Consortium PSYCHIATRICUMConsortium PSYCHIATRICUMConsortium PSYCHIATRICUM2712-76722713-2919Eco-Vector4310.17816/CP43SPECIAL ARTICLEСПЕЦИАЛЬНАЯ СТАТЬЯResearch ArticleCommunity-based Mental Health Services in NorwayВнебольничная психиатрическая служба в Норвегииhttps://orcid.org/0000-0002-4821-1267RuudTorleifРуудТорлиф
Norway

MD, PhD

torleif.ruud@medisin.uio.noFriisSveinФриисСвен
Norway
svein.friis@medisin.uio.noDivision of Mental Health Services, Akershus University HospitalОтделение психического здоровья, Университетская больница АкерсхусаClinic of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of OsloКлиника исследований в области здравоохранения и психиатрии, Институт клинической медицины, Университет ОслоDivision of Mental Health and Addiction, Institute of Clinical Medicine, University of OsloОтделение психического здоровья и лечения зависимостей, Институт клинической медицины, Университет ОслоDivision of Mental Health and Addiction, Department of Research and Innovation, Oslo University HospitalОтделение психического здоровья и лечения зависимостей, Отделение исследований и инноваций, Университетская больница Осло200320212147540311202020032021Copyright ©; 2021, Ruud T., Friis S.Copyright ©; 2021, Рууд Т., Фриис С.2021Ruud T., Friis S.Рууд Т., Фриис С.https://creativecommons.org/licenses/by/4.0https://consortium-psy.com/jour/article/view/43

Community-based mental healthcare in Norway consists of local community mental health centres (CMHCs) collaborating with general practitioners and primary mental healthcare in the municipalities, and with psychiatrists and psychologists working in private practices. The CMHCs were developed from the 1980s to give a broad range of comprehensive mental health services in local catchment areas. The CMHCs have outpatient clinics, mobile teams, and inpatient wards. They serve the larger group of patients needing specialized mental healthcare, and they also collaborate with the hospital-based mental health services. Both CMHCs and hospitals are operated by 19 health trusts with public funding.

Increasing resources in community-based mental healthcare was a major aim in a national plan for mental health between 1999 and 2008. The number of beds has decreased in CMHCs the last decade, while there has been an increase in mobile teams including crisis resolution teams (CRTs), early intervention teams for psychosis and assertive community treatment teams (ACT teams). Team-based care for mental health problems is also part of primary care, including care for patients with severe mental illnesses. Involuntary inpatient admissions mainly take place at hospitals, but CMHCs may continue such admissions and give community treatment orders for involuntary treatment in the community.

The increasing specialization of mental health services are considered to have improved services. However, this may also have resulted in more fragmented services and less continuity of care from service providers whom the patients know and trust. This can be a particular problem for patients with severe mental illnesses. As the outcomes of routine mental health services are usually not measured, the effects of community-based mental care for the patients and their families, are mostly unknown.

Внебольничная психиатрическая служба в Норвегии состоит из местных центров психического здоровья (МЦПЗ), сотрудничающих с врачами общей практики, первичной психиатрической службой в муниципалитетах, а также психиатрами и психологами, ведущими частную практику. МЦПЗ были сформированы в 1980-х годах для оказания широкого спектра услуг по охране психического здоровья на подведомственных им территориях. Центры располагают амбулаторными клиниками, выездными бригадами и стационарными отделениями. Они обслуживают большую группу пациентов, нуждающихся в специализированной психиатрической помощи, а также сотрудничают с психиатрическими службами на базе больниц. МЦПЗ, как и больницы, управляются 19 здравоохранительными трестами, которые финансируются государством.

Увеличение ресурсов внебольничной психиатрической службы было важной целью национальной программы психического здоровья с 1999 по 2008 г. За последнее десятилетие на фоне снижения количества больничных коек в МЦПЗ наблюдается рост числа выездных бригад, в том числе кризисных бригад, бригад по раннему вмешательству при психозе, а также ассертивных бригад. Бригадная помощь при проблемах с психическим здоровьем также является частью первичной медико-санитарной помощи, включая помощь пациентам с тяжёлыми психическими заболеваниями. Недобровольная госпитализация в основном происходит в больницах, однако МЦПЗ могут обеспечивать преемственность такой госпитализации, а также назначать недобровольное амбулаторное лечение.

Считается, что с увеличением специализации психиатрической службы улучшается её качество. Однако увеличение специализации также может повлечь за собой бóльшую фрагментированность услуг и отрицательно повлиять на непрерывность оказания помощи специалистами, с которыми пациенты знакомы и которым доверяют. Это может представлять собой особую проблему для пациентов с тяжёлыми психическими заболеваниями. Поскольку результаты оказания стандартной медицинской помощи обычно не измеряются, действие внебольничной психиатрической службы на пациентов и их семьи остаётся по большей части неизвестным.

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