社区精神卫生服务模式的探索*

我国人口众多,精神卫生资源又缺乏,传统的精神卫生服务模式已远远无法满足患者的需要。因此,改变原来的服务模式,由院内服务过渡到以社区为基础的与精神病专科医院相结合的模式。     

精神卫生服务的国际发展趋势及中国探索：专科医院-社区一体化、以复元为目标、重视家庭参与

目前,许多发达国家重视发展社区精神卫生服务,精神卫生服务体系相对完善,形成了专科医院-社区一体化的服务模式,以复元为目标,强调家庭参与的重要性,整合医院、家庭、社会等多方资源,提供全方位的精神卫生服务。我国部分地区已初步建立了专科医院-社区一体化的服务模式,但各地区精神卫生资源不平衡,社区精神卫生服务尚不完善,精神卫生的服务理念尚未从传统的"管理和服药"思维转变过来,仅强调家属参与,而非包括患者在内的家庭的参与。我国精神卫生服务未来的发展方向应以复元为目标,构建家庭参与的专科医院-社区一体化的服务模式。     

县级精神病医院改革的难点与对策

精神卫生事业关系到人民群众的身心健康,关系到社会的安定及社会主义精神文明建设。探讨基层精神病专科医院在新形势下如何进一步加快改革,面向农村,加强自身建设,提高整体素质,适应社会主义市场经济的发展,在激烈的医疗市场竞争中,求生存、求发展,从而保证广大人民群众对精神卫生的需求,有着十分重要的现实意义。笔者就目前县级精神病专科医院在改革中面临的难点和应采取的对策作一浅议。     

精神病专科医院改革构思

目前,在卫生工作中,精神病专科医院几乎成了“被遗忘的角落”,在市场经济的大潮中,面临着“分化瓦解”,发展的道路上“危机四伏”。如何使这类医院在改革中求得生存和发展,是当前必须着重解决的问题。 长期以来,精神病专科医院扎根基层,为保护群众的健康,维护社会稳定做出了不可磨灭的贡献。然而,现在却面临着无法可依,竞争无序;收支不平衡,负担沉重;政策不到位,难以为继;设备落后,技术低下;人才匮乏,后劲不足等方面的困境。 要改变精神病专科医院目前所处的困境,必须在政策上给予扶助,在经费上给予资助,帮助精神病专科医院“站”起来。 精神卫生工作立法迫在眉睫 尽快建立《中华人民共和     

连云港市第四人民医院

连云港市第四人民医院．是连云港市唯一的市属传染病、精神病专科医院、市精神卫生防治中心、市重症精神病集中收治单位、司法精神病鉴定医院。     

社区精神卫生服务体系及社会行为因素对精神疾病的影响

本文在国内外精神卫生服务防治管理体系现状基础上探讨了我国社区精神卫生服务体系建设及社会行为环境因素对精神病人群健康的影响。基于精神疾病三级防治模式,提出我国社区精神卫生服务体系发展策略,指出发展社区精神卫生服务体系和改善良好的社会环境,将有利于精神病患者社会功能恢复,降低精神疾病发病率、减少肇事肇祸率,促进社会稳定都有重要意义,并为我国精神卫生防治管理及社区精神卫生发展提供参考。     

全情投入 用心领导——访江门市第三人民医院陈海泉院长

<正>江门市第三人民医院是一所集医、防、教、研为一体的地市级精神心理与老年人关怀专科医院,担负着江门市全市精神疾病的医疗、社区康复和卫生服务技术指导任务,现定位为三级精神病专科医院。近几年来,医院相继被评为"全国医药卫生系统先进集体"、"广东省卫生系统创先争优先进集体"、"江门市五邑廉洁清风先进集体"等;陈海泉院长荣获"中国最具惠民精神基层医院院长"、"广     

江西省重性精神病患者免费救治卫生服务体系建设

2012年以来,江西省以实施重性精神病患者免费救治管理工作为抓手,整合精神卫生工作资源,在实施人才队伍建设、完善精防体系、构建重性精神病救治救助工作长效管理机制方面进行了积极探索和创新。2014年,江西省贫困家庭重性精神病患者免费救治被评为"中国医改十大举措"。据2018年数据显示,全省精神卫生服务机构246家,精神卫生编制床位数10 419张,开放床位数15 000余张,每10万人精神科医生数2. 83人,每10万人精神科病床数33. 7张,有基层精防网络的县(市、区) 100个,符合国家精神卫生服务医疗机构的配置标准,已形成以专科防治机构或专科医院为龙头,县级精神科门诊为枢纽,乡村(社区)精神卫生人员为网底的精神卫生服务体系。同时针对存在的现状问题,提出应对策略。     

精神病医院在卫生改革中的困惑及对策

一、精神病专科医院的特殊性精神病医院是一个比较特殊的专科医院,无论从设址、服务对象、管理模式、医疗护理方式、方法,以及社会地位等诸多方面,都显示出其不同于综合医院或其它专科医院的特点。因此,逐步加深对精神病医院特殊性的认识,对于深化医院改革、加强管理以及制定改革政策,提高精神卫生服务能力有重要的现实意义。     

法律视角下《精神卫生法》施行后精神病专科医院诊疗护理中的若干问题分析

《中华人民共和国精神卫生法》的实施有助于保障精神障碍患者的合法权益,明晰医疗机构及医务人员的职责范围,促进精神卫生事业的发展进步。精神病专科医院是《中华人民共和国精神卫生法》相关内容的实施主体之一,但各种因素的综合作用使目前医疗机构中治疗、护理尚存在不足,精神障碍患者的合法权益也未得到充分保护。通过分析列举部分当前精神病专科医院在治疗、护理中存在的不足,提出了针对性建议,以增强其精神卫生服务能力。     

Funeral for a friend (an existential view on hospital closure)

Views the closure of a hospital in an unusual manner. Questions the role of health workers as "care in the community" comes to the fore. Raises questions about psychiatric hospitals, people with mental health problems and mental health workers.     

The transfer of care: U.S. mental health policy since World War II.

Recent criticism of mental health policy has raised many questions about the so-called "mental health revolution." Following World War II, the federal government and the growing mental health lobby planned the first nationally oriented system of psychiatric treatment, rehabilitation, and prevention. The rapidly expanding National Institute of Mental Health coordinated that policy, particularly through its Community Mental Health Centers program. Custodial state hospitals were depopulated and their patients "dumped" in nursing and boarding homes, which now constitute the largest arena for and most expensive form of psychaitric care. While there has been some progress in decreasing the hospital population and in improving conditions, as well as in providing services to certain people who otherwise would never receive them, failures have been more dominant. Admission and readmission rates have climbed precipitously. Unplanned hospital discharge has led to hundreds of thousands of ex-patients living in dangerous, nontherapeutic nursing homes were the main concern is profit. They, and many others, are maintained on psychiatric drugs, another source of profit as well as a dangerous technology. Community mental health programs have maintained psychiatry's traditional class, race, and sex biases, and have incurred widespread intrusion into communities. This article shows that such problems are part of an interconnected system in which the driving forces are fiscal crisis, ideological justifications for dumping patients, attempts to pass responsibility from state governments to federal and local bodies, restrictions on government and insurance reimbursements, the free enterprise economics of the nursing home and drug industries, and the professionalist practices of the mental health field.     

Organization and financing of mental health care in Poland

ORGANIZATION OF CARE: Health care is provided to patients with mental disorders by the state health care facilities as well as by social help agencies. Mental health care services are provided mostly by mental health facilities and partly by primary care units. Outpatient clinics, separate for psychiatric patients and substance abusers, are the most numerous mental health care units, amounting to a total of 1120. Intermediate care facilities include 110 day hospitals, 23 community mobile teams and ten hostels. The number of hospital beds amounts to 31913, i.e. 8.3 beds per 10000 population. 80% of beds are located in mental hospitals. TRENDS OF DEVELOPMENT: The trends in mental health care development are outlined in the Mental Health Programme and accompanying documents accepted by the Minister of Health and Social Welfare. The programme defines specific goals to be achieved by the year 2005 in the primary, secondary and tertiary prevention of mental disorders. In the domain of mental health care accessibility the most important goals are the following: a significant reduction in the number of beds in large mental hospitals, a marked (nearly threefold) rise in the number of beds in psychiatric wards at general hospitals and a significant increase in the number of community-based forms of care (e.g. a fourfold rise in the number of day hospitals). FINANCING OF CARE: Before 1999, the health care system was financed from the state budget and the health care spendings were subject to a political auction each year. Allocation of funds among hospitals and health care centres was based on the total previous year budgetary spendings of particular facilities and did not take into account a detailed cost analysis. Such a financing approach, although giving a feeling of a relative financial safety, did not encourage health care facilities to introduce an organizational flexibility and to expand the scope of their services. In psychiatry, it manifested itself in a very slow development of some community psychiatry forms (mostly day hospitals, mobile community teams and hostels). The Health Care Institutions Act has created a legal framework for the financial management of health care units in their new, independent form. Conditions for health care financing through regional sickness funds were thus created. The financing is currently based on contracts made by sickness funds with health care facilities for specific health services. Both the quantity and price of services should be mutually negotiated. Some simplified measures of services offered were used during the first insurance financing year. In mental hospitals and day hospitals it was a person-day; in out-patient care it was a visit. Both cost indicators were aggregated, including all the components present so far in the functioning a given unit.     

Deinstitutionalization, another way: The Italian mental health reform

The article describes the Italian experience of deinstitutionalizationin psychiatry, a reform which has attracted international recognitionas being the only instance of an industrial society eliminatingdetention in a mental hospital from its range of mental healthagencies and services. The first part of the article highlights the differences betweenthe Italian experience and psychiatric reforms in Europe andthe US, where deinstitutionalization has been reduced to dehospitalization.The problems and failings of these reforms are examined. The second part describes the operation, very different in contentand method from the above quoted experiences, of the Italianform of deinstitutionalization. Starting from a critique ofthe rationalistic problem-solution "paradigm" in psychiatry,it has developed as a complex social process which: a)involvesall its subjects as active participants, b) transforms the powerrelationship existing between the patient (and citizen) andthe institution, c) creates mental health services which completelyreplace detention in mental hospitals by deconstructing themand reconverting the material and human resources found in them. An example of this reconversion is given in the way in whichmental health services have been organized in Trieste. The fourth part examines the reform law arising from the deinstitutionalizationprocess and the characteristics of its implementation, in orderto show how this process continues through implementation. In the light of these considerations, deinstitutionalizationis no longer perceived as an aspect of the "welfare crisis",but rather as a significant pointer to new post-welfare socialpolicies.     

Deinstitutionalization, another way: the Italian mental health reform.

The article describes the Italian experience of deinstitutionalization in psychiatry, a reform which has attracted international recognition as being the only instance of an industrial society eliminating detention in a mental hospital from its range of mental health agencies and services. The first part of the article highlights the differences between the Italian experience and psychiatric reforms in Europe and the US, where deinstitutionalization has been reduced to dehospitalization. The problems and failings of these reforms are examined. The second part describes the operation, very different in content and method from the above quoted experiences, of the Italian form of deinstitutionalization. Starting from a critique of the rationalistic problem-solution "paradign" in psychiatry, it has developed as a complex social process which: a) involves all its subjects as active participants, b) transforms the power relationship existing between the patient (and citizen) and the institution, c) creates mental health services which completely replace detention in mental hospitals by deconstructing them and reconverting the material and human resources found in them. An example of this reconversion is given in the way in which mental health services have been organized in Trieste. The fourth part examines the reform law arising from the deinstitutionalization process and the characteristics of its implementation, in order to show how this process continues through implementation. In the light of these considerations, deinstitutionalization is no longer perceived as an aspect of the "welfare crisis", but rather as a significant pointer to new-post-welfare social policies.     

构建医务人员心理健康体系的若干思考

医务人员心理健康问题长期被忽视,有心理疾病或存在心理障碍的医务人员呈现逐年增多的趋势.心理健康问题产生的原因主要是社会环境变化加剧,使整个医务人员的心理压力增大,心理失衡加剧;工作环境压力增加,使医务人员长期处于体力和精神双重压力之中;个人生活环境变化.“心病”的防治关键在于建立一套行之有效的预防体系,这一体系至少应包括营造宽松的心理健康环境,健全预防机制,形成积极的个人心理导向三个方面.     

洛阳市综合性医院和精神病专科医院护士心理健康水平的调查

目的了解综合性医院和精神病专科医院护士心理健康水平,反映护理职业对个体心理健康的影响。方法采用SCL-90量表,分别对洛阳3家综合性医院241名护士和2家精神病专科医院176名护士进行调查,量表结果与中国常模进行比较。结果综合医院心理健康总分、、阳性项目数、以及躯体化、强迫症状、抑郁、敌对、恐怖因子分显著高于中国常模;专科医院阳性项目数和抑郁因子分显著高于中国常模。综合性医院与精神病专科医院对比,专科医院的护士心理水平优于综合性医院。结论护士存在较多的心理问题,可能是由于职业的高度紧张、高度风险所致。护理管理应关注本职业人群的心理健康,对护理人员开展心理健康教育,提高心理健康水平。     

Evaluation of a telepsychiatry pilot project.

We assessed a telepsychiatry pilot project in which a psychiatric hospital was linked with mental health clinics in five general hospitals. Information was collected through questionnaires administered to patients, service providers and psychiatric consultants, and by interviews. The technology was considered easy to use by participating health-care professionals and patients, and the quality of the sound and picture was adequate. Survey data suggested acceptance and satisfaction on the part of patients, service providers and psychiatric consultants. An economic analysis indicated that at 396 consultations per year the service cost the same as providing a travelling psychiatrist (C$610 per consultation); with more consultations, telepsychiatry was cheaper. Information gathered during the evaluation suggested that the use of videoconferencing for psychiatric consultations was a viable option for an integrated, community-based mental health service.     

Evaluation of attempted suicide in emergency departments in Sanliurfa province, southeastern Turkey

Aim

Attempted suicide is one of the most important public health problems among preventable causes of mortality in the general population. Identifying risk factors for the prevention of suicide is a major public health goal. The aim of this study was to determine the annual rate of attempted suicide, related risk factors, and interventions, among referrals to emergency departments in the Sanliurfa province of southeastern Turkey.

Subjects and methods

Data were obtained from all emergency departments in the province based on the ‘Suicide Attempt Registry’ standardized records for the calendar year 2010. Socio-demographic characteristics, aetiology, psychiatric history, psychiatric consultations, and interventions were examined. The groups were analysed with the chi-square test; the significance level was set at p?<?0.05.

Results

The annual rate of suicide attempts was 55.39 in 100,000 for the calendar year 2010. The rate was 3.47 times higher among women than men, and in particular 4.15 times higher for the 15–24 year age group among women than in men with the highest incidence of suicide attempts. The majority of cases were referred in April and May. Medication or toxic agent ingestions comprised 90.3 % of cases. The main reason for attempts was family problems or domestic violence among women, and economic hardships among men, and rates of physical and mental problems were similar for both sexes. Only 8.8 % of cases were subsequently referred for psychiatric consultation. Among cases with a prior suicide attempt history, 44.6 % had a reported psychiatric disorder.

Conclusion

The results of this investigation show that strengthening of surveillance and emergency healthcare systems, enhancement of mental health literacy, and inter-sector collaboration for development of community empowerment programmes are of vital importance for prevention of attempted suicide. The low rate of psychiatric referrals for subsequent intervention represented a major gap in urgent mental health services in the region.     

亚定点医院在重大突发公共卫生事件中的实践探索

探索重大突发公共卫生事件中以亚定点医院为代表的医疗管理模式。从上海新国际博览中心W1亚定点医院的实际运行情况出发,对其医疗供需、收治标准、运行效果、存在问题等逐一分析,结合本医疗队的经验,提出新的工作模式和管理思路。亚定点医院为普通型和有基础疾病的新冠病毒阳性感染者提供及时有效的救治,缓解了定点医院的运行压力,但也暴露出人员配置、信息化支撑、院感防控等方面的问题。采取“两级缓冲、双向转诊”的工作模式和“三个快、三个准、三个稳、三个全”的管理方案,可为患者提供及时、有效、适宜的医疗服务,缓解定点医院运行压力。