Tsunoda Masashi, Ueno Bunya, Takeshima Tadashi, Minami Ryuichi, Takaoka Michio, Ishige Kyoko, Oi Teru, Sasaki Shoko
Department of Public Health, Fukushima Medical University.
Nihon Koshu Eisei Zasshi. 2004 Jan;51(1):20-9.
In accordance with the partial amendment of the Law on Mental Health and Welfare for People with Mental Disorders, some mental health and welfare work has been performed under the jurisdiction of cities, towns and villages instead of prefectures since April, 2002. What is the role of prefectural health centres in supporting cities, towns and villages under the partial amendment? To consider this question in the light of transfer of responsibilities from prefectures to the municipalities, we investigated the situation in municipalities in October, 2001.
A total of 500 municipalities with populations less than 100,000 were recruited and questionnaire survey was carried out to study the mental health and welfare work, the department in charge and other relevant data.
A total of 359 municipalities responded to the questionnaire (the response rate was 71.8%). Mental health and welfare work came under the jurisdiction of 58.5% of the municipalities. The persons in charge were mainly public health nurses and officers and few municipalities had specialists. About 64% of the municipalities had designated a department in charge of the transferred work, but only 16% had designated the number of persons in charge. Although municipalities must provide services for patients living at home as of April, 2002, under the partial amendment, 24.2% of municipalities had already been providing such service previously. About 60% of municipalities had staff who planned to participate in training for care management. For the office work related to the delivery of the health and welfare note for people with mental disorders and public expenditure for hospital expenses, 16.2% of municipalities had designated specialists as persons in charge and 24.2% of municipalities had secured space for privacy. Almost all (98.6%) municipalities pointed to problems in the transfer, which included the shortage of specialists and requested health centres to provide specific information.
Although mental health and welfare work comes under the jurisdiction of over half of the municipalities, few have specialists for this purpose. Support services for patients living at home were often provided by the municipalities prior to the partial amendment of the Law going into effect. As municipalities stressed the shortage of specialists and requested specific information, health centres need to support municipalities from the standpoint of their specialized abilities.
根据《精神障碍者心理健康与福利法》的部分修订内容，自2002年4月起，部分心理健康与福利工作由市、镇、村而非都道府县管辖。在部分修订的情况下，都道府县保健所支持市、镇、村的作用是什么？为了从都道府县向市町村的责任转移角度考虑这个问题，我们于2001年10月对市町村的情况进行了调查。
共招募了500个人口不足10万的市町村，并进行问卷调查以研究心理健康与福利工作、主管部门及其他相关数据。
共有359个市町村回复了问卷（回复率为71.8%）。58.5%的市町村负责心理健康与福利工作。负责人主要是公共卫生护士和官员，很少有市町村有专科医生。约64%的市町村指定了负责转移工作的部门，但只有16%指定了负责人数量。尽管根据部分修订内容，市町村自2002年4月起必须为居家患者提供服务，但24.2%的市町村此前已经在提供此类服务。约60%的市町村有工作人员计划参加护理管理培训。对于与发放精神障碍者健康与福利手册以及医院费用公共支出相关的办公室工作，16.2%的市町村指定专科医生为负责人，24.2%的市町村确保了隐私空间。几乎所有（98.6%）的市町村都指出了转移过程中的问题，包括专科医生短缺，并要求保健所提供具体信息。
尽管超过一半的市町村负责心理健康与福利工作，但为此目的的专科医生很少。在法律部分修订生效前，市町村通常就为居家患者提供支持服务。由于市町村强调专科医生短缺并要求提供具体信息，保健所需要从其专业能力角度支持市町村。
