不同部门主办的社区心理卫生服务体系比较研究-孙娜云.docx

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1、华中科技大学 硕士学位论文 不同部门主办的社区心理卫生服务体系比较研究 姓名：孙娜云 申请学位级别：硕士 专业：社会医学与卫生事业管理 指导教师：吴均林 2011-05 不同部门主办的社区心理卫生服务体系比较研究 研究生：孙娜云 导师：吴均林教授 中文摘要 目的 本研究在查阅相关文献，收集整理相关资料的基础上，依托科技部国家科技支撑 计划项目，选取新疆克拉玛依市和湖北省武汉市开展心理卫生服务的社区进行调查研 究，了解社区心理卫生服务人员的现状，分析比较两地区不同部门举办社区心理卫生 服务的体系建设特点，在运作过程中存在的问题，为构建符合我国国情的、科学合理 的社区心理卫生服务体系提出建议。 对

2、象和方法 本研究采用了文献研究、问卷调查、访谈法等，以湖北省武汉市和新疆克拉玛依 市从事社区心理卫生服务的工作人员为问卷调查对象，以社区心理卫生相关行政主管 部门负责人、社区（心理 ） 卫生服务机构负责人和心理卫生服务工作人员为访谈对象。 对收集的资料进行分析整理，将数据输入 Excel数据库，运用 SPSS12.0统计软件对 资 料进行分析，主要包括描述性统计分析、 T检验、卡方检验等相关统计方法。 结果 1. 克拉玛依和武汉市的社区心理卫生服务人员均以女性为主；年龄构成方面，克 拉玛依以 30岁至 40岁年龄段的人数最多，占 54.55%，武汉市则以 20岁至 30岁年龄 段的人数最多，占

3、 31.18%;文化程度方面，两地区均以大专学历为主，所占比例分别 为 43.64%和 36.56%，但本科学历所占比例武汉市明显高于克拉玛依；职称构成方面， 克拉玛依有 92.73%的被调查者没有职称，武汉市有 50.54%的被调查者具有初级职称 ; 从业时间方面，两地区均 以工作 1年的人数比例为最多，分别占 61.82%和 78.49%; 两地区的从业人员均以兼职为主，所占比例分别为 78.18%和 97.85%;专业背景方面， 克拉玛依以教育学为主，占 21.82%，其次为心理学，占 14.55%，武汉市以护理学为 主，占 38.71%，其次为临床医学，占 36.56%;在目前工作岗位

4、方面，克拉玛依以社 区委员为主，占 45.45%，武汉市以公共卫生科为主，占 40.86%;两地区拥有心理咨 询师执业资格证书的人员比例都过低，分别仅为 3.64%和 2.15%。 2. 在人员培训方面，两地区社区心理卫生服务人员的培训率有差异，克拉玛依的 培训率高于武汉市的培训率，其比例分别为 98.18%和 64.52%。服务人员接受心理卫 生知识的培训时间两地区均以一周为主，其比例分别为 38.89%、 60%，其次是一个月， 其比例分别为 27.78%、 20.00%，接受培训内容均以心理健康教育为主，应答人数比 例分别为 90.74%和 86.67%，专题讲座和岗前培训是两地区社区心

5、理卫生服务人员接 受心理知识培训的主要方式，也是其获得心理学知识的主要途径。 3. 在开展社区心理卫生服务内容上，两地区都是以心理卫生宣教、心理健康讲座 为主；服务形式上，均以板报宣传、发放心理健康材料、举办专题讲座三种方式为主。 4. 武汉市的服务人员在治疗水平、诊断水平方面均高于克拉玛依的服务人员，且 两地区表现出显著性差异，但总体上，两地区服务人员的专业能力及工作能力的自我 评估均处于较低水平，且在各项服务能力自我评估方面均未表现出显著性差异。 5. 两地区的服务人员均在很大程度上认为开展社区心理卫生服务工作对促进居 民的心理健康有重要作用，但承担工作的意愿程度较低。工作量方面，两地区的

6、服务 人 员均认为自己的工作量较大，克拉玛依分别有 40%和 25.45%的被调查者认为自己 的工作量是超负荷和满负荷，武汉市分别有 39.78%和 22.58%的被调查者认为自己的 工作量是满负荷和超负荷。两地区服务人员的工作满意度表现出显著性差异，总体上， 克拉玛依服务人员的满意度较高。 6. 被调查者在工作中希望得到的支持方面，克拉玛依有 63.64%的人员选择了技 术支持，武汉市则有 84.95%的人员选择了经费支持；在开展工作的制约因素方面， 克拉玛依的服务人员认为专业人员是首要因素，武汉市的服务人员则认为经费是首要 制约因 素；在是否应该获得相应报酬方面，两地区大多数服务人员都认为

7、应该获得相 应报酬。 7. 克拉玛依举办社区心理卫生服务的模式是在社区中建立专门的心理卫生服务 机构，隶属于民政系统。武汉市举办社区心理卫生服务的模式是在原有的社区卫生服 务机构中补充心理卫生服务的内容，隶属于卫生系统。政策制定方面，克拉玛依还没 有专门的心理卫生文件，武汉市则已颁布了武汉市精神卫生条例。 8. 两地区社区心理卫生服务体系的筹资模式均以国家财政拨款为主，但克拉玛依 有政府拨付给心理健康教育工作的专项经费，而武汉市开展工作的经费则是含在公共 卫生经费中。 结论 1. 两地区社区心理卫生服务人员队伍均以中青年为主，学历、职称偏低，从事心 理卫生服务的时间较短，且大都是兼职人员。民政

8、系统模式缺少有医学背景专业的服 务人员，卫生系统模式缺少有心理学背景专业的服务人员。与国外相比，我国社区心 理卫生服务体系中专业人才缺乏，队伍结构不合理。 2. 民政系统服务人员的培训率高于卫生系统，但总体上，服务人员接受心理卫生 知识的培训时间较短，培训内容单一，缺乏完善的培训制度。 3. 民政系统的社区心理卫生服务体系职能侧重于预防，而卫生系统则重在治疗康 复，两种模式提供心理卫生服务的内容和形式相似，但缺乏多样化。 4. 民政系统内社区心理卫生服务人员的工作满意度高于卫生系统的人员满意度， 但总体上服务人员的工作满意度较低，且大多数服务人员都认为自己的工作量较大。 5. 两地区社区心理卫

9、生服务体系的组织结构和管理机制不同，各有特点，都取得 了一定的成效，但都是在单个政府部门的主管下开展工作，筹资机制也都是政府拨款， 与国外相比，筹资方式呈现出渠道单一的特点。 对策建议 1. 加快相关政策法规的制定，完善社区 心理卫生服务体系的建设。 2. 加大经费投入，建立以政府投入为主的多渠道筹资机制，完善补偿机制。 3. 培养专业人才，加强社区心理卫生服务人员队伍建设。 4. 整合资源，建立多部门协作机制。 5. 加大宣传力度，提高居民对心理卫生的认识。 关键词： 社区心理卫生服务体系比较 A Comparative Study on Community Mental Health Se

10、rvice System Sponsored by Different Departments Graduate: Sun Nayun Supervisor: Prof. Wu Junlin Abstracts Objective Based on investigating a lot of documents, and collecting relative references, the research originated from the national science and technology support projects, select communities tha

11、t carry out the community mental health service in Karamay, Xinjiang and Wuhan, Hubei Province, to conduct investigations and research, to understand the current situation of the community mental health service staff, to analyze and compare their own features and problems of community mental health

12、services system of different departments in the two areas, and the study will put forward many suggestions to establish science and reasonable community mental health services system that accord with the situations of our country. Objects and Methods The main methods in this paper used are documenta

13、tion method, questionnaire, interviewing, etc. The questionnaire investigation was conducted among the community mental health service staff of Karamay, Xinjiang and Wuhan, Hubei Province which are selected randomly, and the persons in each area who are the administrative department leader of commun

14、ity mental health, the director of community (mental) health service center and the mental health service staff are invited to make an interview. Then based on the collection of all data, establish the database with Excel, and input data, and using SPSS 12.0 statistic software to deal with data, the

15、 mainly statistics method including description statistics, t-test and chi-square statistics. Results 1. The community mental health service workers are mostly female both in Karamay, Xinjiang and Wuhan, Hubei Province. Different in the age structure, the number among 3040 age group is the largest i

16、n Karamay, being 54.55%, and the number among 20- 30 age group is the largest in Wuhan, being 31.18%. Regarding the education background of them, the majority is tertiary educated both in the two areas, and the proportion is 43.64% and 36.56% respectively, but compared with Karamay, the proportion o

17、f undergraduate of Wuhan is much higher. There are 92.73% staff investigated do not have professional title in Karamay, and 50.54% staff investigated are with primary professional title in Wuhan. In the number of working years in mental health services, the proportion of one year is the highest both

18、 in the two areas, accounting for 61.82% and 78.49% respectively, and 78.18% staff in Karamay and 97.85% staff in Wuhan are part-time workers. In the professional background, the personnel of Karamay are mostly pedagogy profession, accounting for 21.82%, followed by psychology, accounting for 14.55%

19、, Wuhan are mostly nursing profession, accounting for 38.71%, followed by clinical medicine, accounting for 36.55%. In the present position, community members are the majority with the proportion of 45.45% in Karamay, and public health section is the majority with the proportion of 40.86% in Wuhan.

20、The proportion of staff that have psychology certificate is too low, being only 3.64% and 2.15% respectively. 2. The training rate of community mental health service workers between the two areas are different, which is 98.18% in Karamay, and is 64.52% in Wuhan. The time of the personnel of two area

21、s receive psychological knowledge training are mainly one week, the proportion is 38.89% and 60% respectively, followed by one month, accounting for 27.78% and 20.00% respectively, and mental health education is the main training content, the percentage of response persons is 90.74% and 86.67% respe

22、ctively. The personnel of two areas get psychological knowledge mainly by specific lecture and pre-job training, which are two primary ways of training. 3. The community health service contents that the two areas carry out, they both put mental health education and lecture on mental health first, an

23、d the service forms are mainly blackboard newspaper publicity, distribution of mental health materials, and lectures. 4. The level of the treatment and diagnosis of the personnel of two areas both show significant differences, and the level of service personnel in Wuhan is higher than in Karamay. On

24、 the whole, the psychology professional capabilities and the work capabilities of self-evaluation of the personnel in two areas are low, and there is no significant difference among the self- eva5. The personnel of two areas regard it as of great important to promote the mental health of the residen

25、ts that carry out community mental health services, but their willingness to undertake work is low. Most of them consider their workload to be very heavy, overload is 40% and full load is 25.45% in Karamay, and it is 22.58%,39.78% respectively in Wuhan. The job satisfaction of the personnel in Karam

26、ay is higher, and different from that in Wuhan. 6. There is 63.64% staff in Karamay who considers the professional staff as the major restricting factor, wants technical support, and 84.95% staff in Wuhan wants fund support, which was considered as the major factor. Most of mental health service sta

27、ff in two areas think they should be paid for their labor. 7. The model of community mental health service in Karamay is to establish special mental health services in the community, which is affiliated with civil affairs departments, and the model in Wuhan is to supply mental health service in the

28、original community health service organizations, which is affiliated with health system. On the aspect of the policy, the government has already promulgated Wuhan Mental Health Act in Wuhan city, but it has no special laws in Karamay. 8. The financing model of community mental health service system

29、of the two areas both mainly rely on financial allocation of the country, but there is special fund of mental health education in Karamay, and the fund of work is included in the fund of public health in Wuhan city. Conclusions 1. The community mental health service staff of two areas are mainly in

30、middle and young age groups, their academic degree and professional title are lower, and most of them work in mental health services for a shorter time, and are part-time workers. The model of civil administration lacks service staff that has medicine background, and the model of health system lacks

31、 staff that has psychology background. Compared with foreign countries, the community mental health system of our country lacks professional personnel, and the team structure is irrational. 2. The training rate of community mental health service staff of civil affairs departments is higher than that

32、 in health system. On the whole, the time of services personnel receive psychological knowledge training was shorter, the training content was single, and the training system was imperfect. 3. The function of community mental health service system of civil affairs departments focus on prevention, an

33、d that of health system focus on rehabilitation treatment, and the content and form of mental health of the two models provide are resemblance, but not diversified. 4. The job satisfaction of the personnel of civil affairs departments is higher than that of health system, but both are lower as a who

34、le, and most of them think their workload is greater. 5. There are differences in the organizational structure and management system of community mental health system between the two areas, and both obtain the good achievement. However, they all do the work under the direction of a single government

35、 department, and the financing model both mainly rely on government grant, which show a feature of single channel compared with foreign countries. Countermeasures The government should promptly formulate the relevant regulation and policy to improve the community mental health service system, and in

36、crease the input of fund, establish a multi-channel fund-raising mechanism with the government grant as the driving force, and the compensation mechanism should be perfected. To strengthen the construction of the community mental health staff, more specialized personnel should be trained. Integrate

37、resources and establish a kind of coordination mechanism of multiple departments. The government should enhance propaganda to enhance public understanding of mental health. Key words: community; mental health service; system; comparison 独创性声明 本人郑重声明，本学位论文是本人在导师指导下进行的研究工作及取得的研 究成果的总结。尽我所知，除文中已经标明引用的内

38、容外，本论文不包含任何其 他个人或集体已经发表或撰写过的研究成果。对本文的研究做出贡献的个人和集 体，均已在文中以明确方式标明。本人完全意识到本人将承担本声明引起的一切 法律后果。 本学位论文作者完全了解学校有关保留、使用学位论文的规定，即：学校有权保留并向 国家有关部门或机构送交论文的复印件和电子版，允许论文被查阅和借阅。本人授权华中科 技大学可以将本学位论文的全部或部分内容编入有关数据库进行检索，可以采用影印、缩印 或扫描等复制手段保存和汇编本学位论文。 学位论文作者签名： 日期： 年 月 日 学位论文版权使用授权书 保密 ，在 _ 年解密后适用本授权书。 本论文属于 不保密口。 (请在以

39、上方框内打 V ） 学位论文作者签名： 日期： 年 月 日 指导教师签名： 日期： 年 月 日 .If. 1 1刖目 1.1研究背景 随着医学模式的转变和健康观念的增强，人们逐渐认识到心理健康同生理健康一 样，是构成整体健康的重要组成部分。现阶段，我国正处在经济与社会的快速发展时 期，竞争日益激烈，人们所承受的心理压力越来越大，已经严重影响到身心健康，各 种心理问题也越来越多，越来越复杂。据统计，我国有各类精神病患者约 1600万， 各类精神疾病所造成的负担占疾病总负担的 1/5,排名首位 1。促进心理健康和防治精 神疾病是全社会共同的责任，心理卫生问题已经成为严重危害人类身心健康的重大公 共

40、卫生问题之一。 80年代以来我国进行了一系列的心理健康状况以及精神疾病流行病学调查研究， 其结果均表示社会心理失衡与个体心理健康状况恶化，心理疾病需要引起高度关注。 1982年，地方精神疾病流行学 调查协作组对全国 12个地区精神疾病流行病学的调查 显示，各类严重精神疾病的终生患病率为 12. 96%。 ，张维熙等人在 1993年对该 12个 地区中的 7个地区进行了第二次精神疾病的流行病学调查，其结果显示，各类精神障 碍时点患病率为 11. 18/%，终生患病率为 13. 47/%，而 1982年相同 7个地区的时点患 病率为 9.11/%，终生患病率为 11.30/%，精神疾病患病率呈上升

41、趋势 2-3。 2001年世 界卫生组织和我国卫生部对浙江省 15岁以上人群进行的精神疾病流行病学调查结果 显示，精神疾病总时点患病率为 17.3%，最常见的疾病为心境障碍、焦虑障碍和物质 使用障碍。 2002年江西省各类精神疾病的时点患病率为 29.80%。 ，总患病率为 36.08%。，其中情感障碍、精神分裂症和酒依赖排在总患病率中的前三位。栗克清等 人的研究显示， 2004年河北省各类精神疾病的时点患病率为 162. 4%。，终生患病率为 185. 1/%4-6。 2008年，杨宠等人对我国 6个省市 5类职业人群进行心理健康状况的调 查结果显示，我国职业人群的焦虑和抑郁状况较为严重，亟待加强对他们进行心理疏 导 7。有研究表明，近年来抑郁症状发生率及抑郁症患病率在城市人群中有明显上升 趋势 8，长期处于焦虑、抑郁等心理问题的状态下，易引起心身疾病，从而影响人们 的心理健康水平和生活质量。 随着各类心理疾病发病率持续升高，心理卫生服务工作的重要性已经引起了政府