Boundary Maintenance as a Barrier to Mental Health Help-seeking for Depression Among the Old Order Amish

This paper describes "boundary maintenance" as a barrier to help-seeking for depression within an Old Order Amish enclave. Observations and qualitative interview data were collected from 50 members of the Old Order Amish enclave and from the 8 mental health providers in their rural community. The Amish reported fairly high levels of depression, concomitantly high levels of reluctance to seek treatment for depression from mental health providers, and very low levels of service utilization. The functionality of boundary maintenance to group cohesion was discovered to be a significant barrier to help-seeking for depression from outside providers. Boundary maintenance was achieved through two social control mechanisms: religious-based stigmatization of depression and the construction of mental health providers as illegitimate help agents. Suggestions have been made to assist providers in achieving cultural competence among the Amish, in order to reduce the threat that the Amish perceive to their cultural boundaries.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

“健康中国战略”下社区精神健康服务协同供给的实现框架及路径

精神健康问题已成为影响经济社会发展的重大公共卫生问题和社会问题。基于社区的精神健康服务有利于精神疾病的早发现、早治疗、早控制,是促进精神健康的重要途径。我国当前的社区精神健康服务需综合运用健康治理、优势治理和协同治理的规律和方法,重组社区事务,建立协同平台,完善监护制度,加强考核评估的协同,提升服务能力,对社区居民不同的精神健康服务需求进行多层次、整体性回应。     

Profile of Community Mental Health Service Needs in the Moretele District (North-West Province) in South Africa

BACKGROUND: The emergence of democracy in South Africa led to a need to transform all public structures, including the health care system. The aim has been to transform these structures in order to bring them in line with the new culture of human rights. Transformation of the whole health care system is motivated by a number of key objectives, which include achieving equity in resource allocation and health service delivery, developing primary health care infrastructure and decentralising services to promote community participation. AIMS OF THE STUDY: In the context of de-institutionalising mental health services in South Africa, this study aimed to investigate community mental health service needs of mental health service users and that of their families in the Moretele district, North-West province, South Africa. METHODS: The study was conducted in three clinics situated in three different communities in the Moretele district. Data collection consisted of : 147 clinical record reviews, 105 interviews with patients followed by a joint interview with a family member, 83 interviews with caregivers and eight interviews with community key informants (traditional healers, a civic leader, a councillor, a retired teacher, and a physician). RESULTS: The majority of service users were males (54%). The mean age was 41 years and 63% had completed primary schooling.Patients were recorded as having only one of two primary diagnoses, namely schizophrenia (57%) or epilepsy (41%). However, a review of prescribed drugs and caregiver interviews showed that there was a presence of mood disorders among service users. The local hospital was service users primary entry point into the mental health care system, followed by traditional healers (30%). Interviews with service users, service providers and caregivers reveal limited knowledge of patient illness. Nevertheless, service users who had epilepsy were more likely to provide details of their illness than those with mental illness. Above half of service users had basic social skills such as bathing, eating, washing and using public transportation independently. Feelings of loneliness and isolation were common among service users in the community; seventy nine percent (79%), for example spent their days entirely in their homes. Only 7% reported contact with friends. Experiences of community discrimination and exploitation of people with mental illness were reported in key informant interviews and by service users themselves. DISCUSSION: The main community mental health service needs identified in this study were: (i) Improved quality of mental health services at clinics. (ii) Better co-ordination of services (clinic, hospital, social work and traditional healers) and removal of barriers to health service utilisation. (iii) Alleviation of the social isolation of mental health service users by building on existing community structures and individuals willing to engage in partnerships with service providers. The authors indentify a need to train primary health care providers in mental health in order to promote the adequate diagnosis and detection of common psychiatric illnesses.They also point out the need for social support interventions to enable people with mental illness to deal with loneliness and isolation and a need for psycho-educational programmes to make patients and caregivers better informed about mental illness.     

健康服务特性与医疗卫生的两种可推动机制

医疗卫生服务包括对身心处于健康的人群给予健康维护和促进、对疾病的发生进行预防以及对身心处于发生疾病的人群给予治疗和护理。作者在分析了卫生服务和医疗服务的经济行为特征之后提出，卫生服务能被公共服务机制所推动，而不能被交易机制所推动；大病医疗服务能被交易机制所推动，而不能被公共服务机制所推动。社区医疗具有特殊的保障意义，只能在公共服务机制下才能被推动。建议兼顾两者的效率，组合两种机制，构成完整的面向全面健康的复合型保障机制。     

The impact of community mental health reform on service users: a cohort study

British mental health services have undergone considerable reform in recent years. This paper reports a study designed to assess the impact of these changes on service users. The functioning of 100 randomly selected users of community mental health services in a North Wales town was assessed before the advent of two significant service changes – the establishment of a local Community Mental Health Team (CMHT) and the introduction of the main community care reforms in April 1993. Repeat assessments of sample members were made on three further occasions over the following 27 months, with a 9-month interval between each. Comparison of baseline and follow-up data suggested that services were appropriately targeted on users with a severe and enduring mental illness and that the functioning of this client group was successfully maintained over the study period. However, the establishment of a CMHT was associated with a temporary fall in social functioning, quality of life and satisfaction with services and there was no evidence to conclude that organizational reforms had led to an improvement in user outcomes in the medium term. Future mental health reorganization should be based on the evidence of research which includes an assessment of the impact of reforms on service users.     

城市社区公共卫生服务投入模式探讨

通过探讨城市社区公共卫生服务投入主体、投入主体与服务提供机构之间以及机构提供的公共卫生服务与基本医疗服务之间的关系,提出如何实施"政府购买服务"以进一步完善公共卫生服务投入模式的建议.     

The National Mental Health Plan in Chile: 10 years of experience]

Dealing with mental health problems is undoubtedly an increasingly important public health responsibility around the world. In Chile, because of the changes in the epidemiological profile of the population, the lifetime prevalence of mental and behavioral disorders has reached 36%. In response, the Ministry of Health of Chile, through its Mental Health Unit, prepared the National Plan for Mental Health and Psychiatry. The Plan establishes objectives, strategies, and steps to improve the well-being and mental health of Chileans. This piece describes the model of care for mental health and psychiatry used in Chile's public health care system, analyzes the main difficulties encountered and the achievements made in the 10 years that the Plan has been in place, and makes recommendations for improving the Plan. Over the 10-year period, the new model for mental health and psychiatry has managed to make a place for itself in the public health care system. Indicators show that the beneficiaries of the public health care system in Chile now have greater access to mental health services than before the new model of community care was established, have broader health care coverage, and receive better quality services.     

精神分裂症社区服务现状与发展策略研究

目的旨在探讨推行具有中国特色社区精神卫生服务的可行性举措。方法回顾国内外面向精神分裂症的社区精神卫生服务不同模式及其发展现状,分析影响发展的因素。结果我国精神分裂症的社区精神卫生服务需要从建立健全精神卫生体系、加强社会宣传和促进多部门合作等方面入手进行研究、探索。结论顺应全球精神卫生服务模式转变,积极发展精神分裂症的社区精神卫生服务势在必行。     

上海市社区医护人员精神卫生知识的现状及影响因素*

目的了解上海市社区医护人员的精神卫生知识现状及其影响因素,为今后针对性开展培训、提高社区心理卫生服务能力提供依据。方法依托上海市心理卫生服务体系建设三年行动计划项目,选取上海市3家试点社区卫生服务中心的医护人员进行调查,采用"非精神科临床医师心理卫生知识调查问卷"对医护人员进行调查。结果 (1)本次调查总体平均分50.0分,各维度得分均低于60.0%满分;(2)职业类别、参与精防工作和参加过培训是影响精神卫生及各维度知识得分的主要因素;(3)家庭医生的精神卫生知识得分较高57.4分,相比公共卫生人员高12.3分,家庭医生各维度的知识得分均较高,其次是中医/理疗/康复人员;(4)参加精防工作人员的精神卫生知识得分比没有参与的高14.6分,其各维度的知识得分均较高;(5)参加过培训在个别维度的得分较高。结论社区医护人员的精神卫生知识水平总体偏低,对抑郁、焦虑等心理疾病的认识有待提高;培训与实践相结合,是提高社区医护人员精神卫生知识水平的有效途径。