Rethinking mental health care: bridging the credibility gap
Rethinking mental health care: bridging the credibility gap
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DOI：
10.1097/wtf.0000000000000065
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发表时间：
2014-12-01
影响因子：
1.4
通讯作者：
Patel, Vikram
中科院分区：
文献类型：
--
作者：
Patel, Vikram
全球精神卫生创新的重点是解决“供应方”障碍，以减少治疗差距，并在这样做的时候，重新定义了关于精神卫生保健的三个核心假设，即什么是精神卫生保健干预，谁是精神卫生保健提供者，什么是精神卫生保健环境。然而，单靠这种创新并不能缩小治疗差距，因为精神卫生专家对精神障碍的理解与世界其他地方对心理痛苦的概念之间存在差距，精神卫生专家使用的精神障碍的理解最好地体现在诊断系统和由此产生的流行病学工具上。正是这种“可信度”的差距需要通过三个关键途径来弥合：首先，将可以从生物医学干预中受益的精神障碍与轻度抑郁状态区分开来;主要通过在正规医疗保健系统之外提供的低强度心理社会干预为抑郁状态提供干预;并根据在一般人群中观察到的现象模式，而不是在专家环境中观察到的现象模式，对诊断类别进行描述。
Innovations in global mental health have focused on addressing the 'supply side' barriers to reduce the treatment gap and, in doing so, have redefined three core assumptions regarding mental health care, namely, what comprises a mental health care intervention, who is a mental health care provider and what is a mental health care setting. However, such innovations alone will not reduce the treatment gap because of the gap between the understanding of mental disorder that mental health specialists use, best illustrated through the diagnostic systems and the epidemiological instruments arising from them, and how the rest of the world conceptualises psychological suffering. It is this 'credibility'gap that needs to be bridged in three key ways: first, to distinguish mental disorders that could benefit from biomedical interventions from milder distress states; to offer interventions for distress states mainly through low intensity psychosocial interventions delivered outside the formal health care system; and to base the descriptions of diagnostic categories on the patterns of phenomena observed in general populations, rather than those observed in specialist settings.