Introduction
According to statistics, there are about 100 million persons suffering from mental health conditions in China, of which, 16 million have severe conditions. Mental illness and disability have become the biggest economic burden among all diseases. Although it has received more and more attention from government at different levels and relevant sectors, financial inputs has been increasing yearly, the main intervention is still medical treatment in hospital and at home. The present situation of persons with mental health conditions in China can be described two “90%”, i.e. 90% of persons with mental health conditions stay at home and 90% of their time is spent at home. Without sufficient support from communities, they normally fall into a various cycle called “revolving door” phenomenon between hospital and family, which lead to repeated illness and gradually become disabled.
据统计,中国目前有精神障碍者1亿人,其中1600万严重精神障碍者。精神病及精神残疾所带来的疾病负担已超出其他疾病,成为最大的负担。尽管精神健康得到各级政府及相关部门越来越多的重视,经费投入也在逐年增加,但目前的干预仍然是以在医院和家庭的治疗为主。中国精神障碍者存在两个”90%”, 即,90% 的患者呆在家里,每个患者90%的时间呆在家里。由于缺乏足够的社区支持,他们通常陷入“旋转门”现象的恶性循环中,即“治疗-复发-再治疗”和“医院-家庭-医院”,他们在这样的循环中逐渐发展为残疾。
With joint efforts, the first phase (2011-2014) of EU-funded Action has successfully reached its objectives to integrate mental health care into primary health service in 3 districts of China. i.e. Haidian district in Beijing, Changchun and Tongling. The second phase was also launched in Harbin and Yanqing districts on the 1 March 2014 with aim to implement policies and laws at international and national level that address mental health and human rights, i.e. United Nations Convention on Rights of Persons with Disabilities (UNCRPD) and New Mental Health Law of China. It is necessary to introduce relevant disability/mental health development concepts and trend to partners so that their understanding and approach towards mental health will be shifted from pure medical model to social and human right-based model.
在多方共同努力下,欧盟项目的第一阶段(2011-2013年)成功的实现了其预期的目标,在北京的海淀、安徽的铜陵及吉林的长春三个地方,成功的将精神健康纳入了初级卫生保健。 二期项目于2014年启动,致力于在项目地通过实施国际国内相关的政策和法律,即《残疾人权利公约》及《中华人民共和国精神卫生法》,促进精神健康发展,保障精神障碍者的权利。因此,有必要在项目开始阶段向合作伙伴介绍与残疾和精神健康相关的发展理念和趋势,以帮助合作伙伴将认识和干预措施从医疗模式转向尊重权利的社会模式。
With the effect of new Chinese mental health law, it has been anticipated that there will be a rapid shift from hospital based psychotic care to community based mental health. The seminar was an important platform to bring major stakeholders like government sectors, institution and NGOs together, in order to discuss how successful experience of deinstitutionalization in western countries can be implemented in Chinese context.
随着中国新精神卫生法的生效,快速的将以精神病院为主的治疗转向以社区服务为主成为了人们的期待。这个研讨会是一个重要平台,它把包括政府、机构和非政府等在内的主要利益相关方聚在一起,共同探讨发达国家成功的去机构化经验如何与中国的国情有效的结合。
This seminar was held during the “World Mental Health Day”, thus, it was also an important event to advocate to government, professionals and the public on the rights of persons with mental health conditions.
该研讨会在“世界精神健康日”期间举办,因而也是一个向政府、机构和公众倡导精神障碍者权力的重要活动。
The seminar had honor to have the following distinguished guests to the opening ceremony and made remarks.
该研讨会有幸请到下列代表出席开幕式并做了重要讲话:
- Victor Giner, Attache’, EU Cooperation Instruments, EU Delegation to China and Mongolia
- Dr. Giuseppe Perricone, First Secretary of Italian Embassy to China
- Mr. Han Jibin, Head of the Second Division on Rehabilitation China Disabled Persons’ Federation (CDPF)
- Mrs. Wen Hong, Vice President of China Association of Persons with Psychiatric Disability and their Relatives
- Yao Guizhong, Deputy Director of PUIMH
- Alessandro Lorato, EU-funded Action Coordinator
- 欧盟驻华及蒙古代表团、欧盟合作处专员维克.吉纳先生
- 意大利驻华使馆一等秘书朱塞佩先生
- 中国残疾人联合会康复二处处长韩纪斌先生
- 中国精神残疾人及亲友协会副主席温洪女士
- 北京大学第六医院副院长姚贵忠先生
- 欧盟项目协调员亚历桑德罗.罗拉托先生
Short time was allocated to each speaker, but a lot of important issues were addressed and useful information was shared. The following is the summary of the opening ceremony.
尽管每个代表的发言时间有限,但他们的发言涉及到很多重要的与精神健康相关的问题,也带来很多有用的信息:
- Community mental health has been developed in Italy for over 50 years, it is meaningful to work with Chinese partners to develop it in Chinese context.
社区精神健康在意大利经历了50多年的发展,能将其经验与中国的实际情况相结合是一件有意义的事。
- EU supported Action has greatly promoted the mental health development in China and it also shows NGO can play an important role in social development; the Action also facilitated the cooperation and dialogue between NGO and government.
欧盟项目促进了中国精神健康的发展,它展示NGO在社会发展中可以起到重要的作用,同时,项目也促进了NGO和政府的合作和交流。
- The current environment for mental health development in China is favorable, i.e. China has ratified UNCRPD, relevant policies and laws were issues accordingly, e.g. Suggestions on Further Promote Disability Development by the State Council issued in 2008; Law on Protection of Rights of Persons with Disability was revised in 2008; improvement of both Social Security and Service System were included in national social and economic development; New Law on Mental Health was approved on 2013, 1 May; Regulations on prevention of disability and rehabilitation are under process for approval etc. Although mental health was started in a late stage in China, it has been gradually integrated into framework of legislation, working system, public service and social-economic development.
目前中国的精神卫生工作面临有利的环境:中国批准了《联合国残疾人权利公约》,并制定了相应的政策和修改了相应的法律以促进公约的实施,如:2008年出台的《中共中央国务院关于促进残疾人事业发展的意见》、2008年修改的《中华人民共和国残疾人保障法》、将建立残疾人的社会保障体系和服务体系纳入国家社会经济发展中、2013年5月1日正式生效的《中华人民共和国精神卫生法》、残疾预防及康复条例正在审批中。
- As a public health issue, Government should take major responsibility for mental health. Take CDPF as example, its major funding is from government at different levels, NGOs mainly provide technical support and pilot projects for demonstration and advocacy.
作为公共卫生问题,政府在精神卫生工作中起主导作用。以中国残联的工作为例,主要的经费来自政府,非政府机构主要提供技术支持、建立示范和倡导。
- Community mental health is the direction, but it should be developed step by step based on Chinese context. Deinstitutionalization can only be done when communities have capacity to meet needs, e.g. a big shortage of social worker in communities is one constrain.
发展社区精神健康是方向,但应根据中国的实际情况一步一步走。只有在社区能满足需求的情况下才能考虑去机构化,如目前社区普遍缺乏社工就是存在的问题之一。
- The central government and 18 relevant government sectors are taking leading role for mental health in China and they will have a meeting soon to discuss how to further promote community mental health.
精神卫生由中央政府和相关的18个部门共同负责。这些部门最近会召开会议讨论如何进一步提高社区精神健康。
- Due to stigma and discrimination, most of persons with mental health conditions either stay in hospital or at home, it is very difficult for them to access job and other opportunities, thus, it is important to improve capacity of communities.
由于歧视等原因,精神障碍者通常是呆在医院或家里,因此,提升社区的服务能力很重要。
- China Association of Persons with Psychiatric Disability and their Relatives has 3 committees, i.e. Family Member Working Committee, Autism Committee and Community Service Promotion Committee. Promotion of community service is one priority of the Association.
中国精神残疾人及亲友协会下属有三个委员会:家庭工作委员会、自闭症工作委员会和社区服务促进委员会。促进社区精神健康是该协会的主要工作之一。
- For long period, services for persons with severe mental health conditions were focused on “treatment and control”; this should be changed, persons with mental health conditions have potential and capacity, their human rights and dignity should be respected.
长期以来,对重度精神病患者的服务主要是“治疗和控制”,这种模式应该改变,精神障碍者有潜力和能力,他们的权利和尊严应该得到尊重。
- The EU-funded Action has been implemented based on model and experience of Italy; Chinese context should be considered when developing mental health.
欧盟项目的实施是基于意大利的模式和经验,在发展精神卫生时,中国的国情也应考虑在内。
Following the objectives of the Seminar, a number of presentations was given for information and experience exchange.
根据研讨会目标,通过一系列报告进行了信息和经验分享。
1. UNCRPD and mental health 《联合国残疾人权利公约》与精神健康
The UNCRPD highlights that persons with disabilities include those who have “mental impairments” and emphasizes the need to: 1) ensure their full and equal enjoyment of all human rights and fundamental freedoms; and 2) promote their participation in civil, political, economic, and cultural spheres with equal opportunity.
《联合国残疾人权利公约》强调残疾人包括精神障碍的人,要确保他们:1)享受同等的人权和基本的自由;2)要提供他们参与社会、政治、经济和文化等方面的平等机会。
Mr. Giampiero Griffo, representative of Disability People International (DPI) in Italy and Mr. Kirihara Naoyuki, representative of DPI Asia Pacific Japan gave an overall introduction on contents and principles of UNCRPD, highlighted articles which are closely linked to persons with mental health conditions. Mr. Naoyuki also briefed the development of mental health service in Japan and how persons with mental health themselves pushed those changes.
来自国际残疾人意大利的格里弗和来自国际残疾人亚太地区的铜原尚之先生介绍了《联合国残疾人权利公约》的内容和原则,并强调了那些与精神障碍者密切相关的条款。铜原尚之先生还介绍了日本精神卫生服务的发展历程和精神障碍者们如何推动其中的一些改变。
Both presentations showed that mental health is not a pure medical issue, but psychosocial issues; thus, a paradigm shift from medical model to social and right-based model is the key for mental health development. Our work should aim to ensure that dignity and human rights of persons with mental health conditions are respected.
两个报告都显示精神健康不是一个单纯的医疗问题,而是社会心理问题,因而,从医疗模式转向基于人权的社会模式是精神健康发展的关键。我们的工作应该致力于促进精神障碍者的权利和尊严得到尊重。
As China has ratified UNCRPD, it is the Country’s responsibility to develop laws, policies and actions to implement them to ensure the human rights of persons with mental health conditions. In this aspect, there is an urgent need to move the current institutional focus to community-based approach.
中国已经批准了《联合国残疾人权利公约》的实施,因而,有责任通过政策和法律的实施确保精神障碍者的权利,从这个角度来看,有必要将以机构为中心的服务模式转向以社区为中心。
2. Chinese Mental Health Law 中国的精神卫生法
Dr. Tang Hongyu from the Sixth Hospital of Peking University participated in the consulting and research of mental health legislation. He gave a brief introduction on the new law.
来自北京六院的唐宏宇主任,参与了中国精神卫生立法的咨询与研究工作,他对新的精神卫生法做了简要的介绍。
After 27 years’ efforts, China finally passed the first Mental Health Law. The new Law was developed in line with country situation and learning from international mental health laws and experience. The new Law aims to speed up the mental health development, to standardize the mental health service and to protect rights of persons with mental health conditions. The new Law also focuses on solving the current outstanding issues based on reality, i.e. to balance the rights of patients and safety of the public, to well combine prevention, treatment, rehabilitation, service and management, to establish mechanism with clear responsibility of all stakeholders.
通过27年的努力,中国最终批准了第一部精神卫生法。该法遵循国际精神卫生立法的基本原则,吸取国际经验,确立符合国情的立法宗旨。围绕三大宗旨:发展精神卫生事业、规范精神卫生服务、维护精神障碍患者的合法权益。尊重与立足现实,着重解决当前突出问题.平衡患者权益保护和公众安全,坚持预防为主,预防与治疗、康复相结合,服务与管理相结合的方针。明确责任,建立机制。
The concepts of developing community rehabilitation units is also included in the Law, the specific model or approach should follow the local situation, such as, day care center, half-way home etc.
精神卫生法里明确有建立社区康复机构的要求,具体模式根据当地的实际情况而定,可以是日间中心、中途宿舍等形式。
Based on the new Law, China will make efforts to strengthen both institutional and community services.
在实施精神卫生法中,中国将同时加强机构和社区的服务能力。
Every Province was requested to develop and implement policies accordingly based on local situation to ensure the implementation of the new Law. Relevant government sectors and institutes need to include implementation of the new Law into their responsibilities, i.e. Health, Civil Affair, Police, DPF, Education, Finance,Hospitals etc. Among the project sites, Changchun city has developed a regulation based on the national new Law and local situation.
要求各省按新精神卫生法的要求、结合当地的实际情况,出台相应的政策,保障法律的落实。各相关政府部门和机构,如卫生、民政、公安、残联、财政、教育、医院等,要将新精神卫生法的落实纳入其工作职责。在三个项目点中,长春出台了相应的条例。
3. National 686 project 国家686项目
This is the largest mental health project in the world initiated in 2004 by National Health and Family Planning Commission. The outbreak of SARS in 2003 exposed the weakness and problems of the public health system in China, consequently, the center government allocated CNY 3.7 billion to improve the public health system, of which, CNY686,000 was utilized for improving mental health services. In the past 10 years, the project has gradually moved from “control of persons with severe mental health conditions” to “management and treatment”; it has been also developed into routine practice from a project through establishment of sustainable working system and mechanism.
这是世界上最大的精神卫生项目,由国家卫生计生委于2004年发起。2003年发生的非典暴露了中国公共卫生体系的弱点和问题,于是,由中央政府拨款37亿用于提高公共卫生体系,其中,686万元用于提高精神卫生服务。在过去的十年中,该项目逐渐从“重型精神病控制”转向对这些患者的“管理和治疗”,也通过建立可持续的系统和机制将该项工作从项目转为了常规工作。
The project greatly mobilized resources to provide medical care and rehabilitation services in both institutions and communities, so far, 4 million patients were registered in database, 3.25 million persons have received follow up and family support, subsidy was provided to almost half million poor patients for medication and hospital treatment. Capacities of human resource were improved through two-level training, i.e. national and local.
该项目通过资源动员,巨大的提高了机构和社区的医疗服务和康复能力,到目前为止,有400万病人登记在信息库,325万人接受到随访服务和家庭支持,近50万人接受了服药和住院治疗的补贴。人力资源也通过国家和地方两级培训得到提高。
This project has made great achievement in terms of providing basic health care and rehabilitation services in a wide coverage (covers 1926 counties/districts in 275 prefectures).
该项目在提供广覆盖的基本医疗服务方面取得巨大成效,项目覆盖了275个地市的1926个县/区。
Since the new Mental Health Law is taking effect and inputs from government will be increased accordingly, more efforts will be taken to further strengthen the institutional and community services.
随着新精神卫生法的生效,国家的投入也会相应的增加,这些投入将进一步加强机构和社区的服务。
4. Progress of EU funded Action 欧盟项目进展
Dr. Yao Guizhong gave an overall introduction of the EU-funded Action, representatives from Tongling and Changchun cities presented the project implementation respectively. The Action has greatly facilitated the development of community mental health in 3 districts through establishing Community Mental Health Units (CMHUs) and Residential Open Units (ROUs), so far, the following units have been established
姚院长对项目作了总体的介绍,来自铜陵和长春的代表分别分享了项目在当地的实施情况。该项目通过社区精神卫生中心和开放式居住机构的建设,巨大的促进了项目地的社区精神健康发展。到目前为止:
- Tongling district of Anhui province: 4 CMHUs and 1 ROU in hospital 铜陵建立了4个社区精神卫生中心和1个院内开放式居住机构。
- Changchun district of Jilin: 2 CMHUs and 1 ROU in hospital 长春建立了两个社区精神卫生中心和一个院内开放式居住机构。
- Haidian district of Beijing: 23 CMHUs and 1 ROU in hospital and 4ROUs outside of hospital. 北京的海淀区建立了23个社区精神卫生中心和一个院内开放式居住机构。
It is very encouraging to see achievement and positive changes happened in the past 3-years, which has laid solid foundation for the second phase of the Action.
项目在过去三年中取得了令人鼓舞的成绩,为当地带来积极的改变,为项目二期打下了坚实的基础:
- Districts government paid attention to mental health after all advocacy and leading groups were established to provide policy and financial support to the Action, which consists of relevant government sectors, i.e. health, civil affair, social security, finance, education, DPF, media, etc.
通过倡导,精神健康得到当地政府的重视,设立了相应的领导小组为项目的实施提供政策和资金等方面的支持,领导小组成员来自卫生、民政、社会保障、财政、教育、残联、媒体等部门。
- A working mechanism/system of leading by Government with cooperation of Government sector and participation of society was primarily formulated, which is important for resource mobilization and network. Collaboration has been established with major stakeholders like DPF, Civil Affair, CDC, community Committee etc., each of them has a role.
建立了以政府为主导、部门配合和社会参与的工作机制,充分动员资源,建立网络。项目与残联、民政、疾控等部门建立了合作,各司其责。
- Psychiatric hospital and community health centers were working together to provide accessible and affordable services to people with mental health conditions. Capacity of community health centers on mental health care and rehabilitation was improved, meanwhile, hospital started to involve in public health work. Working opportunities are opening to users.
精神病院和社区卫生中心密切配合,为精神障碍者提供可及的、可以承担的服务。社区卫生中心在精神健康服务方面的能力得到提升,同时,精神病院也积极参与到公共卫生服务中。
- Establishment and running of ROUs brought advanced model of service, which provide opportunities for users to obtain various skills for their social participation and inclusion.
社区精神卫生中心和开放式居住机构的建立,带来了新的服务模式,让精神障碍者有机构学习各种必须的社会参与和社会融合的能力。
- International experience and local situation were well combines.
国际经验和地方情况有效结合。
- Capacity of professionals of hospitals was improved, especially, for Community-based Mental Health. Doctors do not passively wait patients in the hospital, but deliver service to communities proactive.
精神病院专业人员的能力得到提升,特别是社区服务方面的能力,医生不再被动的等患者上门,而是主动的将服务提供到社区。
- Awareness of community on mental health has been greatly improved.
社区精神健康的意识得到提升。
- The Action has been linked to other existing projects/progamme like 686 Project, national mental health project for persons with severe mental problems, foster and care center run by DPF etc.
该项目与当地现有的项目和工作相结合,如686项目、国家重型精神病社区服务项目、残联的托养重型和日间中心等。
- Families received needed support, such as information, counseling etc.
家庭得到所需的服务,如信息、咨询等。
There were also challenges 挑战:
- Lack of mental health professionals. 缺乏精神卫生专业人员
- Lack for volunteer and social workers. 缺乏志愿者和社工
- The proportion of mental health is too low among the work of community health center. 社区卫生中心的工作中精神卫生比重低.
- Most of patients can’t proactively participate in activities organized by CMHUs. 大部分病人不能主动参与社区精神卫生中心的活动。
- Limited Government fund to community mental health. 政府在社区精神健康方面的投入不足。
- Stigma and low level of support from society, i.e. lack of job opportunities etc. 社会的歧视和支持不够,如缺乏工作机会。
- Difficult to open ROU out of hospital. 院外设开放式居住机构困难。
- Constrains of institution. 机制障碍。
The Districts have plan to strengthen cooperation and network with other stakeholders for mental health development:
两个地区都有计划在今后的工作中与其他相关部门和机构合作:
- To link the EU-funded Action with 686 project; DPF work/programme; programme on community service for persons with server mental conditions and development of open hospital ward. 与686 项目、重型精神病社区服务、开放式医院结合。
- To strengthen cooperation with relevant government sectors to mobilize resource and to further improve prevention, treatment and rehabilitation system. 与政府相关部门合作,充分动员资源以提高预防、治疗和康复体系。
- To develop human and community based rehabilitation system through implementing the new Mental Health Law. 通过实施新精神卫生法,建立以病人为中心、以社区为中心的康复体系。
- Link the Action with various social services. 将项目与各种社会服务相结合。
5. Experience of Italy 意大利经验
Three experts from Italy, Dr. Giovanna Del Giudice, Dr. Francesco Colizzi and Dr. Alberta Basaglia shared the experience on mental health development in Italy, concepts of community mental health and practice.
来自意大利的三位专家,Dr. Giovanna Del Giudice, Dr. Francesco Colizzi 和 Dr. Alberta Basaglia 分享了意大利的精神卫生发展经验、社区精神健康理念和实践。
During the Seminar, the issue on how to balance the safety of the public and the rights of persons with mental health conditions, especially for those with server conditions, was raised. Both Dr. Giudice and Dr. Basaglia responded this through introduction of experience and practice in Italy. Before 1960’s, persons with server mental health condition in Italy were also regarded as “dangerous people” as they might harm others, there was very serious stigma and discrimination from the society, therefore, strategy and solutions were put them under “control” through “obligatory treatment in isolated hospital”, of course, in such situation, it is not possible for this group of people to have their rights and dignity.
在研讨会期间,关于如何平衡公众的安全和精神障碍者,特别是重度精神障碍者的权利被提到。Dr. Giudice and Dr. Basaglia 通过意大利的经验回应了这一问题。在60年代以前,意大利的重度精神病患者也被认为是“危险“的人,因为他们有可能给其他人带来伤害,因而社会对他们有严重的歧视,解决的途径和策略也是将他们强制关在精神病院中,当然,在那样的环境中,这些人是不可能享有他们的人权和尊严的。
Luckily, started from 1960’s, Dr. Basaglia initiated advocacy on human rights of persons with mental health conditions by breaking the traditional understanding: to establish open hospitals, to have humanized relations among professionals, patients, families and member of societies, to give patient right to express themselves and respect to their life etc., however, the situation wasn’t changed immediately. Through consistent efforts, in 1970’s, patients finally realized the right of free treatment with protection by law. Treatment and rehabilitation has been gradually moved from psychiatric hospitals to communities, patients’ right as citizen were respected. Consequence, psychiatric hospitals were closed.
幸运的是,从六十年代开始,巴萨利亚医生等人开始倡导精神病患者的权利,呼吁打破传统的认识,建立开放的医院,建立专业人员、病人、家属和社会之间人性化的关系,给病人表达他们自己的权利,尊重病人的生活等。然而,情况没有马上因此而改变。在他们坚持不懈的努力下,到70年代,精神障碍者终于享有在法律保护下的自由治疗,治疗和康复也逐渐由医院转进社区,病人作为公民的权利得到尊重,精神病医院也因为被关闭了。
Generally, deinstitutionalization is a trend worldwide, since 1950’s, a lot of countries already started process of deinstitutionalization. Deinstitutionalization doesn’t mean close all psychiatric hospitals immediately, it took decades for Italy to close psychiatric hospitals after a lot of research, discussion and development and improvement of community service, because there should be adequate services to replace hospitals. However, as deinstitutionalization is the direction, it is important to start the process by prioritizing actions towards mental health. The change should start from psychiatric professionals and staff so that patients will be treated with freedom.
总体来说,去机构化是全球精神卫生发展的趋势,从50年代开始,很多国家就已经开始这个过程。去机构化并不是指立即关闭精神病院,在意大利也是经过几十年的研究、讨论、发展、提高社区服务等逐步得以实现的,因为需要有足够的社区服务来替代医院的服务。然而,因为去机构化是发展趋势,因此,有必要尽早考虑精神健康发展中需要优先开展的工作。改变应该从医务人员开始,让病人得到自由的治疗。
6. Community Mental Health 社区精神健康
Dr. Franco Colizzi elaborated the concepts of community based mental health, which aims to provide to support to persons with mental health conditions to participate and include in all aspects of community life, their dignity and rights are respected.
弗兰克医生介绍了社区精神健康的理念,社区精神健康以支持精神障碍者参与和融入社区生活的方方面面,使他们的权利和尊严得到尊重。
Mental health conditions are actually found in people of all ages, regions, countries and communities. It is estimated that approximately 25-30 % population have mental health conditions, and that one in four people will be affected at some stage during their life.
精神障碍存在于所有年龄、信仰、国家和社区中。据统计,有25-30 % 的人口有精神健康问题,每4人中就有一人在某个阶段有精神健康问题。
Community Based Rehabilitation (CBR) is an important strategy within general community development for the rehabilitation, poverty deduction, equalization of opportunities and social inclusion of all people with disabilities (CBR joint Position Paper by ILO, UNESCO and WHO). Mental health is included.
社区康复是为残疾人提供康复、减贫、平等机会和社会融合的重要社区发展策略(世界卫生组织、联合国教科文组织和世界劳工组织的《社区康复联合声明书》)。精神健康也包括在这样策略中。
Key concepts of community mental health: Mental health is an important part of community development and persons with mental health conditions can contribute to the development; the vicious cycle among poverty and persons with mental health conditions should be broken: common myths and traditional understanding about mental health conditions should be reduced/eliminated, such as mental health conditions are uncommon, people with mental health problems are violent and endanger the safety to others if they are allowed to live in the community, it is difficult to treat and people will never get better, it is brought on by weakness of character etc..
社区精神健康的重要理念包括:精神健康是社区发展的重要部分,精神障碍者能为社区发展做贡献;存在于精神障碍者和贫困之间的恶性循环需要被打破;应该减少/消除对精神障碍常见的误解,如,精神健康问题不常见,精神障碍者都有暴力倾向,如果允许他们在社区内生活,会危害其他人的安全,精神障碍很难治疗,他们永远不会好,精神健康问题有性格缺陷造成等等。
Therefore, mental health should be promoted in communities; various supports and services should be provided to help persons with mental health conditions and their families, such as access to medical care, psychological support, social participation, and livelihood opportunities etc.
因此,应在社区内促进精神健康,为精神障碍者提供各种支持和服务,如医疗服务、心理辅导、社会参与、生计机会等。
Specific issues related to mental health: children and adolescents, gender, crisis situation like disaster, war etc.
和精神健康相关的一些特殊问题包括儿童和青少年的精神健康、性别、紧急情况如灾害等。
People with mental health conditions, their family members and communities are central to community mental health; they should be empowered to fully participate in all stages of the development.
精神障碍者、他们的家人和社区是社区精神健康的核心,需要提高他们的能力,使他们能参与到发展的每个阶段。
Self-help group (SHG) is proved an important strategy to empower person with mental health conditions and their family members.
自助组是经过证明过的、能提高精神障碍者和他们家庭能力的重要策略。
Due to translation, time for discussion is very limited, but some important issues/questions were raised during the seminar.
因为翻译,尽管时间非常有限,但一些重要的问题得到讨论。
1. Prioritization between community-based service and institutional service. 机构和社区发展的优先性。
This issue caused very hot discussion. Representatives pointed that China has ratified the UNCRPD and approved the new Mental Health Law; the isolated institutional treatment and control should be changed. Limited resource should be utilized for development of community as provision of community service is the direction, the focus on community should be started as early as possible.
研讨会中对这个问题的讨论非常热烈。有代表指出:中国批准了《联合国残疾人权利公约》和《精神卫生法》,封闭式的机构治疗应该改变。有限的资源应更多的用于发展社区服务,这是未来的发展方向,对社区的加强应该尽早开始。
Some arguments and concerns: 一些争议和顾虑
- Number of patient is still increasing. The capacity of current service is far behind the need in terms of number of psychiatric professionals and beds allocated.
精神病患者的数量在不断增加。目前的机构服务能力,如人力资源、床位等,远远满足不了需求。
- Communities are not ready to take responsibilities, there is such a dearth of mental health resources in the community, and the absence of well-trained mental health social worker is just an example.
社区还没有足够的能力来满足需求,社区资源还很匮乏,如缺少经过培训的社工就是一个例子。
- The community health system is not equipped to handle the surge in outpatients that would occur if severely ill patient refuse to be treated in hospitals. Take Changchun city as example, there are 220 communities, it is impossible to allocate one doctor to each community health center.
如果严重的病人拒绝住院治疗,社区卫生中心没有能力提供相应的医疗服务,以长春为例,共有220个社区,不可能每个社区卫生中心都派一个医生。
- People trust more health care provided by hospitals. 人们更相信精神病院的专业服务。
- Community and institution should be supportive and supplementary to each other. The institution can provide necessary medical care while community can do screening, referral, follow up support to patients and family members, and awareness rising in the communities.
社区和精神病院应该是相互支持、相互补充。精神病院可以提供必要的医疗服务,社区可以筛查、转介、随访、对家庭提供支持和提高社区精神健康意识。
- In 2009, Chinese invested CNY 9 billion for hospital development; future financial inputs will focus more on community.
2009年,国家已经投入90亿人民币建设机构,未来不会再对机构有如此大的投入,而是会把更多的投入转向社区。
- It took decades for Italy for the process of deinstitutionalization, thus, the transition in China will also take time and Country context should be considered.
意大利的精神卫生去机构化花了几十年的时间,因而,中国的去机构化也不可能在短时间内完成,同时,应充分考虑国情。
- There are also constrains from institution, e.g. patients can get re-imbursement for hospital medical care based on the current health insurance system.
社区精神健康的发展也有来自机制上的障碍,如目前的医疗保险只覆盖病人在医院的医疗服务。
2. Project expansion and sustainability. 项目的扩展和可持续性
With the support of the project, both Changchun and Tongling cities have established ROUs within in hospital, however, it is still very difficult for them to open new unit outside of the hospital and replicate the model in a large scale basis in the near future due to constrains of human resource, funding, mechanism etc.
在项目的支持下,长春和铜陵都建立了院内开放式居住机构,但要在院外建立这样的机构和近期内大规模的发展这样的模式都有困难,如资金、人力和机制的障碍。
There is no problem for sustaining the current project through collaboration with DPF etc.
项目结束后要继续目前的项目活动没有问题,可以与其项目相结合。
3.How should the rights of patients and the safety of others be balanced? 如何平衡病人的权利和其他人的安全?
There is still a big concern on harm that persons with severe conditions may cause to others, thus, how to balance the rights of patients and the safety of others is still an issue. This is however a big myth and misunderstanding, which lead to discrimination and exclusion. Obviously, effort still needed to raise awareness on mental health.
精神病患者有可能对他人带来的伤害仍然是一个备受关注的问题,因此,有很多关于如何去平衡病人的权利和他人的安全的顾虑。然而,这样的顾虑包含有对精神病巨大的误解,正是这些误解导致歧视和排斥。很显然,还需要努力提高公众对精神健康的认识。
4. Do the ROU and CMHU fit in the new Mental Health Law? 社区精神卫生中心和开放式居住机构是否包含在新精神卫生法?
Article 54 of the new Mental Health Law states that“community rehabilitation organizations shall provide a venue and facilities for persons with mental disorders needing rehabilitation, and operate rehabilitation trainings for them in areas such as self-assisted living skills and social adjustment skills.”Community rehabilitation unit including various vocational training center, work and treatment unit, agriculture and treatment unit, day care center, foster and care center, midway home etc.
新精神卫生法第54条明确指出:“社区康复机构应当为需要康复的精神障碍患者提供场所和条件,对患者进行生活自理能力和社会适应能力等方面的康复训练。”这里的社区康复机构包括各种职业培训、工疗、农疗、日间照料、托养、中途之家等形式。
The ROU and CMHU do fit in the Mental Health Law. 社区精神卫生中心和开放式居住机构符合新精神卫生法。
AIFO acknowledges with appreciation, the following inputs that helped in the successful completion of the Seminar: AIFO真诚的感谢下列支持,使研讨会成功举办:
- PUIMH’s long-term cooperation and its contribution to the Seminar venue and logistic arrangement. 感谢北京六院长期以来的合作和为研讨会提供了场地及后勤安排。
- Mr. Giampiero Griffo, Mr. Kirihara Naoyuki, Dr. Giovanna Del Giudice, Dr. Alberta Basaglia, Dr. Francesco Colizzi, Dr. Yan Guizhong, Dr. Tang Hongyu, Dr. Ma Ning, Dr. Chu Wenge, Mr. Gao Hongfei well prepared PPTs and openly shared their knowledge, experience and thoughts. 感谢格里弗先生、铜原尚之先生、乔安娜博士、巴萨利亚博士、弗朗科博士、姚贵忠博士、唐宏宇主任、马宁主任、储文革院长、高宏飞处长精心准备的报告材料和他们毫无保留地分享他们的知识、经验和想法。
- Ms. Guo Fei and Ms. Bai Wei are excellent interpreters for the Seminar and did translation for all PPTs. 感谢郭菲女士和白薇女士为研讨会做了大量的翻译工作。
- Yoshiko Miwa, who were interpreter for Mr. Kirihara’s report. Miwa 感谢女士翻译了铜原尚之先生的报告。
- Ms. Guo Fei did logistic arrangement for foreign participants. 感谢郭飞女士和白巍女士为研讨会做了大量的翻译工作。
- Representatives from Italia Embassy, EU Delegation, CDPF, China Association of Persons with Mental Health Condition and Relatives for making them available for the seminar and their sharing. 感谢意大利使馆、EU代表处、中国残联和中国精协的代表们在百忙中抽时间参加研讨会,并做了分享。
- Participants from the Action sites of Nanguan in Changchun, Tongling in An’hui, Yanqing in Beijing and Harbin city for their efforts of Action implementation. 感谢所有项目点的参会人员,感谢他们长期以来的合作和在项目实施中所做的努力。
Appendix 1: Agenda
October 8, 2014 (Wednesday)
In the morning: United Nations Convention on the Rights of persons with Disabilities
9.00-9.30 Opening Remarks
09.30-10.30 Introduction to the contents and principles of the United Nations Convention on the Rights of Persons with Disabilities –UNCRPD-
Mr. Giampiero Griffo, Representative of Disability People International (DPI)- Italy
10.30-10.45 Coffee break
10.45-11.45 UNCRPD and mental health
Mr. Kirihara Naoyuki, Representative of DPI Asia Pacific-Japan and Psychiatric Survivor’s Union Japan Board Member
11.45-12.00 Questions from the moderator and Audience and Discussion
12.00-13.30 Lunch
In the afternoon: China’s mental health service and Mental Health Law
13.30-14.30 The Chinese experience of “686” Program
Ms. Ma Ning, Responsible of 686 Program
14.30-14.45 Coffee break
14.45-15.45 The new mental health law in China
Mr. Tang Hongyu, Chinese expert in Chinese mental health law
15.45-16:15 Questions from the moderator and Audience and Discussion
October 9, 2014 (Thursday)
In the morning: Introduction to EU funded Action and Practice in the pilot districts
9.00-10.00 Community based psychiatry EU funded Action –the first and the second phase (2011-2017)
Dr. Yao Guizhong, Deputy Director of the Peking University Institute of Mental Health/the Sixth Hospital of Peking University (PUIMH)
10.00-10.15 Coffee break
10-15-11.15 Community based psychiatry EU funded project: the experience of Nanguan and Tongling districts
Dr. Chu Wenge, Nanguan Deputy Director of the Third Hospital of Tongling, Anhui Province
Dr. Gao Hongfei, Director of Intervention Centre on Psychological Crisis in Changchun, Jilin Province
11.15-11:45 Questions from the moderator and Audience and Discussion
12.00-13.30 Lunch
In the afternoon: Development course of mental health service in China
13.30-14.30 From the hospital to the community. Dr. Franco Basaglia’s experience in the city of Trieste (Italy)
Dr. Alberta Basaglia, psychologist, Franco Basaglia’s daughter
Dr. Giovanna Del Giudice, Italian expert on Community Based Psychiatry
14.30-14.45 Coffee break
14.45-15.45 Community based psychiatry and human dignity
Dr. Francesco Colizzi, Italian expert on Community Based Psychiatry
15.45-16:15 Questions from the moderator and Audience and Discussion
October 10, 2014 (Friday)
In the morning: Introduction to the Italian model of Community Based Psychiatry
9.00-10.00 Introduction to Self Help Group
Dr. Francesco Colizzi, Italian expert on Community Based Psychiatry
10.00-10.15 Coffee break
10.15-11.15 Psychosocial rehabilitation and income generating and employment program
Dr. Giovanna Del Giudice, Italian expert on Community Based Psychiatry
11.15-11.45 Discussion
12.00-13.30 Lunch
Appendix 2: Introduction to Foreign Experts
Mr. Giampiero Griffo, Representative of Disability People International (DPI)- Italy
Mr. Giampiero Griffo is responsible of the Section on Disability of the National Library of the city of Naples (Italy) and Co-Director of the Center for Disability Studies Robert Castel of the University “Suor Orsola Benincasa” of Naples, which is the Italian member of the European Accademic network on disability. Very active at local, national and international level since 1972 for the Associations working for the defense of human rights of disabled People, Mr. Giampiero Griffo is member of the World Council of “Disabled People International” and of the Board of “European Disability Forum”. He published several articles, books and researches at national and international level. 格里弗先生:国际残疾人(Disabled People International)意大利代表
格里弗先生自1972年以来积极维护残疾人权利。他是国际残疾人(Disabled People International)世界理事会及欧洲残疾论坛董事会成员。在意大利国内外发表过文章,书籍及研究成果
Mr. Kirihara Naoyuki, Representative of Disability People International (DPI)-Asia Pacific
Mr. Kirihara Naoyuki is a board member of the Psychiatric Survivor’s Union Japan. He got master degree at the Ritumeikan University. He is also member of "Japan National Group of Mentally Disabled People". 铜原尚之先生:国际残疾人亚太地区代表;日本精神幸存者联盟董事会成员;Ritumeikan大学硕士学位;同时也是日本国家精神残疾人团体的成员。
Dr. Giovanna Del Giudice, Italian expert on Community Based Psychiatry
Dr. Giovanna Del Giudice, Doctor psychiatrist, started to work on December 1971 in the psychiatric hospital of Trieste (Italy), under the Direction of Dr. Franco Basaglia. She participated to all the process of deinstitutionalization and to the construction of the process of community based psychiatry, with a particular attention to the gender issues. Dr. Giovanna Del Giudice was Director of the Mental Health Department of the cities of Caserta and Cagliari (Italy) and mental health consultant in other Provinces of Italy. She coordinates several projects of international cooperation on mental health issues. She wrote many publications and she has been President of the Association CoPerSaMM (Conferenza Permanente per la Salute Mentale nel Mondo) since November 2013. 乔安娜,意大利社区精神卫生专家。乔安娜是一名精神病专家,于1971年开始在意大利迪里亚斯特精神病院工作,主管为弗朗科.巴萨利亚。参与了意大利精神病院关闭及社区精神卫生服务发展的全部过程,同时关注性别问题。曾任意大利卡塞塔省及卡利亚里地区的卫生部主管及意大利其他地区的卫生顾问。她负责不同项目在精神卫生领域国际合作的协调,发表过不同的文章。从2013年11月起担任全球精神卫生永久性会议机构主席。
Ms. Alberta Basaglia, psychologist, Franco Basaglia’s daughter
Ms. Alberta Basaglia, psychologist, is responsible of the “Young Participation Service” and “Cultures of peace” of the town hall of Venice (Italy). She has been coordinating the “Woman Center” and the “non-violence Center” in the City of Venice since 1980. She has a long work and research experience on the main themes linked to the fight against the gender violence and all the discriminations. She is also Counselor against against all the discriminations at the Study University of Padova (Italy). In 2013 she published a book (Picasso’s clouds) on the memory of his father, Dr. Franco Basaglia, who promoted the Law 180 (or Basaglia Law), which closed down all the psychiatric hospitals in Italy in 1978 and led to their gradual replacement with a whole range of community-based services, including settings for acute in-patient care. 阿尔伯塔.巴萨利亚,心理学专家,父亲为弗朗科.巴萨利亚。负责意大利威尼斯“年轻人的参与服务”及“和平的文化”两个项目;从1980年开始协调威尼斯“妇女中心”及“无暴力中心”事务;在对性别暴力及歧视方面有长期工作和研究经验。2013年,她出版了纪念父亲弗朗科.巴萨利亚的书,而正是他的父亲推动了第180号法令,根据该法令,意大利在1978年关闭精神病院并逐步发展了社区精神卫生服务,包括急性住院治疗。
Dr. Franco Colizzi, Italian expert on Community Based Psychiatry
Dr. Franco Colizzi, psychiatrist and psychotherapist, is the Director of the Operative Unit of the Mental Health Center of the cities of Brindisi and San Vito dei Normanni (Italy) since 2008. He was member of AIFO Administration Council from 2002 to 2014 and he was AIFO National President for two mandates. From 2005 to 2011, after visiting many project of International Cooperation in 15 Countries all over the world, Dr. Franco Colizzi wrote many books, two of which related to the activities held with AIFO. He was teacher in the University of Bari and had political responsibility at provincial and district level; Dr. Colizzi also created several local Associations, such as for the defense of mental health and for the non-violence principles. 弗朗科,意大利社区精神卫生专家。为精神疾病专家及心理治疗师。自2008年起担任 布林迪西及圣维托德伊诺尔曼尼精神卫生中心主任。于2002年至2014年担任爱福协会管理委员会委员,曾两次担任爱福协会主席。自2005至2011年期间,考察了全球15个国家执行的多个国际合作项目,之后写了很多书。其中两本书跟爱福协会开展的项目有关。曾是Bari大学的老师,并在区级及省级担任政治领域工作。他也曾成立过不同的地区性协会 ,例如有的是有关精神卫生及非暴力领域。
Appendix 3: Introduction to Chinese Experts
Dr. Yao Guizhong, Doctor of Medicine, chief physician, tutor for Master students, Deputy Director of the Sixth Hospital of Peking University. Member of Experts Group on “Central Government’s Subsidy to Local Management and Treatment on Severe Mental Illnesses Specification Project”, Experts Group leader of Severe Mental Illnesses under “National Basic Public Health Service”, expert on popularization of science and health in Beijing Health Bureau. He has been engaged in psychosocial rehabilitation on mental illnesses, family intervention on the disease, practice and study on prevention and control of mental disease at communities for a long time. He organizes “ Series of Lecture on Mental Health Knowledge“ throughout the year, he is chief editor of Mental Rehabilitation Newspaper, has created mental rehabilitation bases and explored intervention service model for mental disorders of the integration of hospital and communities in Haidian district, Beijing. He has written over twenty articles and Participated in more than 10 psychiatric monographs.
姚贵忠,医学博士,主任医师,硕士研究生导师,北京大学第六医院副院长,卫生部“中央补助地方重性精神疾病管理治疗项目”专家组成员,卫生部“国家基本公共卫生服务规范”重性精神疾病专家组组长,北京市卫生局健康科普专家。长期从事精神疾病的社会心理康复、家庭干预以及社区防治的实践与研究,常年组织“精神卫生知识系列讲座”,主编《精神康复报》,创办精神康复基地,并在北京市海淀区探索“医院社区一体化”的精神疾病全程干预服务模式。撰写论文20余篇,参编10余部精神病学专著。
Dr. Tang Hongyu, male, chief physician in the Sixth Hospital of Peking University, director of ethics committee; director of psychiatric physician session under Chinese Medical Doctor Association; He graduated from Hunan Medical Institute in 1987, received master’s degree from Peking Medical University in 1992, he went to University of Melbourne and Harvard University for short term study in 2003 and 2012. From 1999 to 2007, he participated in consulting and research in mental health legislation. Since 2001, he has been in charge of many national projects on mental health service and training, formulation and amendment of standardized training outline and detailed regulations on in-patient doctor behaviors. He is specialized in Clinical Psychiatry and Psychiatric Ethics and Law.
唐宏宇,男,北京大学第六医院主任医师,伦理委员会主任委员, 中国医师协会精神科医师分会会长
1987年本科毕业于湖南医学院,1992年硕士毕业于北京医科大学
2003和2012年分别在墨尔本大学和哈佛大学短期进修
1999年-2007年参与中国精神卫生立法的咨询与研究工作
2001年以来主持多项国家级精神卫生服务与培训项目,主持精神科住院医师规范化培训大纲和细则的制订和修订
专长:临床精神病学、精神医学伦理与法律
Ms. Ma Ning, Doctor of Medical Science, she got master’s degree in Public Health, she is deputy director of Public Health Department in the Sixth Hospital of Peking University, office director of Mental Health Center under China’s Center for Disease Control, secretary of Emergency Expert Advisory Committee on Psychological Aid Group. She was a visiting scholar to University of Rochester in 2009. She has been majorly involved in community based mental health service, rehabilitation treatment on severe mental illnesses, research on mental health policy, one National Natural and Scientific Funds and one capital health development research. She has published fourteen essays in the name of the first author, five SCI, participated in two psychiatric monographs. Currently, she is in charge of the central government’s subsidy to local mental health projects and management system of information on national severe mental disorder.
马宁,医学博士,公共卫生硕士,北京大学第六医院公共卫生事业部副主任,中国疾控中心精神卫生中心办公室主任,卫生部应急专家咨询委员会心理援助组秘书。2009年美国罗切斯特大学访问学者。主要工作领域包括社区精神卫生服务、重性精神疾病康复治疗、精神卫生政策研究等。承担国家自然科学基金1项,首都卫生发展科研专项1项。第一作者发表论文14篇,SCI 5篇。参编著作2部。目前主要负责参与管理中央补助地方精神卫生项目和国家严重精神障碍信息管理系统。
Dr. Chu Wenge, deputy director of the Third Hospital of Tongling, psychiatric doctor and associate chief physician.
储文革,铜陵第三医院副院长,精神科医生,副主任医师
Dr. Deng Hua, psychiatric doctor in the Sixth Hospital of Changchun;Director of Intervention Center on Psychological Crisis in Changchun.
邓华,长春六院精神科医生,主治医师;长春市心理危机干预中心主任
According to statistics, there are about 100 million persons suffering from mental health conditions in China, of which, 16 million have severe conditions. Mental illness and disability have become the biggest economic burden among all diseases. Although it has received more and more attention from government at different levels and relevant sectors, financial inputs has been increasing yearly, the main intervention is still medical treatment in hospital and at home. The present situation of persons with mental health conditions in China can be described two “90%”, i.e. 90% of persons with mental health conditions stay at home and 90% of their time is spent at home. Without sufficient support from communities, they normally fall into a various cycle called “revolving door” phenomenon between hospital and family, which lead to repeated illness and gradually become disabled.
据统计,中国目前有精神障碍者1亿人,其中1600万严重精神障碍者。精神病及精神残疾所带来的疾病负担已超出其他疾病,成为最大的负担。尽管精神健康得到各级政府及相关部门越来越多的重视,经费投入也在逐年增加,但目前的干预仍然是以在医院和家庭的治疗为主。中国精神障碍者存在两个”90%”, 即,90% 的患者呆在家里,每个患者90%的时间呆在家里。由于缺乏足够的社区支持,他们通常陷入“旋转门”现象的恶性循环中,即“治疗-复发-再治疗”和“医院-家庭-医院”,他们在这样的循环中逐渐发展为残疾。
With joint efforts, the first phase (2011-2014) of EU-funded Action has successfully reached its objectives to integrate mental health care into primary health service in 3 districts of China. i.e. Haidian district in Beijing, Changchun and Tongling. The second phase was also launched in Harbin and Yanqing districts on the 1 March 2014 with aim to implement policies and laws at international and national level that address mental health and human rights, i.e. United Nations Convention on Rights of Persons with Disabilities (UNCRPD) and New Mental Health Law of China. It is necessary to introduce relevant disability/mental health development concepts and trend to partners so that their understanding and approach towards mental health will be shifted from pure medical model to social and human right-based model.
在多方共同努力下,欧盟项目的第一阶段(2011-2013年)成功的实现了其预期的目标,在北京的海淀、安徽的铜陵及吉林的长春三个地方,成功的将精神健康纳入了初级卫生保健。 二期项目于2014年启动,致力于在项目地通过实施国际国内相关的政策和法律,即《残疾人权利公约》及《中华人民共和国精神卫生法》,促进精神健康发展,保障精神障碍者的权利。因此,有必要在项目开始阶段向合作伙伴介绍与残疾和精神健康相关的发展理念和趋势,以帮助合作伙伴将认识和干预措施从医疗模式转向尊重权利的社会模式。
With the effect of new Chinese mental health law, it has been anticipated that there will be a rapid shift from hospital based psychotic care to community based mental health. The seminar was an important platform to bring major stakeholders like government sectors, institution and NGOs together, in order to discuss how successful experience of deinstitutionalization in western countries can be implemented in Chinese context.
随着中国新精神卫生法的生效,快速的将以精神病院为主的治疗转向以社区服务为主成为了人们的期待。这个研讨会是一个重要平台,它把包括政府、机构和非政府等在内的主要利益相关方聚在一起,共同探讨发达国家成功的去机构化经验如何与中国的国情有效的结合。
This seminar was held during the “World Mental Health Day”, thus, it was also an important event to advocate to government, professionals and the public on the rights of persons with mental health conditions.
该研讨会在“世界精神健康日”期间举办,因而也是一个向政府、机构和公众倡导精神障碍者权力的重要活动。
The seminar had honor to have the following distinguished guests to the opening ceremony and made remarks.
该研讨会有幸请到下列代表出席开幕式并做了重要讲话:
- Victor Giner, Attache’, EU Cooperation Instruments, EU Delegation to China and Mongolia
- Dr. Giuseppe Perricone, First Secretary of Italian Embassy to China
- Mr. Han Jibin, Head of the Second Division on Rehabilitation China Disabled Persons’ Federation (CDPF)
- Mrs. Wen Hong, Vice President of China Association of Persons with Psychiatric Disability and their Relatives
- Yao Guizhong, Deputy Director of PUIMH
- Alessandro Lorato, EU-funded Action Coordinator
- 欧盟驻华及蒙古代表团、欧盟合作处专员维克.吉纳先生
- 意大利驻华使馆一等秘书朱塞佩先生
- 中国残疾人联合会康复二处处长韩纪斌先生
- 中国精神残疾人及亲友协会副主席温洪女士
- 北京大学第六医院副院长姚贵忠先生
- 欧盟项目协调员亚历桑德罗.罗拉托先生
Short time was allocated to each speaker, but a lot of important issues were addressed and useful information was shared. The following is the summary of the opening ceremony.
尽管每个代表的发言时间有限,但他们的发言涉及到很多重要的与精神健康相关的问题,也带来很多有用的信息:
- Community mental health has been developed in Italy for over 50 years, it is meaningful to work with Chinese partners to develop it in Chinese context.
社区精神健康在意大利经历了50多年的发展,能将其经验与中国的实际情况相结合是一件有意义的事。
- EU supported Action has greatly promoted the mental health development in China and it also shows NGO can play an important role in social development; the Action also facilitated the cooperation and dialogue between NGO and government.
欧盟项目促进了中国精神健康的发展,它展示NGO在社会发展中可以起到重要的作用,同时,项目也促进了NGO和政府的合作和交流。
- The current environment for mental health development in China is favorable, i.e. China has ratified UNCRPD, relevant policies and laws were issues accordingly, e.g. Suggestions on Further Promote Disability Development by the State Council issued in 2008; Law on Protection of Rights of Persons with Disability was revised in 2008; improvement of both Social Security and Service System were included in national social and economic development; New Law on Mental Health was approved on 2013, 1 May; Regulations on prevention of disability and rehabilitation are under process for approval etc. Although mental health was started in a late stage in China, it has been gradually integrated into framework of legislation, working system, public service and social-economic development.
目前中国的精神卫生工作面临有利的环境:中国批准了《联合国残疾人权利公约》,并制定了相应的政策和修改了相应的法律以促进公约的实施,如:2008年出台的《中共中央国务院关于促进残疾人事业发展的意见》、2008年修改的《中华人民共和国残疾人保障法》、将建立残疾人的社会保障体系和服务体系纳入国家社会经济发展中、2013年5月1日正式生效的《中华人民共和国精神卫生法》、残疾预防及康复条例正在审批中。
- As a public health issue, Government should take major responsibility for mental health. Take CDPF as example, its major funding is from government at different levels, NGOs mainly provide technical support and pilot projects for demonstration and advocacy.
作为公共卫生问题,政府在精神卫生工作中起主导作用。以中国残联的工作为例,主要的经费来自政府,非政府机构主要提供技术支持、建立示范和倡导。
- Community mental health is the direction, but it should be developed step by step based on Chinese context. Deinstitutionalization can only be done when communities have capacity to meet needs, e.g. a big shortage of social worker in communities is one constrain.
发展社区精神健康是方向,但应根据中国的实际情况一步一步走。只有在社区能满足需求的情况下才能考虑去机构化,如目前社区普遍缺乏社工就是存在的问题之一。
- The central government and 18 relevant government sectors are taking leading role for mental health in China and they will have a meeting soon to discuss how to further promote community mental health.
精神卫生由中央政府和相关的18个部门共同负责。这些部门最近会召开会议讨论如何进一步提高社区精神健康。
- Due to stigma and discrimination, most of persons with mental health conditions either stay in hospital or at home, it is very difficult for them to access job and other opportunities, thus, it is important to improve capacity of communities.
由于歧视等原因,精神障碍者通常是呆在医院或家里,因此,提升社区的服务能力很重要。
- China Association of Persons with Psychiatric Disability and their Relatives has 3 committees, i.e. Family Member Working Committee, Autism Committee and Community Service Promotion Committee. Promotion of community service is one priority of the Association.
中国精神残疾人及亲友协会下属有三个委员会:家庭工作委员会、自闭症工作委员会和社区服务促进委员会。促进社区精神健康是该协会的主要工作之一。
- For long period, services for persons with severe mental health conditions were focused on “treatment and control”; this should be changed, persons with mental health conditions have potential and capacity, their human rights and dignity should be respected.
长期以来,对重度精神病患者的服务主要是“治疗和控制”,这种模式应该改变,精神障碍者有潜力和能力,他们的权利和尊严应该得到尊重。
- The EU-funded Action has been implemented based on model and experience of Italy; Chinese context should be considered when developing mental health.
欧盟项目的实施是基于意大利的模式和经验,在发展精神卫生时,中国的国情也应考虑在内。
Following the objectives of the Seminar, a number of presentations was given for information and experience exchange.
根据研讨会目标,通过一系列报告进行了信息和经验分享。
1. UNCRPD and mental health 《联合国残疾人权利公约》与精神健康
The UNCRPD highlights that persons with disabilities include those who have “mental impairments” and emphasizes the need to: 1) ensure their full and equal enjoyment of all human rights and fundamental freedoms; and 2) promote their participation in civil, political, economic, and cultural spheres with equal opportunity.
《联合国残疾人权利公约》强调残疾人包括精神障碍的人,要确保他们:1)享受同等的人权和基本的自由;2)要提供他们参与社会、政治、经济和文化等方面的平等机会。
Mr. Giampiero Griffo, representative of Disability People International (DPI) in Italy and Mr. Kirihara Naoyuki, representative of DPI Asia Pacific Japan gave an overall introduction on contents and principles of UNCRPD, highlighted articles which are closely linked to persons with mental health conditions. Mr. Naoyuki also briefed the development of mental health service in Japan and how persons with mental health themselves pushed those changes.
来自国际残疾人意大利的格里弗和来自国际残疾人亚太地区的铜原尚之先生介绍了《联合国残疾人权利公约》的内容和原则,并强调了那些与精神障碍者密切相关的条款。铜原尚之先生还介绍了日本精神卫生服务的发展历程和精神障碍者们如何推动其中的一些改变。
Both presentations showed that mental health is not a pure medical issue, but psychosocial issues; thus, a paradigm shift from medical model to social and right-based model is the key for mental health development. Our work should aim to ensure that dignity and human rights of persons with mental health conditions are respected.
两个报告都显示精神健康不是一个单纯的医疗问题,而是社会心理问题,因而,从医疗模式转向基于人权的社会模式是精神健康发展的关键。我们的工作应该致力于促进精神障碍者的权利和尊严得到尊重。
As China has ratified UNCRPD, it is the Country’s responsibility to develop laws, policies and actions to implement them to ensure the human rights of persons with mental health conditions. In this aspect, there is an urgent need to move the current institutional focus to community-based approach.
中国已经批准了《联合国残疾人权利公约》的实施,因而,有责任通过政策和法律的实施确保精神障碍者的权利,从这个角度来看,有必要将以机构为中心的服务模式转向以社区为中心。
2. Chinese Mental Health Law 中国的精神卫生法
Dr. Tang Hongyu from the Sixth Hospital of Peking University participated in the consulting and research of mental health legislation. He gave a brief introduction on the new law.
来自北京六院的唐宏宇主任,参与了中国精神卫生立法的咨询与研究工作,他对新的精神卫生法做了简要的介绍。
After 27 years’ efforts, China finally passed the first Mental Health Law. The new Law was developed in line with country situation and learning from international mental health laws and experience. The new Law aims to speed up the mental health development, to standardize the mental health service and to protect rights of persons with mental health conditions. The new Law also focuses on solving the current outstanding issues based on reality, i.e. to balance the rights of patients and safety of the public, to well combine prevention, treatment, rehabilitation, service and management, to establish mechanism with clear responsibility of all stakeholders.
通过27年的努力,中国最终批准了第一部精神卫生法。该法遵循国际精神卫生立法的基本原则,吸取国际经验,确立符合国情的立法宗旨。围绕三大宗旨:发展精神卫生事业、规范精神卫生服务、维护精神障碍患者的合法权益。尊重与立足现实,着重解决当前突出问题.平衡患者权益保护和公众安全,坚持预防为主,预防与治疗、康复相结合,服务与管理相结合的方针。明确责任,建立机制。
The concepts of developing community rehabilitation units is also included in the Law, the specific model or approach should follow the local situation, such as, day care center, half-way home etc.
精神卫生法里明确有建立社区康复机构的要求,具体模式根据当地的实际情况而定,可以是日间中心、中途宿舍等形式。
Based on the new Law, China will make efforts to strengthen both institutional and community services.
在实施精神卫生法中,中国将同时加强机构和社区的服务能力。
Every Province was requested to develop and implement policies accordingly based on local situation to ensure the implementation of the new Law. Relevant government sectors and institutes need to include implementation of the new Law into their responsibilities, i.e. Health, Civil Affair, Police, DPF, Education, Finance,Hospitals etc. Among the project sites, Changchun city has developed a regulation based on the national new Law and local situation.
要求各省按新精神卫生法的要求、结合当地的实际情况,出台相应的政策,保障法律的落实。各相关政府部门和机构,如卫生、民政、公安、残联、财政、教育、医院等,要将新精神卫生法的落实纳入其工作职责。在三个项目点中,长春出台了相应的条例。
3. National 686 project 国家686项目
This is the largest mental health project in the world initiated in 2004 by National Health and Family Planning Commission. The outbreak of SARS in 2003 exposed the weakness and problems of the public health system in China, consequently, the center government allocated CNY 3.7 billion to improve the public health system, of which, CNY686,000 was utilized for improving mental health services. In the past 10 years, the project has gradually moved from “control of persons with severe mental health conditions” to “management and treatment”; it has been also developed into routine practice from a project through establishment of sustainable working system and mechanism.
这是世界上最大的精神卫生项目,由国家卫生计生委于2004年发起。2003年发生的非典暴露了中国公共卫生体系的弱点和问题,于是,由中央政府拨款37亿用于提高公共卫生体系,其中,686万元用于提高精神卫生服务。在过去的十年中,该项目逐渐从“重型精神病控制”转向对这些患者的“管理和治疗”,也通过建立可持续的系统和机制将该项工作从项目转为了常规工作。
The project greatly mobilized resources to provide medical care and rehabilitation services in both institutions and communities, so far, 4 million patients were registered in database, 3.25 million persons have received follow up and family support, subsidy was provided to almost half million poor patients for medication and hospital treatment. Capacities of human resource were improved through two-level training, i.e. national and local.
该项目通过资源动员,巨大的提高了机构和社区的医疗服务和康复能力,到目前为止,有400万病人登记在信息库,325万人接受到随访服务和家庭支持,近50万人接受了服药和住院治疗的补贴。人力资源也通过国家和地方两级培训得到提高。
This project has made great achievement in terms of providing basic health care and rehabilitation services in a wide coverage (covers 1926 counties/districts in 275 prefectures).
该项目在提供广覆盖的基本医疗服务方面取得巨大成效,项目覆盖了275个地市的1926个县/区。
Since the new Mental Health Law is taking effect and inputs from government will be increased accordingly, more efforts will be taken to further strengthen the institutional and community services.
随着新精神卫生法的生效,国家的投入也会相应的增加,这些投入将进一步加强机构和社区的服务。
4. Progress of EU funded Action 欧盟项目进展
Dr. Yao Guizhong gave an overall introduction of the EU-funded Action, representatives from Tongling and Changchun cities presented the project implementation respectively. The Action has greatly facilitated the development of community mental health in 3 districts through establishing Community Mental Health Units (CMHUs) and Residential Open Units (ROUs), so far, the following units have been established
姚院长对项目作了总体的介绍,来自铜陵和长春的代表分别分享了项目在当地的实施情况。该项目通过社区精神卫生中心和开放式居住机构的建设,巨大的促进了项目地的社区精神健康发展。到目前为止:
- Tongling district of Anhui province: 4 CMHUs and 1 ROU in hospital 铜陵建立了4个社区精神卫生中心和1个院内开放式居住机构。
- Changchun district of Jilin: 2 CMHUs and 1 ROU in hospital 长春建立了两个社区精神卫生中心和一个院内开放式居住机构。
- Haidian district of Beijing: 23 CMHUs and 1 ROU in hospital and 4ROUs outside of hospital. 北京的海淀区建立了23个社区精神卫生中心和一个院内开放式居住机构。
It is very encouraging to see achievement and positive changes happened in the past 3-years, which has laid solid foundation for the second phase of the Action.
项目在过去三年中取得了令人鼓舞的成绩,为当地带来积极的改变,为项目二期打下了坚实的基础:
- Districts government paid attention to mental health after all advocacy and leading groups were established to provide policy and financial support to the Action, which consists of relevant government sectors, i.e. health, civil affair, social security, finance, education, DPF, media, etc.
通过倡导,精神健康得到当地政府的重视,设立了相应的领导小组为项目的实施提供政策和资金等方面的支持,领导小组成员来自卫生、民政、社会保障、财政、教育、残联、媒体等部门。
- A working mechanism/system of leading by Government with cooperation of Government sector and participation of society was primarily formulated, which is important for resource mobilization and network. Collaboration has been established with major stakeholders like DPF, Civil Affair, CDC, community Committee etc., each of them has a role.
建立了以政府为主导、部门配合和社会参与的工作机制,充分动员资源,建立网络。项目与残联、民政、疾控等部门建立了合作,各司其责。
- Psychiatric hospital and community health centers were working together to provide accessible and affordable services to people with mental health conditions. Capacity of community health centers on mental health care and rehabilitation was improved, meanwhile, hospital started to involve in public health work. Working opportunities are opening to users.
精神病院和社区卫生中心密切配合,为精神障碍者提供可及的、可以承担的服务。社区卫生中心在精神健康服务方面的能力得到提升,同时,精神病院也积极参与到公共卫生服务中。
- Establishment and running of ROUs brought advanced model of service, which provide opportunities for users to obtain various skills for their social participation and inclusion.
社区精神卫生中心和开放式居住机构的建立,带来了新的服务模式,让精神障碍者有机构学习各种必须的社会参与和社会融合的能力。
- International experience and local situation were well combines.
国际经验和地方情况有效结合。
- Capacity of professionals of hospitals was improved, especially, for Community-based Mental Health. Doctors do not passively wait patients in the hospital, but deliver service to communities proactive.
精神病院专业人员的能力得到提升,特别是社区服务方面的能力,医生不再被动的等患者上门,而是主动的将服务提供到社区。
- Awareness of community on mental health has been greatly improved.
社区精神健康的意识得到提升。
- The Action has been linked to other existing projects/progamme like 686 Project, national mental health project for persons with severe mental problems, foster and care center run by DPF etc.
该项目与当地现有的项目和工作相结合,如686项目、国家重型精神病社区服务项目、残联的托养重型和日间中心等。
- Families received needed support, such as information, counseling etc.
家庭得到所需的服务,如信息、咨询等。
There were also challenges 挑战:
- Lack of mental health professionals. 缺乏精神卫生专业人员
- Lack for volunteer and social workers. 缺乏志愿者和社工
- The proportion of mental health is too low among the work of community health center. 社区卫生中心的工作中精神卫生比重低.
- Most of patients can’t proactively participate in activities organized by CMHUs. 大部分病人不能主动参与社区精神卫生中心的活动。
- Limited Government fund to community mental health. 政府在社区精神健康方面的投入不足。
- Stigma and low level of support from society, i.e. lack of job opportunities etc. 社会的歧视和支持不够,如缺乏工作机会。
- Difficult to open ROU out of hospital. 院外设开放式居住机构困难。
- Constrains of institution. 机制障碍。
The Districts have plan to strengthen cooperation and network with other stakeholders for mental health development:
两个地区都有计划在今后的工作中与其他相关部门和机构合作:
- To link the EU-funded Action with 686 project; DPF work/programme; programme on community service for persons with server mental conditions and development of open hospital ward. 与686 项目、重型精神病社区服务、开放式医院结合。
- To strengthen cooperation with relevant government sectors to mobilize resource and to further improve prevention, treatment and rehabilitation system. 与政府相关部门合作,充分动员资源以提高预防、治疗和康复体系。
- To develop human and community based rehabilitation system through implementing the new Mental Health Law. 通过实施新精神卫生法,建立以病人为中心、以社区为中心的康复体系。
- Link the Action with various social services. 将项目与各种社会服务相结合。
5. Experience of Italy 意大利经验
Three experts from Italy, Dr. Giovanna Del Giudice, Dr. Francesco Colizzi and Dr. Alberta Basaglia shared the experience on mental health development in Italy, concepts of community mental health and practice.
来自意大利的三位专家,Dr. Giovanna Del Giudice, Dr. Francesco Colizzi 和 Dr. Alberta Basaglia 分享了意大利的精神卫生发展经验、社区精神健康理念和实践。
During the Seminar, the issue on how to balance the safety of the public and the rights of persons with mental health conditions, especially for those with server conditions, was raised. Both Dr. Giudice and Dr. Basaglia responded this through introduction of experience and practice in Italy. Before 1960’s, persons with server mental health condition in Italy were also regarded as “dangerous people” as they might harm others, there was very serious stigma and discrimination from the society, therefore, strategy and solutions were put them under “control” through “obligatory treatment in isolated hospital”, of course, in such situation, it is not possible for this group of people to have their rights and dignity.
在研讨会期间,关于如何平衡公众的安全和精神障碍者,特别是重度精神障碍者的权利被提到。Dr. Giudice and Dr. Basaglia 通过意大利的经验回应了这一问题。在60年代以前,意大利的重度精神病患者也被认为是“危险“的人,因为他们有可能给其他人带来伤害,因而社会对他们有严重的歧视,解决的途径和策略也是将他们强制关在精神病院中,当然,在那样的环境中,这些人是不可能享有他们的人权和尊严的。
Luckily, started from 1960’s, Dr. Basaglia initiated advocacy on human rights of persons with mental health conditions by breaking the traditional understanding: to establish open hospitals, to have humanized relations among professionals, patients, families and member of societies, to give patient right to express themselves and respect to their life etc., however, the situation wasn’t changed immediately. Through consistent efforts, in 1970’s, patients finally realized the right of free treatment with protection by law. Treatment and rehabilitation has been gradually moved from psychiatric hospitals to communities, patients’ right as citizen were respected. Consequence, psychiatric hospitals were closed.
幸运的是,从六十年代开始,巴萨利亚医生等人开始倡导精神病患者的权利,呼吁打破传统的认识,建立开放的医院,建立专业人员、病人、家属和社会之间人性化的关系,给病人表达他们自己的权利,尊重病人的生活等。然而,情况没有马上因此而改变。在他们坚持不懈的努力下,到70年代,精神障碍者终于享有在法律保护下的自由治疗,治疗和康复也逐渐由医院转进社区,病人作为公民的权利得到尊重,精神病医院也因为被关闭了。
Generally, deinstitutionalization is a trend worldwide, since 1950’s, a lot of countries already started process of deinstitutionalization. Deinstitutionalization doesn’t mean close all psychiatric hospitals immediately, it took decades for Italy to close psychiatric hospitals after a lot of research, discussion and development and improvement of community service, because there should be adequate services to replace hospitals. However, as deinstitutionalization is the direction, it is important to start the process by prioritizing actions towards mental health. The change should start from psychiatric professionals and staff so that patients will be treated with freedom.
总体来说,去机构化是全球精神卫生发展的趋势,从50年代开始,很多国家就已经开始这个过程。去机构化并不是指立即关闭精神病院,在意大利也是经过几十年的研究、讨论、发展、提高社区服务等逐步得以实现的,因为需要有足够的社区服务来替代医院的服务。然而,因为去机构化是发展趋势,因此,有必要尽早考虑精神健康发展中需要优先开展的工作。改变应该从医务人员开始,让病人得到自由的治疗。
6. Community Mental Health 社区精神健康
Dr. Franco Colizzi elaborated the concepts of community based mental health, which aims to provide to support to persons with mental health conditions to participate and include in all aspects of community life, their dignity and rights are respected.
弗兰克医生介绍了社区精神健康的理念,社区精神健康以支持精神障碍者参与和融入社区生活的方方面面,使他们的权利和尊严得到尊重。
Mental health conditions are actually found in people of all ages, regions, countries and communities. It is estimated that approximately 25-30 % population have mental health conditions, and that one in four people will be affected at some stage during their life.
精神障碍存在于所有年龄、信仰、国家和社区中。据统计,有25-30 % 的人口有精神健康问题,每4人中就有一人在某个阶段有精神健康问题。
Community Based Rehabilitation (CBR) is an important strategy within general community development for the rehabilitation, poverty deduction, equalization of opportunities and social inclusion of all people with disabilities (CBR joint Position Paper by ILO, UNESCO and WHO). Mental health is included.
社区康复是为残疾人提供康复、减贫、平等机会和社会融合的重要社区发展策略(世界卫生组织、联合国教科文组织和世界劳工组织的《社区康复联合声明书》)。精神健康也包括在这样策略中。
Key concepts of community mental health: Mental health is an important part of community development and persons with mental health conditions can contribute to the development; the vicious cycle among poverty and persons with mental health conditions should be broken: common myths and traditional understanding about mental health conditions should be reduced/eliminated, such as mental health conditions are uncommon, people with mental health problems are violent and endanger the safety to others if they are allowed to live in the community, it is difficult to treat and people will never get better, it is brought on by weakness of character etc..
社区精神健康的重要理念包括:精神健康是社区发展的重要部分,精神障碍者能为社区发展做贡献;存在于精神障碍者和贫困之间的恶性循环需要被打破;应该减少/消除对精神障碍常见的误解,如,精神健康问题不常见,精神障碍者都有暴力倾向,如果允许他们在社区内生活,会危害其他人的安全,精神障碍很难治疗,他们永远不会好,精神健康问题有性格缺陷造成等等。
Therefore, mental health should be promoted in communities; various supports and services should be provided to help persons with mental health conditions and their families, such as access to medical care, psychological support, social participation, and livelihood opportunities etc.
因此,应在社区内促进精神健康,为精神障碍者提供各种支持和服务,如医疗服务、心理辅导、社会参与、生计机会等。
Specific issues related to mental health: children and adolescents, gender, crisis situation like disaster, war etc.
和精神健康相关的一些特殊问题包括儿童和青少年的精神健康、性别、紧急情况如灾害等。
People with mental health conditions, their family members and communities are central to community mental health; they should be empowered to fully participate in all stages of the development.
精神障碍者、他们的家人和社区是社区精神健康的核心,需要提高他们的能力,使他们能参与到发展的每个阶段。
Self-help group (SHG) is proved an important strategy to empower person with mental health conditions and their family members.
自助组是经过证明过的、能提高精神障碍者和他们家庭能力的重要策略。
Due to translation, time for discussion is very limited, but some important issues/questions were raised during the seminar.
因为翻译,尽管时间非常有限,但一些重要的问题得到讨论。
1. Prioritization between community-based service and institutional service. 机构和社区发展的优先性。
This issue caused very hot discussion. Representatives pointed that China has ratified the UNCRPD and approved the new Mental Health Law; the isolated institutional treatment and control should be changed. Limited resource should be utilized for development of community as provision of community service is the direction, the focus on community should be started as early as possible.
研讨会中对这个问题的讨论非常热烈。有代表指出:中国批准了《联合国残疾人权利公约》和《精神卫生法》,封闭式的机构治疗应该改变。有限的资源应更多的用于发展社区服务,这是未来的发展方向,对社区的加强应该尽早开始。
Some arguments and concerns: 一些争议和顾虑
- Number of patient is still increasing. The capacity of current service is far behind the need in terms of number of psychiatric professionals and beds allocated.
精神病患者的数量在不断增加。目前的机构服务能力,如人力资源、床位等,远远满足不了需求。
- Communities are not ready to take responsibilities, there is such a dearth of mental health resources in the community, and the absence of well-trained mental health social worker is just an example.
社区还没有足够的能力来满足需求,社区资源还很匮乏,如缺少经过培训的社工就是一个例子。
- The community health system is not equipped to handle the surge in outpatients that would occur if severely ill patient refuse to be treated in hospitals. Take Changchun city as example, there are 220 communities, it is impossible to allocate one doctor to each community health center.
如果严重的病人拒绝住院治疗,社区卫生中心没有能力提供相应的医疗服务,以长春为例,共有220个社区,不可能每个社区卫生中心都派一个医生。
- People trust more health care provided by hospitals. 人们更相信精神病院的专业服务。
- Community and institution should be supportive and supplementary to each other. The institution can provide necessary medical care while community can do screening, referral, follow up support to patients and family members, and awareness rising in the communities.
社区和精神病院应该是相互支持、相互补充。精神病院可以提供必要的医疗服务,社区可以筛查、转介、随访、对家庭提供支持和提高社区精神健康意识。
- In 2009, Chinese invested CNY 9 billion for hospital development; future financial inputs will focus more on community.
2009年,国家已经投入90亿人民币建设机构,未来不会再对机构有如此大的投入,而是会把更多的投入转向社区。
- It took decades for Italy for the process of deinstitutionalization, thus, the transition in China will also take time and Country context should be considered.
意大利的精神卫生去机构化花了几十年的时间,因而,中国的去机构化也不可能在短时间内完成,同时,应充分考虑国情。
- There are also constrains from institution, e.g. patients can get re-imbursement for hospital medical care based on the current health insurance system.
社区精神健康的发展也有来自机制上的障碍,如目前的医疗保险只覆盖病人在医院的医疗服务。
2. Project expansion and sustainability. 项目的扩展和可持续性
With the support of the project, both Changchun and Tongling cities have established ROUs within in hospital, however, it is still very difficult for them to open new unit outside of the hospital and replicate the model in a large scale basis in the near future due to constrains of human resource, funding, mechanism etc.
在项目的支持下,长春和铜陵都建立了院内开放式居住机构,但要在院外建立这样的机构和近期内大规模的发展这样的模式都有困难,如资金、人力和机制的障碍。
There is no problem for sustaining the current project through collaboration with DPF etc.
项目结束后要继续目前的项目活动没有问题,可以与其项目相结合。
3.How should the rights of patients and the safety of others be balanced? 如何平衡病人的权利和其他人的安全?
There is still a big concern on harm that persons with severe conditions may cause to others, thus, how to balance the rights of patients and the safety of others is still an issue. This is however a big myth and misunderstanding, which lead to discrimination and exclusion. Obviously, effort still needed to raise awareness on mental health.
精神病患者有可能对他人带来的伤害仍然是一个备受关注的问题,因此,有很多关于如何去平衡病人的权利和他人的安全的顾虑。然而,这样的顾虑包含有对精神病巨大的误解,正是这些误解导致歧视和排斥。很显然,还需要努力提高公众对精神健康的认识。
4. Do the ROU and CMHU fit in the new Mental Health Law? 社区精神卫生中心和开放式居住机构是否包含在新精神卫生法?
Article 54 of the new Mental Health Law states that“community rehabilitation organizations shall provide a venue and facilities for persons with mental disorders needing rehabilitation, and operate rehabilitation trainings for them in areas such as self-assisted living skills and social adjustment skills.”Community rehabilitation unit including various vocational training center, work and treatment unit, agriculture and treatment unit, day care center, foster and care center, midway home etc.
新精神卫生法第54条明确指出:“社区康复机构应当为需要康复的精神障碍患者提供场所和条件,对患者进行生活自理能力和社会适应能力等方面的康复训练。”这里的社区康复机构包括各种职业培训、工疗、农疗、日间照料、托养、中途之家等形式。
The ROU and CMHU do fit in the Mental Health Law. 社区精神卫生中心和开放式居住机构符合新精神卫生法。
AIFO acknowledges with appreciation, the following inputs that helped in the successful completion of the Seminar: AIFO真诚的感谢下列支持,使研讨会成功举办:
- PUIMH’s long-term cooperation and its contribution to the Seminar venue and logistic arrangement. 感谢北京六院长期以来的合作和为研讨会提供了场地及后勤安排。
- Mr. Giampiero Griffo, Mr. Kirihara Naoyuki, Dr. Giovanna Del Giudice, Dr. Alberta Basaglia, Dr. Francesco Colizzi, Dr. Yan Guizhong, Dr. Tang Hongyu, Dr. Ma Ning, Dr. Chu Wenge, Mr. Gao Hongfei well prepared PPTs and openly shared their knowledge, experience and thoughts. 感谢格里弗先生、铜原尚之先生、乔安娜博士、巴萨利亚博士、弗朗科博士、姚贵忠博士、唐宏宇主任、马宁主任、储文革院长、高宏飞处长精心准备的报告材料和他们毫无保留地分享他们的知识、经验和想法。
- Ms. Guo Fei and Ms. Bai Wei are excellent interpreters for the Seminar and did translation for all PPTs. 感谢郭菲女士和白薇女士为研讨会做了大量的翻译工作。
- Yoshiko Miwa, who were interpreter for Mr. Kirihara’s report. Miwa 感谢女士翻译了铜原尚之先生的报告。
- Ms. Guo Fei did logistic arrangement for foreign participants. 感谢郭飞女士和白巍女士为研讨会做了大量的翻译工作。
- Representatives from Italia Embassy, EU Delegation, CDPF, China Association of Persons with Mental Health Condition and Relatives for making them available for the seminar and their sharing. 感谢意大利使馆、EU代表处、中国残联和中国精协的代表们在百忙中抽时间参加研讨会,并做了分享。
- Participants from the Action sites of Nanguan in Changchun, Tongling in An’hui, Yanqing in Beijing and Harbin city for their efforts of Action implementation. 感谢所有项目点的参会人员,感谢他们长期以来的合作和在项目实施中所做的努力。
Appendix 1: Agenda
October 8, 2014 (Wednesday)
In the morning: United Nations Convention on the Rights of persons with Disabilities
9.00-9.30 Opening Remarks
09.30-10.30 Introduction to the contents and principles of the United Nations Convention on the Rights of Persons with Disabilities –UNCRPD-
Mr. Giampiero Griffo, Representative of Disability People International (DPI)- Italy
10.30-10.45 Coffee break
10.45-11.45 UNCRPD and mental health
Mr. Kirihara Naoyuki, Representative of DPI Asia Pacific-Japan and Psychiatric Survivor’s Union Japan Board Member
11.45-12.00 Questions from the moderator and Audience and Discussion
12.00-13.30 Lunch
In the afternoon: China’s mental health service and Mental Health Law
13.30-14.30 The Chinese experience of “686” Program
Ms. Ma Ning, Responsible of 686 Program
14.30-14.45 Coffee break
14.45-15.45 The new mental health law in China
Mr. Tang Hongyu, Chinese expert in Chinese mental health law
15.45-16:15 Questions from the moderator and Audience and Discussion
October 9, 2014 (Thursday)
In the morning: Introduction to EU funded Action and Practice in the pilot districts
9.00-10.00 Community based psychiatry EU funded Action –the first and the second phase (2011-2017)
Dr. Yao Guizhong, Deputy Director of the Peking University Institute of Mental Health/the Sixth Hospital of Peking University (PUIMH)
10.00-10.15 Coffee break
10-15-11.15 Community based psychiatry EU funded project: the experience of Nanguan and Tongling districts
Dr. Chu Wenge, Nanguan Deputy Director of the Third Hospital of Tongling, Anhui Province
Dr. Gao Hongfei, Director of Intervention Centre on Psychological Crisis in Changchun, Jilin Province
11.15-11:45 Questions from the moderator and Audience and Discussion
12.00-13.30 Lunch
In the afternoon: Development course of mental health service in China
13.30-14.30 From the hospital to the community. Dr. Franco Basaglia’s experience in the city of Trieste (Italy)
Dr. Alberta Basaglia, psychologist, Franco Basaglia’s daughter
Dr. Giovanna Del Giudice, Italian expert on Community Based Psychiatry
14.30-14.45 Coffee break
14.45-15.45 Community based psychiatry and human dignity
Dr. Francesco Colizzi, Italian expert on Community Based Psychiatry
15.45-16:15 Questions from the moderator and Audience and Discussion
October 10, 2014 (Friday)
In the morning: Introduction to the Italian model of Community Based Psychiatry
9.00-10.00 Introduction to Self Help Group
Dr. Francesco Colizzi, Italian expert on Community Based Psychiatry
10.00-10.15 Coffee break
10.15-11.15 Psychosocial rehabilitation and income generating and employment program
Dr. Giovanna Del Giudice, Italian expert on Community Based Psychiatry
11.15-11.45 Discussion
12.00-13.30 Lunch
Appendix 2: Introduction to Foreign Experts
Mr. Giampiero Griffo, Representative of Disability People International (DPI)- Italy
Mr. Giampiero Griffo is responsible of the Section on Disability of the National Library of the city of Naples (Italy) and Co-Director of the Center for Disability Studies Robert Castel of the University “Suor Orsola Benincasa” of Naples, which is the Italian member of the European Accademic network on disability. Very active at local, national and international level since 1972 for the Associations working for the defense of human rights of disabled People, Mr. Giampiero Griffo is member of the World Council of “Disabled People International” and of the Board of “European Disability Forum”. He published several articles, books and researches at national and international level. 格里弗先生:国际残疾人(Disabled People International)意大利代表
格里弗先生自1972年以来积极维护残疾人权利。他是国际残疾人(Disabled People International)世界理事会及欧洲残疾论坛董事会成员。在意大利国内外发表过文章,书籍及研究成果
Mr. Kirihara Naoyuki, Representative of Disability People International (DPI)-Asia Pacific
Mr. Kirihara Naoyuki is a board member of the Psychiatric Survivor’s Union Japan. He got master degree at the Ritumeikan University. He is also member of "Japan National Group of Mentally Disabled People". 铜原尚之先生:国际残疾人亚太地区代表;日本精神幸存者联盟董事会成员;Ritumeikan大学硕士学位;同时也是日本国家精神残疾人团体的成员。
Dr. Giovanna Del Giudice, Italian expert on Community Based Psychiatry
Dr. Giovanna Del Giudice, Doctor psychiatrist, started to work on December 1971 in the psychiatric hospital of Trieste (Italy), under the Direction of Dr. Franco Basaglia. She participated to all the process of deinstitutionalization and to the construction of the process of community based psychiatry, with a particular attention to the gender issues. Dr. Giovanna Del Giudice was Director of the Mental Health Department of the cities of Caserta and Cagliari (Italy) and mental health consultant in other Provinces of Italy. She coordinates several projects of international cooperation on mental health issues. She wrote many publications and she has been President of the Association CoPerSaMM (Conferenza Permanente per la Salute Mentale nel Mondo) since November 2013. 乔安娜,意大利社区精神卫生专家。乔安娜是一名精神病专家,于1971年开始在意大利迪里亚斯特精神病院工作,主管为弗朗科.巴萨利亚。参与了意大利精神病院关闭及社区精神卫生服务发展的全部过程,同时关注性别问题。曾任意大利卡塞塔省及卡利亚里地区的卫生部主管及意大利其他地区的卫生顾问。她负责不同项目在精神卫生领域国际合作的协调,发表过不同的文章。从2013年11月起担任全球精神卫生永久性会议机构主席。
Ms. Alberta Basaglia, psychologist, Franco Basaglia’s daughter
Ms. Alberta Basaglia, psychologist, is responsible of the “Young Participation Service” and “Cultures of peace” of the town hall of Venice (Italy). She has been coordinating the “Woman Center” and the “non-violence Center” in the City of Venice since 1980. She has a long work and research experience on the main themes linked to the fight against the gender violence and all the discriminations. She is also Counselor against against all the discriminations at the Study University of Padova (Italy). In 2013 she published a book (Picasso’s clouds) on the memory of his father, Dr. Franco Basaglia, who promoted the Law 180 (or Basaglia Law), which closed down all the psychiatric hospitals in Italy in 1978 and led to their gradual replacement with a whole range of community-based services, including settings for acute in-patient care. 阿尔伯塔.巴萨利亚,心理学专家,父亲为弗朗科.巴萨利亚。负责意大利威尼斯“年轻人的参与服务”及“和平的文化”两个项目;从1980年开始协调威尼斯“妇女中心”及“无暴力中心”事务;在对性别暴力及歧视方面有长期工作和研究经验。2013年,她出版了纪念父亲弗朗科.巴萨利亚的书,而正是他的父亲推动了第180号法令,根据该法令,意大利在1978年关闭精神病院并逐步发展了社区精神卫生服务,包括急性住院治疗。
Dr. Franco Colizzi, Italian expert on Community Based Psychiatry
Dr. Franco Colizzi, psychiatrist and psychotherapist, is the Director of the Operative Unit of the Mental Health Center of the cities of Brindisi and San Vito dei Normanni (Italy) since 2008. He was member of AIFO Administration Council from 2002 to 2014 and he was AIFO National President for two mandates. From 2005 to 2011, after visiting many project of International Cooperation in 15 Countries all over the world, Dr. Franco Colizzi wrote many books, two of which related to the activities held with AIFO. He was teacher in the University of Bari and had political responsibility at provincial and district level; Dr. Colizzi also created several local Associations, such as for the defense of mental health and for the non-violence principles. 弗朗科,意大利社区精神卫生专家。为精神疾病专家及心理治疗师。自2008年起担任 布林迪西及圣维托德伊诺尔曼尼精神卫生中心主任。于2002年至2014年担任爱福协会管理委员会委员,曾两次担任爱福协会主席。自2005至2011年期间,考察了全球15个国家执行的多个国际合作项目,之后写了很多书。其中两本书跟爱福协会开展的项目有关。曾是Bari大学的老师,并在区级及省级担任政治领域工作。他也曾成立过不同的地区性协会 ,例如有的是有关精神卫生及非暴力领域。
Appendix 3: Introduction to Chinese Experts
Dr. Yao Guizhong, Doctor of Medicine, chief physician, tutor for Master students, Deputy Director of the Sixth Hospital of Peking University. Member of Experts Group on “Central Government’s Subsidy to Local Management and Treatment on Severe Mental Illnesses Specification Project”, Experts Group leader of Severe Mental Illnesses under “National Basic Public Health Service”, expert on popularization of science and health in Beijing Health Bureau. He has been engaged in psychosocial rehabilitation on mental illnesses, family intervention on the disease, practice and study on prevention and control of mental disease at communities for a long time. He organizes “ Series of Lecture on Mental Health Knowledge“ throughout the year, he is chief editor of Mental Rehabilitation Newspaper, has created mental rehabilitation bases and explored intervention service model for mental disorders of the integration of hospital and communities in Haidian district, Beijing. He has written over twenty articles and Participated in more than 10 psychiatric monographs.
姚贵忠,医学博士,主任医师,硕士研究生导师,北京大学第六医院副院长,卫生部“中央补助地方重性精神疾病管理治疗项目”专家组成员,卫生部“国家基本公共卫生服务规范”重性精神疾病专家组组长,北京市卫生局健康科普专家。长期从事精神疾病的社会心理康复、家庭干预以及社区防治的实践与研究,常年组织“精神卫生知识系列讲座”,主编《精神康复报》,创办精神康复基地,并在北京市海淀区探索“医院社区一体化”的精神疾病全程干预服务模式。撰写论文20余篇,参编10余部精神病学专著。
Dr. Tang Hongyu, male, chief physician in the Sixth Hospital of Peking University, director of ethics committee; director of psychiatric physician session under Chinese Medical Doctor Association; He graduated from Hunan Medical Institute in 1987, received master’s degree from Peking Medical University in 1992, he went to University of Melbourne and Harvard University for short term study in 2003 and 2012. From 1999 to 2007, he participated in consulting and research in mental health legislation. Since 2001, he has been in charge of many national projects on mental health service and training, formulation and amendment of standardized training outline and detailed regulations on in-patient doctor behaviors. He is specialized in Clinical Psychiatry and Psychiatric Ethics and Law.
唐宏宇,男,北京大学第六医院主任医师,伦理委员会主任委员, 中国医师协会精神科医师分会会长
1987年本科毕业于湖南医学院,1992年硕士毕业于北京医科大学
2003和2012年分别在墨尔本大学和哈佛大学短期进修
1999年-2007年参与中国精神卫生立法的咨询与研究工作
2001年以来主持多项国家级精神卫生服务与培训项目,主持精神科住院医师规范化培训大纲和细则的制订和修订
专长:临床精神病学、精神医学伦理与法律
Ms. Ma Ning, Doctor of Medical Science, she got master’s degree in Public Health, she is deputy director of Public Health Department in the Sixth Hospital of Peking University, office director of Mental Health Center under China’s Center for Disease Control, secretary of Emergency Expert Advisory Committee on Psychological Aid Group. She was a visiting scholar to University of Rochester in 2009. She has been majorly involved in community based mental health service, rehabilitation treatment on severe mental illnesses, research on mental health policy, one National Natural and Scientific Funds and one capital health development research. She has published fourteen essays in the name of the first author, five SCI, participated in two psychiatric monographs. Currently, she is in charge of the central government’s subsidy to local mental health projects and management system of information on national severe mental disorder.
马宁,医学博士,公共卫生硕士,北京大学第六医院公共卫生事业部副主任,中国疾控中心精神卫生中心办公室主任,卫生部应急专家咨询委员会心理援助组秘书。2009年美国罗切斯特大学访问学者。主要工作领域包括社区精神卫生服务、重性精神疾病康复治疗、精神卫生政策研究等。承担国家自然科学基金1项,首都卫生发展科研专项1项。第一作者发表论文14篇,SCI 5篇。参编著作2部。目前主要负责参与管理中央补助地方精神卫生项目和国家严重精神障碍信息管理系统。
Dr. Chu Wenge, deputy director of the Third Hospital of Tongling, psychiatric doctor and associate chief physician.
储文革,铜陵第三医院副院长,精神科医生,副主任医师
Dr. Deng Hua, psychiatric doctor in the Sixth Hospital of Changchun;Director of Intervention Center on Psychological Crisis in Changchun.
邓华,长春六院精神科医生,主治医师;长春市心理危机干预中心主任