Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.
Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.
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DOI：
10.1371/journal.pone.0088437
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Prince M
中科院分区：
文献类型：
--
作者：
Hanlon C;Luitel NP;Kathree T;Murhar V;Shrivasta S;Medhin G;Ssebunnya J;Fekadu A;Shidhaye R;Petersen I;Jordans M;Kigozi F;Thornicroft G;Patel V;Tomlinson M;Lund C;Breuer E;De Silva M;Prince M
关于如何在低收入和中等收入国家实施心理健康服务，以适应国家内部和国家之间遇到的不同环境，人们知之甚少。在本文中，我们比较了五个LMIC(埃塞俄比亚、印度、尼泊尔、南非和乌干达)参与改善精神卫生保健计划(Prime)的基线背景、挑战和机会。其目的是为制定和执行将心理健康纳入初级保健的全面地区计划提供信息。利用现有工具和专家共识，为这项研究开发了一个情况分析工具。在所有五个区中，所获得的横断面信息基本上都是公开的。优质研究区面临着巨大的背景和卫生系统挑战，其中许多挑战在各个地点都很常见。目前还没有关于精神障碍现有治疗覆盖面的可靠信息。特别是在低收入国家，缺乏许多精神卫生保健的卫生服务组织要求，包括支持这项服务的专门精神卫生专业人员和可靠的药物供应。在所有地点，社区心理健康素养都很低，没有多部门工作或与传统或宗教治疗师合作的模式。然而，卫生系统的机会是显而易见的。在每个地区都有可能应用现有的结核病和艾滋病毒或非传染性疾病护理模式，这些模式建立了检测护理、外展和坚持支持的辍学情况的机制。大多数地区的社区卫生工作者和志愿人员的广泛网络为扩大精神卫生保健提供了进一步的机会。各地点的基线卫生系统准备水平较低，这突出表明，卫生保健组织、卫生设施和社区层面的干预措施对于可持续地提供纳入初级保健的高质量精神卫生保健至关重要。
Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.
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影响因子：
15.8
作者：
Dua T;Barbui C;Clark N;Fleischmann A;Poznyak V;van Ommeren M;Yasamy MT;Ayuso-Mateos JL;Birbeck GL;Drummond C;Freeman M;Giannakopoulos P;Levav I;Obot IS;Omigbodun O;Patel V;Phillips M;Prince M;Rahimi-Movaghar A;Rahman A;Sander JW;Saunders JB;Servili C;Rangaswamy T;Unützer J;Ventevogel P;Vijayakumar L;Thornicroft G;Saxena S
通讯作者：
Saxena S
影响因子：
4.5
作者：
Kebede, D;Alem, A;Beyero, T
通讯作者：
Beyero, T
DOI：
10.1111/j.1469-7610.2010.02209.x
发表时间：
2010-07-01
影响因子：
7.6
作者：
Jordans, Mark J. D.;Komproe, Ivan H.;de Jong, Joop T. V. M.
通讯作者：
de Jong, Joop T. V. M.
影响因子：
6.7
作者：
Awas, M;Kebede, D;Alem, A
通讯作者：
Alem, A
影响因子：
6.7
作者：
Alem, A;Kebede, D;Kullgren, G
通讯作者：
Kullgren, G