Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study.
Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study.
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DOI：
10.1017/s2045796017000634
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发表时间：
2018-03
影响因子：
8.1
通讯作者：
Hanlon C
中科院分区：
文献类型：
--
作者：
Lempp H;Abayneh S;Gurung D;Kola L;Abdulmalik J;Evans-Lacko S;Semrau M;Alem A;Thornicroft G;Hanlon C
本文的目的是：（i）探讨三个中低收入国家（LMICs）的精神卫生服务使用者、其照顾者、精神卫生中心负责人和政策制定者参与加强精神卫生系统的经验（埃塞俄比亚、尼泊尔和尼日利亚）; ㈡分析这种参与的潜在好处和障碍;以及（iii）确定实现更多服务使用者和护理者参与所需的策略。进行了一项跨国定性研究，采访了83个精神卫生服务的利益相关者。我们的分析表明，服务用户和照顾者参与卫生系统的加强过程是一个陌生的概念，为大多数参与者。他们报告说，直接参与的机会非常有限。耻辱和贫穷被认为是参与的主要障碍。与会者确定了几项战略，以克服现有的障碍，促进服务用户和照顾者参与加强精神卫生系统的过程中，如支持获得治疗，促进精神卫生和增强服务用户的能力。这项研究表明，服务用户的能力建设和加强用户群体将使他们能够从知情的角度为政策制定做出有意义的贡献。在中低收入国家，服务使用者及其照顾者参与精神卫生决策仍处于起步阶段。需要采取有效的战略来克服现有的障碍，例如为博士学位提供更广泛的资金。与服务使用者和照顾者进行参与性研究，以制定、实施和评估在中低收入国家当地和文化上可接受的参与方法。
The aims of this paper are to: (i) explore the experiences of involvement of mental health service users, their caregivers, mental health centre heads and policy makers in mental health system strengthening in three low- and middle-income countries (LMICs) (Ethiopia, Nepal and Nigeria); (ii) analyse the potential benefits and barriers of such involvement; and (iii) identify strategies required to achieve greater service user and caregiver participation. A cross-country qualitative study was conducted, interviewing 83 stakeholders of mental health services. Our analysis showed that service user and caregiver involvement in the health system strengthening process was an alien concept for most participants. They reported very limited access to direct participation. Stigma and poverty were described as the main barriers for involvement. Several strategies were identified by participants to overcome existing hurdles to facilitate service user and caregiver involvement in the mental health system strengthening process, such as support to access treatment, mental health promotion and empowerment of service users. This study suggests that capacity building for service users, and strengthening of user groups would equip them to contribute meaningfully to policy development from informed perspectives. Involvement of service users and their caregivers in mental health decision-making is still in its infancy in LMICs. Effective strategies are required to overcome existing barriers, for example making funding more widely available for Ph.D. studies in participatory research with service users and caregivers to develop, implement and evaluate approaches to involvement that are locally and culturally acceptable in LMICs.