공중보건의의 정신장애자 진료실태에 관한 연구

A Study on the Current Status of the Care for the Mentally 111 Patients by Public Health Physicians

The authors investigated the current status and problems of care for the mentally ill patients by public health physicians. The subjects were 314 public health physicians, who replied to self reporting questionnaires. The results are as follows ; 1) There are few psychiatric facilities near most of health subcenters, and only 18.5% of Public Health Physicians consult with psychiatrists. 2) The average proportion, of mental illness namely the number of mentally ill patients divided by that of the whole patients, is 2.1 %. The number of mentally ill patients per resident population of 100,000 is 172. 3) Most of public health physicians show positive attitude toward his participation in the care for mentally ill patients. 4) The will ingness of participation of public health physicians in care for mental ill patients are significantly different depending on experience of internship, interested field of medicine, and attitude of family member to the psychiatric admission. The proportions of mental illness weresigniflcantly different depending on their experience in the psychiatric ward. 5) 71.0% of public health physicians treat mentally ill patients with psychotropic durgs, but many of them dont’s have nor prescribe psychotropic drugs except anxiolytics. 6) Public health physicians refer 35.9% of the mentally ill patients to the psychiatric facilities, and the referral rate of the psychosis is higher than that of the neurosis. 7) Public health physicians reported the difficulties in care of the mentally ill patients as follows ; low affordability for medical costs lack of psychiatric knowledge of the public health physicians, deficiency of effectiveness in the delivery and consultation system of mental healthservice. 8) Public health physicians suggested the followings as possible solutions for above problems ; providing practical manual for the mental illness, extended support for the mentally ill patients by the government, estabishment of the psychiatric consultation system, reinforcement of psychiatric education in medical college, inclusion of psychiatric lectures in the public health physicians，reeducation programs and etc.. 9) The desirable delivery system of mental health service in rural area is that the public health physicians care for the mentally ill patients under the consultation with the psychiat- rist. 10) The performance of the public health physicians’ roles in mental health as identifier, referral agent care provider and consultant was insufficient.