Mitchell Penny
Faculty of Medicine, Centre for Health Programs, Policy and Economics, University of Melbourne, Melbourne, Victoria, Australia.
Health Soc Care Community. 2009 Feb;17(1):71-82. doi: 10.1111/j.1365-2524.2008.00800.x. Epub 2008 Aug 11.
Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.
几十年来，精神卫生保健服务提供模式的变化给初级卫生和社会护理服务带来了压力，要求它们更多地参与其中。在英国、澳大利亚和新西兰等国家，精神卫生政策认识到这些服务需要做出更大贡献，并呼吁加强部门间合作。在澳大利亚，迄今为止，大部分投资都集中在专科精神卫生服务与初级医疗保健的发展和整合上，评估研究表明已取得了一些进展。然而，在精神健康问题患者所接受护理的全面性和连续性方面，尤其是在社会和心理社会干预方面，仍然存在严重不足。很少有研究探讨非医学初级卫生和社会护理服务在精神卫生保健中实际或潜在发挥的作用的性质。缺乏关于这些作用的信息可能阻碍了针对这些服务的服务改进举措的发展。本文报告了一项探索性研究的结果，该研究考察了澳大利亚维多利亚州41种不同的非医学初级卫生和社会护理服务在精神卫生保健中的作用。2004年采用目的抽样策略收集了数据。采用了一种新颖的调查提供者的方法，即每个机构内的受访者作为一个小组共同完成一项结构化调查，同时收集定量和定性数据。本文报告了定量分析的结果，包括一项初步的主成分分析，该分析考察了作用的结构。非医学初级卫生和社会护理服务目前正在履行各种各样的精神卫生保健职责，并且它们渴望更多地参与这项工作。然而，这些提供者不赞成采用针对患有精神障碍的客户进行选择性定位的方法。
