Morrow M H, Hemingway D, Grant J, Jamer B
Centre for the Study of Gender, Social Inequities and Mental Health, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
Rural Remote Health. 2012;12:1971. Epub 2012 May 29.
Since the late 1980s, British Columbia (BC) Canada has been undergoing a process of regionalization of health services which includes decentralization and the demand for self-sufficiency with respect to caring for people with mental health issues. In BC, regionalization has meant the continued downsizing of its one large provincial psychiatric hospital Riverview, which has resulted in relocating patients from this hospital to cities and towns throughout BC, and the establishment and/or renovation of psychiatric tertiary-care facilities to treat local community members who experience mental ill health. In the context of the relocation of psychiatric tertiary care, communities in northern BC face the specific challenge of having to provide these specialized services in remote settings, not only for people transferred from Riverview, but also for the increasing number of people 'aging-in-place' in a region that has the fastest growth of older adults in BC. Little is known about the capacity of these remote communities to manage change, develop broader models of care, and integrate people with psychogeriatric mental health issues with residents at existing facilities.
This study employed a qualitative research design which involved field research in the rural community where people were transferred, and interviews and focus groups with key people involved in the transfer process. In the analysis of the data a gender-based lens was applied to clarify the differing needs and concerns of male and female patients and to attend to possible needs relating to culture and ethnicity.
The findings illustrate persistent 'hinterland-metropolis' and 'front-line versus administrative staff' tensions, with respect to resource distribution and top-down governance, and demonstrate the need for more transparent and comprehensive planning by health authorities with respect to instituting mental health reforms in a northern context, as well as improved communication between administrative and front-line staff. The research suggests that it is important to attend to the differing needs of women and men in the context of psychogeriatric care, as well as to other factors such as ethnicity and culture, in order to provide appropriate care. Finally, building community capacity to deal with the complex needs of patients is severely hampered not only by facility and regional health authority staff turnover, but also the stresses inherent to working in northern communities which include geographic, social and economic challenges.
Increased local engagement is a way to identify and address challenges related to relocating psychogeriatric care to northern and remote settings, and to enhance psychogeriatric care provision in similar locales. While provincial and regional level 'big picture' planning is a necessity, study participants highlighted the critical role of local perspective and expertise.
自20世纪80年代末以来，加拿大不列颠哥伦比亚省（BC省）一直在经历卫生服务区域化进程，其中包括权力下放以及对心理健康问题患者护理实现自给自足的要求。在BC省，区域化意味着其一家大型省级精神病院——河景医院持续缩减规模，这导致患者从该医院转移至BC省各地的城镇，并建立和/或翻新精神病三级护理设施，以治疗当地患有精神疾病的社区成员。在精神病三级护理转移的背景下，BC省北部的社区面临着在偏远地区提供这些专业服务的特殊挑战，不仅要为从河景医院转移来的患者提供服务，还要为该地区日益增多的“就地养老”人群提供服务，该地区是BC省老年人增长最快的地区。对于这些偏远社区管理变革、发展更广泛护理模式以及将患有老年精神健康问题的人与现有设施中的居民融合的能力，人们了解甚少。
本研究采用定性研究设计，包括在患者被转移至的农村社区进行实地研究，以及对参与转移过程的关键人员进行访谈和焦点小组讨论。在数据分析中，运用了基于性别的视角来阐明男性和女性患者的不同需求和关注点，并关注与文化和种族相关的可能需求。
研究结果表明，在资源分配和自上而下的治理方面，存在持续的“内地 - 大都市”以及“一线与行政人员”之间的紧张关系，并表明卫生当局在北方背景下进行心理健康改革时需要更透明和全面的规划，以及行政人员和一线人员之间改善沟通。研究表明，在老年精神病护理背景下关注男性和女性的不同需求以及种族和文化等其他因素，以提供适当护理非常重要。最后，社区应对患者复杂需求的能力建设不仅受到设施和地区卫生当局人员更替的严重阻碍，还受到在北方社区工作所固有的压力的阻碍，这些压力包括地理、社会和经济挑战。
增加地方参与是识别和应对将老年精神病护理转移到北部和偏远地区相关挑战以及加强类似地区老年精神病护理服务的一种方式。虽然省级和地区层面的“宏观”规划是必要的，但研究参与者强调了地方视角和专业知识所起的关键作用。
