小学生心理健康问题与心理健康教育工作探讨

小学生正处于身心发展的重要时期,随着生理、心理的发育和社会阅历的扩展及思维方式的变化,特别是面对社会竞争的压力,他们容易在学习、生活、人际交往、自我意识和升学就业等方面,遇到各种心理困惑和问题[1]。笔者在查阅     

Mental health care in Cambodia

An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization.     

Mental health issues: ethical considerations

Employer-initiated psychiatric evaluations raise a number of ethical issues particular to mental health in the workplace. This article addresses the ethical concerns and potential legal implications of psychiatrist and employee role ambiguity (e.g., "mutual deception"); describes the elements common to psychiatric examinations in this setting; offers one way to provide information and documentation of a confidentiality waiver; reviews some differences between psychiatric and general medical IME evaluations; discusses interview and report record "ownership"; reviews dangerousness assessment strengths and limitations; and addresses treatment and restoration to fitness issues.     

Mental health issues of gay and lesbian adolescents

The mental health concerns of gay and lesbian adolescents are best understood within the context of cultural limitations, including a problematic conceptualization of adolescence, homophobia, and erotophobia. Within this framework, background information about homosexuality is presented; and the special social pressures and psychologic problems of gay and lesbian youth are discussed, with particular attention paid to internalized homophobia, developmental issues, and the “coming-out” process. Differences between gay and lesbian mental health issues are highlighted. Finally, practical suggestions regarding treatment planning are provided.     

Mental health services and outcome-driven health care.

Mental disorders and mental symptoms often go untreated in both chronic care and primary care settings. However, they covary with functional disability. They are likely to impair social and occupational function in medical outpatients and to cause excess instrumental and cognitive disability in frail older persons. In both groups, they are frequent and often remediable. The costs of untreated mental disorders are often shifted to caregivers and to society in general. To ensure adequate mental health care requires a reorientation of medical care toward optimizing function and well-being as well as longevity. Such a reorientation will necessarily entail more attention to treatable mental disorders. Research is needed to (1) develop firm knowledge on which to base integrated medical and mental health treatment and (2) evaluate the potential economic benefits of combined care. Incentives must be changed if such a paradigm of care is to prosper.     

Ethical issues in community health care

Health care professionals are expected to base their practice on a set of ethical principles, including truthfulness, beneficence, nonmaleficence, justice, and confidentiality. Dilemmas can arise, however, when a medical professional is called upon to act in opposition to personal values or in cases where the values of patient, health care worker, and sponsoring institution conflict. The author outlines several of the ethical dilemmas that have arisen in community medicine in Sri Lanka. Since preventive medicine is based on the assumption that protection of public health is primary, individual rights and freedom of choice may be overruled, as, for example, in the case of mandatory testing and isolation for communicable diseases. Numerous ethical dilemmas arise in family planning, including whether physicians are mandated to refuse women a permanent method of fertility control when the required spousal consent has not been obtained. In these cases, the physician must weigh the administrative requirement for spousal consent against the principle of physician-patient confidentiality. Physicians are also placed in a difficult situation when patients request Depo-Provera--a contraceptive method that has been banned in the US due to its side effects but remains available in Sri Lanka--or postcoital contraception given the illegality of abortion in the country. Throughout the Third World, physicians constantly encounter challenges to the ethical principle of just, equitable distribution of health care resources.     

Mental health in the mainstream of health care

Mental health policy making has moved steadily into the mainstream of health policy. The phenomenon has expanded the resources available to people with mental disorders. It has also led to decisions that are based on inadequate understanding of mental illnesses and their treatment. Continued progress in the well-being of people with mental disorders requires expanded engagement of the mental health community with mainstream health policymakers.     

Legal and ethical issues in HIV / AIDS care

People in India, including foreigners, can be forced to submit their blood for HIV testing at the discretion of a health officer. Once tested, no statute exists to protect the confidentiality of that medical information. Section 51 of the Goa Public Health Act and local municipal laws provide for the notification of AIDS cases. There are presently 67 AIDS surveillance centers in India. No statute obliges doctors to treat people with HIV. However, once treatment is started, the doctor is obliged to continue treatment to ensure that the patient does not die, with treatment being administered only with the patient's consent. No statute exists which requires the HIV testing of employees in the workplace or prisoners. Only defense personnel are being routinely tested for HIV. Furthermore, there are no specific criminal offenses for transmitting HIV and no policies regarding HIV-infected employees. Preventive measures are contained in local municipal laws, local public health laws, and the Epidemic Diseases Act, and vaccine and drug trials are conducted under the Drugs and Cosmetics Act.     

The epidemiology of HIV infection, AIDS, and health care worker risk issues.

Acquired immunodeficiency syndrome (AIDS) has been a silent epidemic for 22 years. The 1st documented isolate of the human immunodeficiency virus (HIV) was detected retrospectively in a blood specimen from a young Central African man who had participated in a study in 1959. AIDS cases were 1st reported in 1981. 2 factors kept the AIDS epidemic silent: 1) the long incubation period between the initial infection and the onset of disease; and 2) the relatively recent intrusion of the virus into developed nations. Almost 100,000 people in the US now have AIDS. AIDS was found to be transmitted by blood; therefore, there is concern among health care workers (HCWs) about the risk of AIDS transmission. In the US, AIDS was 1st described in 1981 in 5 sexually active homosexual young men in Los Angeles. Soon, AIDS was describe in clusters of patients in other cities. It is defined as many unusual infections or cancers that suggest a poorly functioning immune system for which no other cause can be found. Statisticians with the US Public Health Service have used mathematical models to estimate the magnitude of HIV infection in the US. They currently estimate this to be 1-1.5 million infected persons. AIDS is not spread by casual transmission. The 3 established transmission routes--sex, contact with blood, and being born to an infected mother--are not equally efficient. It is estimated that all infected persons will sooner or later become seriously ill with HIV-related disease. To date, only 1 drug (Azidothymide or AZT) has been licensed as an effective antiviral drug. In April, 1988 the Centers for Disease Control (CDC) reported that HCWs developed AIDs with the same statistical frequency as the rest of the general population. The number of HCWs who have developed disease as a result of occupational exposure is so small that it is statistically undetectable. This does not mean there is no risk for occupational infection, but only that it is a relatively low risk for most HCWs. The major risk for transmission of HIV infection to HCWs is associated with handling sharp instruments. The major preventive effort should be directed at this problem. The CDC has suggested a system of infection precautions called "Universal Precautions" to protect HCWs from HIV infection. Another approach is "Body Substance Isolation." It is intended to be a complete isolation and precautions system. Reusable instruments should receive disinfection. Management of HCWs with potential exposure to HIV is discussed.     

Mental health care roles of non-medical primary health and social care services

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.     

PSRO: issues in health care policy

Enactment of the law regarding Professional Standards Review Organizations (PSROs) represents a major shift in health care policy in the United States. PSRO is an experiment in developing a national quality assurance system. It raises issues of quality versus cost control, professional versus public accountability, and confidentiality. These issues must be examined critically by social workers.