Mental health policy in South Africa: development process and content
Mental health policy in South Africa: development process and content
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DOI：
10.1093/heapol/czp027
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发表时间：
2009-09-01
影响因子：
3.2
通讯作者：
Flisher, Alan J.
中科院分区：
文献类型：
--
作者：
Draper, Catherine E.;Lund, Crick;Flisher, Alan J.
方法采用世界卫生组织（WHO）精神卫生系统评估工具收集SA精神卫生系统的定量数据。卫生组织心理健康政策和计划核对表已为南非1997年心理健康政策准则完成。半结构化访谈提供了对精神卫生政策制定过程、潜在问题和主要利益攸关方之间相互作用的理解。结果1997年的政策方针是否应纳入国家政策，在省级层面存在不确定性。在国家一级，这些准则不被认为是政策，目前正在制定一项新的政策。虽然这些准则是经过广泛协商制定的，并通过国家政策制定进程获得批准，但在省一级的传播和执行方面遇到了困难。这些政策准则的原则符合国际上关于精神卫生保健和服务的建议，但缺乏明确的目标。对精神卫生的重视程度不高，省级精神卫生协调员的资历参差不齐，政策和规划人员有限，省和国家各级的技术能力参差不齐，以及一些省级当局不愿承担推动实施的责任，这些都阻碍了精神卫生政策的实施进程。结论这些发现突出了国家在制定新的精神卫生政策方面的重要性，国家和省级之间的沟通，省级机构承担实施责任的必要性，以及使决策者和规划者能够制定、监测和实施政策的能力建设。
Methods Quantitative data regarding SA's mental health system were gathered using the World Health Organization (WHO) Assessment Instrument for Mental Health Systems. The WHO Checklist for Mental Health Policy and Plans was completed for SA's 1997 mental health policy guidelines. Semi-structured interviews provided understanding of processes, underlying issues and interactions between key stakeholders in mental health policy development.Results There is uncertainty at provincial level regarding whether the 1997 policy guidelines should be considered national policy. At national level the guidelines are not recognized as policy, and a new policy is currently being developed. Although the guidelines were developed through wide consultation and had approval through national policy development processes, difficulties were encountered with dissemination and implementation at provincial level. The principles of these policy guidelines conform to international recommendations for mental health care and services but lack clear objectives.Discussion The process of mental health policy implementation has been hindered by the low priority given to mental health, varying levels of seniority of provincial mental health coordinators, limited staff for policy and planning, varying technical capacity at provincial and national levels, and reluctance by some provincial authorities to accept responsibility for driving implementation.Conclusion These findings highlight the importance of national leadership in the development of new mental health policy, communication between national and provincial levels, the need for provincial structures to take responsibility for implementation, and capacity building to enable policy makers and planners to develop, monitor and implement policy.