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1、Psychosocial Mental Health Aftercare Services,John R.Bola,Ph.D.School of Social WorkUniversity of Southern CaliforniaUSA,美国南加州大学社会工作学院包教授,社会心理干预服务,Causal Models,Biomedical disease?orBio-psycho-socialStress-vulnerability model?,生理疾病？或生理-心理-社会模式还是压力应对的模式？,对病原的解释,Advantages of Biological Disease Model,
2、SimplicityChemical imbalanceReduced responsibility and self-blameStigma management,简单由化学元素不平衡导致责任及自我指责的减少对歧视的处理,生理疾病模式的优点,Limits of Biological Disease Model,Environmental influences are peripheralChange occurs primarily through medicationReduces active participation in the recovery process,外围环境因素单纯依
3、靠药物治疗减少康复过程中的积极参与,生理疾病模式的缺陷,Suppression of symptomsNot a cureSide-effects,只是抑制症状不能治愈副作用,Over-Reliance on Medication,过分依赖药物,Advantages:Multi directional causal influencesPrimary social and psychological interventions,益处多方位考虑原因以社会和心理干预为主,Bio-Psycho-Social Model of Mental Illness,生理-心理-社会模式,Reduce stre
4、ssIncrease supportComprehensive framework for intervention,减少压力增加支持全面的干预架构,Stress-Vulnerability Model,压力诱因模式,Use lowest effective/necessary doseMinimize side-effectsPart of integrated treatment,用最少的剂量达到最佳的效果减少副作用综合治疗方案的一部分,Optimal Use of Medication,药物的最佳使用,Continuum of Mental Health Services,Least r
5、estrictive environmentMaximize functional recoveryCommunity-based,少受环境限制增强功能恢复以社区为依托,心理健康服务的连续性,Using best available evidenceMore helpful to peopleMore effective for society,利用现存最佳的科学证据对患者和家人多提供有效的帮助对社会更有效益,Evidence-Based Practice,循证实践,Use best evidenceTest Adapt services to local conditions and cul
6、ture,使用最佳科研证据测试其可行性调整服务，使其适应本地实际情况,Developing Services,发展服务,Evidence-Based Psychosocial Treatments for Schizophrenia,Family psychoeducationPsychsocial skills trainingCognitive-behavioral therapyVocational rehabilitation,对家庭的心理教育社会心理技巧培训行为意识治疗职业恢复,对精神分裂症患者以循证为基础的社会心理治疗,Psychosocial Treatments for Sch
7、izophrenia,Family mutual supportClient self-helpAssertive Community Treatment(ACT)Supported Employment,家庭互助患者互助社区积极治疗就业支持,对精神分裂症病患的其他社会心理治疗,Family Psychoeducation,Reduces relapse,improves social functioning and reduces caregiver burden.Recognizes and uses a strength of Chinese culture the value of t
8、he family.,减少复发，提高社会功能，减少照顾者的负担肯定和利用中国传统文化的力量-家庭的价值,家庭心理教育,Cochrane Systematic Review(Pharoah et al.2005),Decreased relapse RR 0.72 CI:0.6-0.8 NNT 7Improved medication compliance RR 0.74 CI:0.6-0.9 NNT 7No clear effect on dropout or suicide,减少复发机会提高接受药物治疗的程度对自杀和退出没有明显效果,Cochrane 系统回顾,Initial Objecti
9、ves(Xiong,Phillips et al.1994),Trusting,empathetic relationship.Educate the family about the illness.Enlist collaboration in medication management.Introduce talking therapy.,信任和同情的关系教育家庭成员了解精神疾病在药物服用方面建立合作支持的关系介绍“说话治疗”,初步目的,Educational Content,Schizophrenia(stress-diathesis model)SymptomsCourse(prog
10、nosis)Treatment(medications,stress management,family and social relations,stigma)Relapse prevention,精神分裂症（压力诱因模式）症状病程（预后）治疗（药物，压力处理，家庭于社会关系，歧视）预防复发,教育的内容,Educational Content II.,Problem-solvingEmotional supportCrisis managementSupport improved family functioning,解决问题情感支持危机处理提高家庭的功能,教育的内容之二,Reduction
11、 in“Expressed Emotion”Critical/hostileOver-involved,减少“表达情感”批评/责怪过分介入,Educational Content III.,教育的内容之三,Hospital-basedPsychoeducation,Symptom recognitionMedication and symptom relationshipStress and symptom relationshipFoster collaboration,认识症状药物与症状的关系压力和症状的关系加强合作,以医院为依托的心理教育,Inpatient dosage reducti
12、on trial?,What is the lease effective dosage of medications?Is it feasible and instructive to reduce inpatient dosage?Stress likely to increase upon discharge.,药物的最少剂量？减少住院病人药物剂量的可行性？出院时的压力有可能增大,住院病人减少药物剂量的实验,Symptom Management,Symptom recognitionSymptom-medication relationshipSymptom-stress relatio
13、nship,认识症状症状与药物的关系压力与症状的关系,症状的处理,Discharge Planning,Living arrangements?Social and occupational considerations?Outpatient services(medication,case management)Continuity of helping relationships?,居住安排如何？社会及职业的考虑？门诊服务（药物，个案管理）帮助关系的延续？,出院安排,Suicide Risk,AssessmentMonitoringEarly warningPrevention,评估检测及
14、早提醒预防,自杀的隐患,Continuity of Treatment,Develop ongoing,supportive,and trusting relationship with family.Increase understanding,compliance,likelihood of later contact if needed.,发展与家人持续的支持及信任关系增强了解,合作及以后需要时的联系,治疗的延续,Social Work and Psychiatry,Furthering collaborative relationshipsRecognition of complime
15、ntary strengthsShared commitment to best client outcomes,推动合作关系承认相互的互补性以病患的最高利益为己任,社会工作者与精神科医生,Knowledge development requires a scientific communityHealthy society requires commitment to the well-being of each person,知识的发展需要一个科学的社区健康的社会需要关心每个成员的身心健康,Collaborative Partnerships,合作伙伴,Building upon what
16、 is knownEvaluating new treatments How can we improve what we do?,在现存知识的基础上不断积累评估新的治疗方法可以如何提高服务质量?,Advancing Knowledge,更新知识,Psychosocial interventions Management of social servicesSocial science research,社会心理干预社会服务管理社会科学研究,Social WorkMental Health Professional Education,社会工作和社会福利,Objectives:introduc
17、e the concepts of mental illnesses and psychosocial rehabilitation to social work practitioners and students.Foster cooperative inter-professional relationships(e.g.,psychiatry,psychology,nursing.)in the treatment of mental illness.,目标：本课程旨在向不熟悉精神健康社会工作实践的社会工作从业者和学生介绍精神疾病和社会心理康复的基本概念。同时也希望在整合性治疗方法的学
18、习过程中向其他专业人士，如精神科医生，心理医生，护士和职业治疗师介绍社会工作者在其中扮演的角色。,Social Work Mental Health Curriculum,发展中国心理健康教学大纲,Contents 内容,心理疾病：定义及流行程度(I)心理疾病：定义及流行程度(II)社会心理康复的概念和社会工作者的角色文化在精神疾病中的角色心理健康的政策和服务,Mental Illness:Definitions and Prevalence Estimates(I)Mental Illness:Definitions and Prevalence Estimates(II)Concepts
19、of Psychosocial Rehabilitation and the roles of social workersThe Role of Culture in the Conceptualization of Mental IllnessMental Health Policy and Services,Contents 内容,对心理疾病的生理干预对精神疾病的社会心理干预对心理疾病的社会态度：歧视融生理，心理和社会成分的综合干预方式家庭在照顾精神病患者中的角色在心理健康服务方面的跨领域合作（精神科医生，心理医生，社工，护士等）,Biological Interventions for
20、 Mental IllnessPsychosocial Interventions for Mental IllnessSocial Attitudes towards the Mentally Ill:StigmaIntegrating Biological Psychological and Social Components of Mental Health ServicesThe Role of Family in Care and Treatment of the Mentally IllInterdisciplinary Collaboration in Mental Health
21、 Services(Psychiatry,Psychology,Social Work,Nursing,etc.),Format and Assessment 形式与评估方式,Format:The sessions are conducted in the format of lectures,role plays and discussions.Each session lasts for two hours,and can be run on a weekly basis or as a sandwiched course.Assessment:In order to be granted
22、 a certificate from the organizers,participants must attend at least 80%of the classes,and complete two assignments which shall be written in Chinese or English.,形式：本课程将以讲座，角色扮演，讨论的方式进行。每节两个小时，每星期一次或隔星期一次。评估:为获得组办者颁发的证书，学员必须出席80%以上的课程，并用中文或英文完成两份作业。,Colleagues 指导教员,John Bola 包教授博士 Xuesong He 何雪松博士 Daniel Wong 黄富强博士 Shengming Yan 鄢盛明博士,谢谢！,
