关于构建严重精神障碍患者强制社区医疗制度的思考

Thinking About Building Mandated Community Treatment System for People With Severe Mental Disorders

居家的重性精神障碍患者如果漏管失控,将会是潜在的社会危险因素。借鉴美国的协助门诊治疗、英国的监督社区治疗、我国台湾地区的强制社区治疗制度,我国内地也应该建立起适合自身情况的强制社区医疗制度,以加强对居家精神障碍患者的管理和照护。精神科医师应综合考虑患者病识感、依从性及危险性3项因素,从而确定居家患者是否需要社区治疗。患者应与辖区内社区卫生服务中心、乡镇卫生院签订治疗协议,并积极履行协议,接受危险性评估;如居家患者严重违约或拒绝接受评估,应责令其接受强制社区医疗,以避免精神障碍患者自伤或他伤等肇事肇祸事件的发生。

Patients with severe mental disorders at home being out of control will pose potential risk for the society. Using assisted outpatient treatment in the United States, supervised community treatment in the UK and mandated community treatment in Taiwan region for reference,we should build mandated community treatment system which is suitable for the conditions of China's Mainland, in order to promote the management and care for people with severe mental disorders at home. Psychiatrists should consider three factors including patients＇ awareness of illness, compliance and risk, then whether patients need community treatment can be judged. Patients should sign the agreement of treatment with community health service centers and township hospitals,after which patients should actively perform the agreement and accept risk assessment. If patients default seriously or refuse to receive assessment,they shall be ordered to receive mandated community treatment to avoid the patients from injuring themselves or others.