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目的:了解四川地震后部分极重及重灾区的精神病院及乡镇卫生院、村卫生室提供灾后精神卫生和心理社会支持(mental health and psychosocial support,MHPSS)的能力。方法:参照联合国机构间常委会对MHPSS的定义和分级,自编问卷,包括卫生机构基本信息及目前提供服务的情况,近2年接受MHPSS培训及教材和参考书的情况,提供MHPSS的意愿及可行性。调查来自县级精神病院1所、乡镇级精神病院1所、乡镇卫生院5所和村卫生室5所的医生共30名,从业年限1~42年(中位数12年)。并对其中10人进行深入访谈,了解个人从业经历、地震对医疗机构的影响、学习和提供MHPSS的经历和感受等。结果:县级和乡镇级精神科医师在辖区内的人口比例分别为0.68/10万人和0.83/10万人。震前无相关培训;震后11人接受过1~7天(中位数2天)的非分级培训,且教材和参考书严重不足。仅有19人表示有时间提供MHPSS服务,可能的时间为(6.9±2.5)h/周。县级和乡镇级精神病院需管理地震前的已住院患者及震后新发病例。县精神病院开展了某些形式的心理健康宣传教育。只有2所乡镇卫生院提供灾后约20人/月的门诊心理咨询。精神科医师震前没有受过心理危机干预培训,没有治疗诊治创伤后应激障碍的经验。基层非精神科医生觉得自己的能力有限,无法给受灾群众提供到位的服务。乡镇卫生院仅有地西泮这一种基本精神科药品。地震对医疗机构的建筑有不同程度的破坏,乡镇级精神病院病房全部倒塌。结论:四川地震后县级及以下医疗机构提供精神卫生和心理社会支持的能力极为有限。建议今后对相关人员开展实用的、有针对性的分级培训;采取措施改变基层卫生机构缺乏基本精神科药品的现状;在新建或改造精神病院时,加强硬件的抗灾强度。
Objectives: To understand the mental health and psychosocial support (MHPSS) capabilities of psychiatric hospitals, township hospitals and village clinics in some extremely heavy and severely affected areas after the Sichuan earthquake. Methods: With reference to the definition and classification of MHPSS by the IASB, self-compiled questionnaires, including the basic information of health institutions and the current services provided, received MHPSS training and teaching materials and reference materials in the past two years and provided the wishes of MHPSS and feasibility. A total of 30 doctors, including 1 county-level mental hospital, 1 township-level mental hospital, 5 township hospitals and 5 village clinics, were surveyed. Their working years range from 1 to 42 years (median 12 years). In-depth interviews were conducted with 10 of them to understand personal experience, the impact of earthquakes on medical institutions, and the experience and feelings of learning and providing MHPSS. Results: The population proportion of county-level and township-level psychiatrists in the area was 0.68 / 100,000 and 0.83 / 100,000, respectively. There was no relevant training before the earthquake; 11 people had received non-graded training of 1 to 7 days (median 2 days) after the earthquake, and the teaching materials and reference books were seriously under-represented. Only 19 said they had time to provide MHPSS service, with a possible duration of (6.9 ± 2.5) h / week. County-level and township-level mental hospitals need to manage patients who have been hospitalized before the earthquake and new cases after the earthquake. County mental hospitals to carry out some forms of mental health education. Only 2 township clinics provided outpatient counseling about 20 persons / month after the disaster. Psychiatrists have not been trained in psychology before the earthquake, and there is no experience in treating post-traumatic stress disorder. Primary non-psychiatrists feel that they have limited capacity to provide the affected people with services in place. Township hospitals only diazepam this kind of basic psychotropic drugs. The earthquake destroyed the construction of medical institutions in varying degrees, and wards of township-level mental hospitals all collapsed. Conclusion: The capacity of medical institutions at county level and below to provide mental health and psychosocial support after the Sichuan earthquake was extremely limited. It is proposed to carry out practical and targeted training for relevant personnel in the future; measures should be taken to change the current situation of the lack of basic psychiatric drugs in primary health institutions; and the intensity of hardware disaster resistance in the construction or rehabilitation of psychiatric hospitals.