Marconi T J
Acta Psiquiatr Psicol Am Lat. 1976 Dec;22(4):277-81.
The author contends that in order to meet Mental Health requirements in Latin American countries, an effort must be made in modifying the training of personnel, ranging from high ranking psychiatrists and specialists, to community leaders. He examines the current possibilities and needs and assesses the consequences of new training methods. Starting from a summary review of the three main models for Mental Health Programs: Mental Institution or Hospital, Mental Health Unit and Comprehensive Program, an evaluation is made of the many advantages of the latter. The training of personnel for the Comprehensive Program reflects its structure of delegations. The lower level, D5, is the whole population having any mental health risks. In order to prevent them, leaders at the D4 level must be trained, preferably among recovered patients, at the ratio one D4 for every 500 D5. Training and supervision of D4 leaders is made by D3 leaders, recruited among intermediate professionals: teachers, nurses, priests, auxiliaries in mental health, etc. The ratio is one D3 every 20 D4. The following level is that of D2 leaders, in which specialists (psychologists, social assistants, psychiatric nurses, etc.) act on a professional basis. The ratio is one D2 every 4 D3. Finally, the upper level is D1, the directors of the program, psychiatrists having the direction, supervision and training of D2 leaders. The ratio is one D1 every 2,5 D2. An evaluation is made of the experience carried out at Santiago (Chile) where it lasted eight years, and at Córdoba (Argentina) during eight months. The final evaluation stresses the advantages of the system, which at an extremely low cost/benefit ratio provides a comprehensive covering, profiting by the natural health resources of the community, otherwise neglected in their full potential benefits.
作者认为,为满足拉丁美洲国家的心理健康需求,必须努力改变从高级精神科医生和专家到社区领袖等各类人员的培训方式。他研究了当前的可能性和需求,并评估了新培训方法的后果。从对心理健康项目的三种主要模式:精神病院、心理健康单元和综合项目的简要回顾入手,对综合项目的诸多优势进行了评估。综合项目的人员培训反映了其分级结构。较低层级,即D5级,是所有有心理健康风险的人群。为预防这些风险,必须培训D4级的领袖,最好从康复患者中选拔,比例为每500名D5级人员配备1名D4级领袖。D4级领袖由D3级领袖进行培训和监督,D3级领袖从教师、护士、牧师、心理健康辅助人员等中级专业人员中选拔,比例为每20名D4级领袖配备1名D3级领袖。下一层级是D2级领袖,由专家(心理学家、社会助理、精神科护士等)以专业身份开展工作,比例为每4名D3级领袖配备1名D2级领袖。最后,最高层级是D1级,即项目主任,由精神科医生对D2级领袖进行指导、监督和培训,比例为每2.5名D2级领袖配备1名D1级领袖。对在智利圣地亚哥进行了八年的以及在阿根廷科尔多瓦进行了八个月的经验进行了评估。最终评估强调了该系统的优势,即以极低的成本效益比提供全面覆盖,利用社区的自然健康资源,否则这些资源的全部潜在效益将被忽视。