizational systems, political ideologies and professional cultures. Such ignorance is built into the system, and it can serve agencies’ political purposes and offer them a means of attaining desired goals. The sociological literature offers a number of insights into relations between organizations. The concept of ignorance, however, has received little attention, yet it is one of the most striking aspects of joint planning.     

On the Inside: A Narrative Review of Mental Health Inpatient Services

This paper describes and discusses the results of a narrativereview of inpatient mental health services in the UK. Four mainthemes emerge from the review: the growing pressure on inpatienthospital services; the negative experience of inpatient servicesreported by many service users; the problematic nature of hospitaldischarge; and possible alternatives to hospital admission.This review also suggests that a failure to recognize and acton what appears to be happening in hospitals could result ininpatient care once again being subject to the scrutiny andcriticism that cast a shadow over psychiatric services in the1960s and 1970s. To stop this happening, current governmentpolicy is right to focus attention back onto acute care throughnew guidance and by commissioning research. However, changesalso need to take place at a practice level so that front lineworkers are familiar with conditions in local acute servicesand can challenge unacceptable behaviour/services in supportof their service users. With current changes in the make-upof local mental health services and a greater emphasis on partnershipworking between health and social care, it may be that socialcare practitioners can do this not only from the outside, butincreasingly ‘on the inside’ (from within integratedhealth and social care organizations).     

The monamine hypothesis,placebos, and problems of theory construction in psychology and psychiatry

Can there be scientific theories in psychology, medicine or psychiatry? I approach this question through an in-depth analysis of a typical experiment for clinical depression involving the monoamine hypothesis, drug action, and placebos. I begin my discussion with a reconstruction of Adolf Grünbaum’s conceptual analysis of what a placebo is. I then use his notion of “intentional placebo” to discuss a typical experiment using the monoamine hypothesis, two drugs, and a placebo. I focus on the theoretical aspects of the experiment, especially on the notion of causal explanation. I then raise five conceptual and methodological problems for theory construction. These problems focus on questions of the causal efficacy of placebos and drugs; ad hoc versus ceteris paribus explanations in biomedicine and psychology; and the falsifiability of the monoamine hypothesis. I conclude by pointing out the need for further, rigorous philosophical analysis concerning the possibility of theory construction in psychology, medicine or psychiatry.     

A review essay: recent literature on cognitive science

Can there be scientific theories in psychology, medicine or psychiatry? I approach this question through an in-depth analysis of a typical experiment for clinical depression involving the monoamine hypothesis, drug action, and placebos. I begin my discussion with a reconstruction of Adolf Grünbaum’s conceptual analysis of what a placebo is. I then use his notion of “intentional placebo” to discuss a typical experiment using the monoamine hypothesis, two drugs, and a placebo. I focus on the theoretical aspects of the experiment, especially on the notion of causal explanation. I then raise five conceptual and methodological problems for theory construction. These problems focus on questions of the causal efficacy of placebos and drugs; ad hoc versus ceteris paribus explanations in biomedicine and psychology; and the falsifiability of the monoamine hypothesis. I conclude by pointing out the need for further, rigorous philosophical analysis concerning the possibility of theory construction in psychology, medicine or psychiatry.     

Staff Support Groups in the Helping Professions: Principles,Practice, and Pitfalls by Hartley,P., & Kennard,D. (Eds.)

The topic of discharge from inpatient psychiatric units is written about frequently. However, inpatient groups which focus on discharge issues are rarely discussed. This paper briefly reviews the literature on discharge issues groups with the finding that while long-term psychiatric units focus on patients' feelings about leaving the hospital, existing acute adult psychiatric unit groups do not. An alternative model, the Discharge Issues Group which does allow for patients to express their feelings about discharge, is presented. Two case examples are cited to illustrate how the group functions.