Global Mental Health 5 - Barriers to improvement of mental health services in low-income and middle-income countries
Global Mental Health 5 - Barriers to improvement of mental health services in low-income and middle-income countries
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DOI：
10.1016/s0140-6736(07)61263-x
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发表时间：
2007-09-29
期刊：
影响因子：
168.9
通讯作者：
Underhill, Chris
中科院分区：
文献类型：
--
作者：
Saraceno, Benedetto;van Ommeren, Mark;Underhill, Chris
尽管一些国家发表了备受瞩目的报告，并开展了有希望的活动，但在大多数低收入和中等收入国家，精神卫生服务发展的进展一直缓慢。我们通过对国际精神卫生专家和领导人的定性调查，审查了精神卫生服务发展的障碍。障碍包括：普遍的公共卫生优先议程及其对供资的影响;精神卫生服务分散化的复杂性和阻力;在初级保健环境中实施精神卫生保健的挑战;接受精神卫生保健培训和监督的工作人员数量少，类型少;精神卫生领导层经常缺乏公共卫生观点。在改善精神卫生服务方面取得进展的许多障碍可以通过产生政治意愿来克服，以组织可获得和人道的精神卫生保健。精神障碍患者的倡导者需要澄清他们的信息并进行合作。必须克服资源分散的阻力，特别是在许多精神卫生专业人员和医院工作人员中。初级保健中的精神卫生投资很重要，但不太可能持续下去，除非在此之前或同时发展社区精神卫生服务，以便为初级保健工作者提供培训，监督和持续支持。必须加紧调动和承认社区中的非正规资源。没有受过正式专业培训的社区成员和精神障碍患者及其家人需要参与宣传和提供服务。全人口在获得人道精神卫生保健方面的进展将取决于对政治、领导、规划、宣传和参与的更多关注。
Despite the publication of high-profile reports and promising activities in several countries, progress in mental health service development has been slow in most low-income and middle-income countries. We reviewed barriers to mental health service development through a qualitative survey of international mental health experts and leaders. Barriers include the prevailing public-health priority agenda and its effect on funding; the complexity of and resistance to decentralisation of mental health services; challenges to implementation of mental health care in primary-care settings; the low numbers and few types of workers who are trained and supervised in mental health care; and the frequent scarcity of public-health perspectives in mental health leadership. Many of the barriers to progress in improvement of mental health services can be overcome by generation of political will for the organisation of accessible and humane mental health care. Advocates for people with mental disorders will need to clarify and collaborate on their messages. Resistance to decentralisation of resources must be overcome, especially in many mental health professionals and hospital workers. Mental health investments in primary care are important but are unlikely to be sustained unless they are preceded or accompanied by the development of community mental health services, to allow for training, supervision, and continuous support for primary care workers. Mobilisation and recognition of non-formal resources in the community must be stepped up. Community members without formal professional training and people who have mental disorders and their family members, need to partake in advocacy and service delivery. Population-wide progress in access to humane mental health care will depend on substantially more attention to politics, leadership, planning, advocacy, and participation.