The structural reform of mental health services.
Notice bibliographique
Résumé
During past decades many countries have initiated extensive mental health care system reforms, and the main goal of these reforms has been the transfer of treatment of the mentally ill from psychiatric hospitals to the community. For example, assessment of the results of these reforms in Italy and Austria demonstrates considerable reduction in the number of psychiatric beds, higher quality and more available community services, and increased total expenditure for mental health services. However, because sufficient data is not yet available, many questions regarding how these reforms impact improvement in patient clinical parameters remain unanswered. Some of the answers to these questions can be gleaned from the results of research carried out in the United States and Canada in the 1980s. This research evaluated transfer of psychiatric treatment from a hospital setting to a community service setting. The results demonstrated that community treatment models were more effective than a hospital treatment model in reducing the number of hospitalizations and shortening length of stay. Patient monitoring also demonstrated good integration into the community. However, alongside the research supporting these reforms, there is some research that demonstrates a number of possible disadvantages: an increase in the number of homeless and in the mortality rate among psychiatric patients, and an increase in rehospitalization rates of chronically ill patients," referred to as the "Revolving Door Syndrome." To avoid the disadvantages that could possibly accompany the reform, particular attention needs to be given to planning and funding, so that development of community services and reduction in psychiatric hospital system correspond. Care must be taken to ensure that the number and the geographic location of these services meets the need of the population at risk, and that staff is available and well trained. A monitoring system should be set in place to monitor the patients according to the clinical standards agreed upon, and at the same time guidelines should be set up to evaluate the functioning of community services. The structural reform is progressing and should be completed at the end of 2005. However, development of community services is not progressing at the desired rate. In January 2003, the Israeli government made a decision to transfer the responsibility for medical insurance for the mentally ill from the government to the Sick Funds. However, an agreement between the Ministry of Health, the Ministry of the Treasury and the Sick Funds has yet to be signed and the government's decision has yet to be realized. This has caused development of community services to come to a halt, and neither the government nor the Sick Funds are investing in community development. We can only hope that the transfer of responsibility for health insurance for the mentally ill from the State to the Sick Funds will be completed soon and that development of community service for the mentally ill will then move forward quickly.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,006 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,001 | 0,006 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».