Tekrarlayan Psikiyatrik Yatışlı Bir Olgu ve Türkiye’de Toplum Adli Ruh Sağlığı Hizmetlerinin Gerekliliğinin İncelenmesi

Abstract

Kronik psikiyatrik hastalığı olan hastaların psikiyatri servislerine tekrarlayan yatışları olarak tanımlanan döner kapı fenomeninin anlaşılabilmesi ve önlenebilmesi için ortaya çıkmasında olası etkenlerin saptanması önemlidir. Tekrarlayan psikiyatri yatışları ile ilgili altta yatan etkenler hastalığa ve hastaya ait bireysel özellikler olabileceği gibi, yataklı tedavi ve toplum bakımının düzenlenmesi gibi bakım sistemindeki sorunlar ve çeşitli sosyal, toplumsal etkenler olabilir. Ayaktan tedavi yaklaşımlarında iyileştirici sağlık politikalarının, yeniden yatışlar üzerine azaltıcı etkisi olmaktadır. Türkiye’de toplum ruh sağlığı merkezlerinde psikiyatri hastalarının ayaktan takibi ile ilgili düzenlemeler yapılmış olsa da, adli psikiyatrik popülasyonla özel olarak ilgilenen toplum temelli ruh sağlığı hizmeti yapılanması bulunmamaktadır. Toplum temelli tedaviler yeniden hastaneye yatışı azaltsa da adli psikiyatri hastalarında suç işleme sıklığını ve şiddetini azaltmamaktadır. Bu anlamda adli psikiyatri hastalarına yönelik özgün tedavi yaklaşımlarının geliştirilmesi gerekmektedir. Biz bu olgu sunumunda tekrarlayıcı suç davranışları olan, 15 yıllık süre içerisinde çeşitli güvenlik seviyelerindeki psikiyatri servislerinde 26 defa yatışı yapılan, toplamda 1450 günü hastanede yatarak tedavide geçiren psikotik bozukluk tanılı hastada, tekrarlayan yatışlarla ilgili bireysel ve toplumsal etkenleri tartışacağız. Aynı zamanda psikiyatrik bakım ve adli psikiyatrik bakım ile ilgili sorun alanlarını gözden geçirmeyi amaçlamaktayız.

Keywords

• Döner kapı fenomeni
• tekrarlayan psikiyatri yatışları
• psikiyatri yatışları
• toplum adli ruh sağlığı hizmetleri
• adli psikiyatri
• adli psikiyatrik tedavi

A Case with Recurrent Psychiatric Hospitalizations and the Review of Requirement of Community Forensic Mental Health Services in Turkiye

Abstract

Determining the possible factors in the emergence of the revolving door phenomenon, defined as the recurrent admissions of patients with chronic psychiatric diseases to psychiatric services, is important in terms of understanding and preventing it. The underlying factors related to recurrent psychiatric hospitalizations encompass individual characteristics of the patients and disorders, alongside, problems in the health care system and various social factors including arranging inpatient treatment and community care. Effective health policies in psychiatric outpatient treatment approaches have a reducing effect on readmissions. Although arrangements have been made for outpatient follow,up of psychiatric patients in community mental health centers in Turkiye, there is an insufficiency of a community forensic mental health service structure that is specifically oriented toward the forensic psychiatric population. Despite the observation about the reduction in rehospitalization rates associated with community,based interventions, they do not reduce the rate of recidivism and violence among forensic psychiatric patients. In this sense, specialized treatment modalities must be developed for the care of forensic psychiatric patients. In this case report, we will discuss the individual and social factors related to recurrent hospitalizations in a patient diagnosed with psychotic disorder who exhibited repetitive criminal behavior, and was hospitalized 26 times, a total of 1450 days in psychiatric services at various security levels within 15 years. We also aim to review problematic areas related to psychiatric care and forensic psychiatric care.

Keywords

• Revolving door phenomenon
• psychiatric rehospitalization
• psychiatric hospitalisation
• community forensic mental health services
• forensic psychiatry
• forensic psychiatric treatment

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