Challenge of psychiatric rehabilitation for patients with long-term hospitalizations using the Nirje’s normalization principles as a valuation standard: two case studies

This research investigates the current care of hospitalized, chronically mentally ill persons to determine to what extent current hospitalization supports Nirje’ s principles of normalization. We propose that care-providers try to incorporate rehabilitation programs that help the patients acquire the pattern and rhythm of living necessary for them to live in the community in their daily hospital life rather than to fit the patients into hospital rules or schedule. Therefore, care-providers must look back on their own views of the humanity, disabled people, and support and may have to change them if necessary. It is important that care-providers do not give up having psychiatric patients not give up restoration of normal social living. To develop such individual attempts into rewarding activities, it is necessary to set goals in the hospital and to let an interdisciplinary team work to achieve them. Moreover, the situation is expected to change if efficient care management is implemented to support psychiatric patients in the community. High-quality care to realize independent living of patients in the community including collection and distribution of information, management of symptoms, assistance for self-care, and psychological education is provided at hospitals that maintain the idea of, and strong belief in, providing high-quality care for returning patients to the community. The findings of this study will provide insights into how to design better hospitalization and/or community care for the mentally ill.

セイシン ホケン フクシ ニオケル ガクサイテキ タショクシュ レンケイ ニヨル チーム ケア ノ コウカ ソクテイ

Despite great interests on interdisciplinary collaborative team care (ICTC) in psychiatric care, a limited number of studies regarding the practice of ICTC and its evaluation has been reported in Japan. There is little consistency in the selection of the outcome variables and the methods of measurement, so that the effectiveness of ICTC has not been clearly shown. The purpose of this article is to emphasize the needs for systematic evaluation of ICTC in psychiatric care, as well as to identify some methodological essentials for the evaluation research on the management innovation. Use of more a scientific research design, such as an experimental design with controlling of extraneous variables or an extensive qualitative research, and more adequate outcome variables and the instruments should be considered for the future research. The future diffusion of ICTC as a new health care model in Japan can depend on the researchers who recognize the importance of the evidence-based management, like as the evidence-based medicine, present scientific evidences on improved health care and reduced costs as the outcome of ICTC, and provide a guideline for the health care organizations to evaluate their practice of ICTC. Despite great interests on interdisciplinary collaborative team care (ICTC) in psychiatric care, a limited number of studies regarding the practice of ICTC and its evaluation has been reported in Japan. There is little consistency in the selection of the outcome variables and the methods of measurement, so that the effectiveness of ICTC has not been clearly shown. The purpose of this article is to emphasize the needs for systematic evaluation of ICTC in psychiatric care, as well as to identify some methodological essentials for the evaluation research on the management innovation. Use of more a scientific research design, such as an experimental design with controlling of extraneous variables or an extensive qualitative research, and more adequate outcome variables and the instruments should be considered for the future research. The future diffusion of ICTC as a new health care model in Japan can depend on the researchers who recognize the importance of the evidence-based management, like as the evidence-based medicine, present scientific evidences on improved health care and reduced costs as the outcome of ICTC, and provide a guideline for the health care organizations to evaluate their practice of ICTC

住民の精神障害者に対する意識調査

精神障害者が地域で生活するためには地域住民の理解と協力が不可欠である．精神障害者が参加する行事への住民の参加度と精神障害者に対する意識に加え，彼らとのつきあい方との関係を明らかにし，さらに，それによって精神障害および精神障害者に対する理解を促進するための住民への啓発方法を検討することが本報告の目的である．A県のB保健所の管轄区域の住民６００人を対象とした郵送法による質問紙調査を行った．回収率は４８．８％（２９３人）であった．地域住民のなかで精神障害者が参加する行事に参加した経験のある人は，１）精神障害への認識度が高かった，２）精神障害者の社会復帰のために「何か役に立ちたい」と思っている人が多かった，一方で３）精神障害者の社会復帰への支援に，協力できないと回答した人は全回答者の１割しかいなかった．精神障害者が地域で生活するために必要なものは「地域住民の精神障害についての関心と理解そして精神障害者に対する支援である」と，住民自らが感じていた．住民を巻き込んだ体験的啓発活動の実践が，精神障害者に対する理解や支援を拡大させることになるということが示唆された．Background : It is essential for mentally disabled persons who live in the community to be understood and cooperated by local residents. Aim : This study investigated the relationship between the participation of the residents to the event held in the psychiatric hospital and their attitudes towards mentally handicapped persons. The research objective is to find the method to the residents for promoting an understanding of mental disorders. Method : A mail survey was conducted in the area covered by the B health center in A prefecture. The candidate６００ residents（２．２％ of all residents）who live in B county were selected（age range : ２０-６０ y.o.）. Participants comprised ２９３ respondents（recovery ratio : ４８．８％）. Comparison was carried out by the respondents who joined or did not join the event held in the psychiatric hospital. Results : Their understanding of mental disorders is relatively high in the participants. Most of them are willing to do something for mentally disabled persons’ social rehabilitation. Ten percent of all respondents would choose ‘can’t go along with mentally handicapped persons’ social rehabilitation support’. Conclusion : The results suggest that the provision of the opportunity for personal contact with mentally handicapped persons are important for improving the educational activity of the public about mental illnesses and considered to be important measures for promoting the acceptance and support of the mentally handicapped persons by the local residents