Global mental health 6 - Scale up services for mental disorders: a call for action
Global mental health 6 - Scale up services for mental disorders: a call for action
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DOI：
10.1016/s0140-6736(07)61242-2
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发表时间：
2007-10-06
期刊：
影响因子：
168.9
通讯作者：
Tomlinson, M.
中科院分区：
文献类型：
--
作者：
Chisholm, D.;Flisher, A. J.;Tomlinson, M.
我们呼吁全球卫生界、各国政府、捐助者、多边机构和其他精神卫生利益攸关方，如专业机构和消费者团体，扩大所有国家精神障碍服务的覆盖面，特别是在低收入和中等收入国家。我们认为，核心精神障碍的一个基本的，基于证据的一揽子服务应扩大规模，并应加强对精神障碍患者及其家人的人权保护。有三个问题对扩大进程至关重要。需要哪些资源？如何监测实现这些目标的进展情况？心理健康研究的重点应该是什么？为了解决这些问题，我们首先估计，按必要规模提供服务所需的金额在低收入国家为每人每年2美元，在中低收入国家为3 -4美元，与为全球疾病负担的其他主要贡献者扩大服务规模的要求相比，这是微不足道的。其次，我们确定了一系列核心和次要指标，以跟踪各国在实现心理健康目标方面取得的进展;许多国家已经对其中许多指标进行了常规监测。第三，我们做了一个优先级设置练习，以确定四类精神障碍在全球精神卫生证据基础中的差距。我们表明，应该为研究提供资金，开发和评估可以由非心理健康专业人员提供的干预措施，并评估卫生系统如何在所有常规护理环境中扩大此类干预措施。我们讨论了克服扩大精神障碍服务的五个主要障碍的战略;一个主要战略是由不同的利益相关者，特别是针对多边机构，捐助者和政府的持续宣传。本系列为宣传提供了证据。现在，我们首先需要全球卫生界的政治意愿和团结，将这些证据转化为行动。现在是采取行动的时候了。
We call for the global health community, governments, donors, multilateral agencies, and other mental health stakeholders, such as professional bodies and consumer groups, to scale up the coverage of services for mental disorders in all countries, but especially in low-income and middle-income countries. We argue that a basic, evidence-based package of services for core mental disorders should be scaled up, and that protection of the human rights of people with mental disorders and their families should be strengthened. Three questions are critical to the scaling-up process. What resources are needed? How can progress towards these goals be monitored? What should be the priorities for mental health research? To address these questions, we first estimated that the amount needed to provide services on the necessary scale would be US $2 per person per year in low-income countries and $3-4 in lower middle-income countries, which is modest compared with the requirements for scaling-up of services for other major contributors to the global burden of disease. Second, we identified a series of core and secondary indicators to track the progress that countries make toward achievement of mental health goals; many of these indicators are already routinely monitored in many countries. Third, we did a priority-setting exercise to identify gaps in the evidence base in global mental health for four categories of mental disorders. We show that funding should be given to research that develops and assesses interventions that can be delivered by people who are not mental health professionals, and that assesses how health systems can scale up such interventions across all routine-care settings. We discuss strategies to overcome the five main barriers to scaling-up of services for mental disorders; one major strategy will be sustained advocacy by diverse stakeholders, especially to target multilateral agencies, donors, and governments. This Series has provided the evidence for advocacy. Now we need political will and solidarity above all from the global health community, to translate this evidence into action. The time to act is now.