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1、Psychosocial Mental Health Aftercare ServicesJohn R.Bola,Ph.D.John R.Bola,Ph.D.School of Social WorkSchool of Social WorkUniversity of Southern CaliforniaUniversity of Southern CaliforniaUSAUSA美国南加州大学社会工作学院包教授社会心理干预服务社会心理干预服务Causal ModelsBiomedical disease?orBio-psycho-socialStress-vulnerability mod
2、el?生理疾病？或生理-心理-社会模式还是压力应对的模式？对病原的解释对病原的解释Advantages of Biological Disease ModelSimplicitySimplicityChemical imbalanceChemical imbalanceReduced responsibility Reduced responsibility and self-blameand self-blameStigma managementStigma 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生理疾病模式的优点Limits of B
3、iological Disease ModelEnvironmental Environmental influences are peripheralinfluences are peripheralChange occurs primarily Change occurs primarily through medicationthrough medicationReduces active Reduces active participation in the participation in the recovery process recovery process 外围环境因素单纯依
4、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生理疾病模式的缺陷Suppression of Suppression of symptomssymptomsNot a cureNot a cureSide-effectsSide-effects只是抑制症状不能治愈副作用Over-Reliance on Medication过分依赖药物过分依赖药物Advantages:Advantages:+Multi directional Multi directional causal influencescausal influences+Primary social and Primary so
5、cial and psychological psychological interventionsinterventions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生理生理-心理心理-社会模式社会模式Reduce stressReduce stressIncrease supportIncrease supportComprehensive Comprehensive framework for framework for interventionintervention减少压力增加支持全面的干预架构Stre
6、ss-Vulnerability Model 压力诱因模式压力诱因模式Use lowest effective/Use lowest effective/necessary dosenecessary doseMinimize side-effectsMinimize side-effectsPart of integrated Part of integrated treatmenttreatment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药物的最佳使用药物的最佳使用Continuum of Mental Health Ser
7、vicesLeast restrictive Least restrictive environmentenvironmentMaximize functional Maximize functional recoveryrecoveryCommunity-basedCommunity-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心理健康服务的连续性连续性Using best available Using best available evidenceevidenceMore helpful to peopleMore helpful to peopleMore effect
8、ive for More effective for societysociety利用现存最佳的科学利用现存最佳的科学证据证据对患者和家人多提供对患者和家人多提供有效的帮助有效的帮助对社会更有效益对社会更有效益Evidence-Based Practice循证实践循证实践Use best evidenceTest Adapt services to local conditions and culture 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发展服务发展服务Evidence-Based Psychosocial Treatments
9、for SchizophreniaFamily Family psychoeducationpsychoeducationPsychsocialPsychsocial skills training skills trainingCognitive-behavioral Cognitive-behavioral therapytherapyVocational rehabilitationVocational 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对精神分裂症患者以循证为基础的社以循证为基础的社会心理治疗会心理治疗Psychosocia
10、l Treatments for SchizophreniaFamily mutual supportFamily mutual supportClient self-helpClient self-helpAssertive Community Assertive Community Treatment(ACT)Treatment(ACT)Supported EmploymentSupported 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对精神分裂症病患的其他社会心理治疗其他社会心理治疗Family PsychoeducationReduces relaps
11、e,improves Reduces relapse,improves social functioning and social functioning and reduces caregiver burden.reduces caregiver burden.Recognizes and uses a Recognizes and uses a strength of Chinese strength of Chinese culture the value of the culture the value of the family.family.减少复发，提高社会功能，减少照顾者的负担
12、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家庭心理教育Cochrane Systematic Review(Pharoah et al.2005)Decreased relapse RR 0.72 Decreased relapse RR 0.72 CI:0.6-0.8 NNT 7CI:0.6-0.8 NNT 7Improved medication Improved medication compliance RR 0.74 compliance RR 0.74 CI:0.6-0.9 NNT 7CI:0.6-0.9 NNT 7No clear effect on No clear
13、effect on dropout or suicidedropout or suicide减少复发机会减少复发机会提高接受药物治疗的提高接受药物治疗的程度程度对自杀和退出没有明对自杀和退出没有明显效果显效果Cochrane 系统回顾系统回顾Initial Objectives(Xiong,Phillips et al.1994)(Xiong,Phillips et al.1994)1.1.Trusting,empathetic Trusting,empathetic relationship.relationship.2.2.Educate the family about the Educ
14、ate the family about the illness.illness.3.3.Enlist collaboration in Enlist collaboration in medication management.medication management.4.4.Introduce talking therapy.Introduce talking therapy.1.1.信任和同情的关系信任和同情的关系2.2.教育家庭成员了解教育家庭成员了解精神疾病精神疾病3.3.在药物服用方面建在药物服用方面建立合作支持的关系立合作支持的关系4.4.介绍介绍“说话治疗说话治疗”初步目的初
15、步目的Educational ContentSchizophrenia(stress-diathesis model)SymptomsCourse(prognosis)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教育的内容Educational Content II.Problem-solvingProblem-solvingEmotional sup
16、portEmotional supportCrisis managementCrisis managementSupport improved family Support improved family functioningfunctioning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教育的内容之二Reduction in Reduction in“Expressed Emotion”“Expressed Emotion”Critical/hostileCritical/hostile Over-involvedOver-involved减少“表达情感”批评/责怪 过分介入Ed
17、ucational Content III.教育的内容之三教育的内容之三Hospital-basedPsychoeducationSymptom 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以医院为依托的心理教育心理教育Inpatient dosage reduction trial?What is the lease effective What is the lease effec
18、tive dosage of medications?dosage of medications?Is it feasible and instructive to Is it feasible and instructive to reduce inpatient dosage?reduce inpatient dosage?Stress likely to increase upon Stress likely to increase upon discharge.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住院病人减少药物剂量的
19、实验剂量的实验Symptom ManagementSymptom recognitionSymptom-medication relationshipSymptom-stress relationship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症状的处理Discharge PlanningLiving arrangements?Living arrangements?Social and occupational Social and occupational considerations?considerations?Outpatient servicesOutpatient se
20、rvices(medication,(medication,case management)case management)Continuity of helping Continuity of helping relationships?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？出院安排出院安排Suicide RiskAssessmentAssessmentMonitoringMonitoringEarly warningEarly warningPreventionPrevention评估检测及早提醒预防自杀的隐患自杀的隐患Con
21、tinuity of TreatmentDevelop ongoing,Develop ongoing,supportive,and trusting supportive,and trusting relationship with family.relationship with family.Increase understanding,Increase understanding,compliance,likelihood of compliance,likelihood of later contact if needed.later contact if needed.发展与家人持
22、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治疗的延续Social Work and PsychiatryFurthering collaborative Furthering collaborative relationshipsrelationshipsRecognition of Recognition of complimentary strengthscomplimentary strengthsShared commitment to Shared commitment to best client outcomesbest client outcomes推动合作关
23、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社会工作者与精神科医生与精神科医生Knowledge Knowledge development requires a development requires a scientific communityscientific communityHealthy society requires Healthy society requires commitment to the well-commitment to the well-being of each personbeing of each person知识的发展需要一个科学的社区健康
24、的社会需要关心每个成员的身心健康Collaborative Partnerships合作伙伴合作伙伴Building upon what is Building upon what is knownknownEvaluating new Evaluating new treatments treatments How can we improve How can we improve what we do?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更新知识更新知识Psychosocial Psychosocial
25、 interventions interventions Management of social Management of social servicesservicesSocial science research Social 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社会工作和社会福利ObjectivesObjectives:n nintroduceintroduce the concepts of the concepts of mental
26、illnesses and mental illnesses and psychosocial rehabilitation psychosocial rehabilitation to social work practitioners to social work practitioners and students.and students.n nFoster cooperative inter-Foster cooperative inter-professional relationships professional relationships(e.g.,psychiatry,(e
27、.g.,psychiatry,psychology,nursing.)in the psychology,nursing.)in the treatment of mental illness.treatment of mental illness.目标：目标：目标：目标：n n本课程旨在向不熟悉精神本课程旨在向不熟悉精神健康社会工作实践的社会健康社会工作实践的社会工作从业者和学生介绍精工作从业者和学生介绍精神疾病和社会心理康复的神疾病和社会心理康复的基本概念。基本概念。n n同时也希望在整合性治疗同时也希望在整合性治疗方法的学习过程中向其他方法的学习过程中向其他专业人士，如精神科医生，专业人
28、士，如精神科医生，心理医生，护士和职业治心理医生，护士和职业治疗师介绍社会工作者在其疗师介绍社会工作者在其中扮演的角色。中扮演的角色。Social Work Mental Health Curriculum发展中国心理健康教学大纲Contents 内容内容n n心理疾病：定义及流行心理疾病：定义及流行程度程度 (I)(I)n n心理疾病：定义及流行心理疾病：定义及流行程度程度 (II)(II)n n社社会会心理康心理康复复的的概概念和念和社社会会工作者的角色工作者的角色n n文化在精神疾病中的角文化在精神疾病中的角色色n n心理心理健康的政策和服健康的政策和服务务Mental Illness:
29、Definitions and Prevalence Estimates(I)Mental Illness:Definitions and Prevalence Estimates(II)Concepts of Psychosocial Rehabilitation and the roles of social workersThe Role of Culture in the Conceptualization of Mental IllnessMental Health Policy and ServicesContents 内容内容n n对心理疾病的生理干预对心理疾病的生理干预n n对
30、精神疾病的社会心理对精神疾病的社会心理干预干预n n对心理疾病的社会态度：对心理疾病的社会态度：歧视歧视n n融生理，心理和社会成融生理，心理和社会成分的综合干预方式分的综合干预方式n n家庭在照顾精神病患者家庭在照顾精神病患者中的角色中的角色n n在心理健康服务方面的在心理健康服务方面的跨领域合作（精神科医跨领域合作（精神科医生，心理医生，社工，生，心理医生，社工，护士等）护士等）Biological Interventions for Mental IllnessPsychosocial Interventions for Mental IllnessSocial Attitudes to
31、wards 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 Services(Psychiatry,Psychology,Social Work,Nursing,etc.)Format and Assessment
32、形式与评估方式形式与评估方式n nFormat:Format:The sessions are The sessions are conducted in the format of conducted in the format of lectures,role plays and lectures,role plays and discussions.Each session discussions.Each session lasts for two hours,and can be lasts for two hours,and can be run on a weekly basis
33、 or as a run on a weekly basis or as a sandwiched course.sandwiched course.n nAssessment:Assessment:In order to In order to be granted a certificate from be granted a certificate from the organizers,participants the organizers,participants must attend at least 80%of must attend at least 80%of the cl
34、asses,and complete two the classes,and complete two assignments which shall be assignments which shall be written in Chinese or English.written in Chinese or English.n n形式：形式：形式：形式：本课程将以讲座，本课程将以讲座，本课程将以讲座，本课程将以讲座，角色扮演，讨论的方式角色扮演，讨论的方式角色扮演，讨论的方式角色扮演，讨论的方式进行。每节两个小时，进行。每节两个小时，进行。每节两个小时，进行。每节两个小时，每星期一次或隔
35、星期一每星期一次或隔星期一每星期一次或隔星期一每星期一次或隔星期一次。次。次。次。n n评估评估评估评估:为获得组办者颁为获得组办者颁为获得组办者颁为获得组办者颁发的证书，学员必须出发的证书，学员必须出发的证书，学员必须出发的证书，学员必须出席席席席80%80%以上的课程，并以上的课程，并以上的课程，并以上的课程，并用中文或英文完成两份用中文或英文完成两份用中文或英文完成两份用中文或英文完成两份作业。作业。作业。作业。Colleagues 指导教员n nJohn BolJohn Bola a 包教授博士包教授博士 n nXuesonXuesong He g He 何雪松博士何雪松博士 n nDaniel WongDaniel Wong 黄富强博士黄富强博士 n nShengming Yan Shengming Yan 鄢盛明博士鄢盛明博士