Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.
Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.
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DOI：
10.1186/s13031-014-0030-5
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发表时间：
2015
影响因子：
3.6
通讯作者：
Komproe IH
中科院分区：
文献类型：
--
作者：
Luitel NP;Jordans MJ;Adhikari A;Upadhaya N;Hanlon C;Lund C;Komproe IH
精神卫生问题是全球一个严重的公共卫生问题。目前，在低收入和中等收入国家（LMIC），五分之四的严重精神疾病患者没有得到有效的治疗。迫切需要解决这一巨大的治疗差距。改变专业精神卫生工作者（精神科医生和心理学家）的工作重点，从仅仅提供服务到同时设计和管理精神卫生服务;建设初级卫生保健工作者的临床能力，以及提供精神卫生服务的监督和质量保证，可能有助于扩大中低收入国家的精神卫生服务。然而，很少有人知道，在脆弱的国家设置，如尼泊尔的心理健康政策和服务的背景下，这些战略。一个标准的情况分析工具是由改善精神卫生保健计划（PRIME）财团开发的，用于系统地分析和描述尼泊尔目前在精神卫生保健方面的差距，以便为制定地区一级的精神卫生保健计划提供信息。它由六个部分组成;一般资料（例如人口、社会经济状况）;精神健康政策和计划;精神健康治疗的覆盖范围;地区保健服务;以及社区服务。数据来自第二手来源，包括科学出版物、报告、项目文件和医院记录。尼泊尔于1997年通过了心理健康政策，但政策框架的实施尚未开始。与其他中低收入国家一样，分配给心理健康的预算很少。心理健康服务集中在大城市，每10万人口中有0.22名精神病医生和0.06名心理学家。在建立地区一级精神卫生保健方案方面遇到的主要挑战包括：卫生工作者负担过重，初级保健中心缺乏精神药物，现有系统缺乏精神卫生监督，卫生和人口部缺乏协调机构。克服这些挑战的战略包括卫生和人口部参与这一进程，特别是提供精神药物和任命一名高级官员促进项目活动，以及与国家卫生培训中心合作开展培训方案。这项研究描述了尼泊尔精神卫生保健面临的许多挑战。大多数这些挑战都不是新的，但这项研究有助于我们了解这些困难，概述了国家和地区层面的因素，有一个直接影响地区层面的精神卫生保健计划的发展。本文的在线版本（doi：10.1186/s13031-014-0030-5）包含补充材料，可供授权用户使用。
Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry of Health and Population (MoHP). Strategies to overcome these challenges included involvement of MoHP in the process, especially by providing psychotropic medicines and appointing a senior level officer to facilitate project activities, and collaboration with National Health Training Centers (NHTC) in training programs. This study describes many challenges facing mental health care in Nepal. Most of these challenges are not new, yet this study contributes to our understanding of these difficulties by outlining the national and district level factors that have a direct influence on the development of a district level mental health care plan. The online version of this article (doi:10.1186/s13031-014-0030-5) contains supplementary material, which is available to authorized users.
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影响因子：
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作者：
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