香港心理衞生期刊 三十七卷 第二期 二０一一年冬 Hong Kong Journal of Mental Health Volume 37 No. 2 Winter 2011
Message from Chief Editor
中國精神衛生服務現狀
謝斌 上海交通大學醫學院附屬精神衛生中心 |
摘要
|
中國的現代精神醫學是隨著殖民時代到來而主要由西方傳教士引入的。但一直到1949年以後，精神衛生服務在中國才真正規範化、科學化和系統化，服務資源不斷增加、服務能力和質量不斷提高。但是，與大衆日益增長的精神健康需求相比，中國的精神衛生服務在法律和保障政策、基層和社區服務網路建設、服務模式轉變等方面仍存在明顯的不足。隨著國家醫療改革和精神衛生立法的推進，精神衛生服務在公平、可級、高效、權益保障等方面將有機會迎來新的發展。 |
Abstract
| Mental Health Care in China The modern psychiatry in China is mainly introduced by Western missionary physicians during the colonial era. But not until 1949, the mental health service really to be organized in standardized and scientific way in China. Since then there have been significant increase in service resources, capacity and quality. However, compared with the growing mental health needs, there are significant deficiencies in legal and financial policy, primary care and community based service network, and service model transformation. As the progress of national health care reform and mental health legislation, the nation is facing a new opportunity to develop mental health care in different dimensions such as equity, accessibility, effectiveness, and patients rights protection. |
Keywords
| 中國、精神衛生服務 |
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中國大陸精神衞生服務的主要問題與對策
賈福軍 廣東省人民醫院 廣東省精神衞生中心 |
摘要
| 根據浙江省 (Shi, Q.C., Zhang, J.M., & Xu, F.Z., 2005)和河北省(Li, K.Q., Cui, Z., & Cui, L.J., 2007)最近的流行病學調查結果推算，中國大陸15歲以上精神疾病的總患病率約15%；根據更早的七省市流調結果(Zhang, W.X., Shen, Y.C., & Li, S.R., 1998)推算，大陸有重性精神疾病患者1600萬人，受到情緒障礙和行為問題困擾的17歲以下兒童和青少年約3000萬人。因此各類精神疾病至少在一億人以上，而且整體上治療率較低(Phillips, M.R., Zhang, J.X., & Shi, Q.C., 2009)。從精神衞生服務資源上看，每萬人口擁有精神科住院床位1.43張，每10萬人口擁有精神科醫師1.26人，精神科護士2.40人。可見，中國大陸精神衞生服務需求與服務資源不足的矛盾非常突出。 |
Abstract
| The Current Issues of Mental Health Service in China The paper discusses the current issues of mental health service in China. It first examines the inadequacies of professionals, including psychiatrists and psychiatric nurses, followed by discussion on the mental health system establishment, the roles and obligations of government in mental health services, the development of integrated psychiatric hospitals and the need for mental health policy research. |
Keywords
| 中國精神衞生、問題、對策 |
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增權取向建構精神醫療社會工作實習方案
萬心蕊 謝依君 台灣心理衛生社會工作學會 |
摘要
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本文藉描述過去數十年精神醫療社會工作實習重視教導實習生社會工作之功能性角色之歷史，以透視科技理性典範之醫療模式－強調技術訓練的治療典範，對專業知識造成影響，形成階級性宰制，故台灣心理衛生社會工作學會之實習工作小組，針對此狀況，企圖透過增權取向之實習實驗方案，於僵化的醫療體制中，社工員（督導）、實習生及與精神疾病倖存者三者之間能發展出平等的夥伴關係，以實踐社工尊重人性、公平、正義的價值觀。此過程採取行動研究法，於行動中反映社工實習的精神、目的、核心能力；各種權力壓迫關係及爭鬥、專業界限等，並探討對實習生、督導、精神醫療和社工教育體制造成的衝擊、影響，及對未來發展做出建議。 |
Abstract
| The empowerment approach program for psychiatric social work practicum The therapeutic paradigm emphasizing the functional role, focusing on skill training, is the mainstream of psychiatric social work practicum for decades, which has a great influence on the construction of social work knowledge. The practicum team of the Society of Taiwan Mental Health Social Work tried to take empowerment approach to run practicum program, provided a new opportunity for social workers ( in this program as supervisors), students, and clients to develop an equal partnership and bring the social work values such as humanity and social justice into full play. Using action research method, this article has two goals, first, presenting the content and result of the experiential practicum program, including the spirits, goals and core abilities of social work practice, power oppression, struggles and professional boundaries. Second, exploring this program’s impacts and influences for practicum students, supervisors, psychiatric medical system, and social work education system. At the end of the article, providing suggestions for social work practicum. |
Keywords
| 精神醫療社會工作實習、增權取向、行動研究 |
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Attitude towards Recovery in Chinese Mental Health Professionals
Bonnie W M Siu Y M Yeung M Y Poon Lina N N Sun Castle Peak Hospital |
Abstract
| Objectives: Recovery is an influencing mental health service direction around the world and different overseas countries have adopted recovery as either their national policies or guiding principles of mental health service reform. It is worthwhile to explore the feasibility of implementation of recovery in the Chinese populations. This study aimed to explore the attitude of Chinese mental health professionals towards recovery. Methods: A convenient sample of Chinese mental health professionals of different disciplines including psychiatrists, psychiatric nurses, occupational therapists, clinical psychologists and social workers in Castle Peak Hospital were asked to fill in the Recovery Attitudes Questionnaire-16 (RAQ-16). Their acceptance of recovery was explored. Results: 206 Chinese mental health professionals completed the RAQ-16. In general, they had high acceptance of recovery. Almost all of the participants strongly agreed or agreed that a good understanding of one’s mental illness helps in recovery (96.6%) and that the recovery process requires hope (95.6%). About 70% strongly agreed or agreed that all people with serious mental illnesses can strive for recovery. Conclusion: Chinese mental health professionals have positive attitude and high acceptance of recovery and their mental readiness for the implementation of recovery is supported. |
摘要
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中國精神科專業人員對｢康復進程｣的態度 目的: *｢康復進程｣ 乃全球精神科服務的重大方向。世界各地均以此為其精神科服務改革的政策。此研究旨在探討｢康復進程｣在中國人精神科服務體系的可行性及調查中國精神科專業人員對｢康復進程｣的態度。 方法: 一群青山醫院中國籍的專業人員包括精神科醫生、護士、職員治療師、心理學家、及社工填寫了問卷，以探討他們對｢康復進程｣的態度。 結果: 共二佰零六位專業人員填寫了問卷。概括而言，他們對｢康復進程｣的態度正面，接受度亦高。多於九成的專業人員認為對自身精神病的認識及抱有希望的態度可促進｢康復進程｣。另外，大約七成同意嚴重精神病患者亦可擁有｢康復進程｣。 總結: 中國精神科專業人員對｢康復進程｣的態度正面。他們對｢康復進程｣的推行已有了心理上的預備。 *｢康復進程｣乃青山醫院精神科專業人員透過病人及職員的聚焦小組對“Recovery”的中文詮譯。强調「康復進程」是一個個人化的過程，精神病患者在過程中不但學會好好管理自己的精神健康，同時也是一個追求進步的過程，無論疾病所造成的限制是否存在，都可以超越疾病，過著滿足、有希望、又有貢獻的生活。 |
Keywords
| Chinese, Mental Health Professionals, Recovery |
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One-year outcome of a district-based Kwai Tsing Personalised Care Programme for patients with severe mental illness using a recovery-orientated case management approach in Hong Kong
W K Lee S F Chan P S Wong Y Chow M S Li Bonson H K Kan Patrick Kwong William T L Lo S F Hung Kwai Chung Hospital Margaret Tay Kenny K Wong Hospital Authority |
Abstract
| Aim: To evaluate the treatment effectiveness of the district-based Kwai Tsing (KT) Personalised Care Programme (PCP) for patients with severe mental illness (SMI) Methodology: The first approach is a 12-month KT PCP Pre-post outcome comparison in the service utilization profile and clinical-psycho-social profile of 102 recruited subjects and their carers using computerised data from a territory-wide retrospective decision support system and multiple locally validated assessment tools. The second approach is a 12-month controlled outcome comparison of KT PCP versus Sham Shui Po district (SSP) Standard Community Care (SCC) in the service utilization profile. Result: KT PCP showed statistically significant favourable outcomes in both pre-post comparison and controlled outcome comparison in total in-patient episodes, total length of hospital stay and total Accident Emergency Department attendances for psychiatric problems. Pre-post outcome comparison also demonstrated statistically significant reduction of symptoms, reduction of total HoNOS score, improvement of social and occupational functioning, reduction of unmet needs and reduction of overall carers’ burden. Conclusion: District-based PCP appeared to be a successful service model in Hong Kong to enhance the recovery and social inclusion of patients with SMI in the community. |
摘要
|
為重性精神病患者而設，以個案管理和復元導向服務模式，實施地區為本的葵青區個案復康支援計劃的一年成效研究 香港2010/11年度的特首施政報告落實推行地區為本的個案復康支援計劃，葵青區個案復康支援計劃已於二零一零年四月在葵涌醫院正式投入服務，目的是透過個案管理，於葵青區為重性精神病患者，提供持續及個人化的深入支援服務，並加強與社區夥伴合作，協助患者復元和融入社會。本研究比較了參與葵青區個案復康支援計劃的首102位重性精神病患者一年前後的醫療數據和與深水埗區標準社區服務對照組作比較兩種方法，發現接受了葵青區個案復康支援計劃服務一年的重性精神病患者，於以下各方面，得到顯著改善：使用精神科住院服務次數和留院時間減少、為精神科問題而向急症室求診次數減少、病徵減少、社交及職業功能增加、未能滿足的健康和日常生活需求得以減少、他們家人的負累得以減少。結果顯示個案復康支援計劃是一個有效和成功的嶄新服務模式，協助重性精神病患者復元和融入社會。 |
Keywords
| Recovery, Personalized Care, case management, severe mental illness |
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A Study of Acculturation and Psychological Well-Being of New Immigrant Women from Mainland China
W W Fung City University of Hong Kong |
Abstract
| This study explored the acculturation and coping process of new immigrant women migrated to Hong Kong from Mainland China. Findings of studies conducted in pluralistic or multicultural societies have consistently shown that integration is the strategy that could bring about the most favourable adjustment outcome of immigrants, while marginalization the most unfavourable, with separation and assimilation in between. However, it is argued that when the dominant group is expecting immigrants to assimilate, such as in the case of Hong Kong, immigrants adopting an integration strategy may face with more stress since the larger society is less tolerant of cultural diversity; instead, adopting an assimilation strategy may result in the most adaptive adjustment and better psychological well-being, since they can gain entrance to the larger society and avoid the pressure demanding them to abandon their native culture. It was hypothesized that among the four modes of acculturation, the order in terms of adaptive adjustment in descending order should then be: assimilation, integration, marginalization, and separation. A correlation study was used to test the various hypotheses. Respondents were 410 new immigrant married women from Mainland China, who had been residing in Hong Kong for less than twenty-four months. Data were collected through individual interviews with the use of a set of structured questionnaire. Two instruments on measuring stress of acculturation and level of acculturation were specially developed for this study. As predicted, the assimilated respondents were found to have the lowest level of stress of acculturation and the highest level of psychological well-being, whereas the separated group had the highest level of stress of acculturation and the lowest level of psychological well-being. The integrated and marginalized groups were having intermediate levels of stress and well-being. |
摘要
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從中國大陸遷移到香港的新移民婦女涵化的過程 此項研究探討了從中國大陸遷移到香港的新移民婦女涵化的過程。過去在多元文化社會中進行的研究，結果通常標示出採取共融 (integration) 策略的新移民一般適應得最好，採取邊緣化 (marginalization) 的策略則最為不利，而採取分離 (separation) 或同化 (assimilation) 策略，其適應結果則在兩者之間。不過，當整體社會要求新移民同化，例如在香港，採取共融策略的新移民可能面臨更大的壓力，因為主體社會並不接納多元文化；相反，採取同化策略可能會帶來較好的心理健康，因為此舉有助減輕要求他們放棄原有文化的壓力，令他們有較大機會融入主流社會。基於這假設，按以上四種不同的涵化模式，推斷其適應結果順序應為： 同化、 融合、 邊緣化與分離。此研究採用了相關性分析的方法來測試這假設，被訪者為410位來自中國大陸的已婚新移民婦女。研究採取個人訪談方式，並透過一組結構化的問卷進行資料收集。問卷設計中包括了兩個專門為這項研究開發的量表，分別量度被訪者所面對的涵化壓力和涵化策略。如所料，研究結果顯示採取同化策略的被訪者面對的涵化壓力最低，心理健康則最好，而採取分離策略的被訪者涵化壓力最高，心理健康則最差。 |
Keywords
| Acculturation, stress, immigrant, integration, assimilation |
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How do Chinese Cognitive-Behavioural Therapy Trainees View Their Own Therapy Competence and the Cultural Compatibility of this Therapy for Chinese Clients with Depression in Hong Kong?
Daniel F K Wong Department of Applied Social Studies City University of Hong Kong |
Abstract
| Background: There is growing need and demand for the application of and training for cognitive-behavioural therapy (CBT) in different cultures. While there are increasing evidences to suggest that CBT is applicable to people of different culture backgrounds, such as the Chinese in Hong Kong, there is a lack of a documentation concerning the training of CBT practitioners of different cultural backgrounds. Aim: This article aimed to document the subjective experience of 20 trainees who undertook our one-and-a-half-year cognitive-behavioural therapy (CBT) training programme. Method: In-depth interviews were carried out with all of the trainees, and these interviews were transcribed and coded. Results: Content analysis of the transcripts suggests that the trainees had gained an understanding of the CBT framework and felt competent in facilitating clients’ acquisition of adaptive cognitive and behavioural responses. They were less confident in facilitating the modification of rigid dysfunctional rules and values. Many of the trainees mentioned the culturally attuned CBT exercises and worksheets as being useful in helping clients to acquire cognitive and behavioural strategies to handle their distress and depressive moods. With regard to the modes of training, the trainees were particularly appreciative of the live demonstration and coaching. Lastly, these trainees considered CBT to be culturally compatible with Chinese values and with Chinese people’s preference for certain styles of therapy practice. Conclusions: The findings are useful as a reference for developing CBT training for practitioners of Chinese-speaking backgrounds. |
摘要
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認知行為療法的華人受訓者如何看待自身的治療能力感和使用該療法治療香港抑鬱症患者時的文化兼容性 研究背景：認知行為治療（CBT）發展至今，眾多的證據顯示認知行為治療適用於不同文化背景的群體，例如將治療方法應用於香港華人。與此相關的認知行為治療培訓的需要亦與日俱增。然而，目前缺乏一些有關此類訓練的相關資料。 |
Keywords
| Cognitive-Behavioual Therapy, professional trading, Chinese |
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How does the way we think about Schizophrenia influence the way we treat our patients
Professor Sir Robin Murray Professor of Psychiatric Research Institute of Psychiatry, Kings College Strand, London |
| Transcript of the presentation at the 20th Professor P.M. Yap Memorial Lecture of The Mental Health Association of Hong Kong Delivered on 2nd September 2011. |
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