The "treatment gap" in global mental health reconsidered: sociotherapy for collective trauma in Rwanda
The "treatment gap" in global mental health reconsidered: sociotherapy for collective trauma in Rwanda
复制标题
DOI：
10.3402/ejpt.v6.28706
复制
发表时间：
2015-11-19
影响因子：
5
通讯作者：
Richters, Annenniek
中科院分区：
文献类型：
--
作者：
Jansen, Stefan;White, Ross;Richters, Annenniek
背景资料：精神障碍的“治疗差距”（TG）是指需要护理的人数和接受护理的人数之间存在的差异。这一概念得到世界卫生组织的大力推广，并在中低收入国家得到广泛应用。虽然接受了许多显而易见的好处，从这种方法的流动，重要的是要批判性地反思的TG的概念的局限性及其对精神卫生servicesinRwand.Objective建设能力的影响：文章强调关注的证据基础，心理健康干预措施是不是全球有效的，并problematizes精神病学的方法在国际精神卫生准则的优势。具体而言，医疗化的社会问题和有限的方式，“社区”已被概念化的全球精神卫生话语的风险得到解决。而不是用来作为提高经济效率的方法（即，减少医疗保健费用），应促进“社区”作为利用集体力量和资源的一种手段，以帮助促进心理健康。这可能是特别有益的情况下，如卢旺达，社区生活已被集体暴力破坏，由此产生的社会隔离构成了一个重要的决定因素的精神distress.Conclusions：向前迈进，有必要考虑替代范式，个人的痛苦被理解为社会困扰的症状，这超出了更个性化的TG范式。社会疗法是卢旺达过去10年来使用的一种干预措施，它是如何建立支持社区以促进心理健康和心理社会福祉的一个例子。
Background: The "treatment gap" (TG) for mental disorders refers to the difference that exists between the number of people who need care and those who receive care. The concept is strongly promoted by the World Health Organization and widely used in the context of low- and middle-income countries. Although accepting the many demonstrable benefits that flow from this approach, it is important to critically reflect on the limitations of the concept of the TG and its implications for building capacity for mental health services in Rwanda.Objective: The article highlights concerns that the evidence base for mental health interventions is not globally valid, and problematizes the preponderance of psychiatric approaches in international guidelines for mental health. Specifically, the risk of medicalization of social problems and the limited way in which "community" has been conceptualized in global mental health discourses are addressed. Rather than being used as a method for increasing economic efficiency (i.e., reducing healthcare costs), "community" should be promoted as a means of harnessing collective strengths and resources to help promote mental well-being. This may be particularly beneficial for contexts, like Rwanda, where community life has been disrupted by collective violence, and the resulting social isolation constitutes an important determinant of mental distress.Conclusions: Moving forward there is a need to consider alternative paradigms where individual distress is understood as a symptom of social distress, which extends beyond the more individually oriented TG paradigm. Sociotherapy, an intervention used in Rwanda over the past 10 years, is presented as an example of how communities of support can be built to promote mental health and psychosocial well-being.