Beyond the crisis: building back better mental health care in 10 emergency-affected areas using a longer-term perspective
Beyond the crisis: building back better mental health care in 10 emergency-affected areas using a longer-term perspective
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DOI：
10.1186/s13033-015-0007-9
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发表时间：
2015-03-12
影响因子：
3.6
通讯作者：
Saxena, Shekhar
中科院分区：
文献类型：
--
作者：
Epping-Jordan, JoAnne E.;van Ommeren, Mark;Saxena, Shekhar
背景：特别是在低收入和中等收入国家，在实现以社区为基础的全面精神卫生保健方面仍然存在重大差距。加速精神卫生改革的一个可能重要但被忽视的机会存在于紧急情况中，例如武装冲突或自然灾害。尽管紧急情况对受影响人群的心理健康和福祉产生不利影响，但它也引起了对这些问题的关注和资源，并为精神卫生服务的发展提供了机会。病例描述：如果病例代表受紧急情况影响的低收入或中等收入国家或地区，在2000年至2010年期间发起，成功地改变了精神卫生系统，并且能够由直接参与该病例的专家记录在案，则视为病例。根据这些标准，纳入了来自不同受紧急情况影响环境的10个案例：阿富汗、布隆迪、印度尼西亚（亚齐省）、伊拉克、约旦、科索沃、巴勒斯坦被占领土、索马里、斯里兰卡和东帝汶。讨论和评价：这些案例一般表明，可以利用紧急情况对精神卫生系统进行实质性和可持续的改进。从这些经验中，我们总结了如何实现这一目标的10条共同经验教训。这些经验教训包括从一开始就对精神卫生改革采取长期观点的重要性，以及注重解决新发和已有精神障碍的全系统改革。结论：如果在每次危机中都作出战略性努力，将对精神卫生问题的短期关注转化为精神卫生改革的动力，全球精神卫生保健的进展将会更快。
Background: Major gaps remain - especially in low- and middle-income countries - in the realization of comprehensive, community-based mental health care. One potentially important yet overlooked opportunity for accelerating mental health reform lies within emergency situations, such as armed conflicts or natural disasters. Despite their adverse impacts on affected populations' mental health and well being, emergencies also draw attention and resources to these issues and provide openings for mental health service development.Case description: Cases were considered if they represented a low- or middle- income country or territory affected by an emergency, were initiated between 2000 and 2010, succeeded in making changes to the mental health system, and were able to be documented by an expert involved directly with the case. Based on these criteria, 10 case examples from diverse emergency-affected settings were included: Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, occupied Palestinian territory, Somalia, Sri Lanka, and Timor-Leste.Discussion and evaluation: These cases demonstrate generally that emergency contexts can be tapped to make substantial and sustainable improvements in mental health systems. From these experiences, 10 common lessons learnt were identified on how to make this happen. These lessons include the importance of adopting a longer-term perspective for mental health reform from the outset, and focusing on system-wide reform that addresses both new-onset and pre-existing mental disorders.Conclusions: Global progress in mental health care would happen more quickly if, in every crisis, strategic efforts were made to convert short-term interest in mental health problems into momentum for mental health reform.