严重精神障碍残疾者“医院-社区一体化”职业康复规范化建设研究

Standardization Building of Occupational Rehabilitation Based on ‘Hospital-community Integration' Service Model for Patients with Mental Disability due to Severe Mental Disorder

背景作为全国精神卫生综合管理试点的创新项目,长宁区组建多学科服务团队介入严重精神障碍残疾者"医院-社区一体化"职业康复服务。目的分析严重精神障碍残疾者"医院-社区一体化"职业康复规范化建设的实施状况。方法从团队组织、服务路径、培训模块、日常运作等方面阐述规范化建设运行状况,评价规范康复率、肇事肇祸率、满意度等指标完成情况。结果长宁区初步形成了由政府部门及街镇提供社会支持,由专业机构和高校提供技术支撑、由多学科服务团队提供专业干预和指导,由社会组织和家庭成员共同参与的"医院-社区一体化"职业康复规范化建设模式。这一模式为严重精神障碍残疾者建立了职业康复路径和培训模块,提供了职业康复训练、精神健康社会服务、心理疏导为一体的综合干预。截至2017年累计接受服务的严重精神障碍残疾者62例,2016—2017年年均服务人次数2 124例次,严重精神障碍残疾者抽样满意度从96.7%(60/62例次)提高至99.3%(142/143例次),家属抽样满意度从95.1%(78/82例次)提高至98.6%(140/142例次),年均规范康复率为99.5%(4 227/4 248例次),年均疾病复发率和再住院率为4.8%(3/62),肇事肇祸事件发生率为0。结论长宁区开展的"医院-社区一体化"职业康复规范化建设一定程度上补充了现有体系中对严重精神障碍残疾者及其家属的服务,满足了多元康复需求,推进辅助性就业,为完善相关服务提供了政策依据。

BackgroundAs an important pilot project of National Mental Health Comprehensive Management,this study formed a muti-disciplinary team to provide occupational rehabilitation based on “hospital-community integration” service model for people with mental deformity in the Changning District of Shanghai.ObjectiveTo analyze the standardized building of occupational rehabilitation based on “hospital-community integration” service model.MethodsWe described the situation from four aspectsteam organization,service path,training module and daily operation,and evaluated rehabilitation rate,accident rate and satisfaction rate.ResultsThe model gained social support from government departments and towns,received technical support from institutions,colleges and universities,acquired professional guidance from mental health multifunctional team,and promoted participation from social organizations,mental health social services and family members of patients.This model established rehabilitation paths and training modules,provided occupational rehabilitation training and comprehensive intervention.As of 2017,the comprehensive service modelhas received 62 patients with severe mental disorder and serviced 2 124 visits annually.The statistic results of two consecutive years （from 2016 to 2017） showed the satisfaction rate of patients increased from a baseline of 96.7%（60/62） to 99.3%（142/143）,meanwhile the satisfaction rate of their families increased from a baseline of 95.1%（78/82） to 98.6%（140/142）,the annual standard rehabilitation rate reached 99.5%（4 227 /4 248） ,the average rate of palindromia and rehospitalization per year reached 4.8% （3/62） and the accident rate remained unchanged at 0.Conclusion“Hospital-community integration” model in Changning complements the existing system,meets various rehabilitative needs for patients with mental disability due to severe mental disorder and their family members,creates auxiliary jobs and provides policy basis for the standardization building of occupational rehabilitation.