Kramer M
Psychol Med. 1976 May;6(2):185-215. doi: 10.1017/s003329170001374x.
The planning of health services consists of a process that generally involves the following steps: (a) situational analysis, or the description, definition and statement of the problem, its characteristics and dimensions in relation to population and time; (b) the formulation of alternative tactical approaches to the handling and solution of the problem; (c) decision analysis or the selection of a plan; (d) discussion and implementation of the plan selected; (e) evaluation of the results achieved in relation to the problem, situations or populations concerned. This paper discusses the content of a programme of mental health services research for collecting and analysing the information needed to apply these processes to the planning of mental health services, monitoring the manner in which the plan is being implemented, and assessing its effectiveness in achieving short-term and intermediate objectives and long-term goals. Statistical and epidemiological information play an important role in these processes, particularly in the situational analysis and the evaluation processes. Illustrations have been provided of types of data that are produced in the national mental health statistics programme in the United States. Difficulties in using such data to answer questions concerning the needs for mental health services, and manpower requirements for delivering services to meet these needs are discussed. In many instances, currently available data are quite inadequate for answering key issues such as these, plus others related to living arrangements of the population, the effect of services on the persons who receive them, their families and the communities in which they live. Thus, much still remains to be done to develop systematic, comparative morbidity statistics on the incidence, duration and prevalence of mental disorders in the general population, on the needs for mental health services, and on the effectiveness of our efforts to prevent disorders that can be prevented, and to reduce the amount of disability and distress caused by those that cannot be prevented or terminated. A series of problems have been identified, the solutions to which would assist materially in providing data that would narrow gaps between available knowledge and that which is needed. The importance of establishing well-staffed research units at the catchment area level with stable funding to accomplish this is underscored. It is a matter of the greatest urgency that adequate resources--financial, manpower, scientific and administrative--be made available to solve these problems. If this is not done, then effordts to document quantitatively the effectiveness of programmes to prevent and control mental disorders will continue to suffer from many of the same shortcomings that have impeded our past and continue to impede current efforts to accomplish this.
(a) 情况分析，即对问题进行描述、界定和说明，包括其特征以及与人口和时间相关的范围；(b) 针对问题的处理和解决制定可供选择的策略方法；(c) 决策分析，即选择一项计划；(d) 对所选计划进行讨论并实施；(e) 评估就相关问题、情况或人群所取得的成果。本文讨论了一项精神卫生服务研究计划的内容，该计划旨在收集和分析将这些过程应用于精神卫生服务规划、监测计划实施方式以及评估其在实现短期和中期目标及长期目标方面有效性所需的信息。统计和流行病学信息在这些过程中发挥着重要作用，尤其是在情况分析和评估过程中。文中给出了美国国家精神卫生统计计划所产生的数据类型示例。讨论了利用此类数据回答有关精神卫生服务需求以及提供服务以满足这些需求所需人力的问题时所面临的困难。在许多情况下，目前可得的数据远远不足以回答此类关键问题以及其他与人口生活安排、服务对接受服务者及其家庭和所在社区的影响相关的问题。因此，在制定关于普通人群精神障碍发病率、病程和患病率、精神卫生服务需求以及我们预防可预防障碍并减少不可预防或无法终止障碍所导致的残疾和痛苦的努力成效的系统、可比发病率统计方面，仍有许多工作要做。已确定了一系列问题，解决这些问题将极大地有助于提供缩小现有知识与所需知识之间差距的数据。强调了在集水区层面设立人员配备充足、资金稳定的研究单位以实现这一目标的重要性。提供充足的资源——财政、人力、科学和行政资源——以解决这些问题是最为紧迫的事项。如果不这样做，那么定量记录预防和控制精神障碍计划有效性的努力将继续受到许多同样的缺陷的困扰，这些缺陷过去阻碍了我们，并且目前仍在阻碍我们实现这一目标的努力。
