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国内外精神分裂症社区管理模式的比较研究

Comparative Study of Community-Based Management Models of Schizophrenia at Home and Abroad

  • 摘要: 精神分裂症作为一类具有高致残性和迁延性的重性精神疾病,给我国社会和患者造成了沉重的疾病负担。社区管理是精神分裂症长期、全面管理的重要环节。在多年的探索中,以个案管理(case management, CM)、主动式社区治疗(assertive community treatment, ACT)和危机干预(crisis interventions, CI)为主的社区管理模式已被验证有利于患者的整体康复,但其具体实施情况在国内外存在差异。 基于这一现状,本文通过系统分析国内外研究,深入探讨了不同管理模式的特点及差异成因,进而对我国社区管理发展提出针对性建议:在个案管理方面,建议根据地区经济水平和资源条件实施分级管理,以提升资源配置效率;在ACT模式应用中,应立足我国实际,重点发展以家庭为核心的综合干预体系;针对危机干预环节,则需构建家庭-社区-公安联动机制,同时强化专业培训并完善转诊流程。我们呼吁未来我国应增加资源的投入,深化理论研究,并积极倡导社会各方的广泛参与,共同推动国内精神分裂症社区管理模式的持续优化。

     

    Abstract: Schizophrenia, a severe mental illness characterized by high disability and chronicity, imposes a heavy disease burden on society and patients in China. Community-based management plays a crucial role in the long-term and comprehensive management of patients with schizophrenia. Through years of exploration, community-based management models—primarily focused on case management, assertive community treatment (ACT), and crisis intervention—have proven beneficial to the overall recovery of patients. However, notable differences exist in the implementation of these models between domestic and international practices. Given this context, we systematically analyze domestic and international research to examine the characteristics of different management models and the causes of the differences. Based on this analysis, we propose targeted recommendations for improving community-based management of schizophrenia in China. Regarding case management, a tiered approach should be adopted according to regional economic conditions and resource availability to optimize the efficiency of resource allocation. For ACT, we suggest developing a family-centered integrated intervention framework adapted to China's specific context. Finally, regarding crisis intervention, a collaborative family-community-police response mechanism should be established, complemented by enhanced professional training and streamlined referral procedures. We advocate enhancing resource allocation and theoretical research, along with broader involvement of all sectors of society, to jointly optimize the community-based management model for schizophrenia in China.

     

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