中国精神科床位资源的理论配置

Allocation proposal of psychiatric beds in China

目的:在考虑精神障碍住院治疗"急慢分治"需求的前提下,提出适合我国国情的精神科床位配置方案,为制定全国性精神卫生服务资源配置规划提供参考。方法:通过文献复习、专家咨询,获得目前使用住院服务的主要精神障碍(精神病性障碍、双相情感障碍、重性抑郁障碍和老年期痴呆)的患病率和急慢性住院治疗的比例、平均住院日的数据,根据世界卫生组织推荐的精神科床位配置计算公式,计算精神科床位配置方案。结果:全国精神科床位的最低配置(满足可能有危害社会行为的精神病性障碍和双相情感障碍患者的急、慢性住院治疗需要)为262562张(床位密度1.97张/万人口),其中急性床位112206张,慢性床位150356张;中等配置(在最低配置基础上,进一步满足有严重自杀倾向重性抑郁障碍患者和有明显精神行为症状老年期痴呆患者的急性住院治疗需要)需618461张(4.64张/万人),其中急性468105张,慢性150356张;较高配置(在中等配置基础上,进一步满足可能致残的精神病性障碍和双相情感障碍患者的急、慢性住院治疗需要)需1141340张(8.56张/万人),其中急性692517张,慢性448823张。结论:精神科床位资源配置应分阶段进行,首先满足最低配置,逐步加强床位建设。在各档配置中首先应满足急性住院的需要,在此基础上,进一步增加慢性治疗床位建设。

Objective： Based on the principle of meeting different hospitalization needs of acute and chronic patients with mental disorder, an allocation plan of psychiatric beds in China was proposed to provide a reference for developing the national plan for resource allocation for mental health services. Methods： Data were obtained by literature review, including the prevalence rates of the psychotic disorders, bipolar disorder, major depressive disorder and dementia, which were the disorders principally utilized inpatient services. Data were also collected by Delphi study, including the proportion of patients with above disorders requiring inpatient treatment and their average hospi- talization days. Then how many psychiatric beds were required in China with the computing formula recommended by World Health Organization were calculated. Results： A three-level allocation plan was proposed. The low level was to meet the hospitalization need for the patients with psychotic disorder or bipolar disorder who had high risk violence behavior, and 262,562 psychiatric beds （ 1.97 per 10,000 population） were needed, comprising 112,206 beds for acute admission and 150,356 beds for chronic hospitalization. The middle level, based on the low level, was to further meet the acute hospitalization needs for major depressive disorder patients with serious suicide risk,and dementia patients with obvious behavioral and psychological symptoms, and 618,461 beds （4. 64 per 10,000 population） were required, in which the beds for acute hospitalization went up to 468,105. The high level, based on the middle level, was to further meet the hospitalization need for patients with psychotic disorder or bipolar disorder who had high risk of disability, and 1141340 beds （8.56 per 10,000 population） in total should he allocated, com- prising 692,517 beds for acute admission and 448,823 beds for chronic hospitalization. Conclusions： It suggests that psychiatric beds allocation should be carried out step by step, with the first step to meet the need of low level, then to increase beds number to further meet the higher level needs. For each level, the acute hospitalization need should be met first, then to develop the chronic hospitalization beds.