Promote the community management model and adopt long-acting injection therapy
Help the patients in the secret room get out of the predicament (Big Health Observation)
A few months ago, Ma Hong was injured 4 ribs by her patient.
"We often joke that a psychiatrist who has not been beaten by a patient has an incomplete career." Ma Hong said with a smile afterwards.
As the chief physician of Peking University Sixth Hospital and the deputy director of the Mental Health Center of the China Center for Disease Control and Prevention, Hong Ma has been a psychiatrist in 1983. In the 38 years since he became a psychiatrist, he has read all kinds of discrimination against mental patients in society and the patients themselves Stigma.
Therefore, she did not hate the patient. After being rescued, she said: "What is the dose of this child?" She still worried about the patient's condition.
The mentally ill is like being trapped in a secret room, it is difficult to get out
The patient who attacked Ma Hong was less than 40 years old and had been plagued by schizophrenia for many years. His father who suffered from the same disease had passed away. Because of the delusion that his mother was not a real mother, he could only live with his 80-year-old grandmother.
Due to the deep stigma of this patient, he was afraid that people would know that he was sick, so he did not take medicine on time, and he could not find a job for a long time, resulting in repeated illnesses.
Ma Hong went to visit her, hoping that she would be self-reliant, but the patient suddenly lost control and Ma Hong was injured.
Schizophrenia is a serious mental illness caused by the combination of genetic and environmental factors. It usually occurs in young adults and often suffers from obstacles in perception, thinking, emotion, and behavior.
The main symptom is thinking disorder, such as lack of logic in the process of thinking form and delusion of persecution in thinking content.
In addition, speech hallucinations, emotional retardation, and behavioral withdrawn are also common clinical manifestations of schizophrenia.
As of 2020, there are approximately 6.8 million schizophrenia patients in China.
Ma Hong's injury this time reflects that schizophrenic patients are currently facing huge challenges in disease management and integration into society after recovery.
“Patients don’t want to take medicine in various ways. One is that it’s inconvenient to take the medicine three times or once a day. It must be remembered, and there are some adverse reactions to the medicine. In addition, psychiatric diseases are mainly in the central nervous system, and many people don’t think they are sick. "Ma Hong said, this has caused the recurrence rate of the disease to remain high.
At the same time, due to the public's lack of scientific understanding of schizophrenia and the inherent fear of patients, it is difficult for patients to return to society.
In addition, schizophrenia has a long course of illness, severe illness, and recurrence. The patient has high requirements for family support, which brings a huge economic burden to the patient, family members and society.
"The patient is like being trapped in a secret room." Ma Hong used the escape room game as an example. "Dark and small, it is difficult to get out without help."
To improve medication compliance, Ma Hong often receives wedding candy
The "Healthy China" 2030 Planning Outline clearly points out that the management of treatment and assistance for patients with severe mental disorders will be strengthened, and community rehabilitation services for mental disorders will be fully promoted.
Schizophrenia, as a more serious disease included in the six types of mental disorders in community rehabilitation, is more difficult than the other five types of diseases in the process of achieving community rehabilitation. For this reason, many measures have been taken to improve medication compliance and reduce medication compliance. From the perspective of recurrence, vigorously promote the "fine-divided community management model".
In 2018, the "Management and Treatment of Severe Mental Disorders (2018 Edition)" issued by the National Health Commission wrote in the "Principles of Drug Treatment for Home Patients": For patients at risk of causing accidents, long-acting injections are recommended."
In this regard, Ma Hong said that the reasons for the continuous relapse of many mental patients are mostly related to unexplained withdrawal of the drug. For the patient, long-term medication is a great burden both physically and psychologically. Therefore, the long-acting injection Promotion is necessary.
"Currently, some long-acting injections are given once a month, some once every three months, and in the future, they will be given once every six months." She said that in this way, the impact on patients' study, work, and life is reduced to a very low level.
With the help of long-acting injections, Ma Hong and her patients often have such an agreement: "If you go to college, you will send me the notice; if you are married, you will give it to me, and if you have a baby, you will also give it to me. ."
Ma Hong often receives wedding candy.
The role of fine-divided community management model is very important
October 10th is the 30th "World Mental Health Day". The 2021 World Mental Health Day public welfare project initiated by Bethune Foundation and supported by Janssen Company was launched in Beijing at the same time.
The theme of the event is "Guarding together and letting love return".
As a charitable organization that continues to promote the development of mental health, the Bethune Charity Foundation actively provides support to patients with schizophrenia and their families.
"The ultimate goal of treatment for patients with schizophrenia is recovery and return." Tian Xiaoli, vice chairman and secretary-general of Bethune Charity Foundation, said that this goal is difficult to achieve with the strength of individuals and families, and objectively requires multilateral efforts to provide medical, social, and social services. Comprehensive employment services to truly help patients live a meaningful life.
Among them, the patient-centered fine-divided community management model has played a pivotal role.
In 2004, the state launched a management and treatment program for severe mental disorders.
In 2009, community follow-up management of severe mental illness was included in the national basic public health service project.
With the improvement of the country’s overall economic capacity and the needs of social development, the treatment and management of mental illness has gradually shifted from institutionalized management to humanized management, from a management-based treatment model to a comprehensive management model. Established a three-level management system and follow-up system that was jointly established by the health system and the grassroots community, covering the city, district, and community.
Linking forces from all sides including fine defense, civil affairs, and the Disabled Persons' Federation
At present, some areas in Shanghai and Guangdong are actively exploring and practicing the fine-divided community management model.
Yunfu City, Guangdong Province has launched the "long-term monitoring and stable return" three-year campaign for schizophrenia. For patients with poor compliance, weak family monitoring capabilities or no monitoring, the "medical insurance reimbursement + financial support" and "risk assessment grades" are adopted. Measures such as “advanced at different levels” ensure that all registered patients with schizophrenia in the city receive effective treatment and achieve a stable condition.
Through the trinity care and assistance system of the government, society and family, the community is linked to solve the problems of patients' difficulty in taking medicine, family's difficulty in getting rid of, and social acceptance.
Ma Hong said: “Severe mental disorders such as schizophrenia are one of the major public health challenges facing our country. The application of the finely divided community management model is playing an active role in scientific management of diseases, providing emotional support, and helping to restore social functions. The role of this model. I believe that in the future, this model will be more widely implemented in more regions."
Severely ill treatment is in the hospital, and rehabilitation management is in the community.
With the implementation of policies such as psychiatric graded diagnosis and treatment and medical consortia, the health management of patients with severe mental disorders is exploring the level of community rehabilitation.
“The community is an important place for patients with scoring to recover after they are discharged from the hospital. Only by linking up with the strengths of intensive prevention, civil affairs, and the Disabled Persons’ Federation can we establish a perfect scoring community management model.” said Professor Li Zhiwu, dean of the Beijing Fengtai District Mental Disease Prevention and Treatment Institute , "Through effective follow-up of the disease throughout the course, standardized treatment, to solve the problem of recurrence caused by insufficient medication compliance, so as to control the disease in a long-term and stable manner, and ultimately help the patients with scoring to achieve recovery and return."
In order to bridge the gap of understanding between the public and the patients with schizophrenia, the aforementioned World Mental Health Day event launched an online and offline immersive room escape experience focusing on schizophrenia.
With the help of all parties, the experiencer will unlock the "mental room" and successfully escape, which means that the divided community management model can effectively help patients achieve scientific disease management and return to society.
Reporter: Xiong Jian