农业心理健康服务网络分析
Service network analysis for agricultural mental health.
作者信息
Fuller Jeffrey D, Kelly Brian, Law Susan, Pollard Georgia, Fragar Lyn
机构信息
Department of Rural Health, University of Sydney and Southern Cross University, NSW, Australia.
出版信息
BMC Health Serv Res. 2009 May 29;9:87. doi: 10.1186/1472-6963-9-87.
BACKGROUND
Farmers represent a subgroup of rural and remote communities at higher risk of suicide attributed to insecure economic futures, self-reliant cultures and poor access to health services. Early intervention models are required that tap into existing farming networks. This study describes service networks in rural shires that relate to the mental health needs of farming families. This serves as a baseline to inform service network improvements.
METHODS
A network survey of mental health related links between agricultural support, health and other human services in four drought declared shires in comparable districts in rural New South Wales, Australia. Mental health links covered information exchange, referral recommendations and program development.
RESULTS
87 agencies from 111 (78%) completed a survey. 79% indicated that two thirds of their clients needed assistance for mental health related problems. The highest mean number of interagency links concerned information exchange and the frequency of these links between sectors was monthly to three monthly. The effectiveness of agricultural support and health sector links were rated as less effective by the agricultural support sector than by the health sector (p < .05). The most highly linked across all areas of activity were Rural Financial Counsellors, the Department of Primary Industry Drought Support Workers and Community Health Centres. Hence for a mental health service network targeting farming families these are three key agencies across the spectrum of case work to program development. The study limitations in describing service networks relate to the accuracy of network bounding, self report bias and missing data from non participants.
CONCLUSION
Aligning with agricultural agencies is important to build effective mental health service pathways to address the needs of farming populations. Work is required to ensure that these agricultural support agencies have operational and effective links to primary mental health care services. Network analysis provides a baseline to inform this work. With interventions such as local mental health training and joint service planning to promote network development we would expect to see over time an increase in the mean number of links, the frequency in which these links are used and the rated effectiveness of these links.
背景
农民是农村和偏远社区中的一个亚群体，由于经济前景不稳定、自给自足的文化以及难以获得医疗服务，他们面临着更高的自杀风险。需要早期干预模式来利用现有的农业网络。本研究描述了农村郡中与农业家庭心理健康需求相关的服务网络。这为改进服务网络提供了一个基线。
方法
对澳大利亚新南威尔士州农村可比地区四个宣布干旱的郡中农业支持、卫生和其他人类服务之间与心理健康相关的联系进行网络调查。心理健康联系涵盖信息交流、转诊建议和项目开发。
结果
111个机构中的87个（78%）完成了调查。79%的机构表示，其三分之二的客户需要心理健康相关问题的援助。机构间联系的平均数量最高的是信息交流，这些联系在各部门之间的频率为每月至每三个月一次。农业支持部门认为农业支持与卫生部门联系的有效性低于卫生部门（p < 0.05）。在所有活动领域联系最紧密的是农村金融顾问、初级产业部干旱支持工作人员和社区卫生中心。因此，对于以农业家庭为目标的心理健康服务网络而言，这些是从个案工作到项目开发整个范围内的三个关键机构。本研究在描述服务网络方面的局限性涉及网络界定的准确性、自我报告偏差以及未参与者的缺失数据。
结论
与农业机构合作对于建立有效的心理健康服务途径以满足农业人口的需求非常重要。需要开展工作以确保这些农业支持机构与初级心理健康护理服务建立有效且可操作的联系。网络分析为这项工作提供了一个基线。通过诸如当地心理健康培训和联合服务规划等干预措施来促进网络发展，我们预计随着时间的推移，联系的平均数量、这些联系的使用频率以及这些联系的评定有效性将会增加。
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