Scaling Up for the "Bottom Billion": "5x5" Implementation of Community Mental Health Care in Low-Income Regions
Scaling Up for the "Bottom Billion": "5x5" Implementation of Community Mental Health Care in Low-Income Regions
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DOI：
10.1176/appi.ps.000012011
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发表时间：
2011-12-01
影响因子：
3.8
通讯作者：
Eustache, Eddy
中科院分区：
文献类型：
--
作者：
Belkin, Gary S.;Unuetzer, Juergen;Eustache, Eddy
在最贫穷的国家，常见的精神障碍造成了巨大的健康和社会负担。这个开放论坛描述了一个规划框架，以促进在这些环境中有效、可持续地设计和实施精神卫生服务。它建立在治疗传播方面的研究和作者在几个项目中的经验的基础上，这些项目包括撒哈拉以南非洲的千年村项目和海地的卫生系统伙伴（Zanmi Lasante）。作者描述了一种“护理金字塔”方法，该方法指定了五个关键技能包，以解决资源匮乏环境中常见的精神障碍问题，并制定了五个实施规则：首先评估环境；确定重点护理途径，并将其映射到技能包中；指定决策支持、监督和分类规则；采用质量改进措施；并规划可持续性和能力建设。该框架解决了对共享词汇和一套工具的需求，以协调和比较在不同环境中扩大精神卫生治疗的努力。（精神科服务62:1494-1502,2011）
Common mental disorders pose tremendous health and social burdens in the poorest countries. This Open Forum describes a planning framework to advance effective, sustainable design and implementation of mental health services in these settings. It builds on research in treatment dissemination and on the authors' experience in several initiatives-including the Millennium Villages Project in sub-Saharan Africa and the Partners In Health system in Haiti (Zanmi Lasante). The authors describe a "pyramid of care" approach that specifies five key skill packages to address common mental disorders in low-resource settings and five implementation rules: assess context first; identify priority care pathways and map them across skill packages; specify decision supports, supervision, and triage rules; use quality improvement practices; and plan for sustainability and capacity building. The framework addresses the need for a shared vocabulary and a set of tools to coordinate and compare efforts to scale-up mental health treatment across diverse settings. (Psychiatric Services 62:1494-1502, 2011)