北京市严重精神障碍患者监护人看护管理补贴政策实施效果评价分析

背景　家庭在精神障碍预防、照护、功能康复方面发挥着重要作用，《中华人民共和国精神卫生法》赋予监护人各项权利和义务，但是日常生活中常面临监护人缺位或者监护人照护压力较大的问题。严重精神障碍患者监护人看护管理补贴政策是北京市2016年开始实施的一项政策，旨在帮助患者家庭减轻负担，激励监护人更好履责。目的　了解严重精神障碍患者监护人看护管理补贴政策的实施效果。方法　课题组于2018年11月-2019年1月采用多阶段分层整群抽样方法采用自行设计的问卷调研北京市精神卫生政策的实施情况，本研究数据来自其中关于严重精神障碍患者监护人看护管理补贴政策部分的内容，调查患者/家属对该政策的知晓情况和医务人员对该政策的评价。结果　682例精神障碍患者/家属中，614例（90.0%）患者/家属表示知道该项政策。单因素分析结果显示，不同机构类别、学历、家庭人均月收入、患病年限的患者/家属对监护人看护管理补贴政策的知晓情况比较，差异有统计学意义（P<0.05）；Logistic回归分析结果显示，家庭人均月收入对患者/家属监护人看护管理补贴政策的知晓情况有影响（P<0.05）。631例医务人员中，表示该项政策起到了激励作用的有375例（59.4%），单因素分析结果显示，不同机构类别、职称的医务人员对监护人看护管理补贴政策能否起到激励作用看法不同，差异有统计学意义（P<0.05）；Logistic回归分析结果显示，机构类别对医务人员对监护人看护管理补贴政策能否起到激励作用的看法有影响（P<0.05）。结论　严重精神障碍患者监护人看护管理补贴政策的实施情况较好，但是目前社区精神卫生工作仍然面临政策落实不到位、缺少社会的理解和关注、服务能力有限的问题，建议进一步推动落实精神卫生社区服务政策、完善精神卫生社区服务模式、提高精神卫生社区服务能力。

Implementation Effect of Nursing Care Subsidy Policies for Guardians of Patients with Severe Mental Disorders in Beijing

Background　Family plays an important role in the prevention of mental disorders，and patient care，and functional rehabilitation. The Mental Health Law of the People's Republic of China grants guardians various rights and obligations，but the patient often lacks of a guardian or his guardian faces great pressure caused by nursing workload in daily life. The Interim Measures on Guardians' Application for Subsidies for the Care and Supervision of Patients with Severe Mental Disorders（hereinafter referred to as IMGASCSPSMD） has been implemented in Beijing since 2016，aiming to help to reduce the family burden of the patients，and to incentivize the patient's guardian to better perform duties. Objective　To evaluate the effectiveness of the implementation of the IMGASCSPSMD in Beijing. Methods　From November 2018 to January 2019，our research group adopted a spatially stratified，multi-stage cluster sampling design and a self-designed questionnaire to investigate the implementation effect of mental health policies in Beijing. The data of this study came from part of the investigation，concerning the awareness of the IMGASCSPSMD in patients/patients' family members and the evaluation of the implementation results of the IMGASCSPSMD in medical workers. Results　Of the 682 patients and their family members，614（90.0%） expressed that they knew about the policy. Univariate analysis revealed that the awareness of the IMGASCSPSMD differed significantly among the patients/patients' family members by the level of healthcare agencies for seeking mental health services，education level，household monthly income per person，and the duration of mental disorders（P<0.05）. Logistic regression analysis indicated that household monthly income per person was associated with the awareness of the IMGASCSPSMD among the patients/patients' family members（P<0.05）. Among the 631 medical workers，375（59.4%） indicated that the implementation of IMGASCSPSMD has played an incentive role. Univariate analysis revealed that opinions about the incentive effect of the IMGASCSPSMD implementation varied significantly among medical workers by the level of medical institutions and professional title（P<0.05）. Logistic regression analysis showed that medical workers from different levels of medical institutions had different views on the incentive role of IMGASCSPSMD implementation（P<0.05）. Conclusion　The implementation of the IMGASCSPSMD in Beijing has achieved good effect. However，community-based mental health services are still lack of sufficient policy support which required further implementation and better results，and the understanding and attention from the society. Moreover，the services are limited. Supportive policies concerning community-based mental health services should be further implemented，and the delivery patterns for such services should be improved，and the serving capacities of community-based health organizations should be enhanced.