McCubbin M, Cohen D
National Institute for Public Health, Oslo, Norway.
Health Care Anal. 1999;7(1):57-77. doi: 10.1023/A:1009443902415.
Most writers now recognize that mental health policy and the mental health system are extremely resistant to real changes that reflect genuine biopsychosocial paradigms of mental disorder. Writers bemoaning the intransigence of the mental health system tend to focus on a small analytical level, only to find themselves mired in the rationalities of the existing system. Problems are acknowledged to be system-wide, yet few writers have used a method of analysis appropriate for systemic problems. Drawing upon the General System Theory (GST) analytical perspective, this article advances a systematic approach to understand the mental health system and to facilitate the development of reform strategies that recognize the system's complexity and changing nature. The article first discusses the failure of major reform efforts in the mental health system and the limitations of mainstream analysis of mental health politics and policies with respect to the objectives of analysis and reform. This article describes how systems thinking has thus far influenced the study of the mental health policy and politics system, and argues that a systemic perspective is profitable for reconceiving the mental health system, enabling a fresh basis for the development of reform strategies. The mental health system should be seen as a social system influenced by larger political and economic dimensions, not just as a 'delivery system' scientifically constructed by neutral experts. Furthermore, the policy planning process should be viewed as part and parcel of a mental health system modeled as complex and dynamic. The systemic perspective outlined here should help both to clarify the value-based objectives that we hold for the system and, consequently, to plan for the strategic reforms that have so far eluded us.
如今，大多数作者都认识到，心理健康政策和心理健康系统极难发生真正反映精神障碍生物心理社会范式的切实变革。哀叹心理健康系统顽固不化的作者往往将关注点局限于较小的分析层面，结果却发现自己深陷现有系统的种种合理性之中。问题被认为是系统性的，但很少有作者采用适合系统性问题的分析方法。本文借鉴一般系统理论（GST）的分析视角，提出一种系统方法，以理解心理健康系统，并推动制定认识到该系统复杂性和不断变化本质的改革策略。文章首先讨论心理健康系统重大改革努力的失败，以及主流心理健康政治与政策分析在分析目标和改革方面的局限性。本文描述了系统思维迄今如何影响心理健康政策与政治系统的研究，并认为系统视角有助于重新构想心理健康系统，为制定改革策略提供新的基础。心理健康系统应被视为一个受更大政治和经济层面影响的社会系统，而不仅仅是由中立专家科学构建的“服务提供系统”。此外，政策规划过程应被视为以复杂和动态方式建模的心理健康系统的一部分。这里概述的系统视角应有助于阐明我们对该系统秉持的基于价值的目标，从而为规划迄今一直难以实现的战略改革提供帮助。
