暴力犯罪责任能力有关因素分析.ppt

培训的要求 掌握： 应急处置的指征、处置方式 熟悉： 危险性评估分级、应急事件报告、处置记录和报告 了解 几种常见的应急情况的特点和干预 其他紧急情况 除已经纳入重性精神疾病管理治疗的疾病外，癫痫所致精神疾病、精神活性物质所致精神疾病、重度抑郁伴自杀冲动行为等其他情况，也需要应急医疗处置 特别强调程序合法性 在精神卫生医疗机构对患者实施应急医疗处置之前，患者家属或者监护人应在《重性精神疾病应急医疗处置非自愿医疗意见书》（表1-8）上签字同意 《非自愿治疗医疗意见书》不能及时送达患者家属或者监护人时，由在现场履行公务的公安机关公务人员签字证实 问题与讨论 如何根据当地环境条件和工作特点，制定所在社区/医院的应急处置预案？ 小结 目的：及时干预，减免伤害 对象：急发病或加重，伤害自身/危害他人。急重药物反应 原则：合理，及时，安全 准备：建立医疗组，制定预案，配备设备 报告：家属/知情者—警察—社区/乡镇—精神卫生机构 方式：现场临时性处置，门诊留观，紧急住院 现场措施：危机干预，保护约束，快速镇静，持续治疗，验伤会诊 处置后：记录报告，纳入基层管理 讨论2 对精神疾病患者的院外处置中有哪些重要环节需要加以关注？ 处置记录和报告 由精神科执业医师填写 在应急处置完成后24小时内填写《重性精神疾病应急医疗处置记录单》一式2份（表1-9） 《应急医疗处置记录单》一份留应急医疗处置组存档，另一份随同应急医疗处置有关的材料一并移交： 采取“现场临时性处置”的，移交社区卫生服务中心或者乡镇卫生院保存 采取“精神科门诊留观”的，移交接诊医院的精神科门诊 采取“精神科紧急住院治疗”的，移交接诊医院的精神科住院部 精神卫生医疗机构每季度将《重性精神疾病应急医疗处置季度报表》报所在地的县级精防机构 * * Another important issue for legislation may be involuntary treatment in the community Least restrictive environment In certain countries, people receive involuntary treatment in the community (in accordance with the principle of “least restrictive environment”). This is also known as Community supervision orders Community supervision orders : require patients to reside at a specified place require patients to attend specified treatment programmes such as counselling, education and training and grant access to mental health professionals to patient homes may or may not require patients to submit to involuntary medical treatment: In some countries patients do not have to submit to medication without consent, whereas in others, community treatment orders include the provision for involuntary medical treatment. Availability of comprehensive, quality community treatment facilities The availability of comprehensive, quality community treatment facilities is a pre-requisite for successful community supervision and treatment. * Another important issue for legislation may be involuntary treatment in the community Least restrictive environment In certain countries, people receive involuntary treatment in the community (in