Mental health services implementation in Colombia-A systematic review.
Mental health services implementation in Colombia-A systematic review.
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DOI：
10.1371/journal.pgph.0001565
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发表时间：
2023
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哥伦比亚的精神卫生服务有一段复杂的历史，60年的武装冲突、以临床为主的精神卫生方法以及不平等和耻辱等社会因素塑造了哥伦比亚的精神卫生服务。1990年的《加拉加斯宣言》提出了向分散的社区精神卫生服务和干预转变的建议，其基础是恢复办法和对美洲精神卫生的社会决定因素的重视。哥伦比亚近年来在其法律和实践框架中采用了这些办法，但执行情况参差不齐。这项系统的审查旨在通过审查在哥伦比亚实施精神卫生服务的障碍和促进者，促进对哥伦比亚精神卫生服务的了解。对过去十年发表的定量和定性研究论文进行了搜索，以探索在五个数据库(Medline、PubMed、Scope us、SciELO和BVS)上关于哥伦比亚精神卫生服务的可用同行评议研究，并且没有语言限制。实施研究综合框架(CFIR)被用来构建分析的结构，并确定精神健康服务实施过程中的障碍和促进者。鉴于性别、种族和年龄因素对哥伦比亚健康格局的重要性，我们对《全球精神卫生框架》的社会政治经济学框架中的性别、种族和年龄进行了调整。最后，采用叙述性综合的方法对数据进行总结。确定了1530条记录，12篇文章符合所有纳入标准，并被纳入分析。8篇论文描述了物质使用障碍服务，11篇涉及多学科医疗保健专业人员，7篇在当地范围内实施。实施的主要障碍是缺乏协调、高工作量和低资金。促进者包括协议的使用，以及社区、利益相关者、用户和外部拥护者的参与。调查结果表明，社区和康复办法以及努力改善参与精神卫生领域的多部门行为者(例如，公共和私营组织、使用者及其家庭)之间的协调仍然很重要。
Colombia’s mental health services have a complex history shaped by 60 years of armed conflict, a predominantly clinical approach to mental health, and social factors such as inequities and stigma. The 1990 Caracas declaration proposed a shift towards decentralised community mental health services and interventions based on the recovery approach and emphasis on social determinants of mental health in the Americas. Colombia has adopted these approaches in its legal and practical framework in recent years, but implementation has been uneven. This systematic review aims to contribute to mental health services understanding in Colombia by examining the barriers and facilitators to the implementation of mental health services in Colombia. A search was conducted to explore available peer-reviewed studies on Colombian mental health services across five databases (Medline, PubMed, Scopus, Scielo and BVS) on quantitative and qualitative research papers published in the last ten years and without language restrictions. The Consolidated Framework for Implementation Research (CFIR) was used to structure the analysis and identify barriers and facilitators during the implementation of mental health services. We adapted the CFIR to attend to gender, race and age informed by the Socio-Political Economy of Global Mental Health framework, given the importance of these factors to the Colombian health landscape. Finally, narrative synthesis was used to summarise the data. 1 530 records were identified, and 12 articles met all inclusion criteria and were included in the analysis. 8 papers described substance use disorders services, 11 involved multidisciplinary healthcare professionals, and 7 were implemented at a local scale. The primary barriers to implementation were the lack of coordination, high workloads, and low funding. Facilitators included the use of protocols, and the involvement of communities, stakeholders, users, and external champions. Findings suggest the continued importance of community and recovery approaches and efforts to improve coordination between multi-sector actors involved in the mental health spaces (e.g., public, and private organisations, users and their families).