การพัฒนาระบบการติดตามประเมินอาการผู้ป่วยจิตเวชร่วมกับการใช้สารเสพติด ที่เสี่ยงต่อการก่อเหตุรุนแรงทางสังคม

Abstract

Abstract                                                

This study is an action research aimed at developing a monitoring and assessment system for psychiatric patients with co-occurring substance use, who are at risk of committing social violence. The research was conducted within the context of Kantharawichai Hospital, covering 10 sub-districts under its responsibility in Kantharawichai District. The research involved improving the existing problematic system through the participation of a multidisciplinary team of 20 professionals and an operations committee of 64 members. The development and implementation process was guided by the World Health Organization’s “Six Building Blocks of a Health System” framework. The study period was from January 2022 to December 2023. Quantitative data were analyzed using descriptive statistics, including frequency distribution and percentages, while qualitative data were analyzed using content analysis.

The results showed that a Clinical Practice Guideline (CPG) was developed for assessing psychiatric patients with substance use. Additionally, channels for information referral, follow-up, and systematic assessment were established. After participating in the project, patients classified in the “red” group (high severity) decreased by 42.86%, those in the “yellow” group (moderate severity) decreased by 22.72%, while the “green” group (low severity) increased by 15.68%. Importantly, six patients were newly assessed in the “white” group (no risk), which previously had no patients.

The development model resulted in systemic changes in monitoring and assessing psychiatric patients with substance use, enabling more appropriate, faster, and efficient treatment planning. These improvements were achieved through collaboration among network partners connected via the Six Building Blocks framework, including Service Delivery, Health Workforce, Health Information Systems, Access to Essential Medicines, Health Financing, and Leadership/Governance.

However, key challenges included leaving family members solely responsible for patient care, which may lack adequate knowledge and skills. Additionally, the severe local drug epidemic increased the risk of psychiatric patients returning to substance use cycles if not closely supervised and managed.

Keywords : Mental health system development, psychiatric patients, substance use disorders, risk assessment, community-based care, integrated health services.