Medicalisation in public primary mental health care services in Chile
Medicalisation in public primary mental health care services in Chile
复制标题
智利公共初级精神卫生保健服务的医疗化
DOI：
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Raudelio Machin Suarez
中科院分区：
文献类型：
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作者：
Jorge Luis Crespo Suárez;Raudelio Machin Suarez
将精神卫生服务纳入初级保健是一项全球公认的缩小精神障碍治疗差距的战略，但它也因鼓励日常生活的医疗化而受到批评。在智利，这一战略在过去几十年中得到了支持和迅速推广，今天，所有初级公共保健中心都纳入了精神卫生服务。然而，尽管一些报告强调了综合初级保健出现的问题，但很少对其对服务、团队和社区的影响进行批判性的社会分析。本文旨在分析智利的初级公共精神卫生服务（PPMHS）如何有助于医疗生活。卫生政策，报告，从当地公共卫生问题的研究和作者的经验的证据进行检查，以发展的论点。有人建议，全民健康服务和综合初级公共保健政策和制度化使用的标准分类的精神障碍的问题，支持生存的简化生物医学疾病模型和精神病理学生活的趋势。我们的结论是，这些因素的基础在智利的初级公共精神卫生服务的日常生活的医疗化。与日常实践的关键参与是必要的，以防止PPMHS通过为人们和社区提供医疗解决方案而不是在他们的日常解决问题行为中产生代理来削弱他们的能力。
The integration of mental health services into primary care is a globally acclaimed strategy to close the treatment gap for mental disorders, but it has also been criticised for encouraging the medicalisation of everyday life. In Chile, this strategy has gained support and spread quickly in the last decades, and today, all primary public care centres have incorporated a mental health service. However, although some reports highlight problems that have arisen with integrated primary care, the critical social analysis of its impact on services, teams and communities is scarce. This article aims to analyse how primary public mental healthcare services (PPMHSs) in Chile could be contributing to medicalise life. Health policies, reports, evidence from research on local public health issues and the author’s experience are examined to develop the arguments. It is suggested that issues with the universal health access and integrated primary public care policies and the institutionalised use of standard classifications of mental disorders support the survival of a reductionist biomedical disease model and a trend to psychopathologise life. We conclude that these factors underpin the medicalisation of everyday life in primary public mental healthcare services in Chile. Critical engagement with daily practice is necessary to prevent PPMHSs from disempowering people and communities by providing them with medicalised solutions, instead of generating agency in their everyday problem-solving behaviours.