Integrating mental health care into primary care systems in low- and middle-income countries: lessons from PRIME and AFFIRM.
Integrating mental health care into primary care systems in low- and middle-income countries: lessons from PRIME and AFFIRM.
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DOI：
10.1017/gmh.2017.3
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Lund C
中科院分区：
文献类型：
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作者：
Davies T;Lund C
精神、神经和物质使用(MNS)障碍现在是全球残疾的主要原因，占全球残疾生活年数的23%(Whiteford等人)。2013年)。这种负担大部分由低收入和中等收入国家承担。然而，LMIC中的MNS障碍没有得到他们应得的研究关注或服务人员(Saxena等人)。2006年)，服务需求超过了提供服务和治疗人员的需求。这种服务提供方面的差距通常被称为“待遇差距”。对此，全球精神健康大挑战倡议在2011年发表在《自然》杂志上的一篇文章中提出了MNS障碍的一些研究优先事项(Collins等人。2011年)。根据这一议程，在过去5-6年里，全球精神卫生领域的新创新如雨后春笋般涌现，包括由美国国家精神卫生研究所(NIMH)、欧盟委员会(EC)、英国国际发展部(DFID)、加拿大大挑战和惠康信托基金等资助的一系列倡议。这些创新旨在提供具体的证据基础，以测试和展示干预措施缩小治疗差距的有效性。一项关键战略是根据世卫组织全球精神卫生行动计划(世卫组织，2013年b)的目标，通过任务转移或任务分担，将精神卫生纳入LMIC的初级保健系统。本文件将介绍两项此类倡议的案例研究：改善精神卫生保健方案(PRIME)和非洲精神卫生干预研究重点(ACHEMM)。然后，我们将从我们将精神健康纳入LMIC初级保健的经验中吸取教训。
Mental, neurological and substance use (MNS) disorders are now the leading cause of disability worldwide, contributing to 23% of global years of life lived with disability (Whiteford et al. 2013). Most of this burden is carried by low-and middle-income countries (LMICs). However, MNS disorders in LMICs do not receive the research attention or service personnel they deserve (Saxena et al. 2006), with the demand for services for outweighing the provision of services and treatment personnel. This gap in service provision is often referred to as the ‘treatment gap’. In response, a number of research priorities were proposed for MNS disorders by the Grand Challenges in Global Mental Health initiative in an article published in Nature in 2011 (Collins et al. 2011). In keeping with this agenda, there has been a burgeoning of new innovations in global mental health in the last 5–6 years, including a wide range of initiatives funded by the US National Institute of Mental Health (NIMH), the European Commission (EC), the UK Department for International Development (DFID), Grand Challenges Canada and the Wellcome Trust, among others.These innovations aim to provide a concrete evidence base to test and demonstrate the effectiveness of interventions to narrow the treatment gap. One key strategy is to integrate mental health into primary care systems in LMICs, through task shifting or task sharing, in line with the objectives of the WHO global mental health action plan (WHO, 2013 b). This paper will present case studies of two such initiatives: the PRogramme for Improving Mental health carE (PRIME) and the Africa Focus on Intervention Research for Mental health (AFFIRM). We will then draw out lessons from our experiences of integrating mental health into primary care in LMICs.