农村社区开展精神病防治康复工作管理模式探讨

文章结合绍兴县近10年的农村社区精神病防治康复工作实践经验,分析探讨了农村社区开展精神病防治康复工作管理模式,对辖区无精神卫生专业机构的其它地区开展该项工作有参考价值。     

农村精神病患者就医状况分析

近年来,为适应世界卫生组织倡导的“以社区为基础的社会心理康复”战略方针,我国许多城市已深入开展了多种形式的社区精神卫生服务~([1]),然而农村社区精神卫生服务功能如何,尚少见该方面的报道,为此我们对570例农村精神病患者的就医状况进行了调查分析。     

多部门合作 综合防控重性精神疾病的做法及体会

精神卫生是农村社区重大公共卫生和社会问题。目前由于基层投入不足和人力资源薄弱等问题,精神卫生基本公共卫生服务的成效有限。泰州市姜堰区在世行货款英国政府借款江苏农村卫生发展项目（简称卫Ⅺ项目）中重点加强政府领导、多部门合作、建设综合防控的社区精神卫生服务体系。文章研究探讨了姜堰市的干预设计和实施机制,并通过实施效果的评价认为,加强政府在多部门合作中的主导作用,开发各部门协调合作的机制,重视社区治疗康复服务是发展农村重性精神疾病管理的必要条件。     

我国农村精神卫生服务供给、利用情况分析

农村精神卫生防治形势较为严峻,精神疾病发病率高,治疗率低下,精神卫生医疗资源城乡分布不均衡,农村医疗资源极为短缺,社区精神卫生服务体系发展缓慢,农村精神卫生工作任重道远.     

城市社区与农村乡镇基层精神卫生工作人员专业能力比较研究

目的对城市社区和农村乡镇的基层精神卫生工作人员的卫生服务专业能力进行对比研究。方法选取广西柳州市10个社区卫生服务中心以及24个乡镇卫生院的精神卫生工作人员进行问卷调查,比较其心理健康生知识、精神疾病态度及精神卫生服务能力。结果农村基层精神卫生工作人员在心理健康知识、学习能力、识别能力方面得分高于城市地区(P0.05),而城市基层精神卫生工作人员在态度、沟通方面略高于农村地区(P0.05)。两地区工作执行能力得分均为该地区精神卫生服务专业能力的最低项,所得分数分别为城市地区(1.54±1.56)分、农村地区(1.51±0.50)分,城市地区略高于农村地区。结论建议卫生相关部门应有针对性地对城市和农村地区基层精神卫生工作者进行相关培训。     

上海市长宁区社区精神康复服务资源的现况及建议

正最近的一项流行病学调查显示,我国各类精神障碍患者人数已超过1亿,其中重性精神障碍患者达到1 600万人[1]。精神康复已成为不可忽视的精神卫生问题,急需政府部门和社会组织介入,提供精神康复服务资源。随着我国经济的快速发展,科学技术的进步和医疗卫生服务体系的完善,民众对健康的需求、卫生服务的康复效果要求的提高,需要我们丰富服务形式,加快康复机构的建设,社区精神康复服务的内涵需要逐步多元     

赴泰考察精神卫生的启示

泰国精神卫生事业以提供便捷、优质的精神卫生服务、建立良好的社区康复服务为重点 ,以病人为中心 ,促进了泰国精神卫生的发展。我省赴泰精神卫生考察团应泰国卫生部精神卫生司威纳·威力亚奇察司长的邀请赴泰考察 ,体会如下。1　政府重视精神卫生是推进精神卫生事业发展的基础     

为社会管理创新提供有价值的理念

《北京市精神卫生条例》由北京市第十二届人民代表大会常务委员会第三十三次会议通过,自2007年3月1日起施行以来,明确了精神卫生工作的方针和政府职责,明确了以卫生部门为主、其他部门配合的管理机制;突出了精神健康促进与精神疾病预防,建立了精神疾病监测报告制度;规范了精神疾病的诊断与治疗行为;推动了精神疾病康复体系建设,建立了以社区康复为基础、家庭康复为依托、精神卫生机构提供专业技术指导的精神疾病康复体系;     

精神障碍患者职业康复研究进展

随着我国精神疾病患病率不断上升，其所带来的经济负担随之增加。促进精神障碍患者回归社会是精神卫生工作的重点，职业康复是精神障碍患者回归社会的重要方式。本文通过对职业康复的概念、精神障碍患者职业康复模式的发展现状及精神障碍患者职业康复影响因素等进行阐述，为精神障碍患者职业康复的研究和发展提供借鉴，并为公共精神卫生服务提供者和决策者整合协调精神障碍人群职业康复的资源提供参考。     

在改革中求生存、求发展——山西省太原精神病医院改革纪实

山西省太原精神病医院是1954年筹建的全民所有制专科医院,担负着全省精神疾病的预防、治疗、康复、教学、司法鉴定及农村巡回医疗等繁重任务,是山西省精神卫生的中心。在近几年的改革历程中,瞄准了医疗市场的转变趋势,摸出了发展专科医院的新路子。     

Distribution of Services and Supports for People With Traumatic Brain Injury in Ruraland Urban Missouri

New paradigms of disability suggest that many variables interact to influence the community functioning of people with traumatic brain injury (TBI), including injury severity and social, psychological, and environmental factors. Unfortunately, the majority of TBI outcome research to date has primarily focused on injury severity variables (e.g., neuroradiologic findings, loss of consciousness, posttraumatic amnesia) to the exclusion of environmental variables. Limited environmental resources such as rehabilitation professionals, facilities, and services may be significant barriers that affect outcome for people with TBI, particularly for those in rural areas. Using data from Missouri, where 32% of the population lives in rural counties, this study researched the availability of rehabilitation resources for individuals with TBI, with an emphasis on differences between rural and urban areas. Data indicated that there is a scarcity of rehabilitation professionals (i.e., physiatrists, mental health providers, rehabilitation therapists),facilities (i.e., hospitals offering comprehensive rehabilitation therapies), and services (i.e., support groups) in rural areas of the study state. The results suggest that (1) future rehabilitation researchers need to evaluate the impact of accessibility to rehabilitation services and resources on the outcome of people with TBI and (2) TBI health policy administrators need to consider how to increase rehabilitation resources for people with TBI in rural areas, including the use of rural-based training programs, rural debt-forgiveness training programs, and telehealth systems.     

Gerontological social work and cardiac rehabilitation

Cardiac rehabilitation is a setting in which integrating social work services can benefit older adults. Many cardiac rehabilitation patients endorse symptoms of stress and depression following a cardiac event, impeding their ability to participate fully in cardiac rehabilitation services or recover from a heart attack. Gerontologically trained social workers can improve the care of older adults with heart disease in a variety of ways and this paper discusses the potential roles social workers can play in enhancing care. Two examples demonstrating how community academic partnerships can lead to improved options for older adults following a heart attack are discussed. First, using a microsystems approach, social workers embedded within cardiac rehabilitation may improve patient quality of life, address social service needs, provide mental health treatment, and assist in the completion of standard cardiac rehabilitation assessments. Second, using a macrosystems approach, social workers can help communities by developing partnerships to establish infrastructure for new cardiac rehabilitation clinics that are integrated with mental health services in rural areas. Social workers can serve an important role in addressing the psychological or social service needs of cardiac rehabilitation patients while increasing access to care.     

兰州市城乡居民精神卫生知识知晓率调查与分析

目的：调查兰州市城乡居民对精神卫生知识的掌握程度,进一步提高大众对精神卫生知识的知晓率,更好地预防和控制精神疾患的发生,降低精神患者肇事肇祸的风险。方法采用分层整群随机抽样法,抽取兰州市18岁及以上的常住人口城市居民785人和农村居民741人,调查内容为卫生部办公厅2010年关于精神卫生工作指标调查评估方案的问卷之一,实际调查城市居民688名,农村居民674名。比较城市居民与农村居民对精神卫生知识的知晓程度并进行相关分析。结果本次调查中,兰州市城乡居民精神卫生知识平均知晓率为59．0％,其中城市居民为63．4％,农村居民为54．6％。城市居民精神卫生知识知晓率高于农村居民。回答正确率较低的条目主要集中在精神疾病的病因、预防、长期服药以及重大精神卫生纪念日方面。结论兰州市城乡居民精神卫生知识知晓率较低,未达到国家精神卫生工作纲要的要求,今后需继续加强精神卫生知识的宣传和教育。     

Bridging the gap between professionals and the community in mental health services: findings and policy implications of two demonstration projects

This paper describes two projects which targeted citizens as key players in the well-being and mental health of local communities and have tapped the mutual aid resources of informal helping networks. One of these projects was implemented with people who had mental health problems, many of whom were homeless and dependant drug users, in Quebec's inner city. Two professional workers, who were experienced in neighbourhood interventions (a psychologist and an educator) and a researcher were employed for a period of 28 months (from September 1989 to December 1991). The other project was implemented within the context of primary care for a wide range of health and social problems in a rural LCCS (Local Centre for Community Services). A social worker, who specialized in rural network intervention, was employed for 2 years. The same research team worked on both of the projects. The main objective of both projects was the development and testing of a method of intervention which aimed to encourage citizen involvement, both in promoting the physical and mental health of those suffering from transitory problems, and in the rehabilitation process of those suffering from severe social or mental health problems. In order to accomplish that objective, the professional workers made themselves visible and accessible in the community. The projects generated two very different models of intervention. The inner city model of intervention was tied closely to pivotal citizens and placed a great emphasis on the helper-therapy principle. The rural model was founded on network intervention, mutual aid being more relevant for marginal people. Even though these models of intervention embody provincial and federal government policies, professionals are far from ready and able to change their practice accordingly.     

The mental health care delivery system in greece: regional variation and socioeconomic correlates

BACKGROUND: In Greece, the functional capacity of the mental health care system until 1980, was totally inadequate to meet the increasing mental health needs of the population and to provide efficient and community-based services. This situation was brought to the attention of the Commission of European Communities and a special EEC Regulation No 815/84 provided the financial technical support for an extended psychiatric reform programme. The psychiatric reform programme initiated in 1984 and ended in 1995. AIMS OF THE STUDY: This study compared the geographical distribution of neuropsychiatrists and the mental health care delivery system structural components (psychiatric beds, extramural mental health units and places in rehabilitation services), according to the regional socioeconomic development for the years 1984, 1990 and 1996. Additionally the possible effects of the operation of community-based mental health services on the psychiatric hospitalizations were examined. METHODS: Data on the geographical distribution of neuropsychiatrists in the previously mentioned years were drawn from local Medical Association from each of 54 prefectures of the country. The corresponding distribution of the mental health care delivery system components was made available from the database of the Monitoring and Evaluation of Mental Health Services Unit. Pearson product moment correlations of the regional distribution of neuropsychiatrists and the various components of the mental health care system, as population-based ratios, with the corresponding socioeconomic development in the form of the general index of development were performed. Mental hospital age standardized rates were collected from the Hospital Central Register for the periods 1984-1987 and 1990-1993. Discharge rates were elaborated according to the existence of mental health services in specific regions. RESULTS: A wide regional variation in neuropsychiatrists per 100000 population was found in all three years, with the majority of them working in the greater Athens and Thessaloniki areas. In the geographical distribution of health regions, there is an uneven significant decrease in psychiatric beds between 1984 and 1996. However in almost all regions an increase in extramural services between the two critical periods was noticed, as part of the implementation of the psychiatric reform programme. A parallel and more dramatic increase in the places of rehabilitation in 12 out of 13 regions has been observed during the implementation of the reform programme. At the level of prefectures, the changes across time, in the mean ratios of beds, extramural services and rehabilitation places were not found to be significant. A significant decrease of discharges in prefectures covered by newly established extramural services for the period 1990-1993, compared to discharge rates during the period 1984-1987, when none of these services were in operation in these prefectures, was noticed. The intercorrelation matrix between the various mean values (1990-1996) of the mental health care system components in the 54 prefectures and the local general index of development scores produced statistically significant correlation coefficients. It seems that the greater the level of local socioeconomic development the higher the degree of mental health care delivery system growth. DISCUSSION: Our results have shown uneven regional distribution of neuropsychiatrists, as well as extramural mental health units and rehabilitation places, despite the current reorganization of the whole mental health care delivery system. The positive correlation between the various structural components of the system in the 54 prefectures and the local socioeconomic conditions could be interpreted as follows. Urban areas of higher socioeconomic growth had a long history of development of inpatient services in mental hospitals. In these several community-based alternatives have been established for their transformation into modern ones. Urban areas exhibit also higher psychiatric morbidity and therefore increasing mental health needs. Additionally in several cities local University Psychiatric Departments have developed a variety of mental health and rehabilitation services. Many new services highly specialized and complementary to existing mental hospitals were established in urban areas. Rural areas are mostly uncovered by mental health care facilities. However it seems that the establishment of community-based services could have an effect on mental hospital utilization. CONCLUSION: It becomes evident that after the implementation of the psychiatric reform programme in Greece significant progress in the areas of decentralization of mental health and rehabilitation services has been observed. However there are still areas in many prefectures, mainly rural or semirural, lacking the appropriate delivery of mental health care. IMPLICATIONS FOR HEALTH CARE AND POLICY FORMULATION: Our results suggest that flexible models of services should be introduced for the benefit of population living in areas lacking the necessary socioeconomic resourses. IMPLICATIONS FOR FUTURE RESEARCH: Mental health services research in Greece should focus on quasi-experimental studies on the effectiveness of various models of mental health care in areas of different socioeconomic growth.     

Children's mental health care: differences by race/ethnicity in urban/rural areas

This study examines racial/ethnic disparities in children's mental health and the receipt of mental health services, and whether those disparities differ between urban and rural areas. We find no significant difference between racial/ethnic groups in the prevalence of child mental health problems in either urban or rural areas. However, there are disparities in the use of mental health services. Hispanic children and Black children in urban areas receive less mental health care than their White counterparts, and the disparity persists for Hispanic children in rural areas, even after controlling for other relevant factors. Initiatives to improve access to mental health care for racial/ethnic minorities should recognize these disparities, and address the lack of culturally appropriate services in both urban and rural areas. In addition, outreach should raise awareness among parents, teachers, and other community members concerning the need for mental health services for minority children.     

Preventive agricultural medicine: a student's perspective of farmers' mental health

As a medical student completing a required rural community medicine clerkship, I discovered my home community's concern for mental health of farmers. A local economic downturn affects everyone, but especially the farmers. One farmer had recently committed suicide. Leaning heavily on work presented at a Nebraska summit on the farm crisis and mental health and on the National Rural Health Association issue paper on rural mental health, I found farmer and rural mental health to be a widespread concern, exacerbated by a scarcity of rural mental health resources. In my recommendations for rural Alabama, I endorse recommendations of others, including strengthening the local family physician role as "front door" to the mental health system, outreach with such agents as extension personnel and ministers, and farm crisis hotlines.     

Posttraumatic Stress Disorder in Rural Primary Care: Improving Care for Mental Health Following Bioterrorism

CONTEXT: Recent bioterrorism attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby contributing to increased needs for mental health care, particularly for posttraumatic stress disorder, which has been estimated to occur in 28% of terrorism survivors. PURPOSE: Prior experience with natural disasters suggests that first responders typically focus on immediate medical trauma or injury, leaving rural communities to struggle with the burden of unmet mental health needs both in the immediate aftermath and over the longer term. The purpose of the present article is to draw attention to the greater need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities. METHODS: We reviewed the literature related to bioterrorism events and mental health with an emphasis on rural communities. FINDINGS AND CONCLUSIONS: Public health agencies should work with rural primary care providers and mental health professionals to develop educational interventions focused on posttraumatic stress disorder and other mental disorders, as well as algorithms for assessment, referral, and treatment of post-event psychological disorders and somatic complaints to ensure the availability, continuity, and delivery of quality mental health care for rural residents following bioterrorism and other public health emergencies.     

Access of rural AFDC Medicaid beneficiaries to mental health services

This article examines geographic differences in the use of mental health services among Aid to Families with Dependent Children (AFDC)-eligible Medicaid beneficiaries in Maine. Findings indicate that rural AFDC beneficiaries have significantly lower utilization of mental health services than urban beneficiaries. Specialty mental health providers account for the majority of ambulatory visits for both rural and urban beneficiaries. However, rural beneficiaries rely more on primary-care providers than do urban beneficiaries. Differences in use are largely explained by variations in the supply of specialty mental health providers. This finding supports the long-held assumption that lower supply is a barrier to access to mental health services in rural areas.