我国全科医学教育的政策演进、现实问题与优化路径

全科医学教育是全科医学人才培养的重要途径,是推动基层医疗卫生事业持续良好发展的关键。从政策演变来看,全科医学教育先后经历萌芽起步、探索发展和改革完善3个发展阶段。从实践来看,全科医学教育主要面临人才培养数量不足、培养质量有待提高、全科医学基层就业倾向不高、“校院区”衔接不畅等现实问题。建议进一步认识全科医学教育,加大培养力度;强化专业内涵建设,提高培养质量;建立有效激励机制,赋能可持续发展;深化医教协同,增强合作效能,充分发挥宏观政策的牵引和指导作用,不断推动全科医学教育高质量发展。

     

Putting Values into Practice: Public Policy and the Future of Mental Health Consumer-run Organizations

The purpose of the paper is to reflect on value dilemmas in mental health consumer-run organizations and to discuss implications for research, policy, and practice. We review the roots of consumer-run organizations in the self-help movement and the psychiatric survivor liberation movement, focusing on the distinctive values espoused by consumer-run organizations. We also discuss evidence-based and value-based approaches to mental health policy formulation and mental health reform, noting the particular importance of value-based approaches and the role that consumer-run organizations can play in mental health reform. Based on our experiences conducting a participatory action research study of four mental health consumer-run organizations, we identify and examine several value dilemmas, discuss the lessons that we learned about these value dilemmas, and note their implications for future directions in research, policy, and practice.     

Roberts's, Child versus Childmaker: Future Persons and Present Duties in Ethics and the Law

Book reviewed in this article:
Melinda Roberts, Child versus Childmaker: Future Persons and Present Duties in Ethics and the Law     

Consumer Perspectives of Participation in Vocational Programs by Individuals With Serious Mental Illness: Two Phenomenological Studies

Engagement in worker roles presents significant challenges for individuals with serious mental illnesses. Evolution of vocational rehabilitation programs has yielded evidence-based support for supported employment models. This research presents a phenomenological study of consumer viewpoints concerning participation in earlier vocational rehabilitation programs, followed by a study of supported employment participation perspectives. Initial study themes of Chaos: Living with Disruptions, Mixed Blessings: Vocational Rehabilitation Program, Feelings of Discrepancy, and Searching for Order were reinforced by follow-up study themes of Positive Feelings of Worker Satisfaction and Managing Self/Illness. Consumers identified success in employment outcomes, if able to balance illness and work demands.     

The Provision of Assistive Technology by Occupational Therapists Who Practice in Mental Health

The purpose of this study is to determine what assistive technology devices occupational therapists working in mental health settings use with their clients. Based on the literature, the authors expected that no tech and low tech assistive technology solutions are being used with clients in these settings even though high technology options are available for people with mental illness who have co-existing cognitive disabilities. The findings of the study reveal that indeed no tech and low tech interventions are most often used. Implications for professional development educational programs and further research are suggested.     

The Growing Use of Firearms by Suicidal Older Women, 1979–1992: A Research Note

Suicide among older women (65 +) has received very little attention despite increasing numbers of suicides in this population. An examination of national mortality data from the National Center for Health Statistics for the years 1979 through 1992 shows an increasing trend in rates of suicide among older women and a declining trend among women under 65. Over the 14-year period, firearms replaced poisoning as the most prevalent method of suicide by women 65 and over. The results seem consistent with the assertion that the availability, familiarity, and cultural acceptability of firearms may play a role in the choice of suicide method among older women. Although violent death and the use of firearms are generally associated with males in our society, the trends reported here indicate that greater attention to firearm suicides among older women is warranted.     

Parenting Self‐Construals of Mothers With a Serious Mental Illness: Efficacy,Burden, and Personal Growth1

We explored parenting self‐construals among mothers with serious mental illness (n= 379). Mothers reported feeling moderately positively about themselves as parents, more efficacious than inefficacious, more positive than negative, more valued than disvalued; but also at least somewhat restricted and burdened by motherhood. Factor analyses revealed 3 parenting self‐construal factors: efficacious, burdened, and parenting as a personal growth experience. In hierarchical regression analyses, parenting self‐construal factors significantly added to prediction of parenting behaviors and attitudes (nurturance, explanatory parenting style, and parenting stress), once demographic, mental health history, and current social context variables (support, stress, and current mental health) were taken into account. Maternal parenting self‐efficacy increased (while self‐construal of parenting as a burden decreased) positive parenting style.     

Mental Disorders,Personality Traits,and Grievance-Fueled Targeted Violence: The Evidence Base and Implications for Research and Practice

This article aims to move away from intuitive appeals that link mental disorder with violence such as terrorism, mass murder, and other targeted violence. The article synthesizes the existing evidence base regarding the relationship between mental disorders and personality traits and (a) attitudinal affinities with violent causes, and (b) a number of violent behaviors (including mass murder and terrorism). The evidence base is mixed and the research focus changed across time: from simple and unempirical assertions of causation to an almost complete rejection of their presence to a finer grained and disaggregated understanding. Empirical research examining mental disorder in crime and violence highlights that the commission of such events is a complex synthesis of psychopathology, personal circumstance, and environment. The article concludes with several suggestions regarding future research and practice.     

The Nexus of Stigma and Social Policy: Implications for Pastoral Care and Psychotherapy with Gay, Lesbian, Bisexual and Transgender Persons and Their Families

Dykstra (2006) explains the well weathered approach to homosexuality in the Christian community “love the sinner, hate the sin” may leave many gay, lesbian, bisexual and transgender people feeling unloved and alienated from a community of faith. As clergy and therapists grapple with personal ethics and institutional policy when working with individuals of differing sexual orientations, they may avoid speaking directly about sexuality and may perpetuate the factors which contribute to internalized homophobia. Psychotherapy and pastoral care by nature is political, as decisions are made about which behavior is adaptive or dysfunctional. This article presents an integrated conceptual framework for clergy and clinicians to understand the impact internalized homophobia has on GLBT clients and their families from a person-in-environment perspective.     

The Relationship of Functional Variables and Psychopathology to Aggressive Behavior in Persons With Severe and Profound Mental Retardation

A number of hypotheses have emerged regarding the etiology of physical aggression in persons with mental retardation. Although a multicomponent model is appropriate, results of functional analysis-based studies have yielded promising results in identifying instigating and maintaining factors of aggression. However, the relationship between functional variables and conditions such as psychiatric diagnosis to aggressive behavior has yet to be investigated in persons with mental retardation. We conducted a study examining the prevalence of environmental or physical factors in aggressive behavior in mentally retarded persons with and without psychiatric disturbance. One hundred and thirty-five individuals with mental retardation who exhibited physical aggression were assessed with the Questions About Behavior Function Scale (QABF) to identify environmental or physical contribution to aggressive behavior. One or more behavioral functions were identified for 75% of the participants. Additionally, of 66 of the participants scoring above the clinical cutoff on an assessment for dual diagnosis, 75% met criteria for an environmental or physical function for aggression. No significant differences in number of participants with an identifiable function of aggression were found between the no dual diagnosis and dual diagnosis groups. Our findings underscore the importance of identifying functions underlying aggressive behavior in persons with mental retardation, and the need to consider functional variables regardless of psychiatric condition in treatment planning efforts for such individuals.     

The Intensive Mental Health Program: Development and Structure of the Model of Intervention for Children with Serious Emotional Disturbances

In order to meet the challenging needs and behaviors of children with Serious Emotional Disorders (SED), a school and community based Intensive Mental Health Program (IMHP) was developed and evaluated. We describe the conceptual framework, treatment principles, and model for service delivery for psychological and educational interventions under the umbrella of the IMHP. The program illustrates a model of comprehensive services for children with SED.     

Assessment Use by Counselors in the United States: Implications for Policy and Practice

Although assessment use is a professional activity recognized by every major counseling organization, little is known about which assessments are used in counseling. In this study, 926 respondents from a random national sample of counselors reported their use of personality, projective, career, intelligence/cognitive, educational/achievement, clinical/behavioral, and environmental/interpersonal tests. Test rankings by frequency of use and comparisons by type of counselor and type of test are reported. Implications for policy and practice are discussed.