精神疾病流行病學與社區精神醫療行政——精神疾病盛行率與社區精神醫療人力之探討

PSYCHIATRIC EPIDEMIOLOGY AND ADMINISTRATION OF COMMUNITY PSYCHIATRIC SERVICE: PREVALENCE OF SPECIFIC PSYCHIATRIC DISORDERS AND MANPOWER OF COMMUNITY PSYCHIATRIC SERVICE

三十年來，全臺灣地區之社會、經濟、文化均有相當大之改變，精神疾病之概念與診斷方法也有長足之進步。因此，值得以當今精神疾病之流行病學盛行率資料，在考慮理想精神醫療之狀況下，進行社區中服務所有精神疾病病人所需之人力的探討，以為行政當局推展全國醫療網軟體設計之參考，更可以呈現精神科專科醫師、一般開業醫師與心理輔導人員，所面對之精神疾病類型及其養成教育中所需加以強調之內容。利用適用於18歲以上人口之精神科診斷問卷做社區中各類精神疾病盛行率研究，以獲得之最近一年盛行率與社區成人人口數即可以算出社區的各種精神疾病之病人數。再以可能接受各類別醫療（精神科醫師、一般開業醫師與心理輔導）之比值與之相乘，即可以知道實質上需要接受各種不同類別醫療之病人數。進一步界定精神科醫師與心理輔導人員之工作量，即可以估算我國特定人口數社區內所需要之醫療人數。又可以由一般開業醫師之人數，來估算每位社區一般開業醫師每天所可能遇到精神疾病病人之機會。結果顯示精神科醫師之需求量，在大都市每萬成人人口需0.6人與鄕村0.7人相近，而小鎭則需0.9人。大都市之一行政區（10萬成人人口）需5.5人，一鎭（5萬成人人口）需4.6人，有2萬人人口之鄕需1.3人。總計全臺灣地區需801位精神科醫師。心理輔導人員，大都會每區成人人口需20人，小鎮需17人，鄕村需5人，全國共需服務精神疾病患者之心理輔導人員2983人。一般開業醫師每人每天可能服務之精神疾病人數，大都市為16人，小鎮31人，鄕下23人。本研究對醫療法，全國醫療網實施後之專業人員養成計畫與精神醫學之關聯性，依所呈現之資料，加以詳細討論。

Over the past 30 years, there were great social, economic and cultural changes in Taiwan. Besides, there were also major progresses in psychiatric nosological researches and standard psychiatric diagnostic methods. All of these make a new approach of psychiatric epidemiology possible and a new outlook of mental health planning can be expected. This research was designed to calculate the case number of 18 specific diagnostic categories defined by DSM-III criteria. The total case number in a community was obtained by multiplying population and one year prevalence obtained by using DIS-CM. The case numbers needed to be cared of by psychiatrist, general practioner and counsellor respectively were estimated. The working load of a psychiatrist and a counsellor were also calculated. Then the manpower of psychiatrist and counsellor can be estimated. The number of psychiatric cases needed to be cared of by a general practioner everyday was also estimated. Data showed that every ten thousands of adult population need 0.6 psychiatrist in big city, 0.9 in small town area and 0.7 in rural village. For every administrative unit in big city (100,000 adult population) 5.5 psychiatrists were required. In town, it had adult population of 50,000 and it required 46. psychiatrists. The rural village had 20,000 adult population and 1.3 psychiatrists were required. In all Taiwan adult population, the total need of 801 psychiatrists were estimated, In big city, the «chu'' needed 20 counsellors, the town needed 17 counsellors and the village needed 5 counsellors for psychiatric patients. For all Taiwan adult population, 2983 counsellors were required for care of psychiatric patients. For every general practioner, in big city, he needed to care 16 patients with psychiatric disorders, in town 31 and in village 23 patients. The paper discusses the manpower issue in relating to medically related administrative and educational systems and also the issue of medical laws.