湖北省精神卫生服务人员现状调查

目的 了解湖北省精神卫生服务人员现状,为人力资源规划提供基本依据.方法 采用自制调查表对全省精神卫生机构人力资源现状进行调查.结果 全省有精神科医师1 398人（2.44/10万人）;精神科护士3 175人（5.55 人/10万人）;心理治疗师293人（0.51 人/10万人）;全省21个县（市）无在岗精神科医护人员,37.8％机构未设置精神疾病预防科开展精神社区服务.结论 全省人力资源分布不均衡,区域差异明显;服务人员整体结构欠合理,专业种类不全;人员总体素质偏低,规范服务能力不足,难以满足社区精神卫生工作.     

上海市社区精神卫生服务调查

目的：探讨上海市社区精神卫生服务状况,并提出改进意见。方法：通过网上查询、文献研究、利用已掌握的社区精神卫生服务与精神残疾康复工作的资料和访谈法,调查上海市社区精神卫生服务现状。结果：目前上海市社区精神卫生服务存在的问题：精神卫生法律、法规和政策没有完全落实;社区精神卫生服务体系尚需完善;精神卫生工作投入严重不足;精神卫生工作人员素质亟待提高;社区精神疾病康复服务形式有限。结论：在新医改的形势下,要制定“上海市精神卫生工作体系发展规划”;建立以政府投入为主、多渠道的社区精神卫生工作投入机制;加强精神卫生工作队伍建设;推进和完善社区精神康复服务模式;建立科学的绩效考核体系和机制。     

上海市社区卫生服务中心精神卫生服务基本情况的调研与分析

目的为了贯彻实施<上海市精神卫生条例>,推动社区卫生服务中心建立精神科门诊或心理健康咨询门诊,更好地为市民提供精神卫生服务,上海市疾控精神卫生分中心开展了对全市社区卫生服务中心精神卫生服务与需求基本情况的调研.方法调研采用表格式登记表登录方式,应用构成比进行相对数分析.结果调研数据显示全市有26.16%的社区卫生服务中心尚未开设精神科/心理健康咨询门诊;社区精神科医生仅208人,其中,中专及以下的学历占55.29%,77.88%的人员是初级职称,约四分之一服务人员从未接受过任何精神卫生方面的培训,这在一定程度上影响了对社区人群的服务.讨论建议各级卫生行政部门应当重视社区卫生服务中心建立精神科/心理健康咨询门诊,并为社区卫生服务人员接受精神疾病知识教育创造条件.     

北京市朝阳区社区精神卫生特色服务项目实践与效果研究

朝阳区社区精神卫生特色服务项目的开展有效提高了社区精神卫生服务能力,促进了社 区精神卫生服务队伍建设,拓宽了社区精神卫生服务对象与服务方式。     

上海、昆明两城区居民精神卫生知识知晓与服务需求对比研究

目的调查并比较上海、昆明两城区居民对精神卫生知识的知晓情况以及对社区精神卫生服务的需求情况,分析造成两地差异的可能因素,为因地制宜地制定相关政策、促进居民心理健康提供参考。方法自编调查问卷,在上海3个街道对1317名社区居民、云南省昆明市两个社区内514名社区居民进行调查。结果上海社区居民精神卫生知识知晓情况好于昆明社区居民,后者社区精神卫生服务需求大于前者,但两者总体知晓情况都不理想,社区精神卫生服务需求较大。结论要加强精神卫生知识的宣传普及,大力发展社区精神卫生服务,促进居民心理健康。     

北京市朝阳区精神卫生医联体模式初步探索

为进一步深化医药卫生体制改革,提高基层精神卫生服务能力,朝阳区充分整合北京市 三级精神专科医院、区域内三级综合医院精神心理科及区域内精神专科医疗机构等市区两级精神卫生 资源,成立区域内精神卫生医联体。凝聚北京市内的优质专家资源,成立朝阳区精神医学联络会诊中心, 提供高水平的专业技术支撑。在辖区内所有社区医疗机构设置精神科,为患者提供方便可及的精神科 专业诊疗服务,同时带动社区精神卫生专业人才队伍培养。     

长沙市普通人群的精神卫生知晓情况

目的评定长沙市公众精神卫生和精神疾病预防知识的知晓情况。方法采用多阶段整群随机抽样方法,选取长沙市辖区随机抽取的2个城市社区和2个农村社区的1660户家庭。从15岁及以上的家庭成员中随机抽取1人进行访谈,完成卫生部推荐的精神卫生知晓率标准问卷（20项）调查。结果1563人完成有效问卷调查,其中男性676人,女性887人,平均年龄（标准差）为41．9（15,9）岁。平均（标准差）应答正确率为68．5％（46．4％）,城市社区平均（标准差）应答正确率[70．5％（13．6％）]高于农村社区应答正确率[66．2％13．5％）]（t=6．18,P〈0．001）。正确应答率与年龄负相关（r=一0．21,P〈0．001）,与文化程度正相关（r=0．28,P〈0．001）,与职业和婚姻状态的差异呈多样相关性。采用逐步回归分析发现文化程度、年龄和职业（农民或工人与其他职业比较）为精神卫生知晓率的独立相关因素。问卷20个条目总体内部一致性及4个分量表的内部一致性偏低（alpha=0．27～0．57）。结论长沙市普通居民精神卫生知识总体知晓率相对较高,但有些方面仍需提高,特别是对于精神疾病病因的认识。公众精神卫生知识的知晓能力随人口学特征不同而有较大差异,因此对不同人群进行特定的精神卫生教育可有效地提高社区居民的精神卫生知识知晓率。今后需修订调查问卷,提高信、效度和内部一致性。     

韩国社区精神卫生服务的印象

<正>自上世纪80年代起,随着韩国工业的迅猛发展,其精神卫生服务机构及住院病床数也迅速提升,到90年代中期韩国政府提出社区康复理念,并于首尔建立第一个社区精神卫生中心。随后,很多省市也建立起社区精神卫生机构。其社区服务理念注重"以病人为中心",对精神病患者"轻症状"、"重全人",并将这一理念深入到医疗康复服务的每一细节,对患者病情、身体状况、居住情况、经济能力、劳动能力、生活能力、人际关系等进行综合评估,再结     

上海市社区精神卫生服务投入调查

目的：探讨上海市社区精神卫生服务投入状况.方法：分别从上海市中心城区、准中心城区、周边城区和农村4个部分中各抽取一个区县,采用定性和定量的方法进行实地调研.结果：目前上海市社区精神卫生服务投入存在的问题：投入严重不足;投入结构不合理;投入政策尚未真正落实.结论：对策为：健全和落实精神卫生法律、法规和政策;改革投入体制和机制,可通过增加和调整精神卫生工作投入、变政府财政直接投入为政府购买、建立科学的绩效评估标准等方法来实现;构建重性精神疾病患者免费服药体系.     

美国精神病院的非政府化现象

1963年,美国总统肯尼迪作了著名的关于精神疾病和智力发育不全的国情咨文。翌年,美国国会通过了社区精神卫生法案,由国家出资为各州提供人员和经费,在各指定人口的区域中,实施全面的精神卫生服务工作。1963年以后,美国各级政府新建了788个精神卫生中心,建立起全国性结构完整的社区精神病服务系统。从1955年到1977年,美国政府用于精神卫生的年度经费由1.2亿美元增加到     

A Canadian model for developing mental health services in rural communities through linkages with urban centers

The development of mental health care services in rural areas has been a constant challenge in most countries of significant geographical size. By use of a case study from Canada, the development of a relationship between rural and urban mental health services was described. Issues including referral patterns, service accessibility, professional recruitment and the development of service in rural regions were studied. It is advanced that mental health administrators, policy-makers, clinical service coordinators and educators will find that this approach to the development of mental health services in rural areas has some utility in Canada and in other countries.     

Critical issues in reforming rural mental health service delivery

Critical issues in reforming rural mental health service delivery systems under health care reform are outlined. It is argued that the exclusive focus on health care financing reform fails to include obstacles to effective mental health service delivery in rural areas, which should focus on issues of availability, accessibility, and acceptability, as well as financing and accountability. Characteristics of rural areas are delineated and three assumptions about the structure of rural communities which are shaping the dialogue on rural health and mental health service delivery are examined. These assumptions include the notion that rural communities are more closely knit than urban ones, that rural services can be effectively delivered through urban hubs, and that rural dwellers represent a low risk population which can be effectively served through existing facilities and by extending existing services.This work was supported in part by NIMH Grant #MH 49173-02.     

Situational analysis to inform development of primary care and community-based mental health services for severe mental disorders in Nepal

Background

Nepal is representative of Low and Middle Income Countries (LMIC) with limited availability of mental health services in rural areas, in which the majority of the population resides.

Methods

This formative qualitative study explores resources, challenges, and potential barriers to the development and implementation of evidence-based Comprehensive Community-based Mental Health Services (CCMHS) in accordance with the mental health Gap Action Programme (mhGAP) for persons with severe mental health disorders and epilepsy. Focus Group Discussions (FGDs, n = 9) and Key-Informant Interviews (KIIs, n = 26) were conducted in a rural district in western Nepal. Qualitative data were coded using the Framework Analysis Method employing QSR NVIVO software.

Results

Health workers, general community members, and persons living with mental illness typically attributed mental illness to witchcraft, curses, and punishment for sinful acts. Persons with mental illness are often physically bound or locked in structures near their homes. Mental health services in medical settings are not available. Traditional healers are often the first treatment of choice. Primary care workers are limited both by lack of knowledge about mental illness and the inability to prescribe psychotropic medication. Health workers supported upgrading their existing knowledge and skills through mhGAP resources. Health workers lacked familiarity with basic computing and mobile technology, but they supported the introduction of mobile technology for delivering effective mental health services. Persons with mental illness and their family members supported the development of patient support groups for collective organization and advocacy. Stakeholders also supported development of focal community resource persons to aid in mental health service delivery and education.

Conclusion

Health workers, persons living with mental illness and their families, and other stakeholders identified current gaps and barriers related to mental health services. However, respondents were generally supportive in developing community-based care in rural Nepal.

     

Mental health services for rural elderly: Innovative service strategies

This paper reviews issues in planning and delivering mental health services to rural dwelling elderly. First, comparative data on the prevalence of mental illness among rural elderly, and the availability and accessibility of mental health services in rural areas are presented to provide a basis for subsequent discussion. Next, several strategies for improving the development and delivery of geriatric mental health services to rural areas are discussed. These include: increasing the number and quality of rural mental health providers; adapting or developing diagnostic techniques to improve case identification among rural elderly; providing culturally sensitive mental health services; strengthening informal and formal care linkages in rural communities; developing innovative service delivery models building upon the strengths of rural settings; and emphasizing fluidity as well as continuity in treatment models.     

Assessing mental health services in a rural setting: Service providers’ perspective

Addressing the inadequate and poor provision of mental health services in rural areas is a world-wide challenge. Most people with mental illness in these areas do not have access to mental health services. Using eight attributes of good mental health service as criteria, the purpose of this study was to assess mental health services at Mashashane, a rural area in the Limpopo Province, South Africa. A survey was conducted with a purposively selected sample of health care professionals from four health establishments serving Mashashane. Data was collected using a questionnaire with closed and open-ended questions. Quantitative and qualitative data analyses were used. The results show that out of eight attributes assessed only comprehensiveness was positively perceived. This is an indication of the inadequacy of mental health services, hence their inability to improve the well-being of people with mental illness and their families. Lack of resources was identified as the major hindrance to the delivery of appropriate mental health services. The findings highlighted aspects that contributed to the development of a framework for a community-based program to improve the well-being of people with mental illness and their families in a rural setting.     

Experiences of mental health services by people with intellectual disabilities from different ethnic groups: a Delphi consultation

Background Patient experience of those accessing mental health services has been found to be different between ethnic groups. Although the needs of people with intellectual disabilities (ID) from different ethnic communities are being increasingly recognised, little has been published about their experiences of mental health services. The aim of this study was to establish whether there are any differences in the experiences of people with ID and mental health problems from two ethnic communities in South London. Method A two‐round Delphi process was utilised. White British and Black or Black British service users from a specialist community‐based mental health service for adults with ID completed a specially compiled questionnaire. Statements on participants' experiences, including satisfaction with care, staff members' attitudes, cultural awareness and level of support, were rated using a Likert scale. Results Twenty‐four out of 32 participants (75%) completed both rounds of the Delphi consultation. Consensus (≥80% agreement with the group median) was reached for 20 items in the White group and five items in the Black group. All responses that reached consensus were positive about the services that were being received. The Black group were less positive about a range of their experiences, including the use of medication. Conclusions People with ID from two ethnic groups were able to successfully complete a Delphi consultation regarding their experiences of mental health services. Broad consensus on positive experiences of services was reached in the White group but not for the Black participants.     

Rural mental health coverage under health care reform

Efforts to integrate services and financing under health care reform hold benefits for provision of services to rural mentally ill persons. Remote areas pose a particular challenge as the unique characteristics of rural America are even more evident. The model for managed care in remote rural areas will differ from those used in urban and their adjacent rural areas. Universal coverage would remove the barriers to accessing care for this population, but does not assure availability of adequate mental health services or providers in rural areas. Characteristics of currently available rural mental health services are presented and obstacles to expanded delivery under health care reform are outlined.This work was supported by NIMH Grant #MH 49173-02.     

Farm-Link

The Farm-Link Program is funded by the Australian Government through the Department of Health and Ageing under the National Suicide Prevention Strategy and is coordinated by the University of Newcastle's Centre for Rural and Remote Mental Health in collaboration with New South Wales (NSW) Health's Rural Area Mental Health Services and the NSW Farmers' Association. It was operational across NSW from July 2007 to December 2009 and is funded to continue in the New England region until June 2011. A major aim of the program was to improve access to and responsiveness of mental health services to the needs of people who live and work on farms. Frontline agricultural workers, who have a lot of contact with farmers and their families, received Mental Health First Aid training provided by Farm-Link staff. Across NSW, 220 participants received this training during 2008, and an additional 133 participants received training in the New England region throughout 2009-10. This training is still being delivered by Farm-Link in the New England region. Farmers' mental health networks were developed and expanded to engage both agricultural and mental health agencies, so that pathways to mental health care could be defined, described, and utilized. These networks were developed in selected sites across three rural area health services. By establishing the conditions for successful cross-agency networks to flourish in rural NSW, Farm-Link developed a credible reputation in target communities. An external evaluation, including comparative service network analysis, indicated that Farm-Link successfully identified and established mental health service development interventions in target communities. The evaluation identified a requirement for substantial change within a short-time frame as an inhibiting factor in Farm-Link 2007-09. Farm-Link's ongoing work indicates further time and continuity of service in rural communities has a positive impact on the depth of knowledge built and project aims being delivered. In addition, although documentation of referrals for farmers to various mental health service providers and general practitioners has occurred, more adequate systems need to be developed for the future.     

An evaluative paradigm for community mental health centers using an automated data system

A methodology is presented for the evaluation of community mental health centers using data routinely collected by an automated patient management system (Multistate Information System). Four community mental health centers whose catchment areas were widely diverse in composition participated in the study. A generalized evaluation paradigm was developed with measures and objectives formulated to analyze various stages of care as patients progressed through the community mental health center system. The stages covered were admission, initial modality of service, service delivery in terms of types and amounts of services rendered and termination. Each center was analyzed independently of the others and it was ascertained that the methodology produced useful and informative evaluative data across all four centers.