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Article(id=1241522924767736819, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311070, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1699286400000, receivedDateStr=2023-11-07, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931731645, onlineDateStr=2026-03-19, pubDate=1710000000000, pubDateStr=2024-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931731645, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931731645, creator=13701087609, updateTime=1773931731645, updator=13701087609, issue=Issue{id=1241522919977841545, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931730503, creator=13701087609, updateTime=1773931880386, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523548695622547, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523548695622548, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=877, endPage=882, ext={EN=ArticleExt(id=1241522925199749133, articleId=1241522924767736819, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Quantitative analysis of China’s mental health and mental hygiene policy text in 1999— 2023 based on policy tools, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To summarize the key elements and shortcomings of relevant policies in the field of mental health in China, so as to provide reference for the formulation and improvement of follow-up policies in the field of mental health in China.

Methods

Using NVivo11Plus software and content analysis method, a two-dimensional analysis framework of “policy tool-policy object” was constructed to quantitatively analyze 141 relevant policy texts in the field of mental health at the national level from 1999 to 2023 in China.

Results

China has paid growing attention to mental health, and the National Health Commission, the Ministry of Education, and the Ministry of Civil Affairs were the core departments of policy formulation. The internal structure of supply-oriented policy tools was out of balance, and the application of environmental policy tools was insufficient. Demand-based policy tools were the least used, accounting for 49.96%, 28.36%, and 21.68%, respectively. The policy object was concentrated in the whole system, health system, and education system, accounting for 32.81%, 24.59%, and 21.94%, respectively.

Conclusion

It is suggested that the policy design balance the structure of policy tools, increase the supply of resources, apply strategies and measures, strengthen mental health education and promotion, strengthen community grass-roots mental health services, and standardize the development of social mental health service institutions so as to improve mental health and mental hygiene policy system.

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目的

总结我国心理健康和精神卫生领域相关政策的关键要素及不足，以期为我国心理健康和精神卫生领域后续政策的制定与完善提供参考借鉴。

方法

运用NVivo11 Plus软件，采用内容分析法，构建“政策工具-政策客体”二维分析框架，对我国1999—2023年共141份国家层面的心理健康和精神卫生领域相关政策文本进行量化分析。

结果

国家对于心理健康和精神卫生重视程度越来越高；国家卫生健康委、教育部、民政部是政策制定的核心部门；供给型政策工具内部结构失衡，环境型政策工具应用不足，需求型政策工具使用最少，占比分别为49.96%、28.36%、21.68%；政策客体集中在整体、卫生系统和教育系统，占比分别为32.81%、24.59%、21.94%。

结论

建议今后在政策设计上应平衡政策工具结构，增加资源供给、运用策略措施、加强心理健康教育和促进、强化社区基层精神卫生服务、规范社会心理健康服务机构发展，完善心理健康和精神卫生政策体系。

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朱梦蓉，E-mail:
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陈晓敏（1999—），女，硕士在读，研究方向：卫生政策与管理研究

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陈晓敏（1999—），女，硕士在读，研究方向：卫生政策与管理研究

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陈晓敏（1999—），女，硕士在读，研究方向：卫生政策与管理研究

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Journal of Systems & Management, 2023, 32(2):418-427., articleTitle=The impact of the COVID-19 epidemic on mental health and policy implications, refAbstract=null)], funds=[Fund(id=1241678331914023733, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, awardId=WJW20211001, language=CN, fundingSource=四川省卫健委项目(WJW20211001), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241678294593106379, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, xref=null, ext=[AuthorCompanyExt(id=1241678294605689297, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, companyId=1241678294593106379, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Health Policy and Management, West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241678294614077904, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, companyId=1241678294593106379, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院/华西第四医院卫生政策与管理学系，四川 成都 610041)])], figs=[ArticleFig(id=1241678322401342126, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=EN, label=Figure 1, caption=Two-dimensional analysis framework for mental health policy, figureFileSmall=tfXFcHjYaxSmye4z8jtfcQ==, figureFileBig=zScA/lxdtV6kgHMZnVrBuQ==, tableContent=null), ArticleFig(id=1241678323026293430, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=CN, label=图1, caption=心理健康和精神卫生政策二维分析框架, figureFileSmall=tfXFcHjYaxSmye4z8jtfcQ==, figureFileBig=zScA/lxdtV6kgHMZnVrBuQ==, tableContent=null), ArticleFig(id=1241678323332477632, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=EN, label=Figure 2, caption=Statistics on the issue timing of mental health-related policies, figureFileSmall=fFLaRTtLPE6tjUe1EAagpw==, figureFileBig=E3EdLO7pGVe0fcBWErHq+w==, tableContent=null), ArticleFig(id=1241678323823211205, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=CN, label=图2, caption=心理健康和精神卫生相关政策发文时间统计, figureFileSmall=fFLaRTtLPE6tjUe1EAagpw==, figureFileBig=E3EdLO7pGVe0fcBWErHq+w==, tableContent=null), ArticleFig(id=1241678324418802382, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=EN, label=Figure 3, caption=Social network diagram of mental health policy publications agencies, figureFileSmall=vn52uwe+7j3iz76NU9IU8w==, figureFileBig=0dYbu0t2aX93qqEfpt4Xmg==, tableContent=null), ArticleFig(id=1241678324750152407, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=CN, label=图3, caption=心理健康和精神卫生政策发文机构社会网络关系图, figureFileSmall=vn52uwe+7j3iz76NU9IU8w==, figureFileBig=0dYbu0t2aX93qqEfpt4Xmg==, tableContent=null), ArticleFig(id=1241678324859204316, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=EN, label=Figure 4, caption=Word Cloud Map of the top 150 high-frequency words in mental health policy, figureFileSmall=laVegBKZyy47U4lADckK8g==, figureFileBig=Yc0ZGm7cFF78uoWGCEp+lA==, tableContent=null), ArticleFig(id=1241678325324772066, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=CN, label=图4, caption=心理健康和精神卫生政策前150位高频词词云图, figureFileSmall=laVegBKZyy47U4lADckK8g==, figureFileBig=Yc0ZGm7cFF78uoWGCEp+lA==, tableContent=null), ArticleFig(id=1241678326218158827, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=EN, label=Table 1, caption=

Policies related to mental health services from 1999 to 2023 in China

, figureFileSmall=null, figureFileBig=null, tableContent=
序号年份（年）政策名称发文字号
11999关于加强中小学心理健康教育的若干意见教基［1999］13号
22000关于加强和改进研究生德育工作的若干意见教社政［2000］3号
……………………
1402023教育部等十七部门关于印发《全面加强和改进新时代学生心理健康工作专项行动计划（2023—2025年）》的通知教体艺［2023］1号
1412023关于印发进一步改善护理服务行动计划（2023—2025年）的通知国卫医政发［2023］16号
), ArticleFig(id=1241678327019270899, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=CN, label=表1, caption=

1999—2023年我国心理健康服务相关政策

, figureFileSmall=null, figureFileBig=null, tableContent=
序号年份（年）政策名称发文字号
11999关于加强中小学心理健康教育的若干意见教基［1999］13号
22000关于加强和改进研究生德育工作的若干意见教社政［2000］3号
……………………
1402023教育部等十七部门关于印发《全面加强和改进新时代学生心理健康工作专项行动计划（2023—2025年）》的通知教体艺［2023］1号
1412023关于印发进一步改善护理服务行动计划（2023—2025年）的通知国卫医政发［2023］16号
), ArticleFig(id=1241678327686165239, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=EN, label=Table 2, caption=

Policy tools and their implications

, figureFileSmall=null, figureFileBig=null, tableContent=
政策工具分类次级政策工具含义
供给型政策工具心理和精神问题咨询和援助对相关人群开展心理和精神问题干预和援助
人才支持政府完善人才培养体系，加强服务队伍建设，包括服务人员培训、人员配置、专业设置等
财政支持政府部门为心理健康和精神卫生工作提供资金支持
基础设施建设为促进心理健康和精神卫生工作进行一系列基础设施和软、硬件的供给和配置等
服务网络构建促进机构间信息互通，保证服务体系内跨机构心理健康和精神卫生服务的水平，加强机构间的联通协同
专业建设开展心理和精神学科建设、诊疗能力提升、技术革新等
环境型政策工具目标规划对我国心理健康和精神卫生服务发展方向、工作目标做出规划
规范标准健全心理和精神疾病的诊疗规范、医疗机构疾病管理、信息报告规范和标准等
监督评价建立监督或评价体系，促进相关机构服务工作规范化
组织领导落实各方责任，明确职责分工，提高思想认识，加强相关机构和部门对心理健康和精神卫生工作的管理
策略措施制定心理健康和精神卫生服务发展的策略性措施，如增强相应的科学研究
预案管理把心理健康和精神卫生服务纳入相关应急预案
需求型政策工具心理和精神健康教育与促进推进心理健康、精神卫生相关的宣传教育
医疗和生活保障政府通过医保支付、调整医疗服务价格、医疗救助等手段释放心理健康和精神卫生服务需求，减轻患者负担
试点或示范项目开展相关的应用试点或示范项目，总结推广试点经验
社会力量参与政府通过一些列政策与方法，鼓励并支持社会力量等多方参与心理健康和精神卫生服务供给
), ArticleFig(id=1241678328273367806, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=CN, label=表2, caption=

政策工具及其含义

, figureFileSmall=null, figureFileBig=null, tableContent=
政策工具分类次级政策工具含义
供给型政策工具心理和精神问题咨询和援助对相关人群开展心理和精神问题干预和援助
人才支持政府完善人才培养体系，加强服务队伍建设，包括服务人员培训、人员配置、专业设置等
财政支持政府部门为心理健康和精神卫生工作提供资金支持
基础设施建设为促进心理健康和精神卫生工作进行一系列基础设施和软、硬件的供给和配置等
服务网络构建促进机构间信息互通，保证服务体系内跨机构心理健康和精神卫生服务的水平，加强机构间的联通协同
专业建设开展心理和精神学科建设、诊疗能力提升、技术革新等
环境型政策工具目标规划对我国心理健康和精神卫生服务发展方向、工作目标做出规划
规范标准健全心理和精神疾病的诊疗规范、医疗机构疾病管理、信息报告规范和标准等
监督评价建立监督或评价体系，促进相关机构服务工作规范化
组织领导落实各方责任，明确职责分工，提高思想认识，加强相关机构和部门对心理健康和精神卫生工作的管理
策略措施制定心理健康和精神卫生服务发展的策略性措施，如增强相应的科学研究
预案管理把心理健康和精神卫生服务纳入相关应急预案
需求型政策工具心理和精神健康教育与促进推进心理健康、精神卫生相关的宣传教育
医疗和生活保障政府通过医保支付、调整医疗服务价格、医疗救助等手段释放心理健康和精神卫生服务需求，减轻患者负担
试点或示范项目开展相关的应用试点或示范项目，总结推广试点经验
社会力量参与政府通过一些列政策与方法，鼓励并支持社会力量等多方参与心理健康和精神卫生服务供给
), ArticleFig(id=1241678328613106436, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=EN, label=Table 3, caption=

Top 10 agencies for mental health policy issuance

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序号发文机构发文次数（次）序号发文机构发文次数（次）
1国家卫生健康委596共青团中央12
2教育部527公安部10
3民政部208中共中央宣传部10
4国务院办公厅209国家中医药局9
5财政部1710全国妇联9
), ArticleFig(id=1241678329212891914, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=CN, label=表3, caption=

心理健康和精神卫生政策发文数量前十机构统计

, figureFileSmall=null, figureFileBig=null, tableContent=
序号发文机构发文次数（次）序号发文机构发文次数（次）
1国家卫生健康委596共青团中央12
2教育部527公安部10
3民政部208中共中央宣传部10
4国务院办公厅209国家中医药局9
5财政部1710全国妇联9
), ArticleFig(id=1241678329846231828, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=EN, label=Table 4, caption=

Distribution of policy tools

, figureFileSmall=null, figureFileBig=null, tableContent=
树节点子节点参考点数量及占比（%）
供给型政策工具财政支持39（3.00）
服务网络构建53（4.07）
基础设施建设114（8.76）
人才支持150（11.53）
心理和精神问题咨询和援助269（20.68）
专业建设25（1.92）
合计650（49.96）
环境型政策工具策略措施51（3.92）
规范标准98（7.53）
监督评价55（4.23）
目标规划59（4.53）
预案管理31（2.38）
组织领导75（5.76）
合计369（28.36）
需求型政策工具社会力量参与47（3.61）
试点或示范项目33（2.54）
心理和精神健康教育与促进186（14.30）
医疗和生活保障16（1.23）
合计282（21.68）
合计1 301（100）
), ArticleFig(id=1241678330324382491, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=CN, label=表4, caption=

政策工具分布

, figureFileSmall=null, figureFileBig=null, tableContent=
树节点子节点参考点数量及占比（%）
供给型政策工具财政支持39（3.00）
服务网络构建53（4.07）
基础设施建设114（8.76）
人才支持150（11.53）
心理和精神问题咨询和援助269（20.68）
专业建设25（1.92）
合计650（49.96）
环境型政策工具策略措施51（3.92）
规范标准98（7.53）
监督评价55（4.23）
目标规划59（4.53）
预案管理31（2.38）
组织领导75（5.76）
合计369（28.36）
需求型政策工具社会力量参与47（3.61）
试点或示范项目33（2.54）
心理和精神健康教育与促进186（14.30）
医疗和生活保障16（1.23）
合计282（21.68）
合计1 301（100）
), ArticleFig(id=1241678330802533155, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=EN, label=Table 5, caption=

Policy tool—policy object cross-over analysis results

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政策工具
政策客体		政府教育系统社会心理服务机构社区基层卫生系统用人单位整体
供给型政策工具48156165420029213
环境型政策工具44698201026135
需求型政策工具268210174211111
合计118307349134446459
), ArticleFig(id=1241678331083551529, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924767736819, language=CN, label=表5, caption=

政策工具-政策客体参考点数量交叉分析结果

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政策工具
政策客体		政府教育系统社会心理服务机构社区基层卫生系统用人单位整体
供给型政策工具48156165420029213
环境型政策工具44698201026135
需求型政策工具268210174211111
合计118307349134446459
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基于政策工具的我国1999—2023年心理健康和精神卫生政策文本量化分析
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陈晓敏 , 杨佳敏 , 陈丹镝 , 赵莉 , 朱梦蓉
现代预防医学 | 卫生政策与管理 2024,51(5): 877-882
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现代预防医学 | 卫生政策与管理 2024, 51(5): 877-882
基于政策工具的我国1999—2023年心理健康和精神卫生政策文本量化分析
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陈晓敏, 杨佳敏, 陈丹镝, 赵莉, 朱梦蓉
作者信息
  • 四川大学华西公共卫生学院/华西第四医院卫生政策与管理学系，四川 成都 610041

    • 陈晓敏（1999—），女，硕士在读，研究方向：卫生政策与管理研究

通讯作者:

朱梦蓉，E-mail:
Quantitative analysis of China’s mental health and mental hygiene policy text in 1999— 2023 based on policy tools
Xiao-min CHEN, Jia-min YANG, Dan-di CHEN, Li ZHAO, Meng-rong ZHU
Affiliations
  • Department of Health Policy and Management, West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China
出版时间: 2024-03-10 doi: 10.20043/j.cnki.MPM.202311070
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摘要
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目的

总结我国心理健康和精神卫生领域相关政策的关键要素及不足，以期为我国心理健康和精神卫生领域后续政策的制定与完善提供参考借鉴。

方法

运用NVivo11 Plus软件，采用内容分析法，构建“政策工具-政策客体”二维分析框架，对我国1999—2023年共141份国家层面的心理健康和精神卫生领域相关政策文本进行量化分析。

结果

国家对于心理健康和精神卫生重视程度越来越高；国家卫生健康委、教育部、民政部是政策制定的核心部门；供给型政策工具内部结构失衡，环境型政策工具应用不足，需求型政策工具使用最少，占比分别为49.96%、28.36%、21.68%；政策客体集中在整体、卫生系统和教育系统，占比分别为32.81%、24.59%、21.94%。

结论

建议今后在政策设计上应平衡政策工具结构，增加资源供给、运用策略措施、加强心理健康教育和促进、强化社区基层精神卫生服务、规范社会心理健康服务机构发展，完善心理健康和精神卫生政策体系。

心理健康  /  精神卫生  /  政策工具  /  政策客体  /  文本分析
Objective

To summarize the key elements and shortcomings of relevant policies in the field of mental health in China, so as to provide reference for the formulation and improvement of follow-up policies in the field of mental health in China.

Methods

Using NVivo11Plus software and content analysis method, a two-dimensional analysis framework of “policy tool-policy object” was constructed to quantitatively analyze 141 relevant policy texts in the field of mental health at the national level from 1999 to 2023 in China.

Results

China has paid growing attention to mental health, and the National Health Commission, the Ministry of Education, and the Ministry of Civil Affairs were the core departments of policy formulation. The internal structure of supply-oriented policy tools was out of balance, and the application of environmental policy tools was insufficient. Demand-based policy tools were the least used, accounting for 49.96%, 28.36%, and 21.68%, respectively. The policy object was concentrated in the whole system, health system, and education system, accounting for 32.81%, 24.59%, and 21.94%, respectively.

Conclusion

It is suggested that the policy design balance the structure of policy tools, increase the supply of resources, apply strategies and measures, strengthen mental health education and promotion, strengthen community grass-roots mental health services, and standardize the development of social mental health service institutions so as to improve mental health and mental hygiene policy system.

Mental health  /  Mental hygiene  /  Policy object  /  Text analysis
陈晓敏, 杨佳敏, 陈丹镝, 赵莉, 朱梦蓉. 基于政策工具的我国1999—2023年心理健康和精神卫生政策文本量化分析. 现代预防医学, 2024 , 51 (5) : 877 -882 . DOI: 10.20043/j.cnki.MPM.202311070
Xiao-min CHEN, Jia-min YANG, Dan-di CHEN, Li ZHAO, Meng-rong ZHU. Quantitative analysis of China’s mental health and mental hygiene policy text in 1999— 2023 based on policy tools[J]. Modern Preventive Medicine, 2024 , 51 (5) : 877 -882 . DOI: 10.20043/j.cnki.MPM.202311070
正文
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党的二十大报告明确提出“要重视心理健康和精神卫生”。而随着我国社会经济的快速发展和压力的不断积蓄，个体心理健康和精神疾病的发病率越来越高，据中国精神卫生调查结果显示[1]，我国精神障碍的终身患病率约16.57%，2021年精神障碍居于部分地区城市和农村居民死因构成第11位[2]。精神疾病不仅会造成健康影响和生活困扰，还会导致生产力损失和其他间接成本，造成巨大的疾病负担。可以说，心理健康和精神卫生是公共卫生的重要组成部分，同时也是重大的民生问题和突出的社会问题。因此，如何进一步完善现有心理健康和精神卫生社会支持体系已成为一项愈发受到政府及社会关注的议题，这显然又与法律法规、政策策略的发布与施用密不可分。
目前，我国已陆续颁布了一系列心理健康和精神卫生相关政策，而现有对其政策文本的研究主要集中在心理健康教育[3-7]、儿童心理健康服务[8]、突发公共事件心理援助[9]、精神卫生[10-12]等政策的分析上，缺乏对现有政策文本设计合理性和科学性的全面的量化评价，本文全面收集1999—2023年心理健康和精神卫生相关的141份国家层面政策，构建政策工具-政策客体二维评价框架识别现有政策的优势与不足，提出优化政策的对策建议，以期促进我国心理健康和精神卫生体系良好发展。
1　资料与方法
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1.1　资料来源
为提升政策文件搜索结果的全面性，本研究以“心理”和“精神卫生”为关键词在北大法宝、北大法意、国务院、国家卫生健康委、国家民政部、国家教育部等网站搜索相关政策文件，通过关联检索方式扩大政策样本搜索范围。纳入标准：（1）文本内容与心理健康和精神卫生服务相关，并侧重于宏观层面；（2）国家层面政策；（3）文本类型为法律法规、规划、纲要、办法、意见、方案、通知和公告等，能够充分反映行政意志；（4）政策文本必须公开颁布，并且现行有效。通过检索与纳排，筛选出1999—2023年共141份专项和非专项政策文件作为研究对象，部分内容见表1。
1.2　研究方法
本文先用Excel软件对政策发文时间、发文机构进行描述性分析，用Ucinet 6.0软件生成发文机构社会网络关系图，用镝数图表在线工具制作政策主题特征词云图，再运用NVivo 11 Plus软件编码的方法建立政策工具-政策客体二维框架，分析现有政策设计的科学性和合理性。第一个维度政策工具是政策目标实现的方法和路径，学者对政策工具的分类方法较多，本研究根据实际需要和政策内容特点选取Rothwell和Zegveld[13]的分类方法，将我国心理健康和精神卫生国家层面政策工具分为供给型、环境型和需求型，具体政策工具的分类及含义见表2。第二个维度政策客体即需要落实、执行政策的部门，在本研究中归纳为用人单位、教育系统、政府、卫生系统、社区基层、社会心理机构、整体，其中整体指的是需要全社会共同落实、执行政策。
建立政策工具-政策客体二维框架的具体步骤为：将选取的政策文本导入NVivo11 Plus软件，以一句语义完整的语句为编码单元，对政策文本进行逐句编码。编码过程用自上而下编码方法，先建立政策工具维度的三个树节点，即供给型政策工具、环境型政策工具、需求型政策工具，再对心理和精神健康方面典型的政策文本［如《关于加强心理健康服务的指导意见》（国卫疾控发［2016］77号）］进行逐句编码，每次编码形成一个参考点，将参考点归纳至次级政策工具和政策客体，形成政策工具-政策客体二维分析框架，然后再对其他政策文本进行逐句编码，一个参考点可能归纳至多个政策工具或多个政策客体，见图1。为确保内容分析的准确性与客观性，由两位研究者分别编码，通过信度检验，编码一致性比率达83.96%。
2　结果
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2.1　政策外部特征
2.1.1　发文时间
心理健康政策发文时间统计如图2所示，统计分析1999—2023年每年发布的心理健康政策文件数量，线性回归拟合P值小于0.001，数量呈上升趋势。政策文本发布集中在2016年及以后，发文数量占总数的56.03%。由发文时间分布特点可以看出国家对于心理健康和精神卫生重视程度越来越高。
2.1.2　发文机构
国家卫生健康委、教育部、国务院办公厅、民政部、财政部等49个机构参与制定心理和精神健康相关政策文件，其中参与制定政策数量位于前10位的发文机构见表3。国家卫生健康委和教育部作为关注心理健康和精神卫生服务的主要机构，发文量分别是59和52次，社会网络分析结果如图3所示，去掉单独发文的机构，连线代表机构之间有合作发文，由图可以看出国家卫生健康委、教育部、民政部是政策制定的核心部门。
2.1.3　政策主题特征
运用ROSTCM 6软件对NVivo11软件中编码过的内容进行词频分析，首先进行分词，对照心理和精神健康典型政策文本中的表述修改词库，删掉“开展”“加强”“机构”“部门”等无意义的词后，将前150位高频词导入镝数图表，作出词云图。由图4可见，心理和精神健康服务的主要方式为教育、咨询、治疗、干预、辅导、预防等；重点关注的人群包括学生、精神障碍患者、儿童、青少年、老年人、妇女等；承担工作的主体包括学校、社区、医疗机构、用人单位、行政部门；促进服务发展的措施主要有组织人员培训、完善机制、提高心理和精神健康知识水平、发展服务能力、进行宣传和试点、完善标准规范、进行监督评估、建设服务体系等。
2.2　政策工具
141份政策共编码出1 301个政策工具，由于政策文本范围和编码分析单元的差别，因此本文各类政策工具占比与现有研究结果[10-12]不同，供给型政策工具占比最多，为49.96%，其次是环境型政策工具，为28.36%，需求型政策工具最少，为21.68%，具体政策工具分布见表4。
将政策工具与政策客体进行交叉分析，不同政策客体涉及的供给型政策工具占比都最多，而环境型政策工具和需求型政策工具使用情况存在差异，见表5。政策客体是整体的政策工具最多，其次是卫生系统和教育系统，表明卫生系统和教育系统是心理和精神健康服务的主体，需要重点关注，而社区基层、社会心理服务机构、用人单位涉及的政策工具较少，说明国家对于社区基层、社会心理服务机构、用人单位心理和精神健康服务能力建设的重视程度和资源投入较少，需要加强建设力度。
3　讨论
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3.1　供给型政策工具内部结构失衡，应平衡供给型政策工具结构
供给型政策工具是心理健康和精神卫生发展的推动力，约占所有政策工具的一半，为特定人群提供心理和精神问题咨询和援助占主要部分，政策强调为特殊人群做好心理和精神健康服务有助于提高社会对于心理和精神健康的重视程度。供给型政策工具中人才支持、基础设施建设、服务网络构建、财政支持、专业建设的占比较低。结合相关研究结果[14-15]，我国缺少接受过专业训练的精神卫生专科临床医生，精神卫生机构硬件设备和人才力量普遍薄弱、功能设置不全，难以满足患者治疗需要。特别是心理治疗和心理咨询服务能力不足，基层人员心理健康知识、心理危机干预技能缺乏，尚未形成健全的心理健康服务网络和基层心理健康服务平台，因此政府应加大对心理健康和精神卫生发展的资源投入，包括人才支持、财政支持、基础设施建设、专业建设、服务网络建设等方面，避免供给型政策工具内部结构不均。
3.2　环境型政策工具应用不足，应增加环境型政策工具应用
环境型政策工具内部结构较均衡，其中，策略措施占比仅为3.92%，表明政府应该多采取相关策略措施，在加强科学研究方面应该更加重视各机构之间的合作，继续建立超大规模、多样化的队列，有助于开发更有针对性的治疗方法。既要充分运用互联网拓宽服务范围和内容，又要对互联网、自媒体传播虚假信息进一步加强管理，避免导致公众的恐慌情绪。由于精神卫生服务价格未能体现其价值，导致医务人员积极性不高，人才队伍不稳定[16]，因此还需加强心理健康和精神卫生工作人员培养和使用的制度建设，完善激励保障措施。规范标准和监督评价是保证心理健康和精神卫生服务质量的基础，国家层面尚缺乏对心理健康服务机构及人员规范管理的相关法律法规和行业规范，机构设置标准、人员注册管理、监管职能等规则不够清晰，服务安全和服务质量难以保障，在制定政策时需要增加规范标准和监督评价政策工具的应用，通过综合性系统性改革确保精神卫生服务安全和服务质量。
3.3　需求型政策工具使用最少，应提升需求型政策工具应用比例
需求型政策工具是心理健康和精神卫生事业发展的拉动力，但该类型政策工具运用最少。加强心理和精神健康教育与促进可以提高公民健康素养，提升“每个人是自己心理健康第一责任人”的意识，通过积极自助行为调适情绪困扰与心理压力，增加对心理和精神疾病的认知，减少对心理或精神疾病患者群体的污名化和歧视，支持和鼓励心理或精神疾病患者接受精神卫生服务。而社会力量、试点和示范项目、医疗和生活保障的需求型政策工具运用较少，社会力量参与可以提高心理健康和精神卫生服务能力和水平，应当通过政策引导积极鼓励社会力量参与。成功的心理健康服务综合试点，可为其他地区加强心理健康服务、健全社会心理服务体系提供示范指导，政策设计层面应当重视试点工作和成果的推广。政府通过医保支付、调整医疗服务价格、医疗救助等手段可减轻患者负担，释放心理健康和精神卫生服务需求，有助于心理和精神疾病得到及时治疗，降低疾病损失，政府应当重视在这些方面的投入。
3.4　关注各政策客体，重视社区基层、社会心理服务机构、用人单位服务能力发展
政策客体分析显示由整体负责落实和执行的政策最多，这与现实需要符合，心理健康和精神卫生工作的对象是全社会，目标是提高所有人的心理健康水平，工作的开展需要全社会的加入。其次是卫生系统、教育系统和政府，由社区基层、社会心理服务机构、用人单位负责落实和执行的政策较少，良好的社区精神卫生服务有助于预防和减少精神障碍的发生和发展[17]，我国用于预防精神疾患，促进精神健康和社区精神卫生服务方面的资源不够，因此应当要发展社区力量，确保每个人能得到社区支持。应支持社会心理服务机构发展，并制定服务规范，加强监管。职业人群面临巨大工作和生活压力，是心理健康和精神卫生服务不可忽视的人群，因此政策制定应促进用人单位加强员工关怀，提高员工的心理健康水平。
基金
收起
  • 四川省卫健委项目(WJW20211001)
文献
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2024年第51卷第5期
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doi: 10.20043/j.cnki.MPM.202311070
  • 接收时间：2023-11-07
  • 首发时间：2026-03-19
  • 出版时间：2024-03-10
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  • 收稿日期：2023-11-07
基金
四川省卫健委项目(WJW20211001)
作者信息
    四川大学华西公共卫生学院/华西第四医院卫生政策与管理学系，四川 成都 610041

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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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