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1i20022002(20034)””????””(1)(2)(1)(2)(3)2003/(2003)iiiiiivv1996IOM(InstituteofMedicine)200219991966WayneCountyGeneralHospitalHalfwayHousevivii…………………………………………………………………...…...…i……………………………………………………..….…..…iii…………………………………………………..…...…..…v………………………………………………….………...…..vii………………………………………………………….…..…01………………………05………………………13………………………23………………………25………………………33………………………………….…………..……………49………………………………….…………..……………49………………………………….…………..……………51………………………………….…………..……………55………………………………….…………..……………55………………………………….…………..……………57………………………………….…………..……………61………………………………….…………..……………61………………………………………….…………...……65……….………………………………………..….………75viii125023452001OECDHealthData1960197019801990GDP()()1960()19601961KennedyJointCommissionforMentalIllness6andHealthNIMH(NationalInstituteofMentalHealth)1963CommunityMentalHealthActAidtoDisabled85%1963MentalRetardationFacilitiesCommunityMentalHealthCentersConstructionAct(CommunityMentalHealthCenter)1)2)3)4)5)()(1970)NIMH1971CommunityMentalHealthMovement1973NewYorkHealthMaintenanceOrganizationActUtilizationReviews1975CommunityMentalHealthCentersAmendments12()NIMHECA()(1980)19801983DRGs1985Salmon1984()(1990)1990(duallydiagnosed)71993NationalAdvisoryMentalHealthCouncil1996MentalHealthParityAct(carve-out)(Bennett1991Breakey1996Domenici1993Frank1996Jensen1998Hales1996Santos,1995Shern1995)()PsychiatricRehabilitationConsultants(PRC)NationalAlliancefortheMentallyIll(NAMI)()1920-19601926MacmillanRoyalCommission1959MentalHealthAct1963NationalPlanforcommunitycare()1960-19901971DepartmentofHealth&SocialSecurity(DHSS)1975WhitePaperBetterServicesfortheMentallyIll101986AuditCommissionBetterServicesfortheMentallyIll()200020006NHSPlan20026NationalInstituteforMentalHealthinEngland(NIMHE)8MentalHealthNationalServiceFramework(MHNSF)CareProgrammeApproach(CPA)2000CarersandDisabledChildrenAct1966Sabshin(Bennett1991)Breakey1996(moderncommunitypsychiatry)19501960(cost-effective)(Breakey1996)9NeedsforCareAssessment(NCA)CardinalNeedsSchedule(CNS)CamberwellAssessmentofNeeds(CAN)PerceivedneedforCareQuestionnaire(PNCQ)…1.2.()3.4.101.Bennett,D.H.,FreemanH.L.(Ed.).CommunityPsychiatry.ChurchillLivingstone.1991;40-70.2.BreakeyW.R.(Ed.).IntegratedMentalHealthServices.OxfordUniversityPress1996;29-41.3.DomeniciSPV,MexicoRN.Mentalhealthcareploicyinthe1990s:Discriminationinhealthcarecoverageoftheseriouslymentallyill.JClinPsychiary1993;53(3):5-6.4.Frank,RG,Huskamp,HA,McGuireTG,NewhouseJP.Someeconommicsofmentalhealthcarve-outs.ArchGenPsychiatry1996;53:933-937.5.Hales,R.E.,Yudofsky,S.C.(Ed.).SynopsisofPsychiatry.TheAmericanPsychiatricPress1996;1323-1341.6.JensenGA,RostK,BurtonRP.Mentalhealthinsuranceinthe1990s:Areemployersofferinglesstomore.HealthAffairs1998;17(3):201-209.7.JohnsonS,ProsserD,BindmanJ,SzmuklerG.Continuityofcarefortheseverelymentallyill:conceptsandmeasures.SocPsychiatryPsychiatrEpidemiol1997;32:137-142.8.KnappM,ChisholmD,LeeseMet.al.ComparingpatternsandcostsofschizophreniacareinfiveEuropeancountries:theEPSILONstudy.ActaPsychiatrScand2002;105:42-54.9.Santos,AB,Henggeler,SW,Burns,BJ,Arana,GW,Meisler,N.Researchonfield-basedservices:Modelsforreforminthedeliveryofmentalhealthcaretopopulationswithcomplexclinicalproblems.AmJPsychiatry.1995;152(8):1111-1123.10.ShernDL,DonahueSA,FeltonC,JosephGR,BrierN.Partialcapitationversusfee-for-serviceinmentalhealthcare.HealthAffairs1995;209-217.11.2003;22(3)194-203.111960+1970+1980+1990+13.412.87.82.11.60.822.739.341.03.94.23.41.532.42.12.01.71.688.130.217.91.71.10.6178.8141.495.01.30.90.618.828.330.30.40.547.3103.3142.23.12.51.410.912.39.73.81.70.80.5331.0318.1329.81.72.52.82.936.00.6OECDHealthDATA2001:12GDP1960+1970+1980+1990+0.40.40.50.50.50.30.50.50.50.10.20.30.20.20.30.20.1OECDHealthDATA2001%%%%%()21.48281.973913.51899.852825.08()238.54152.219218.42446.191513.85()175.44270.54485.83989.761311.6()91.48110.1100994.6600()103.07844.94415.37529.4186.37()10.936.075.796.30.41.7Knappet.al.EPSILONstudy2002,2003.13…….---….(2002/9/334)()()1.(Non-hospitalcare)2.(Carebythecommunity)3.(Careinthecommunity)(Rowland,Zeelan,&Waismann1992;Ekdawi,Conning,&Campling,1994)(fulllives)(Ekdawietal.,1994)/(5,305)(13,999)19,304(23,000)84%199774%0.76()9.29()140()132.84()1997Anthony(2002)—(Anthony,Cohen,Farkas,&Gagne,2002,p.2)(WHO,1996)/(Anthonyetal.,2002,p.102)AnthonyLiberman(1994)Rutman(1994)1.2.3.4.198515-(1995)Anthony(2002)19983,561199712559(17)4,122199712813(1992;1995)(2002)19992585313()4811996371,304(1997)1216(1998)()()600-700456-600280250(2002)()19991365717199958%81%Ellison&Russinova(1999)50083%73%62%29%(2003)()13.831(0.97)DeSisto(1999)35VermontMaine()—(recovery)1990Anthonyetal.(2002)18/(p.31)recovery—(Spanioletal.,1994)Deegan(1988)(p.57)Deegan(1988)223514050246-68%(improved)/(recovered)(DeSistoeta.,1999)()—()(ACT)()193525()1.1)(flexibility)—/2)—3)—Deegan(1988)(paraprofessional)4)-—205)—(connection)6)—()2.1)—/2)—3)—4)—(Russinova,1999)1.(1995)2.(1992)3.(1997)4.(2002)—15(2)1-245.(1998)—11(4)73-103216.Anthony,W.,Cohen,M.,Farkas,M.,&Gagne,C.(2002).Psychiatricrehabilitation.Boston,US:CenterforPsychiatricRehabilitat