Mental Health, Disability, and Rehabilitation Project of the Pan American Health Organization, Washington, DC, USA.
Int Rev Psychiatry. 2010;22(4):317-24. doi: 10.3109/09540261.2010.500863.
This paper summarizes a series of events that were historical milestones in Latin America and the Caribbean in the long road toward restructuring and setting up psychiatric and mental health services to shift from the old and obsolete psychiatric hospital models to other, community-based models. This has been and largely remains the principal challenge that we face. The burden of mental illness is described in terms of morbidity, mortality, and disability. In 1990, it was estimated that psychiatric and neurological disorders accounted for 8.8% of the disability-adjusted life years in Latin America and the Caribbean; in 2004 that burden had grown to 21%. However, the treatment gap (sick people who remain untreated) exceeds 60%; added to that there is a prevailing gap in funding and resources for the treatment of mental health problems. In response to these problems, the Pan American Health Organization (PAHO/WHO) has continued to strengthen its technical cooperation with the countries. The 49th Directing Council of PAHO/WHO approved the Strategy and Plan of Action on Mental Health for the region of the Americas, which constitutes a major historical landmark; for the first time, the ministries of health in every country in the hemisphere studied and approved a work programme to improve mental health care based on the experiences gained and expressing a technical and political commitment. It is a key priority to continue working to restructure mental health services and strengthen intersectoral initiatives to promote mental health; specific problems, such as care for vulnerable groups, child and adolescent mental health, suicide, alcohol abuse, and violence, also pose a great challenge for mental health programs today.
本文总结了拉丁美洲和加勒比地区在漫长的精神卫生服务重建和建立道路上的一系列历史里程碑事件，这些事件旨在将旧的、过时的精神病院模式转变为其他以社区为基础的模式。这一直是我们面临的主要挑战。精神疾病的负担体现在发病率、死亡率和残疾率上。1990 年，据估计，精神和神经障碍占拉丁美洲和加勒比地区残疾调整生命年的 8.8%；2004 年，这一负担增长到 21%。然而，治疗缺口（未得到治疗的患病者）超过 60%；此外，用于治疗精神健康问题的资金和资源也存在普遍缺口。针对这些问题，泛美卫生组织（PAHO/WHO）继续加强与各国的技术合作。泛美卫生组织第 49 届理事会批准了《美洲地区精神卫生战略和行动计划》，这是一个重大的历史里程碑；该地区每个国家的卫生部首次根据所获得的经验研究和批准了一项改善精神卫生保健的工作方案，并表达了技术和政治承诺。继续努力重组精神卫生服务和加强促进精神卫生的部门间举措，仍是一项关键优先事项；具体问题，如弱势群体的护理、儿童和青少年精神健康、自杀、酗酒和暴力等，也是当今精神卫生方案面临的巨大挑战。
