CAJ | 학술논문

背景：慢性精神病性障碍所致的疾病负担很高，预计还将快速增长。根据上海市精神卫生条例（为与中国新的精神卫生法相一致，该条例之后又经过了修订），2012年上海建立了基于社区的精神疾病患者管理系统。目标：评估居住在上海市长宁区的精神障碍患者家属提供的监护服务。方法：在上海精神卫生信息管理系统中登记的长宁区社区精神障碍患者共4283例，通过社区卫生服务中心家庭医生和居委会工作人员对患者法定监护人进行调查，实际调查4034人。监护的落实情况是根据规范标准进行评估的，这些标准包括监护人定期参加精神卫生培训课程，以及他们在患者的治疗、日常生活和康复方面的协助情况，也记录了监护不力的主要原因。结果：大多数监护人（3331名，83.6%）充分履行了监护职责。在划分为监护不力的703名监护人中，87%的主要因素为监护人年事已高、自身体弱多病。与监护不力相关的其他因素包括患者病情不稳定、未能坚持服药以及患者独居。患者的诊断、监护人的教育水平以及监护人和患者之间的关系也是监护落实的影响因素。结论：中国城市中，对精神障碍患者实行的以监护人为基础的社区服务工作相当有效。但是，中国人口快速老龄化可能会逐渐降低中国家庭继续承担这个沉重负担的能力。中国实施新的精神卫生法后，需要制定另一种模式，为精神障碍患者提供高品质的、以社区为基础的服务。
배경：만성정신병성장애소치적질병부담흔고，예계환장쾌속증장。근거상해시정신위생조례（위여중국신적정신위생법상일치，해조례지후우경과료수정），2012년상해건립료기우사구적정신질병환자관리계통。목표：평고거주재상해시장저구적정신장애환자가속제공적감호복무。방법：재상해정신위생신식관리계통중등기적장저구사구정신장애환자공4283례，통과사구위생복무중심가정의생화거위회공작인원대환자법정감호인진행조사，실제조사4034인。감호적락실정황시근거규범표준진행평고적，저사표준포괄감호인정기삼가정신위생배훈과정，이급타문재환자적치료、일상생활화강복방면적협조정황，야기록료감호불력적주요원인。결과：대다수감호인（3331명，83.6%）충분리행료감호직책。재화분위감호불력적703명감호인중，87%적주요인소위감호인년사이고、자신체약다병。여감호불력상관적기타인소포괄환자병정불은정、미능견지복약이급환자독거。환자적진단、감호인적교육수평이급감호인화환자지간적관계야시감호락실적영향인소。결론：중국성시중，대정신장애환자실행적이감호인위기출적사구복무공작상당유효。단시，중국인구쾌속노령화가능회축점강저중국가정계속승담저개침중부담적능력。중국실시신적정신위생법후，수요제정령일충모식，위정신장애환자제공고품질적、이사구위기출적복무。
Background:The disease burden associated with chronic psychiatric illnesses is high and is projected to grow rapidly. A community-based management system for persons with mental illness was established in Shanghai in 2012 based on the Shanghai Mental Health Regulaitons that were developed to conform with China’s new mental health law. Aim:Evaluate the guardianship services provided by family members to persons with mental illnesses living in the Changning District of Shanghai. Methods:The legal guardians of 4034 of the 4283 community-dwelling persons with psychiatric disorders living in Changning District who are registered in the Shanghai Informaiton Management System of Mental Health were interviewed by local community health doctors and local neighborhood committee offcials. The adequacy of guardianship was assessed based on standardized criteria (including the guardian’s regular attendance at mental health training sessions, and their level of assistance in the treatment, daily life, and rehabilitaiton of the paitent) and the main reasons for inadequate guardianship were recorded. Results:The majority of guardians (3331, 83.6%) adequately fuliflled their guardianship duites. Advanced age and ill-health of the guardian was the main contribuitng factor in 87% of the 703 cases in which the guardianship was classiifed as inadequate. Other factors associated with inadequate guardianship included the paitent’s unstable clinical condiiton or failure to adhere to medicaiton, and when the guardian did not live in the same household as the paitent. The paitent’s diagnosis, the guardian’s level of educaiton, and the relaitonship between the guardian and paitent were also associated with the adequacy of guardianship. Conclusions: The guardianship-based community services for mentally ill individuals in urban China works reasonably well. But the rapid aging of China’s population may gradually decrease the ability of China’s families to conitnue to assume this heavy burden. Alternaitve models of providing high-quality, community-based services for persons with mental disorders need to be developed as part of the roll-out of China’s new mental health law.