Haasteita palvelujärjestelmälle : kehitysvammaiseksi luokiteltu henkilö psykiatrisessa sairaalassa

Abstract

Ladonlahti selvitti tutkimuksessaan, keitä psykiatrisessa sairaalassa olevat kehitysvammaisiksi luokitellut henkilöt ovat, miksi he ovat sairaalassa ja millaista heidän hoitonsa ja kuntoutuksensa on ollut. Tutkimus toteutettiin yhden erityishuoltopiirin alueella, josta tutkimuksessa mukana olivat kaikki alle 55-vuotiaat kehitysvammaiseksi luokitellut henkilöt, joita oli yhteensä 17. Tutkimusaineisto koostui näitä henkilöitä koskevista asiakirjoista vuosilta 1958-2002 sekä tutkijan itsensä keräämästä kyselylomaketiedosta.

Since the 1970's the goals of normalization, integration and community inclusion have been central in the Finnish human service system for the disabled persons. The number of people living in institutions has decreased, but little attention has been paid to one marginal group: those living in the psychiatric hospitals under the label of mental retardation. The purpose of this study is to find out who they are and how their needs are met in our service system.The method used is a qualitative analysis of all the written documents concerning seventeen people living in psychiatric hospitals in one special care district in Finland. Because of long-lasting placements the data also have a historical perspective. Documents consist of (1) medical certificates and reports, (2) daily reports written by nursing staff, (3) written plans for treatment and care and (4) other documents. Data was also collected using questionnaires. The research is strongly influenced by learning theories and sociological theories instead of viewing the phenomenon as individual pathology.The people studied have been placed in four categories: (1) “acute”, (2) “bounced”, (3) “multiple problems” and (4) “forgotten”. Differences between the types concerned their backgrounds, diagnosis, time spent in a hospital, social relationships, support needed in daily living, independent living skills and behavior problems. How their needs were met also varied widely. Mechanisms and procedures that support the segregation of these people from society are also described: how our service system even turns against it’s own official goals of normalization, integration and community inclusion.Evaluating and taking care of the people with a dual diagnosis is very challenging. We have to develop the flexibility in our service system to better meet these people’s needs. It is also important to take into consideration ethical issues, education and support for the staff. In addition to psychiatric approach there should be a functional approach to better understand behavior problems and a consultative and supportive educational approach to support the development of communication, daily living skills and community inclusion of the people with a dual diagnosis.