在香港，患有“心理疾病”的人口已经过百万。根据香港心理卫生会的资料，“香港康复计划方案（一九九八/九九至二零零二/零三年度）：“群策群力，同创新纪元”公布的预测数字，香港患上各种不同程度精神病的人数超过120万，类别包括：功能性精神病（精神分裂及类精神分裂、情感性精神病）、器质性精神病、神经官能病，及儿童青少年精神病。 虽然，随着社会的发展，“心理疾病”已经向人类袭击，但是，一个有发展潜力的社会，一个和谐的社会，一个人性的社会，除了追求经济的增长，物质的丰富，在“心理疾病”面前不是无所作为，而是知道如何去缓解和输导人们精神和心理压力，如何去治疗和照顾已经患有精神疾病的人群，让人们都能够幸福地生活着。 那么，在香港这么一个高度发达的社会，面对数字如此庞大的患者，这些是如何为他们提供服务的？又采取了什么措施预防和避免精神方面的疾病呢？11月初，笔者去了香港，走访了香港几家为精神病康复者提供服务的社会服务机构。 在香港，精神病患者除了接受医院的治疗，更主要的是接受为出院后的精神病康复者提供服务的“精神病康复者社区服务机构”的康复服务，在这些机构里，出院后的精神病人会接受进一步的康复训练。除了康复服务，这些机构另一部分很重要的工作，就是为普通大众提供精神健康教育服务，让大众正确地疏导自己的心理压力和
正确的
认识精神病及精神病患者。香港的这种服务已经有20多年的历史，所提供的服务非常规范和专业。当然，香港这种精神病康复者社区服务的发展离不开政府资金方面的大力支持，像比如中途宿舍、庇护工厂等硬件设施，都是由政府投资建立。 在中国大陆，对精神病患者的治疗向来以医院治疗为主。但是，随着香港和中国大陆交往的密切，香港的服务模式逐渐为中国大陆所学习。在90年代，《中国残疾人事业“八五”计划纲要》提出了社会化、综合性、开放式的精神病防治康复模式。 在香港嘉道理慈善基金会的资助下，1997年，香港的“利民会”和广州市残疾人联合会合办了“利康家属资源中心”，运用社工的手法和理念，为精神病康复者和其家属提供服务。 笔者了解到，虽然中国大陆近年来在精神病康复服务方面取得了很大的成绩，但是这种康复服务还是以政府为主导在运作，民间机构的力量并没有充分的利用起来。当笔者在问到香港的一所康复机构的负责人，有没有与中国大陆做精神病康复服务的民间NGO交流的时候，她反问我们，“大陆有提供这种服务的民间NGO吗？” 鉴于香港为精神病康复者提供服务的社会服务机构，大都依赖政府资金支持的现状，可能在近期内，中国大陆民间的精神病康复者的服务机构的出现会很渺茫。纳新处长认为，在我国大陆目前的国情下，我们更应该学习的是香港的理念，这比学习香港的硬件设施更重要。 只要理念的火种已经播下，行动就会有力量。 

Va. Studies Directives Giving the Mentally Ill A Say in Their CareBy Chris L. JenkinsWashington Post Staff WriterMonday, September 10, 2007; Page B01 Yvonne Smith has had a pair of mental illnesses diagnosed over the years, but it wasn't until a severe psychotic episode landed her in a psychiatric ward that she came to a sober realization: Although her family and friends had long been supportive of her struggles with bipolar disorder, they couldn't always know what to do when she was incapacitated.So, soon after she left the hospital, she wrote some simple instructions with a psychiatrist and an attorney on how to care for her if she had a severe episode again: She was to be taken to Georgetown University Hospital if possible; she was not to receive antipsychotic drugs through a needle; and electroconvulsive therapy, known as ECT, was prohibited. . "My friends and family know the symptoms of my condition, but they don't always know about recovery," said Smith, 55, a District resident. "I got to a point where I wanted the things that work best for me to be written down, so that if I was ever in the hospital again, there would be clear instructions."Smith's wishes are embedded in a legal document known as a psychiatric advance directive, which is designed to instruct health-care professionals, family members and friends about how mentally ill patients are to be cared for when they are incapacitated.

Prepared when a patient is lucid, the documents often give instructions on what medications or treatments to use, what hospital is preferred and, sometimes, instructions on how the patient should be engaged by mental health professionals. The advance directives are designed to give patients some control over their care.But the directives have also raised concerns, because they're not always binding. In some states the instructions can be revoked by someone going through a psychotic crisis, and in some cases doctors can override a patient's wishes. In addition, some say the documents promote inequality and discrimination by highlighting a mental illness apart from broader health issues, which only serves to stigmatize those with schizophrenia and other severe disorders.The disagreements illustrate the difficulty of trying to expand rights to those with severe mental illness while also providing proper care in emergency situations.As Virginia considers comprehensive revisions to its mental health system this year, one of the issues that lawmakers, mental health professionals and state officials have discussed is whether to implement the little-known directives, which are available in Maryland and the District. As in all states, such mental health-care instructions in Virginia can be passed on to loved ones through health-care proxies, which can give family members the ability to instruct doctors about the care of a mentally ill person. But the state allows people to make future health-care instructions through advance directives only in end-of-life situations.Supporters of advance directives say they give those prone to episodes of psychosis an opportunity to control their treatments during mental breakdowns. Some researchers and psychiatrists also say advance directives can help doctors and their patients talk honestly about what happens during psychotic episodes, increasing the possibility that mentally ill patients will gain insight into their conditions.Like a living will, most advance directive documents require two witnesses and notarization. "The psychiatric advance directives are based on experiences people have had many times over," said Eric Elbogen, a forensic psychologist at the University of North Carolina School of Medicine, who has done research on the documents. "It can help determine what medications work best or which ones don't work at all, because it's based on past, real-life experiences."About 13 million Americans struggle with serious mental illnesses, including bipolar disorder, schizophrenia and severe clinical depression. About two dozen states have psychiatric advance directive statutes that specifically allow for those with mental illness to develop treatment plans. Supporters said that developing a separate psychiatric advance directive law helps promote their usage and can encourage people to take control of their care.That was the case for Marcia Anders of Durham, N.C., who was recently overcome with the gale of despair she recognized all too well as a psychotic breakdown -- the kind that in the past had landed her in the hospital for weeks at a time.Anders, who has bipolar disorder and schizophrenia, was taken to the psychiatric wing of a hospital. There, doctors punched her name into a database and were given instant information on how she wanted to be treated. She was not to be given Haldol, the antipsychotic drug. But the doctor could give her Zyprexa, a drug that she has had a good experience with. And the doctor could see what family member to call."It's something that has made life much, much more manageable, where I don't have to be so afraid anymore," said Anders, who said she first had bipolar disorder diagnosed 30 years ago. "It helps me trust that I'm going to get the right care when I need it."