精神卫生服务需求与资源利用研究

目的掌握山东省精神卫生服务需求和精神卫生资源投入及利用现状。方法抽样调查全省精神疾病患病率及诊治情况,全面调查全省精神卫生资源现状。结果山东省精神疾病全人口患病率为１２２１‰,推算全省现患病人数为１０３０４２８例。１３１９％的患者接受过系统治疗;５２７６％的患者只接受过间断治疗;３４０５％的患者从未接受过治疗。全省共拥有精神科正规病床１０００７张,每万人拥有床位数为１２,精神科病床年平均使用率为８１６％。结论山东省精神卫生资源投入不足,并且存在着精神卫生资源的浪费。     

上海市精神科床位利用现状和发展策略

据统计全市15岁以上居民各类精神病患者率达16．39％;全市精神科病床8560张,平均0．66张／千人;其床位使用率平均为110．04％,一般市、区（县）级精神卫生中心出院病人平均住院天数为200天左右。目前,本市精神科主要问题是布局不合理,各区县精神病科病床分布相差甚大,每千人口平均床位相差38倍;精神病人平均住院时间长; 人员、设施配备不到位。精神科床位发展应以政府防治为主,社会办康复为辅,明确各精神科机构功能定位,缩短住院天数,加强执业准入监管和质量控制,合理规划布局。     

辽宁省综合医院精神卫生服务现状调查

目的 全面了解辽宁省综合医院精神卫生服务现状。方法 采用自制调查表对全省27所综合医院精神科现状进行调查。结果 全省除了鞍山、抚顺、丹东、葫芦岛四个城市没有综合医院设立精神科,其他10市均有分布,其中数量最多的是沈阳市,拥有12所医院（44.4%）。全省总病床891张,病床使用率平均82.3%,精神卫生服务人员310人,医生118人（38.1%）,护士90人（29%）。总门诊量为757.29人次/天。结论 政府应加大对综合医院精神科投入,进行合理布局,规范管理,满足日益增长的精神卫生服务需求。     

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。     

杭州市精神卫生服务资源现状调查

目的：掌握杭州市精神卫生服务资源现状,为杭州市精神卫生服务规划和精神卫生政策制定提供科学依据。方法：采用自编的问卷对杭州市精神卫生专科医院和设有精神科的综合医院进行调查。结果：截至2010年末,杭州市共有16家医疗机构提供精神卫生服务,每10万人拥有精神科医师和护士数分别为4．29、7．07。医生和护士主要集中在市属医疗机构（分别占47．5％、56．3％）和专科医院（分别占61．7％、60．7％）。医生、护士和医技人员以30～39岁组所占的比重最大（分别占42．1％、44．1％、35．4％）。医生中中级职称者最多,占36．7％,护士和医技人员都是初级职称者占多数（分别占56．9％、66．7％）。医生和护士的学历都以本科为多数（分别占53．4％和44．8％）,而医技人员的学历以大专为最多（37．4％）。实际开放床位2445张,床位密度为2．81／万人。结论：杭州市精神卫生服务资源数量不足,地理分布不合理,社区精神卫生服务需加大投入,人力资源结构尚待优化。     

黑龙江省精神卫生服务资源现状调查研究

目的:了解黑龙江省精神卫生机构及人力资源现状,为合理配置精神卫生资源提供数据支持。方法:采用“全国精神卫生医疗机构调查表”及“全国精神卫生防治技术管理机构调查表”进行调查,由市、县精神卫生项目办填写信息并汇总,由省精神卫生项目办进行统计分析。结果:截至2020年底,黑龙江省共有精神卫生机构123家,其中精神专科医院53家,综合医院内设精神(心理)科57家,中医院内设精神(心理)科4家,精神康复机构1家,其他精神卫生机构8家。现有精神科病床21556张,平均175.3张/家,床位密度为6.77张/万人。精神卫生机构由卫生健康系统主管81家(65.85%),民政系统主管9家(7.32%),其他系统主管2家(1.63%);非政府主办31家(25.20%)。提供精神卫生服务的机构中共有精神卫生服务人员5794人。精神卫生医疗床位使用率中位数为58.64%,平均住院日中位数为72天,精神科入院量为48748人/年,精神科出院量为48486人/年。2020年全省精神科门急诊总量为976607人次/年。结论:黑龙江省精神卫生医疗机构覆盖率较低,且床位资源的地域分布不公平,精神科卫生专业技术人员配置仍处于较低水平,应关注相应资源分布的合理性并增加投入。     

广东省卫生资源配置现状分析

目的 通过对广东省2001年卫生资源现状分析,为制定全省卫生规划提供参考。方法 对广东省不同地区各级各类医疗机构卫生资源的多项指标进行绝对数、均数、百分构成的描述分析、比较分析。结果 2001年,广东省共有各级各类卫生机构8638所,床位172735张,卫生人员总数为330418,其中卫技人员占81．21％,全省每千人口平均拥有卫技人员数、医生数、护士数、药剂人员数分别为3、55、1．50、1．13及0．39人,拥有病床数为2．14张,万人拥有一般仪器和大型设备分别为7．62、1．18台。卫生资源配置主要集中在珠江三角洲;各地政府投入差异较大;卫生资源以全民所有制为主体。结论 广东省卫生资源较丰富,但配置不合理。要做好卫生规划,调整卫生资源存量,合理布局,加强对经济欠发达地区卫生资源的投入力度。     

河南省新型农村合作医疗试点县卫生资源状况分析

目的掌握河南省新型农村合作医疗试点县卫生资源的数量、结构、分布和使用效率，以及试点县卫生资源配置中存在的问题，为搞好卫生资源配置，给农民提供优质、足量、高效、适宜的卫生服务，保证新型农村合作医疗试点的成功提供科学依据和政策建议。方法通过报表收集资料。对资料进行描述性分析和对比分析；结果试点县农民年人均卫生事业费为3．74元，千人口拥有床位0．70张，卫生技术人员0．93人，医生0、40人，千人口拥有乡村医生0．52人，医、护比为1：0．57．床、医比为1：0．57，床、护比为1：0．32。县级病床使用率50％左右，乡级30％左右。结论试点县卫生投入不足，资源缺乏，结构不合理，使用效率低。     

云南省精神卫生机构现状调查

目的 :全面了解云南省精神卫生机构资源配置现状,旨在为政府部门改善精神卫生机构防治能力提供相关依据。方法 :采用问卷调查法,通过自制调查表对全省16个州(市)精神卫生机构进行现状调查。结果 :云南省现有精神卫生资源的配备水平为每万人有0.85张精神科床位,每10万人拥有1.34名精神专科医师。60.49%的精神科医师的学历为大学本科,职称构成以初职和中职为主,仅有63.25%(389人)的精神科医师接受过各类培训或继续教育。结论 :云南省精神卫生服务机构严重缺乏,且资源分布不均衡,精神卫生资源匮乏以及专业人员缺乏,继续教育机会欠缺,需进一步加大投入和人才培养。     

2005年昆明市15岁以上居民烟酒行为及所致精神障碍研究

[目的]了解昆明市居民常见烟酒行为及所致精神障碍流行强度及分布情况。[方法]2005年11月,在昆明市按容量比例和随机抽样原则,抽取15岁以上本地常住居民,采用CIDI2．1为调查工具,DSNM—Ⅳ为诊断标准,调查近30天内常见烟酒行为及所致精神障碍患病情况。[结果]调查5033人,近30天患有各类烟酒所致精神障碍的86例,30天患病率为1.96％;终生患病的442例,终生患病率为6．78％。30天患病率与终生患病率居首位的均是尼古丁依赖（30天患病率为1．93％,终生患病率为4．24％）。30天患病率男性与女性分别为3．51％、0．06％（P〈0．01）,终生患病率男性与女性分别为11．97％、0．31％（P〈0.01）;城乡间的差异无统计学意义（P〉0．05）。[结论]昆明市15岁以上居民各类烟酒所致精神障碍患病率较高,尼古丁依赖患病率最高。     

Epidemiological survey of psychiatric disorders in Japanese school children. Part III: Prevalence of psychiatric disorders in junior high school children

In order to determine the prevalence of psychiatric disorders in junior high school children, an epidemiological survey of Japanese regular public junior high school children was conducted using Rutter's questionnaire method for screening and a diagnostic interview by pediatricians for the final diagnosis. Both teacher's and parent's questionnaires by Rutter were utilized. Two pediatricians carried out semi-structured interviews of 10-12 minutes for every child and diagnosed their mental state. In part 1 (previously reported), the Japanese version of Rutter's questionnaires was found to be satisfactory for screening, and the diagnostic interview used in this survey was shown to be a reliable tool for the diagnosis of psychiatric disorders of the adolescent. In part 2, the prevalence of psychiatric disorders was studied in the 592 school children who were the subject of the preliminary survey. In the present study, a total of 1,992 children from 5 junior high schools in Gunma prefecture were surveyed cross-sectionally of whom 1,672 (84.3%) screened negative, and 312 (15.7%) positive. The positives and a part of the negatives were randomly selected for interviews, and were diagnosed as to whether they have psychiatric disorders or not by the criteria of Rutter. The overall prevalence rate of diagnosed psychiatric disorders in these school children was 14.8%, (20.1% for males and 8.3% for females). The prevalence rate is significantly higher in males than in females. Disorders diagnosed were classified into emotional, conduct, and mixed disorder, based on Rutter's classification. No cases of schizophrenia and anorexia nervosa were found here as well as in the preliminary survey. The ratio of emotional to conduct disorders was 1.9. Prevalence of conduct disorder in females was one seventh that in males. This study also revealed that the questionnaire method is effective for screening for psychiatric disorders in children, but is not sufficient for differentiating types of disorders. Therefore the diagnostic interview was shown to be useful not only for epidemiological surveys but also for mental health services.     

深圳市宝安区严重精神障碍患者现况调查

  目的  了解深圳市宝安区目前六种在册严重精神障碍患者的患病率及人口统计学特征,为制定严重精神障碍的防治策略提供科学依据。  方法  选取2019年6月30日前纳入深圳市精神卫生信息管理系统的宝安区患者,对其人口统计学特征进行分析。  结果  宝安区共登记在册严重精神障碍患者7 835例,现住址在宝安区的患者共有6 408例。全区报告患病率为1.97‰,其中最高的是西乡街道(2.95‰),最低的是新桥街道(0.83‰)。在六种严重精神障碍中,精神分裂症最多,占60.82%,其次为双相情感障碍(17.03%)和精神发育迟滞伴发精神障碍(15.48%)。患病人群主要集中在18~44岁年龄组(61.01%),文化程度较低,未婚人士居多;患者合并高血压和糖尿病患病率分别为1.44%和1.46%;个案管理率为3.17%。在2010―2018年间,年度登记病例数和报告发病率都呈现双峰型变动趋势。  结论  精神分裂症是宝安区严重精神障碍综合防控的重点病种,不同类型的严重精神障碍患者具有不同的人口统计学构成,患者的慢性非传染性疾病的筛查和个案管理有待进一步加强。     

温州市综合医院精神卫生服务现状调查

目的：了解温州市综合医院精神卫生服务状况。方法：在温州市11所综合性医院进行问卷调查,内容包括医院规模及医疗服务总体资源,设置精神卫生服务机构及人员配置状况,精神卫生问题会诊情况,精神科联络情况及医院对临床医师进行精神卫生知识培训情况。结果：（1）11所综合医院中有5所设立了精神卫生科室,占45.5%;被调查的3所二甲医院均没有设立精神卫生科室。（2）设立精神卫生科室的5所综合性医院中,精神科会诊率平均为0.57%,在未开设精神卫生科室的医院中,精神科平均会诊率为0.13%,两者之间的差异非常显著。（3）11所医院都没有建立符合我国精神卫生特点的会诊—联络精神病学模式,都没有成立由精神科医师和临床医师共同参加的会诊联络小组。结论：温州市综合性医院精神卫生服务正处在起步阶段,已经开始重视精神卫生服务工作,但是资源配置、精神障碍的识别与处理、会诊联络精神病学工作及继续教育和培训等尚较粗略。     

Homelessness and the use of acute psychiatric beds: findings from a one-day survey of adult acute and low-level secure psychiatric patients in North and South Thames regions

This paper describes the impact of homelessness on the use of adult acute and low-level secure psychiatric beds in North and South Thames regions. We specifically focus on those homeless patients who no longer required the acute psychiatric facilities in order to determine the complement of accommodation and alternative services necessary to enable them to be discharged. A point prevalence survey of all patients occupying adult acute and low-level secure psychiatric beds in North and South Thames regions was carried out on 15 June 1994. All patients occupying adult acute and low-level secure psychiatric beds in 54 mental health providers and seven private psychiatric units in North and South Thames regions were included in the survey. Demographic, admission, and diagnosis data were collected. Homeless patients were identified as those patients not living in permanent accommodation. Ward managers (nurses) were also asked to identify patients who, in their opinion, no longer required acute care and to identify more appropriate provision for these patients. Of the 3978 adult and low-level secure patients enumerated 20.5% (817) were recorded as homeless. A total of 306 homeless patients were identified by ward staff as inappropriately located, of whom 58.2% of were unsuitable to be discharged into the community but still required some form of alternative health provision, for example staffed-housing in the community and in-patient rehabilitation services based in hospitals. However, 51.8% of patients were suitable to be discharged back into the community and the majority required housing as a key component within their 'package of care'. Homeless psychiatric in-patients have contributed to the increasingly precarious state of mental health services provision and represent a failure to provide a sufficient level of community alternatives for those who can no longer access the long-stay hospital services, and for whom the pool of acute psychiatric beds is ever reducing.     

广东省精神卫生机构现状调查

目的 全面了解广东省精神卫生机构现状。方法 采用问卷调查法,通过自制调查表对全省62家精神卫生机构进行现状调查,同时对22家精神病专科医院进行4年前后比较。结果 全省精神科床位数9901张,精神科医师数1236人,精神科护士1909人,分别为1.16张/万人、0.15人/万人和0.22人/万人;病床使用率多数在82.00％;仅有12.00％的精神卫生机构采用开放式管理。22家医院4年前后比较,住院床位数、医生总人数、副高以上医生人数、心电图机台数、电脑台数、医院年总收入和住院月收费均得到增长,工作场所面积、病床使用率、日均门诊次数、日均心理门诊次数、除心电图机和电脑之外的其他设备无增长,政府拨款减少。结论 全省精神卫生机构存在的主要问题是精神卫生资源配置短缺和不平衡,管理模式落后,自身发展困难,政府投入减少。     

2019年郑州市严重精神障碍的流行病学特征分析

目的 了解郑州市严重精神障碍的流行特征,为进一步开展严重精神障碍防治工作提供依据。方法 从国家严重精神障碍患者信息系统导出郑州市辖区的患者,描述分析其流行特征。结果 郑州市2019年底严重精神障碍患者累计登记21941例,报告患病率2.36‰,其中男性2.12‰,女性2.62‰;患病率最高的新密市为4.69‰、最低的郑东新区只有0.62‰;病种分布以精神分裂症为主（71.87%）,其次是精神发育迟滞伴发精神障碍（11.38%）;患病率最高为45～59岁组（5.65‰）;患病人群集中在农村,占61.59%;文化程度偏低,初中及以下患者占73.74%;职业以农民为主,占60.91%;无家族史患者占88.81%;未婚患者较多,占32.02%;家庭在当地贫困线以下患者占33.92%。结论 郑州市严重精神障碍报告患病率处于较低水平,报告管理工作需进一步提升;严重精神障碍管理应重点关注45岁及以上人群且以精神分裂症为主。     

Mental health services for deaf people: a need identified

The unique problems of deaf people suffering from mental health conditions have long been recognised but have received inadequate attention in many parts of the country. In the absence of a specialist psychiatric service for deaf people in Wales a prevalence survey was conducted to estimate the numbers of deaf patients occupying long-stay mental health beds and to assess facilities available to them. A high prevalence of prelingual deafness was found in long-stay psychiatric inpatients, approximating to a relative risk ten times that in the general population. Throughout Wales there are approximately 100 patients with either prelingual or profound postlingual deafness resident in long-stay psychiatric and mental handicap beds. An inadequate provision of specialist support and equipment for all categories of deaf in-patients is demonstrated by the results of this study. Purchasers of mental health services must ensure that an acceptable quality of provision, including both access to a specialist psychiatric service and a supportive in-patient environment, is secured from providers.     

Mental illness, functional impairment, and patient preferences for collaborative care in an uninsured, primary care population

OBJECTIVE: Our goal was to compare the prevalence of mental illness and its impact on functional status in an indigent uninsured primary care population with a general primary care sample. We also hoped to assess patient preferences about mental health and medical service integration. STUDY DESIGN: We compared a survey of consecutive primary care adults in April and May 1999 with a 1997-98 survey of 3000 general population primary care patients. Both studies used the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire and the 20-question Medical Outcomes Study Short Form. POPULATION: The patients were from a private nonprofit primary care clinic in Grand Junction, Colorado, that served only low-income uninsured people. We approached a total of 589 consecutive patients and enrolled 500 of them. MAIN OUTCOME MEASURE: The main outcomes were the prevalence of psychiatric illnesses and the relationship with functional impairment. We compared our findings with a more generalizable primary care population. RESULTS: This low-income uninsured population had a higher prevalence of 1 or more psychiatric disorders (51% vs 28%): mood disorders (33% vs 16%), anxiety disorders (36% vs 11%), probable alcohol abuse (17% vs 7%), and eating disorders (10% vs 7%). Having psychiatric disorders was associated with lower functional status and more disability days compared with not having mental illness. Patients indicated a preference for mental health providers and medical providers to communicate about their care. CONCLUSIONS: This low-income uninsured primary care population has an extremely high prevalence of mental disorders with impaired function. It may be important in low-income primary care settings to include collaborative care designs to effectively treat common mental disorders, improve functional status, and enhance patient self-care.