중앙정신보건사업지원단

사업보고서

2010

중 앙 정 신 보 건 사 업 지 원 단

서 울 의 대 의 료 관 리 학 교 실

보 건 복 지 부

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목 차

제 장 중앙정신보건사업지원단 사업추진 개요1 . ································································ 1추진 배경 및 운영 필요성1. ························································································ 1지금까지 운영 과정2. ··································································································· 3중앙정신보건사업지원단 운영 근거3. ··········································································· 6중앙정신보건사업지원단 조직 구성4. ··········································································· 7

제 장 사업 추진실적 및 사업성과2 . ················································································· 11추진1. An ti-S tigm a Movem en t: M IND Pro jec t ····················································· 11

지역사회정신보건사업 관계자2. W orkshop ······························································ 13대국민 정신질환 태도 조사3. ····················································································· 19지역사회정신보건사업 발전대회4. ·············································································· 24표준형 정신보건센터 평가 지원5. ·············································································· 27아동청소년 정신건강사업 지원6. ················································································ 30정신보건정책 안 마련7. ( ) ····························································································· 33국가정신보건사업 기준개발8. (fram ework ) ································································ 38정신보건법 개정 지원9. ······························································································ 39정신의료기관 평가도구 및 체계 개발10. ··································································· 40국가정신보건 개년 계획 수립11. 5 ············································································· 42

정신보건12. H ea lth P lan 2020 : ················································································ 47광역정신보건센터 지원13. ·························································································· 48정신보건사업안내 개정14. ·························································································· 49사업보고서 인쇄 및 배포15. ······················································································ 54국외 정신보건 회의 및 학회 참여16. ········································································ 55

포럼 정신보건17. H T R&D ························································································ 58

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지역사회정신보건사업 매뉴얼 가이드북 호 제작 배포18. (1 ) ······································ 60목록19. M en ta l H ea lth Annua l R eport ·································································· 61

주요 정신건강사업 추진계획수립 자문20. ································································· 63지원단 운영관련 회의21. ···························································································· 63지원단 홈페이지 운영22. ···························································································· 67사업의 자체평가23. ···································································································· 69기대효과24. ················································································································· 76

제 장 정신보건기관 운영 현황3 . ······················································································ 79정신보건기관 현황1. ··································································································· 79가 시 도별 정신보건기관현황. ‧ ··················································································· 79나 정신병상수 현황. ·································································································· 80다 지역사회 거주시설 현황. ····················································································· 94라 정신보건시설 입원 입소 환자 현황. ( ) ····································································· 97마 외래 및 주간재활 프로그램 현황. ····································································· 120바 지역사회정신보건사업 현황. ·············································································· 127인력 현황2. ··············································································································· 141가 정신보건기관 종류별 상임인력 현황. ································································ 141나 시 도별 정신보건의료 상임인력 현황. ‧ ······························································· 142다 정신보건의료 상임인력 현황 변화 추이 년. (2000 2010 )～ ·································· 143

제 장4 . A n ti-S tigm a M ovem en t: M IN D Pro jec t ························································ 145의 필요성1. An ti-S tigm a Movem en t ······································································ 145

영국의2. An ti-S tigm a M ovem en t ········································································ 148추진 결과3. M IND pro jec t ······················································································ 154

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제 장 년 대국민 정신질환 태도조사5 . 2010 ···································································· 161조사대상자 일반적 현황1. ························································································ 161정신질환 연상이미지2. ····························································································· 162정신질환에 대한 수용도3. ························································································ 163정신건강 관리 및 대처 인식4. ················································································· 180음주폐해 인식5. ········································································································ 184

제 장 년 표준형 정신보건센터 평가6 . 2009 ···································································· 187평가 개요1. ··············································································································· 187평가 지표2. ··············································································································· 188표준형 정신보건센터 세부 평가항목3. ····································································· 189표준형 정신보건센터 질평가 가이드라인4. ······························································ 197

년 표준형 정신보건센터 평가 결과5. 2009 ······························································· 209년 표준형 정신보건센터 평가수행 계획6. 2010 ························································ 218

제 장 정신보건정책 안7 . ( ) ······························································································· 219정신과입원체계재구성 안 마련1. ( ) ············································································· 219정신요양시설 운영방향 개선 안 마련2. ( ) ··································································· 224국가중독관리정책 안 마련3. ( ) ···················································································· 230정신보건센터 운영개선 안 마련4. ( ) ··········································································· 236

제 장 정신의료기관 평가체계 및 평가도구 개발8 . ························································ 241개관1. ························································································································ 241정신의료기관 평가지표 개발2. ················································································· 244정신의료기관 평가지표 개발을 위한 예비평가3. ····················································· 256정신의료기관 시범평가 지표 확정4. ········································································ 257정신의료기관 평가 수행 방안5. ··············································································· 260

제 장 국가 정신보건 개년 계획 수립9 . 5 ········································································ 262계획 수립 개관1. ······································································································ 262국가 정신건강 년 플랜 안2. 5 ( ) ················································································ 266

제 장 정신보건10 . H ea lth P lan 2020: ·········································································· 283목적1. ························································································································ 283추진배경과 방향2. ···································································································· 283추진방향3. ················································································································· 293목표4. ························································································································ 294세부 추진계획5. ········································································································ 299참고자료6. ················································································································· 307

제 장 목록 안11 . M en ta l H ea lth A nnua l R eport ( ) ······················································ 309필요성1. M en ta l H ea lth Annua l Report ······························································ 309

추진 절차2. ··············································································································· 309목록 안3. ( ) ·················································································································· 310

부록 년 표준형 정신보건센터 평가지표1: 2010 ····························································· 323평가개요1. ················································································································· 323

년 표준형 정신보건센터 평가항목2. 2010 ································································ 324세부평가 항목3. ········································································································ 326질평가 가이드라인4. ······························································································· 333평가자 제출 서식5. ··································································································· 346

부록 정신보건시설 현황2: ····························································································· 353

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표 목 차[ ]

표 중앙지원단 사업예산< 1> (2005~2010) ····································································· 10표 정신질환 태도 설문 결과< 2> ················································································ 20표 정신질환자 유병율 응답 결과< 3> ··········································································· 21표 정신보건사업 수행 인지도 응답 결과< 4> ······························································· 21표 정신보건사업 수행 만족 응답 결과< 5> ·································································· 22표 정신보건관련 인식 응답 결과< 6> ··········································································· 23표 음주관련 심각도 및 정부개입 만족 응답결과< 7> ·················································· 24표 시 도 정신보건기관 현황< 8> ․ ················································································· 89표 정신병상수 현황< 9> ································································································ 80표 정신병상수 변화추이< 10> ······················································································· 82표 정신병상수 상대적 구성비의 변화추이< 11> ························································· 84표 국가의 정신병상수 변화추이< 12> OECD ······························································· 85표 정신병상수 지역적분포< 13> ···················································································· 86표 시 도별 정신병상수 분포< 14> ․ ················································································· 87표 정신보건시설 종류별 평균병상이용률< 15> ····························································· 88표 지역별 병상이용률< 16> ··························································································· 90표 정신의료기관 종류별 개방병상수 및 개방병상 비율< 17> ······································ 91표 시 도별 개방병상수의 분포< 18> ․ ············································································· 92표 시 도별 인구 만명당 개방병상수< 19> 10․ ································································ 93표 입소시설 현황< 20> ·································································································· 94표 주거시설 운영 현황< 21> ························································································· 95표 정신보건시설 입원 입소 환자 현황< 22> ( ) ································································· 97표 입원 입소 환자의 성별 분포< 23> ( ) ············································································ 98표 입원 입소 환자의 연령별 분포< 24> ( ) ········································································ 99표 시 도별 입원환자 연령별 분포< 25> ․ ······································································ 101표 입원 입소 환자의 진단별 분포< 26> ( ) ······································································ 104

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표 입원유형별 현황< 27> ···························································································· 106표 시 도별 입원 입소 환자 입원유형 현황< 28> ( )․ ························································· 107표 한국과 일본의 입원형태별 입원환자 분포의 비교< 29> ······································· 109표 재원기간별 분포< 30> ···························································································· 111표 입원 입소 환자의 평균 재원기간 분포< 31> ( ) ·························································· 112표 시 도별 입원환자의 재원기간별 분포< 32> ․ ··························································· 114표 의료보장 종류별 분포< 33> ··················································································· 116표 시 도별 정신보건시설 의료보장별 입원 입소 환자 현황< 34> ( )․ ······························· 117표< 35> 인구 만명 당 정신의료기관 정신보건시설 입원환자수 및 상대적 비율10 ( ) ·············· 119표 정신의료기관별 일평균 외래환자수< 36> ······························································ 120표 시 도별 외래환자수 및 인구 만 명당 비율< 37> 10․ ··············································· 122표 시 도별 낮병원 병상이용률 및 인구 만 명당 낮병원 병상수< 38> 10․ ·················· 123표 정신의료기관 종류별 낮병원 정원수 및 병상이용률< 39> ···································· 124표 시 도별 주간재활 프로그램 운영시설< 40> ․ ··························································· 125표 시 도별 정신보건시설 주간재활 프로그램 이용환자수< 41> ․ ································· 126표 표준형 정신보건센터의 선택사업 현황< 42> ························································· 127표 시 도별 지역사회정신보건사업 등록자 수< 43> ․ ···················································· 128표 중증 정신질환자 대비 등록관리율 추이< 44> ······················································· 129표 등록환자의 성별 분포< 45> ··················································································· 130표 등록자의 연령별 분포< 46> ··················································································· 132표 등록자의 진단별 분포< 47> ··················································································· 134표 등록자의 의료보장 종류별 현황< 48> ··································································· 135표 등록자의 서비스제공기간별 현황< 49> ·································································· 135표 등록자의 성별 분포< 50> ······················································································· 137표 등록자의 의료보장 종류별 분포< 51> ··································································· 137표 연령별 분포< 52> ··································································································· 138표 서비스 제공기간< 53> ···························································································· 139

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표 등록자의 문제 유형< 54> ······················································································· 140표 정신보건기관 종류별 상임인력 현황< 55> ···························································· 141표 시 도별 정신보건의료 상임인력 현황< 56> ․ ··························································· 142표 정신보건의료 상임인력 현황 변화 추이< 57> ······················································· 143표 정신요양시설 입소자 현황< 58> ············································································ 224표 정신요양시설 장기재원 현황< 59> ······································································· 225표 구조영역 평가 부문 및 지표< 60> ········································································· 253표 과정영역 평가 부문 및 지표< 61> ········································································· 254표 결과영역 평가 부문 및 지표< 62> ········································································· 255표 만족도 조사지 예비평가 문항< 63> ······································································· 255표 정신의료기관 구조 지표 인력< 64> : ······································································ 257표 정신의료기관 구조 지표 시설< 65> : ···································································· 258표 정신의료기관 과정 지표 환자 권리< 66> : ··························································· 258표 정신의료기관 과정 지표 임상의료< 67> : ······························································· 259표 정신의료기관 결과 지표< 68> ·············································································· 260표 초발 입원 정신질환자의 장기입원 현황< 69> ······················································· 289표 범죄별 현행범의 음주여부< 70> ············································································ 292표 알코올 관련 성별 사망자수 및 사망률 추이< 71> ················································ 292

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그 림 목 차[ ]

그림 국가 자살률 변화 추이[ 1 ] O ECD (1990~2006) ···················································· 1그림[ 2 ] 정신병상수 증가추이 및 인구 천명당 병상수 추이 평균재원기간 변화 추이, ·················· 2그림 중앙정신보건사업지원단 조직도[ 3 ] ······································································ 7그림 슬로건 이미지[ 4 ] ································································································ 12그림 경기 광역정신보건센터 행사[ 5 ] ··········································································· 12그림 서울 정신보건센터 행사[ 6 ] ·················································································· 12그림 주제발표에 대한 평가[ 7 ] ···················································································· 15그림 특강에 대한 평가[ 8 ] ··························································································· 16그림 분과교육 분과에 대한 평가[ 9 ] : 1 ········································································ 16그림 분과교육 분과에 대한 평가[ 10 ] : 2 ······································································ 17그림 분과교육 분과에 대한 평가[ 11 ] : 3 ······································································ 17그림 워크샵 운영에 대한 전반적인 평가[ 12 ] ···························································· 18그림 정신질환자 유병율 응답결과[ 13 ] ········································································· 21그림 정신보건사업 인지도 변화 추이[ 14 ] ·································································· 21그림 정신보건사업 수행에 대한 만족도[ 15 ] ································································ 23그림 국가정신보건 개년 계획안 수립 과정[ 16 ] 5 ························································· 46그림 정신의료기관 병상 구성 비율[ 17 ] ······································································· 81그림 정신병상수 증가 추이[ 18 ] ··················································································· 83그림 정신의료기관 인구 명당 병상수 추이[ 19 ] 1000 ··················································· 83그림 정신병상수의 상대적 구성비[ 20 ] ········································································· 85그림 시 도별 인구 만명당 정신병상의 상대적 비율[ 21 ] 10․ ·········································· 86그림 정신보건시설 종류별 평균병상이용률[ 22 ] ··························································· 89그림 정신의료기관 병상이용률 변화 추이[ 23 ] ····························································· 89그림 시 도별 인구 만명당 개방병상의 상대적 비율[ 24 ] 10․ ·········································· 93그림 시 도별 지역사회 거주시설의 인구 만명당 상대적 비율[ 25 ] 10․ ···························· 94그림 지역사회 거주시설의 시 도별 이용률 비교[ 26 ] ․ ··················································· 95

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그림 정신보건시설 입원 입소 정신질환자수 구성비[ 27 ] ( ) ············································ 97그림 연도별 정신보건기관 입원환자의 중간연령 변화 추이[ 28 ] ······························· 100그림 정신보건시설별 입원환자의 중간연령 비교[ 29 ] ················································ 100그림 시도별 입원 입소 자의 중간연령 비교[ 30 ] ( ) ························································ 102그림 의료기관 종류별 입원환자의 중간연령 비교[ 31 ] ·············································· 102그림 정신보건기관 종류별 입원환자의 중간연령 비교[ 32 ] ······································· 103그림 입원 입소 환자 진단별 분포[ 33 ] ( ) ········································································ 105그림 시 도별 자의입원 비율[ 34 ] ․ ················································································ 108그림 시 도별 입원 입소 환자의 입원유형 비교[ 35 ] ( )․ ···················································· 110그림 정신보건시설별 입원 입소 환자의 재원기간 변화 추이[ 36 ] ( ) ···························· 113그림 시 도별 입원환자의 재원기간 중간값[ 37 ] ․ ·························································· 115그림 시 도별 입원환자의 의료보장상태별 비율[ 38 ] ․ ··················································· 118그림 전문의 인당 외래환자 수[ 39 ] 1 ·········································································· 121그림 시 도별 외래환자수의 상대적 비율[ 40 ] ․ ····························································· 122그림 낮병원 평균 이용률[ 41 ] ····················································································· 124그림 시 도별 지역사회정신보건사업 등록자수 비교[ 42 ] ․ ············································ 128그림 중증 정신질환자 대비 등록관리율 추이[ 43 ] ····················································· 130그림 지역사회 정신보건시설 등록자 성별 분포[ 44 ] ·················································· 131그림 지역사회 정신보건시설 등록자 연령별 분포[ 45 ] ·············································· 133그림 지역사회 정신보건시설 등록자 의료보장유형별 분포[ 46 ] ································ 136그림 아동청소년 등록자 서비스 제공기간 분포[ 47 ] ·················································· 139그림 아동청소년 등록자 문제 유형별 분포[ 48 ] ························································· 140그림 시 도별 인구 만명당 정신보건인력수 현황[ 49 ] 10․ ············································· 144그림 정신질환 편견해소를 위한 홈페이지[ 49 ] “tim e to change" ··························· 148그림 참여단체[ 50 ] ······································································································ 148그림 참여현황[ 51 ] commun ity ················································································· 149그림 슬로건[ 52 ] ·········································································································· 149

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그림 이벤트 형태[ 53 ] ································································································· 150그림 홍보자료[ 54 ] ······································································································ 150그림 인쇄매체 광고[ 55 ] ······························································································ 150그림 브로셔[ 56 ] ·········································································································· 151그림 지하철 포스터[ 57 ] ······························································································ 151그림 광고[ 58 ] TV ······································································································· 152그림 전단지[ 59 ] 1 ········································································································ 152그림 전단지[ 60 ] 2 ········································································································ 152그림 편견해소를 위한 교육[ 61 ] ················································································· 153그림 온라인을 통한 정신질환 편견 해소 운동[ 62 ] ···················································· 153그림 슬로건 공모에 대한 언론 보도[ 63 ] ··································································· 155그림 슬로건 우수작품 시상[ 64 ] ················································································· 155그림 슬로건 이미지[ 65 ] ······························································································ 156그림 일본 홍콩 한국의 정신장애 스티그마 기획주제세션 개최[ 66 ] · · ··························· 157그림 포스터 발표 현장[ 67 ] ························································································ 158그림 정신질환 연상 단어[ 68 ] ····················································································· 162그림 누구나 걸릴 수 있는 질병[ 69 ] ·········································································· 163그림 누구나 걸릴 수 있는 질병 변화추이[ 70 ] ·························································· 163그림 걸리면 항상 문제[ 71 ] ······················································································· 164그림 걸리면 항상 문제 변화추이[ 72 ] ········································································· 164그림 정상적인 삶[ 73 ] ······························································································· 165그림 정상적인 삶 변화추이[ 74 ] ················································································· 165그림 사회기여[ 75 ] ······································································································ 166그림 사회기여 변화추이[ 76 ] ······················································································· 166그림 위험함[ 77 ] ·········································································································· 167그림 위험함 변화추이[ 78 ] ·························································································· 167그림 사회의 짐[ 79 ] ····································································································· 168

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그림 사회의 짐 변화추이[ 80 ] ····················································································· 168그림 대화 불편함[ 81 ] ······························································································· 169그림 대화 불편함 변화추이[ 82 ] ················································································· 169그림 자제력과 의지부족[ 83 ] ····················································································· 170그림 자제력과 의지부족 변화추이[ 84 ] ······································································· 170그림 친구 외면[ 85 ] ··································································································· 171그림 친구 외면 변화추이[ 86 ] ····················································································· 171그림 성공적 치료[ 87 ] ······························································································· 172그림 성공적 치료 변화추이[ 88 ] ················································································ 172그림 직장 동료[ 89 ] ··································································································· 173그림 직장 동료 변화추이[ 90 ] ····················································································· 173그림 동네 거주 시설[ 91 ] ·························································································· 174그림 동네 거주 시설 변화추이[ 92 ] ············································································ 174그림 아이돌보는 사람[ 93 ] ························································································ 175그림 아이돌보는 사람 변화추이[ 94 ] ·········································································· 175그림 바로 옆집 이웃[ 95 ] ···························································································· 176그림 바로 옆집 이웃 변화추이[ 96 ] ············································································ 176그림 세입자[ 97 ] ········································································································ 177그림 세입자 변화추이[ 98 ] ·························································································· 177그림 친한 사람 결혼 상대자[ 99 ] ·············································································· 178그림 친한 사람 결혼 상대자 변화추이[ 100 ] ······························································ 178그림 직장 추천[ 101 ] ································································································· 179그림 직장 추천 변화추이[ 102 ] ··················································································· 179그림 정신질환 유병율 인지[ 103 ] ·············································································· 180그림 정신질환 유병율 인지 변화추이[ 104 ] ································································ 180그림 정신보건센터 인지[ 105 ] ··················································································· 181그림 정신보건센터 인지 변화추이[ 106 ] ····································································· 181

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그림 정신보건사업 만족[ 107 ] ··················································································· 182그림 정신보건사업 만족 변화추이[ 108 ] ··································································· 182그림 정신건강 도움 전화[ 109 ] ················································································· 183그림 정신건강도움 전화 변화추이[ 110 ] ····································································· 183그림 음주 사회적 피해[ 111 ] ····················································································· 184그림 음주 사회적 피해 변화추이[ 112 ] ······································································· 184그림 절주 캠페인 인지[ 113 ] ····················································································· 185그림 절주 캠페인 인지 변화추이[ 114 ] ······································································· 185그림 음주 폐해 감소 정부 노력[ 115 ] ······································································ 186그림 음주 폐해 정부 노력 변화추이[ 116 ] ································································· 186그림 평가방법[ 117 ] ····································································································· 187그림 정신보건관련 조례[ 118 ] ····················································································· 209그림 사업계획 목표의 적절성[ 119 ] ············································································ 210그림 사업계획 활동 전략의 적절성[ 120 ] ··································································· 210그림 사업계획 자체평가방안의 적절성[ 121 ] ······························································ 211그림 지역사회 자원의 활용[ 122 ] ··············································································· 211그림 신규환자발견체계의 적절성[ 123 ] ······································································· 212그림 사례관리 운영체계의 적절성[ 124 ] ····································································· 212그림 위기관리 및 응급대응체계의 적절성[ 125 ] ························································· 213그림 생애주기별 정신건강증진 사업체계의 적절성[ 126 ] ··········································· 213그림 지역 특성을 반영한 특성화 프로그램 수행[ 127 ] ·············································· 214그림 지역 특성을 반영한 특성화 사업 추진[ 128 ] ····················································· 214그림 사회재활지원 체계의 적절성[ 129 ] ····································································· 215그림 등록회원 사례관리 서비스 질 관리[ 130 ] ·························································· 215그림 문항별 평균[ 131 ] ······························································································· 216그림 시 도별 평균[ 132 ] ․ ······························································································ 217그림 시 도별 센터 평균 비교[ 133 ] ․ ············································································· 217

13

그림 연구수행체계도[ 134 ] ·························································································· 242그림 정신의료기관 평가지표 개발 순서[ 135 ] ···························································· 244그림 평가지표 차 전문가 조사 결과 동의 분율[ 136 ] 1 : ············································· 248그림 만족도조사 항목 차 전문가 조사 결과 동의 분율[ 137 ] 1 : ································ 249그림 평가지표 차 전문가 조사 결과 동의 분율[ 138 ] 2 : ············································· 250그림 만족도조사 항목 차 전문가 조사 결과[ 139 ] 2 ················································· 251그림 향후 평가 진행 일정[ 140 ] ················································································· 261그림 국가정신보건 개년 계획의 틀[ 141 ] 5 ··································································· 266그림 한국인의 사망원인 및 질병부담[ 142 ] ································································ 284그림 정신질환자에 대한 태도 비교[ 143 ] ··································································· 284그림 자살자 수 자살사망률 변화 추이[ 144 ] ․ ······························································· 285그림 정신질환의 낮은 치료율[ 145 ] ·········································································· 286그림 기간별 항우울제 순응률[ 146 ] (% ) ····································································· 286그림 우리나라의 정신병상 증가 현황[ 147 ] ································································ 287그림 국가들의 정신병상 증감 현황[ 148 ] O ECD ······················································· 288그림 우리나라 자살률의 연령별 추이[ 149 ] ································································ 290그림 통계청 사망순위 변화 추이[ 150 ] ······································································· 291

제 장1 . 중앙정신보건사업지원단 사업추진 개요

1. 추진 배경 및 운영 필요성

가. 추진 배경

◦ 우리나라 국민의 정신건강수준은 선진국과 달리 매우 낮은 상태임.

주요 개국 스트레스 조사 입소스 우리나라 로 위- 10 (AP , 2006) : 81% 1 .․년 국민건강영양조사 결과 평소에 스트레스를 많이 느끼는 편이거나 대- 2005

단히 많이 느낀다고 응답한 분율이 임34.8% .

성인의 경우 가 경제문제 가 직장생활 가 부모자녀문제로- 27.6% , 27.1% , 12.5%

스트레스를 느낀다고 응답하였고 청소년의 경우 가 학업문제 가, 58.7% , 11.6%

진로문제로 스트레스를 느낀다고 응답.

◦ 우리나라 국민의 자살 증가율이 심각한 상태임.

우리나라의 자살률은 국가 중에서 위이며 급속히 빠르게 증가하고 있- OECD 4 ,

는 자살률 증가율은 위1

그림[ 1 국가 자살률 변화 추이] OECD (1990~2006)

2

년 우리나라 자살자는 일 평균 명으로 명이 자살로 사망함 이- 2008 1 35.1 12,858 .

는 년 명 자살 사망에 비해서 명 증가한 수치임통계청2007 (12,174 ) 684 ( , 2009).

◦ 년 정신보건법이 제정되었음에도 불구하고 중증정신질환자에 대한1995

관리는 매우 비효율적으로 운영되고 있음.

년을 정신의료기관에 입원해 있는 정신질환자의 평균 재원기간재원기간- 2009 (

중간값도 일 개월 일로 서구 선진국에 비해 여전히 장기재원을 하고) 160 (5 20 )

있음.

년 정신의료기관 정신병상은 총 병상인구 명상 병상임 정- 2008 69,702 ( 1,000 1.42 ).

신요양시설을 포함할 경우 총 병상은 병상임인구 명당 병상, 83,937 ( 1000 1.72 ).

에서는 적정 정신병상을 인구 명당 병상으로 권고하고 있고 이를- WHO 1,000 1

적용할때 우리나라는 정신의료기관의 병상수 만을 고려할 경우에도 이미 년, 2002

에 권고 기준을 넘은 상태임WHO .

그림[ 2 정신병상수 증가추이 및 인구 천명당 병상수 추이 평균재원기간 변화 추이] ,

제 장 중앙정신보건사업지원단 사업추진 개요1 3

나. 필요성

◦ 우리나라에서 번째 이루어진 정신질환 역학조사 조맹제 등 정신질환실2 ( .

태 역학조사 에 의하면 정신분열병 우울증 그리고 알코올의존 및 남. 2006) , ,

용 치료는 외국 개 정신질환 역학조사 결과 등37 (R. Kohn . Bulletin of the

비교하였을 때 약 정도World Health Organization 2004; 82: 858-866) , ⅓

수준밖에 미치지 못하고 있음.

◦ 더불어 정신보건법 재정후 지역사회 중심 정신보건사업을 중심으로 정신

보건정책을 추진함에도 불구하고 년 현재 지역사회정신보건사업은 여2007

전히 미미한 상태임.

◦ 이러한 후진적인 우리나라 정신보건 상태에 대해 지역사회정신보건사업

의 효율적인 활성화와 근거중심 국가정신건강정책 개발을 위해 정신보건전

문가로 구성된 중앙정신보건사업지원단을 적극적으로 운영할 필요가 있음.

2. 지금까지 운영 과정

가. 년 년1999 ~2003

◦ 정신보건법 제정 이후 지역사회정신보건을 정신보건 정책의 중심으로(‘95 )

추진함에 따라 년부터 임의로 설치운영함1999 .․◦ 년부터 한국보건사회연구원에서 위탁 운영함 정신보건사업 기술지원2000 .

및 평가 교육훈련 정신건강홍보 상담 및 정보 제공 정신질환 편견해소, , , , ,

정신보건시설 현황조사 등을 수행하였음 지역사회정신보건사업의 인프라.

를 확대시키기 위한 노력을 중심으로 지원단을 운영하였음 따라서 체계화.

된 사업추진은 미흡하였음.

나. 년 년 기 지원단 운영2004 ~2006 (1 )

◦ 정신보건법이 개정됨에 따라 정신보건사업의 집중적이고 전문적‘04.1.29

4

인 지원을 위하여 중앙정신보건사업지원단 을 설치운영함 정신보건법(『 』 ․제 조제 항 및 같은 법 시행규칙 제 조의 년 월까지 중앙지원단13 6 7 2). 2006 12

기 활동함 단장 조맹제 교수1 ( : )

◦ 법개정 후 년까지 한국보건사회연구원에서 중앙정신보건사업지원단2006

을 위탁 운영하였으며 지역사회정신보건사업의 양적인 확대를 중심으로,

정신보건센터 사업요원을 대상으로 한 교육 및 훈련 등에 초점을 두고 지

원단 운영함.

◦ 년까지 한국보건사회연구원에서 위탁운영 하였으나 국가정신건강정2006 ,

책 개발에 대한 필요성으로 년부터 서울의대 의료관리학교실에서 위탁2007

운영하고 있음.

다. 년 년 기 지원단 운영2007 ~2009 (2 )

◦ 중앙정신보건사업지원단은 년 위탁기관을 서울의대 의료관리학연구2007

소로 옮기면서 지원단 운영 방향에 변화를 도모함 중앙정신보건사업지원.

단은 지역사회정신보건사업에 대한 기술자문 및 중앙정부 정신보건정책 지

원의 역할의 비중을 기존에는 지역사회 정신보건사업 기술지원 및 자문에

초점을 두었다면 서울의대 의료관리학연구소에서 기 중앙지원단을 위탁, 2

하면서 중앙정부 정신보건정책에 대한 지원과 자문으로서 역할의 전환을,

도모함 더불어 년 월에 기 중앙지원단을 구성 단장 이영문 교수. 2007 7 2 ( : ,

하여 운영함2007.7.1~2009.6.30) .

◦ 년 중앙정신보건사업지원단은 기획조정 정책개발 및 지원 역량을2007 ,․강화하는 방향으로 운영방식과 원칙을 새롭게 정립함 첫째 분과중심의 사. ,

업추진 둘째 지방 정신보건사업지원단의 기능강화 셋째 정책기능 강화에, , , ,

초점을 두고 지원단을 운영함 첫째 국가정신건강정책 개년 계획 을 수. , [ 10 ]

립하여 단기 중기 장기적으로 국가정신보건정책의 나아갈 방향을 제시함, , .

둘째 중앙지원단과 지방지원단의 유기적 관계 구축을 위한 발판을 마련함, .

셋째 지역과 관련 조직의 책임성과 역량을 제고하는 방식으로 분권적인,

사업체계를 기초를 마련함.

◦ 년에는 중앙정신보건사업지원단 역할을 정책개발 중심으로 전환하여2008

정신보건법에서 제시한 중앙정신보건사업지원단의 역할 및 기능 확대를 도

모하고자 함 이에 정신보건법 개정과 관련하여 시행령과 시행규칙 개정.

제 장 중앙정신보건사업지원단 사업추진 개요1 5

안 마련을 위한 와 국립정신건강연구원 설립 방안연구 자살예방대책( ) TF ,

계획 수립 국가 정신건강정책 개년 액션플랜 등을 수립함 세부 사업으로, 5 .

국민 정신질환태도조사 및 아동청소년 선별검사 결과 분석 정신보건시설,

기능보강사업 지원에 대한 평가 등을 수행하였음.

◦ 년에는 정신보건사업 지침 개정 작업과 정신보건기관 현황조사 등을2009

수행하였고 아동청소년정신건강선별검사 지원 및 사례관리체계 개발 등에,

대한 연구를 진행하였고 정신보건법 개정을 위한 를 운영하였음 나아, TF .

가 정신보건전문요원 수련제도 개선에 관한 연구를 진행함 기 중앙정신. 3

보건사업지원단을 구성 단장 이영문 하여 운영하였음( : , 2009.7.1~ 2011.6.30) .

라. 년 년 기 지원단 운영2009 ~2010 (3 )

◦ 년 월 일 발족한 기 중앙정신보건사업지원단은 년 아래와 같2009 7 1 3 2010

은 계획 하에 지원단을 운영하였음.

◦ 중앙정신보건사업지원단은 사업을 정책기획분과와 사업지원분과로 나누

어 진행하며 사무국에서 분과에 대한 지원을 함, .

◦ 정책기획분과는 범국민 운동을 진행하고 국가정신보건 계‘ Anti - Stigma ’

획 수립을 위한 연구 사업을 진행 중에 있음 또한 정신보건 영역에서 정‘ .

책적으로 제시되는 문제들의 해결방안을 마련하기 위한 논의를 진행함.

◦ 사업지원분과는 지역사회정신보건사업 관계자 워크샵을 통해 교육 훈련’ ’

을 실시하였으며 정신보건조사통계 자료 생성을 위한 작업을 수행 중에, ‘ ’

있음 또한 정신보건센터 차등지원을 위한 평가 시행을 지원하였으며 추가. ‘

로 평가 자료를 취합하여 결과를 도출하여 관계자 간담회를 통해 년2010

평가계획에 대한 논의를 진행함.

◦ 건강증진사업지원단의 년 전문가 평가 를 통해 요구된 중앙정신보건[2009 ]

사업지원단 사무국 인력확보에 대한 요구에 따라 급 선임연구원 예post-doc (

방의학전문의 을 신규채용하여 지원단 사무국 업무를 함께 수행함) .

6

3. 중앙정신보건사업지원단 운영 근거

가. 법적근거 및 운영목적

(1) 법적근거 정신보건법 제 조 항 동법 시행규칙 제 조의: 13 6 , 7 2

◈ 정신보건법 조 항13 6

지역사회정신보건사업의 집중적이고 전문적인 지원을 위하여 보

건복지부장관은 중앙정신보건사업지원단을 시 도지사는 지방정, ㆍ

신보건사업지원단을 각각 설치 운영할 수 있다.ㆍ

(2) 운영목적

◦ 국가 정신보건사업의 원활한 추진을 위한 근거중심 정신보건정책개발

◦ 국가 정신보건사업의 추진에 대한 자문

◦ 지역사회 정신보건사업의 기술지원

나. 중앙지원단 구성 및 직무범위

(1) 구성

◦ 단장 인을 포함한 인 이상 인 이내 임기 년1 10 15 ( 2 )

◦ 보건복지부 정신보건업무를 담당하고 있는 급 또는 급 공무원 정신과4 5 ,

전문의 및 전문요원 그 밖의 정신보건분야에 관한 전문지식과 기술을 가,

진 자로 구성하며 보건복지부 장관이 임명 또는 위촉

제 장 중앙정신보건사업지원단 사업추진 개요1 7

(2) 직무범위

◦ 지역사회 정신보건사업의 기획 및 조정에 대한 지원

◦ 지역사회 정신보건사업 및 정신보건시설에 대한 평가

◦ 정신보건관련기관 단체 또는 정신보건시설 간의 연계체계 구축 지원,

◦ 정신보건사업의 현황 파악 및 통계

◦ 기타 보건복지부 장관이 지시하는 사항

4. 중앙정신보건사업지원단 조직 구성

가. 조직 구성

(1) 조직도

그림[ 3 중앙정신보건사업지원단 조직도]

8

(2) 사업추진 체계

◦ 분과 운영

정책기획분과-

사업지원분과-

◦ 사무국 운영 및 총괄

서울의대 의료관리학교실의료관리학연구소- ( )

나. 위원 구성

(1) 중앙정신보건사업지원단 위원 명단

성 명 소 속 직위 비 고

이영문 아주대학교 의과대학 교 수 단 장

김 윤 서울대학교 의과대학 교 수 부단장 운영 총괄/

이명수 서울시 정신보건센터 센터장 정책기획분과장

이진석 서울대학교 의과대학 교 수 사업지원분과장

박종익 강원의대 정신과학교실 교 수 단원

강상경 서울대 사회복지학과 교 수 단원

서규동 동양대 사회복지학과 교 수 단원

김경희 서울여자간호대학 교 수 단원

조근호 을지대 중독복지재활학과 교 수 단원

곽영숙 제주의대 정신과학교실 교 수 단원

문용훈 태화샘솟는집 시설장 단원

김명식 전주대 심리학과 교 수 단원

남윤영 국립서울병원 기획홍보과 과 장 단원

백종우 경희의대 정신과학교실 교 수 단원

백은자 맹호영/ 보건복지가족부 정신건강정책과 과 장 단원당연직( )

제 장 중앙정신보건사업지원단 사업추진 개요1 9

(2) 중앙정신보건사업지원단 자문위원 명단

(3) 사무국 인력구성서울의대 의료관리학연구소( )

성 명 소 속 직위 전문영역

기선완 건양대병원 정신과 교 수 정신의학 중독/

김정진 나사렛대 사회복지학과 교 수 사회복지 지역사회/

민성호 연세대원주병원 정신과 교 수 정신의학 알코올중독/

박종운 법무법인 소명 변호사 법학 인권/

배 안 국립나주병원 원 장 정신의학 중증/

서동우 김포한별병원 원 장 정신의학보건학 정책( )/

양 수 가톨릭대학교 간호대학 교 수 간호학 센터/

윤명숙 전북대학교 사회과학대학 교 수 사회복지 중독/

이동우 상계백병원 교 수 정신의학 노인/

최용성 성안드레아병원 진료부장 정신의학 중독/

홍진표 울산대학교 서울아산병원 교 수 정신의학 인권센터/ ,

황태연 용인정신병원 지역정신재활본부 본부장 정신의학 정신재활/

김대진 가톨릭성모병원 교 수 절주

김지혜 성균관대 의대 교 수 심리학 임상심리/

김수진 전남대 간호대학 교 수 아동청소년

김재원 서울의대 교 수 아동청소년

임정수 가천의대 교 수 자살

성명 소속근무

형태직위 비고

이선영 서울대학교 의학연구원 의료관리학연구소 상근 책임연구원 사회복지학 박사

문상준 서울대학교 의학연구원 의료관리학연구소 상근 선임연구원 예방의학 전문의

이은정 서울대학교 의학연구원 의료관리학연구소 상근 연 구 원 사회복지학 석사

김명정 서울대학교 의학연구원 의료관리학연구소 상근 연 구 원 간호학 석사수료

김혜정 서울대학교 의료관리학교실 사무원 비상근 행정보조 보건학사

10

(4) 사업 수행 기간

◦ 년 월 일 월 일 개월2010 1 1 ~ 12 31 (12 )

(5) 년 총사업비 및 연차별 사업예산2008

◦ 년 총사업비 백만원2010 : 220

◦ 연차별 사업예산

구분 2005 2006 2007 2008 2009 2010

금액 250 240 240 220 225 220

표 중앙지원단 사업예산< 1> (2005~2010)

단위 백만원( : )

제 장2 . 사업 추진실적 및 사업성과

1. 추진 장 참조Anti-Stigma Movement: MIND Project (4 )

◦ 정정신질환자에 대한 사회적 편견 감소를 목적으로 정신보건관련 단체들과

함께 를 위한 간담회를 실시하고 협력체결을 통해 인식Anti-Stigma Movement

개선 활동을 진행하는 것에 합의함 관련 단체 뿐 아니라 지역사회정신보건사업.

을 수행하는 개별 정신보건센터 사회복귀시설의 참여를 독려함, .

◦ 더불어 정신질환 편견해소를 위한 범국민적인 관심을 불러일으키고자 사

회적 인식을 개선시킬 수 있는 의미를 담고 있는 슬로건 공모

를 실시함 슬로건 공모를 통해 슬로건 이미지를 제작하고(2010.3.1~3.19) .

를 로 추진 함Anti-Stigma Movement MIND project .

◦ 해마다 중앙지원단에서 진행하는 지역사회정신보건사업관계자 Workshop

을 통해 지역사회정신보건시설에서 근무하는 전문가들이 정신질환에 대한

사회적 편견의 심각성을 공유할 수 있도록 하였으며 정신질환자 당사자,

초청 강의를 통해 전문가들이 당사자 의 지원 방향 가능성 등을Movement ,

논의하는 자리를 마련함 또한 국가인권위원회에서 정신보건전문가로서 편.

견 차별을 대하는 태도를 정립할 수 있도록 도움을 주는 강의를 마련하였,

음.

◦ 한국정신보건사회복지학회의 국제춘계학술대회에서 정신장애와 스티그‘

마란 주제로 기획주제세션을 공동으로 주최하였음 우리나라 뿐 아니라 일’ .

본 홍콩의 사례를 통해 전문가들의 문제의식을 고취시키고 발전방향을 모, ,

색할 수 있는 기회를 마련하였음.

◦ 협력 용인정신병원이 주최하는 국제학술대회에 정신질환에 대한WHO ‘

인식과 사회적 수용이라는 주제로 포스터를 발표하고 사회정신의학회 추’ ,

계학술대회에서 의 진행 내용과 향후 방향 의의Anhti-Stigma Movement ,

등의 발표를 통해 많은 전문가들이 참여해 줄 것을 독려하였음.

12

가. 사업성과

◦ 서울 인천 경기광역정신보건센터 대한간호협회 정신간호사회 대한신경정 , ,

신의학회 대한정신보건가족협회 대한정신분열병학회 한국간호과학회 정, , ,

신간호학회 한국사회복귀시설협회 한국임상심리학회 한국정신보건사회복, , ,

지학회 한국정신보건사회복지사협회 한국정신사회재활협회 지역정신보건, , ,

센터 영등포구 광주동구 대덕구 포천시 경주시 수원시 고양시 나주시( , , , , , , , ),

사회복귀시설 달성베네스트 이 정신질환자 사회적 편견 감소를 위한 인식( )

개선 활동을 진행하기로 협력체결 하였음.

◦ 범국민을 대상으로 실시한 슬로건 공모는 총 건의 작품이 응모되었음302 .

최우수작으로 선정된 작품은 슬로건을 이미지화하여 관련 단체에 배포하여

자유롭게 사용할 수 있도록 하였음.

◦ 최종 선정된 슬로건 이미지

그림[ 4 슬로건 이미지]

◦ 정신보건관련 기관 및 전문가들이 정신질환에 대한 편견 감소를 위한 운

동에 관심을 가지고 참여할 수 있도록 동기를 부여하였으며 사회적 분위,

기 조성에 일부 기여하는 성과를 거두었음.

그림[ 5 경기 광역정신보건센터 행사] 그림[ 6 서울 정신보건센터 행사]

제 장 사업추진실적 및 사업성과2 13

2. 지역사회정신보건사업 관계자 Workshop

가. 추진 내용 및 실적

(1) 진행 내용

◦ 지역사회정신보건사업을 수행하는 관계자를 대상으로 부산 벡스코에서

을 박 일로 진행함Workshop (2010.5.10~5.11) 1 2 .

◦ 사업요원들이 현재 국가정신보건사업의 방향과 정신보건정책에 대한 현

실적인 인식을 통해 비판적이고 발전적인 시각으로 사업 수행을 할 수 있

는 능력을 향상시키기 위해 교육을 실시함.

◦ 또한 지역사회정신보건시설에서 제공하는 서비스의 질을 높이기 위해 사

업요원들을 대상으로 사업에 대한 기획 평가 지역사회 자원 파악 방법 사 , ,

례관리 및 공격행동관리 기술에 대해 보수교육을 실시하여함.

(2) 세부 일정

첫째 날 년 월 일 월요일: 2010 5 10 ( )

등록 확인12:30~14:00부1 14:00~15:00 개회식

진행 이선영 중앙정신보건사업지원단 사무국장: ( )14:00~14:10 개 회 사 이영문 중앙정신보건사업지원단장( )14:10~14:20 인사말씀 이덕형 보건복지부 질병정책관( )14:20~14:30 축 사 배태수 부산광역시청 복지건강국장( )14:30~14:40 축 사 김석모 부산경남 가족협회장( )14:40~14:50 내빈소개 이영문 중앙정신보건사업지원단장( )

장내 정리14:50~15:00 coffee break ( )

부2 15:00~17:30 국가 정신보건 방향우리는 가야할 곳을 향해 가고 있나: ?

14

둘째 날 년 월 일 화요일: 2010 5 11 ( )

좌장 이영문 단장 아주의대 교수: ( , )15:00~15:30 정신보건정책 현주소

김 윤 서울의대 교수( )15:30~16:00 지역사회정신보건 현주소

이명수 (서울시 정신보건센터장)16:00~17:20 지정토론 및 종합토론

배 안 국립나주병원장( )김철권 부산광역정신보건센터장( )백은자 보건복지부 정신건강정책과장( )

17:20~17:30 장내 정리17:30~19:00 저녁식사 개별( )

부3 19:00~22:00 특강 힐링시네마: (healing cinema)진행 심영섭 한국영상응용연구소: ( )

영화치료의 개요 및 영화를 통해 본 상담 기술

부4 09:00~12:00 분과별 Workshop분과 정신보건사업 기획 및 평가1 장소 층 호( : 2 205 )

진행 이진석 서울의대 교수: ( )09:00~10:40 정신보건사업 기획 평가

이진석 서울의대 교수( )10:40~10:50 coffee break10:50~11:20 지역사회자원현황 파악 실제

이현주 서울대학교 사회복지연구소( )11:20~11:50 질의응답11:50~12:00 교육 종료

분과2 Anti-Stigma movement 장소 층 호( : 2 201-4 )진행 전준희 경기 화성시 정신보건센터장: ( )

09:00~09:40 차별받고 있는 사람들전준희 경기 화성시 정신보건센터장( )

09:40~10:20 정신장애의 당사자 운동 가능성김충배 조울증 경험 당사자( )

10:20~10:30 coffee break10:30~11:40 정신보건전문가의 태도

진수명 사무관 국가인권위원회( )

제 장 사업추진실적 및 사업성과2 15

(3) 워크샵 참가자 평가

◦ 주제발표에 대한 평가는 전반적으로 정신보건정책에 대한 이해와 기회

등에서 전반적으로 긍정적인 평가가 있었음.

그림[ 7 주제발표에 대한 평가]

◦ 특강에 대한 평가는 전반적으로 긍정적이었으나 강의시간이나 현장에서,

의 적용 가능성이 상대적으로 낮은 평가를 받음.

11:40~11:50 질의응답11:50~12:00 교육 종료

분과 사례관리 및 공격행동관리3 장소 층 호( : 3 301 )진행 이기연 서울시 정신보건사업지원단 위원: ( )

09:00~10:10 사례관리 수립 및 실제ISP이기연 서울시 정신보건사업지원단 위원( )

10:10~10:20 질의응답10:20~10:30 coffee break10:30~11:40 위험사정 및 공격행동 관리 Ⅰ

정금희 성요한병원 간호과장( )위험사정 및 공격행동 관리Ⅱ

김정화 요한알코올상담센터 팀장( )11:40~11:50 질의응답11:50~12:00 교육 종료

16

그림[ 8 특강에 대한 평가]

◦ 분과교육 중 정신보건사업기획 및 평가 분과 에 대한 평가는 전반적으로(1 )

매우 긍정적인 평가를 받았음 강의시간이 부족하였다는 의견이 있었으며. ,

강사의 성실도에서 매우 높은 점수를 받았음.

그림[ 9 분과교육 분과에 대한 평가] : 1

제 장 사업추진실적 및 사업성과2 17

◦ 분과교육 중 운동 분과 에 대한 평가는 전반적으로 긍정적인Anti-stigma (2 )

평가를 받았음 강의시간 현장에서의 활용이 상대적으로 낮은 평가 받음. , .

그림[ 10 분과교육 분과에 대한 평가] : 2

◦ 분과교육 중 사례관리 및 공격행동 관리 분과 에 대한 평가는 전반적으(3 )

로 긍정적인 평가를 받았음 강의시간이 부족하였다는 의견이 있었음. .

그림[ 11 분과교육 분과에 대한 평가] : 3

18

◦ 워크샵 운영에 대한 평가는 전반적으로 긍정적인 평가를 받았음 강의장.

시설에 대한 평가가 상대적으로 높은 점수를 받았음.

그림[ 12 워크샵 운영에 대한 전반적인 평가]

나. 사업성과

◦ 정신보건센터 사회복귀시설 알코올상담센터 정신요양시설 보건복지부, , , , ,

시도 및 시군구 정신보건사업담당자 중앙 및 지방정신보건사업지원단 위,

원 등 총 여명 참석함750 .

◦ 지역사회정신보건사업을 수행하는데 있어서 현장에서 필요한 실제적인

지식과 기술을 습득할 수 있도록 하여 업무 능력을 향상시킴.

◦ 또한 국가 정신보건정책과 전반적인 현황을 이해할 수 있는 기회를 제공

함으로써 사업의 방향을 설정하는데 도움을 주었음.

제 장 사업추진실적 및 사업성과2 19

3. 대국민 정신질환 태도 조사 장 참조(5 )

가. 추진내용 및 실적

(1) 태도조사 수행 개요

◦ 목 적 년부터 정신질환자에 대한 대국민태도조사를 실시하여 매년: 2002

변화추이를 분석하고 이를 국가 정신보건정책 방향 수립에 기초자료로 활

용함.

◦ 일 시 년 월 일 일 일간: 2010 10 4 ~ 3 (9 )

◦ 대 상 전국 만 세 이상 세 이하 국민 명: 15 69 1,109

◦ 표본추출방법 인구 비례에 의한 성 연령 지역별 할당 무작위 추출법: / /

◦ 조사방법 구�