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2026年5月15日 | 0 评论 | 发布于 赛事动态 | 作者: 官方编辑

每年秋季，中国各地中小学都会开展心理健康普查。然而，筛查出“问题”后，学校缺乏干预能力，医院预约困难，手持筛查报告的家长也束手无策，导致原本应紧密相连的支持系统出现断裂。更令人担忧的是，许多学生在返校后，虽然症状有所缓解，但社会功能并未恢复，陷入“休学—复学—再休学”的恶性循环。

如何打破“医院—机构—家庭—学校”四方协同的障碍，将零散的治疗整合为“全病程管理”的完整图景？

“发现”到“干预”的鸿沟难以逾越

2025年秋季，北京某初中在期初心理健康测评后，班主任将一张写有“PHQ-9得分偏高，请家长带孩子到专业机构进一步评估”的纸条递给了陈女士。陈女士对PHQ-9一无所知，也不清楚是该去医院还是咨询机构，这张纸条让她感到十分茫然和焦虑。

《柳叶刀—精神病学》的一项流行病学研究显示，中国儿童青少年整体精神障碍的患病率为17.5%，其中焦虑障碍占4.7%，重性抑郁障碍占2.0%，多动症患病率达6.3%。尽管教育部和国家卫生健康委持续扩大青少年心理健康筛查的覆盖范围，但从“发现疾病”到“有效干预”之间，依然存在显著的差距。

学校层面存在能力不足的问题。多数学校仅有一名老师负责全校学生的心理工作，需要承担普查、辅导和危机处理等多项任务。当筛查报告显示“高风险”时，老师通常只能通知家长。

医疗资源也面临巨大压力。儿童青少年精神科资源长期短缺，大城市三甲医院的儿少精神科号源极为紧张。即使成功挂号，门诊时间通常不超过20分钟，主要进行诊断和用药决策。大量需要系统心理治疗的孩子在急性期过后，往往无处可去。

家庭层面存在认知上的误区。许多家长对心理问题和思想问题的界限模糊，不确定孩子的状况是否需要就医，不了解心理咨询与精神科就诊的区别，更不知道治疗后的康复过程。

因此，本应环环相扣的支持链条在现实中断裂：学校发现问题后转交给家长，家长因迷茫转交给医院，医院处理完急性症状后又转交给家庭。一个孩子从被筛查出高风险到获得系统干预并走向康复，缺少的不仅仅是专业机构，而是一个完整的、相互衔接的支持体系。

复学的陷阱：症状缓解不等于社会功能恢复

武汉某心理医疗机构的王晶医生观察到一个令人担忧的趋势：越来越多的孩子出现“反复休学”，形成家庭的痛苦循环。一位拥有13年三甲医院精神科从业经验的心理治疗师指出，许多孩子在住院或密集治疗期间恢复良好，但一旦回到家中，往往不到两周就会再次崩溃。

“他们回到家后，所处的环境没有改变——家庭互动模式、学业压力、社交恐惧都没有解决。症状消失了，但他们的社会功能并未恢复。”王晶解释说，“这是两回事，不能混为一谈。”

《中国抑郁障碍防治指南(2025版)》明确指出，抑郁障碍的治疗目标是“社会功能的全面恢复”，而非仅仅“症状缓解”。抑郁障碍的高复发率是其重要特征，需要进行维持期治疗和长程随访。

当前的治疗往往在“症状缓解”阶段就基本结束了。没有人系统评估孩子是否已准备好重新融入同伴关系、课堂压力和家庭生活，也没有后续的跟进。复学本应是皆大欢喜的事情，却可能成为一个高风险的关口。

理解这一困境需要引入“全病程管理”理念。这意味着，心理障碍的干预不是一次就诊、住院或咨询就能完成的，而是一个涵盖急性期、巩固期、康复期和维持期的连续过程。每个阶段都有不同的需求，需要不同的专业支持。《中国抑郁障碍防治指南(2025版)》体现了全病程管理的核心思想，不仅将其作为核心原则，还强调了“全病程治疗”和“序贯心理治疗”的重要性。

以青少年抑郁症为例，各阶段的核心任务大致如下：急性期需要精准诊断与评估，决定是否用药及用药方案，主要由精神科医生主导；巩固期需在稳定用药的同时，开展系统的心理治疗，如认知行为治疗(CBT)、辩证行为治疗(DBT)等循证性疗法；康复期重点在于帮助孩子恢复社会功能，包括重建同伴关系、应对学业压力、推进复学过渡，需要更综合的团队协作；维持期则着眼于预防复发，需要调整家庭系统，建立长期支持网络。

然而，在现行的医疗体系中，通常只有第一个阶段受到重视。其余三个阶段，因不属于传统医疗服务范畴，长期处于空白状态。这也解释了为何许多家庭即使付出巨大的时间和金钱，仍感觉“治不好”——实际上，他们可能只完成了四分之一的治疗。

四端协同：探索“全病程管理”

上海市精神卫生中心儿少精神科原主任杜亚松指出，中国青少年心理问题的诊疗现状存在“医疗资源高度集中、康复支持严重不足”的结构性失衡。他认为，推动“医院—机构—家庭—学校”四方的协同，是下一阶段改善青少年心理健康服务质量的关键方向。

在传统模式下，家长往往是治疗过程的旁观者，最多是孩子就诊的陪同者。但从家庭系统视角来看，家长自身的焦虑状态、亲子互动模式以及家庭对孩子情绪的回应方式，都是影响康复的关键因素。

为解决青少年心理干预难题，教育部、国家卫生健康委等多部门已出台文件，要求加强学校心理健康监测、完善转介机制、推进医校合作。但在执行层面，仍存在一些亟待填补的空白：

一是缺乏标准转介路径。当学校发现高危学生后，如何转介、转介给谁、由谁跟进，目前尚缺乏可操作的规范流程。家长获取信息具有很大的随机性，有必要在国家层面建立标准转介协议，明确各环节的责任主体。

二是缺乏专业衔接岗位。学校端的心理老师和医疗端 Thus, the child, from being screened as high-risk to receiving systematic intervention and recovery, lacks not only a professional institution but also a complete, interconnected support system.

The Trap of Returning to School: Symptom Relief Does Not Equal Restoration of Social Function

Dr. Wang Jing from a psychological medical institution in Wuhan has observed a worrying trend in her clinical practice: an increasing number of children are experiencing "repeated school suspension," forming a painful cycle for families. A psychotherapist with over 13 years of experience in the psychiatric department of a top-tier hospital stated that many children recover well during hospitalization or intensive treatment, but once they return home, they often break down again within two weeks.

"Their environment hasn't changed upon returning home—the family interaction patterns, academic pressure, and social phobia remain unresolved. The symptoms have disappeared, but their social functions have not been restored," said Wang Jing. "These are two different things and cannot be conflated."

The "Guidelines for the Prevention and Treatment of Depression in China (2025 Edition)" clearly states that the treatment goal for depressive disorders is not merely "symptom relief" but "full restoration of social function." The high recurrence rate is a significant characteristic of depressive disorders, making maintenance treatment and long-term follow-up indispensable.

Current treatments often conclude at the stage of "symptom relief." There is no systematic assessment to determine if the child is truly ready to return to peer relationships, academic pressure, and family life, nor is there any follow-up. Returning to school, which seems to be a universally welcomed event, can actually be a high-risk juncture.

Understanding this dilemma requires the introduction of the concept of "full-course management." This implies that the intervention for psychological disorders is not something that can be completed with a single consultation, hospitalization, or period of counseling. Instead, it is a continuous process spanning the acute, consolidation, recovery, and maintenance phases, with different needs and requiring different professional support at each stage. The "Guidelines for the Prevention and Treatment of Depression in China (2025 Edition)" embodies the core idea of full-course management, not only establishing it as a core principle but also emphasizing the importance of "full-course treatment" and "sequential psychotherapy."

Taking adolescent depression as an example, the core tasks at each stage are roughly as follows: the acute phase requires accurate diagnosis and assessment to determine medication use and treatment plans, primarily led by psychiatrists; the consolidation phase requires systematic psychotherapy, such as evidence-based methods like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), alongside stable medication; the recovery phase focuses on helping the child restore social functions, including rebuilding peer relationships, coping with academic pressure, and facilitating the transition back to school, requiring more comprehensive team collaboration; the maintenance phase aims to prevent recurrence, necessitating adjustments to the family system and the establishment of long-term support networks.

However, in the current medical system, often only the first phase receives attention. The remaining three phases, not falling under traditional medical service categories, remain in a prolonged state of neglect. This also explains why many families, despite investing significant time and financial resources, still feel that their children are "untreatable"—they may have only completed one-quarter of the treatment.

Four-Party Collaboration: Exploring "Full-Course Management"

Du Yasong, former director of the Child and Adolescent Psychiatry Department at the Shanghai Mental Health Center, pointed out that the current state of diagnosis and treatment for adolescent psychological problems in China exhibits a structural imbalance characterized by "highly concentrated medical resources and severe lack of rehabilitation support." He believes that promoting collaboration among the "hospital—institution—family—school" four parties is the key direction for improving the quality of adolescent mental health services in the next phase.

In traditional models, parents are often observers in the treatment process, at most accompanying their child to appointments. However, from a family systems perspective, parents' own anxiety levels, parent-child interaction patterns, and the family's responses to the child's emotions are all crucial variables affecting recovery.

To address the challenges in adolescent psychological intervention, multiple departments, including the Ministry of Education and the National Health Commission, have issued documents requiring enhanced school mental health monitoring, improved referral mechanisms, and the promotion of medical-school cooperation. However, in terms of implementation, several gaps still need to be filled:

First, there is a lack of standardized referral pathways. When schools identify high-risk students, there is currently no operational and standardized procedure for referral, determining who to refer to, and who will follow up. Parents' access to information is highly random. It is necessary to establish standardized referral protocols at the national level, clarifying the responsibilities of each party involved.

Second, there is a lack of professional liaison positions. School psychologists are responsible for the school end, and psychiatrists are responsible for the medical end, with virtually no connection between the two. Some developed countries have positions like "school-clinical liaison coordinators" who are specifically responsible for tracking the intervention progress of high-risk students and helping families connect with medical resources.

Third, there is a lack of a formal school re-entry assessment mechanism. Currently, whether a child returns to school is primarily based on the subjective wishes of the parents and the child, lacking standardized functional assessments. A systematic school re-entry assessment mechanism can not only reduce the risk of secondary breakdown for the child but also ensure that schools have the capacity to support students in "special conditions" when they return.

Fourth, the payment mechanism is inadequate. Psychological therapy and rehabilitation services are limited in coverage within China's current medical insurance reimbursement system. The economic burden of long-term intervention largely falls on families, leading many to discontinue treatment after initial symptom relief. Exploring the inclusion of psychological therapy in medical insurance reimbursement and promoting product innovation in commercial insurance in this area are important measures to reduce the rate of treatment interruption.

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