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Recovery in Context: Thirty Years of Mental Health Policy in California.
Perspectives in Biology and Medicine ( IF 1 ) Pub Date : 2021-01-01 , DOI: 10.1353/pbm.2021.0007
Joel T. Braslow , Sarah L. Starks , Enrico G. Castillo , John S. Brekke , Jeremy Levenson

Over the past quarter century, Recovery has become the hegemonic model guiding mental health policy. Advocates presented Recovery as a radical departure from the past, with the promise of dramatically improved outcomes for those with serious mental illness. This article looks at the implementation of Recovery-based policies in California from the 1990s to the present and interrogates the ways these policies emerged out of and reinforced many of the problems they were intended to solve. Against the backdrop of welfare reform, managed care, and a growing belief in market forces and individual responsibility, California policymakers pivoted from rigorously studied pilot programs that were intended to provide intensive, long-term treatment to Recovery-oriented programs that, while initially intensive, promised to "flow" increasingly independent and self-sufficient patients to less-intensive services. Moreover, these new programs promised to produce cost savings by reducing homelessness, hospitalization, and incarceration. Reported outcomes from these programs have been overwhelmingly positive but are based on flawed evaluations that lean more heavily on belief than on evidence. While proclaiming a comprehensive, patient-centered approach, Recovery's embrace of independence over long-term care and social supports has justified a system of care that systematically fails the sickest patients by abandoning them to the streets and jails.

中文翻译:

上下文中的恢复:加利福尼亚三十年的心理健康政策。

在过去的四分之一个世纪里,复苏已成为指导精神卫生政策的霸权模式。倡导者将康复视为与过去的彻底背离,有望显着改善严重精神疾病患者的预后。本文着眼于加利福尼亚州从 1990 年代至今的基于复苏的政策的实施,并探讨了这些政策是如何产生和强化它们旨在解决的许多问题的。在福利改革、管理式医疗以及对市场力量和个人责任日益增长的信念的背景下,加州政策制定者从旨在提供长期强化治疗的严格研究的试点项目转向以恢复为导向的项目,虽然最初是强化,承诺“流动” 越来越独立和自给自足的患者接受强度较低的服务。此外,这些新计划承诺通过减少无家可归、住院和监禁来节省成本。这些项目报告的结果非常积极,但基于有缺陷的评估,这些评估更多地依赖于信念而不是证据。在宣布全面的、以患者为中心的方法的同时,Recovery 对长期护理和社会支持的独立性的拥抱证明了一种护理系统的合理性,该系统通过将病情最严重的患者遗弃到街头和监狱来系统地使其失败。这些项目报告的结果非常积极,但基于有缺陷的评估,这些评估更多地依赖于信念而不是证据。在宣布一种全面的、以患者为中心的方法的同时,Recovery 对长期护理和社会支持的独立性的拥抱证明了一种护理系统的合理性,该系统通过将病情最严重的患者遗弃到街头和监狱来系统地使其失败。这些项目报告的结果非常积极,但基于有缺陷的评估,这些评估更多地依赖于信念而不是证据。在宣布一种全面的、以患者为中心的方法的同时,Recovery 对长期护理和社会支持的独立性的拥抱证明了一种护理系统的合理性,该系统通过将病情最严重的患者遗弃到街头和监狱来系统地使其失败。
更新日期:2021-01-01
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