Scaling up mental health care and psychosocial support in low-resource settings: a roadmap to impact.
Scaling up mental health care and psychosocial support in low-resource settings: a roadmap to impact.
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DOI：
10.1017/s2045796020001018
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发表时间：
2020-11-26
影响因子：
8.1
通讯作者：
Kohrt BA
中科院分区：
文献类型：
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作者：
Jordans MJD;Kohrt BA
尽管最近全球关注心理健康和心理社会支持服务以及越来越多的证据支持干预措施，但在低收入和中等收入国家（LMIC），很少有区域或国家规模的心理健康服务。有无数的挑战和障碍，从测试干预措施，不针对人口或决策者的优先需要，干预措施，不能实现足够的覆盖面，以减少治疗差距在低收入中等收入国家。我们提出了一个“影响路线图”的过程，指导规划的干预措施，从研究空间到实施空间。我们建立了四个标准和九个相关指标，可以在低资源环境下进行评估，以促进成功扩展心理健康和心理社会干预的最大可能性。这些标准是相关性（指标：人口需求、文化和背景适应性）、有效性（心理健康结果的变化、假设的行动机制的变化）、质量（坚持、能力、出勤率）和可行性（覆盖范围、费用）。在研究领域，在进入执行领域之前，需要确立相关性和有效性。在实施领域，需要不断监测质量和可行性，以实现和保持积极的公共卫生影响。最后，需要用这些标准和指标建立一个数据库或储存库，以帮助研究人员建立和监测指标的最低基准，并使决策者和从业人员能够选择在其环境中最有可能成功的干预措施。一个具有一系列可衡量指标的切实可行的路线图是大规模实施干预措施和缩小世界各地心理健康治疗差距的重要一步。
Despite recent global attention to mental health and psychosocial support services and a growing body of evidence-support interventions, few mental health services have been established at a regional or national scale in low- and middle-income countries (LMIC). There are myriad challenges and barriers ranging from testing interventions that do not target priority needs of populations or policymakers to interventions that cannot achieve adequate coverage to decrease the treatment gap in LMIC. We propose a ‘roadmap to impact’ process that guides planning for interventions to move from the research space to the implementation space. We establish four criteria and nine associated indicators that can be evaluated in low-resource settings to foster the greatest likelihood of successfully scaling mental health and psychosocial interventions. The criteria are relevance (indicators: population need, cultural and contextual fit), effectiveness (change in mental health outcome, change in hypothesised mechanism of action), quality (adherence, competence, attendance) and feasibility (coverage, cost). In the research space, relevance and effectiveness need to be established before moving into the implementation space. In the implementation space, ongoing monitoring of quality and feasibility is required to achieve and maintain a positive public health impact. Ultimately, a database or repository needs to be developed with these criteria and indicators to help researchers establish and monitor minimum benchmarks for the indicators, and for policymakers and practitioners to be able to select what interventions will be most likely to succeed in their settings. A practicable roadmap with a sequence of measurable indicators is an important step to delivering interventions at scale and reducing the mental health treatment gap around the world.