Innovations in social psychiatry

Abstract

SYNOPSISSocial psychiatry, like social medicine of which it is a part, has two basic sciences – biology and sociology. People with psychiatric disorders suffer from acute breakdowns or chronic impairments which can be severely disabling in themselves, but these are often precipitated, amplified or maintained by social pressures and social disadvantages and by personal reactions, such as a loss of self-esteem and self-confidence. It is impossible, therefore, to draw a line between the medical and the social aspects of treatment, care and prevention.The chief innovations during the past 40 years have been made in the context of a change-over from a system of care based on large institutions towards a more open but much looser and less-coordinated system of smaller units managed by staff from different professions who have developed their own, sometimes conflicting, views as to the best ways of helping the mentally disabled. Nevertheless, knowledge has accumulated which, if properly applied, could lead to a better quality of life for the ill and disabled and a decrease in the burden placed upon relatives. Further innovations are now required which will lead to the development of a responsible, comprehensive and integrated mental health service.It is not yet known whether social measures taken to relieve or prevent lesser psychiatric disorders will lead to a decrease in the incidence or prevalence of more severe conditions and this question deserves further investigation. There is evidence, however, that relatively inexpensive help can be useful in the short term.Progress will depend upon the accumulation of new knowledge. One of the most encouraging trends has been the improvement of evaluative designs and methods aimed at testing ideas for improving services, thus allowing planners to make better informed decisions.

What do mental health rehabilitation services do and what are they for? A national survey in England

“…This may reflect an increasing focus on recovery and optimism amongst rehabilitation staff. The ''new'' definition also acknowledges the need for a whole system approach to rehabilitation, including appropriate community support, a theme not previously mentioned in classic definitions (Wing, 1980: '' . . .the process of minimizing psychiatric impairments, social disadvantages and adverse personal reactions so that the disabled person is helped to use his or her talents and to acquire confidence and self-esteem through experiencing success in social roles'') and which may reflect the shift of rehabilitation services from inpatient settings into the community.…”

Le pouvoir des professionnels dans la réadaptation : exemple d’un groupe d’usagers du service social

“…Increasingly the purposes and focus of mental health rehabilitation has turned away from a concern to maximise the functioning of individuals towards an interest in helping people with mental needs to interact sufficiently well with their environment so as to gain independence in everyday life (Wing, 1980). Rehabilitation is to be seen, therefore, as a process rather than an event (Sheppard, 1984).…”

“…moyens qui pourraient aider les malades mentaux à interagir assez bien avec H leur environnement et gagner en autonomie dans leur vie quotidienne (Wing, • 1980). La réadaptation est alors apparue comme un processus plutôt que • comme un événement (Sheppard, 1984).…”

Deux modèles de services de réhabilitation en Grande-Bretagne

“…D ne devrait pas y avoir de discrimination pour cause de handicap et tous les efforts devraient être dé-ployés pour éviter la ségrégation dans des communautés isolées. La mise en place d'une approche communautaire a d'abord dû faire place aux problèmes liés à la désinstitutionnalisation et à l'inté-gration dans la communauté de patients ayant été hospitalisés à long terme (Wing, 1980). Ce n'est que dans un second temps que firent surface les problèmes des patients n'ayant pas connu l'asile, mais * L'auteur, psychiatre, remercie le fonds de la recherche en santé du Québec qui a supporté son stage au Maudsley Hospital à Londres.…”