[Programms of community psychiatry].

Abstract

Three main resources in all Health Care Programs are classified into three groups: The Psychiatric Hospital. It is a strictly hierarchical organization, where decisions are made at the top of the pyramid, and authority flows down administrative channels. Tasks are clearly defined, and so are responsibilities. The Therapeutic Community. It is a non-hierarchical group, with the goal of re-socializing disturbed individuals. It stresses group and individual responsibilities, aiming at learning new patterns of interaction. All members, patients and personnel alike, are equal members sharing full responsibilities, including decisions concerning the group and/or the individuals. Joining the group, leaving it, or dismissing a member, are all joint decisions. The underlying theory assumes therapeutic potentialities for a group with those special requirements, and for each of its members, regardless of its roles. The Programs of Community Psychiatry. All resources of large population groups are oriented and origanized into comprehensive community programs. All physical facilities are co-ordinated into a network. Personnel is recruited, whenever possible, using the human resources within the same community. All actions, at all scales, are organically co-ordinated in order to maximize benefits and minimize efforts and expenses. All three systems collide substantially, because of their radically different conceptions, grounds and operating requirements. Their many conflicts are analyzed in detail, assessing their consequences on the efficacity of services. A general conclusion is drawn on the valuable data emerging from the application of different systems simultaneously, allowing for future further evaluations. The author stresses that all three systems must be analyzed within a much broader socio-economical framework, and taking into account additional difficulties emerging from: a) great social distance between patient and therapeutic team, impeding exchanges; b) politically unstable climate for officials in charge of mental health policies; c) lack of psychological and technical fitness and heterogeneity of training affecting most mental health workers and agents.