Mainstreaming Mental Health Care in 42 Countries
Mainstreaming Mental Health Care in 42 Countries
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DOI：
10.1080/23288604.2017.1356424
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发表时间：
2017-01-01
影响因子：
4.1
通讯作者：
Snowden, Lonnie R.
中科院分区：
文献类型：
--
作者：
Shen, Gordon C.;Eaton, Julian;Snowden, Lonnie R.
全球共识和国家政策强调去机构化，或将提供精神卫生保健的工作从机构转向社区。然而，在许多国家，精神病医院和精神病院获得了大部分精神卫生资金，这与表明服务应在社区提供的研究证据不一致。我们的目的是调查影响国际上去机构化的规范、行为者和策略。我们的研究是基于先前关于管理和实施科学的文献。精神卫生保健业务的成败取决于确定和克服与在国家范围内实施创新有关的挑战。我们调查了42个国家的78名专家，了解他们在扩大社区精神卫生保健和/或缩小机构护理方面的知识和经验。我们还向他们询问了上述方法在一个国家实施的背景。我们发现，无论是在机构还是在社区提供的精神卫生保健，在各国似乎都没有标准化。我们的分析还表明，向前推进去机构化需要三类行动者的有意义的参与：政府官员、医疗保健专业人员和地方专家。去机构化的进展取决于这些行为者之间以及与不同利益攸关方之间建立的伙伴关系，这种伙伴关系有可能获得资源并扩大试点项目。总之，不同的国家以不同的方式调整去机构化，以满足特殊的情况和人口需求。应当更加注意用于加强治疗和预防服务的管理和执行战略。
Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institution-based care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services.