Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Int J Ment Health Nurs. 2013 Apr;22(2):116-24. doi: 10.1111/j.1447-0349.2012.00848.x. Epub 2012 Oct 1.
Mental health service provision has traditionally been dominated by biomedical models of illness and disorder, a problem-based orientation, and the assessment and management of risk. While psychotherapeutic approaches are numerous and have been widely utilized, psychotropic medications, either as monotherapy or in conjunction with psychological therapies, remain the mainstay for the 'treatment' of mental health problems. This is despite growing uncertainty over the effectiveness of psychotropic medications (particularly antidepressants), as well as their potential for enduring and debilitating side-effects. This discussion paper outlines the emerging field of positive health, which eschews a psychiatric disorder and illness focus, and is instead oriented towards the identification of strengths, abilities, hopes, and the individual's preferred future. The shift in positive health, from illness towards wellness, aims to build health literacy and the capacity of individuals to make decisions conducive to health, and thereby make more effective the use of health-care services. A positioning of mental health nursing practice within a positive health paradigm is promoted. By illustration, a number of solution-focused mental health assessment questions are tabled to contrast the current format for mental health assessment, which rather than being 'comprehensive', is predominantly concerned only with problem and risk identification, and the search for pathology in the individual.
精神卫生服务的提供传统上一直以疾病和障碍的生物医学模式、基于问题的方法以及风险的评估和管理为主导。虽然心理治疗方法众多且已被广泛应用，但精神药物（无论是单独使用还是与心理疗法结合使用）仍然是治疗精神健康问题的主要方法。尽管抗精神药物（特别是抗抑郁药）的有效性以及它们可能产生持久和使人虚弱的副作用存在越来越多的不确定性，但这种情况仍然存在。本讨论文件概述了积极健康这一新兴领域，该领域避开了精神障碍和疾病的重点，而是侧重于确定优势、能力、希望和个人偏好的未来。从疾病到健康的积极健康转变旨在提高健康素养和个人做出有利于健康的决策的能力，从而更有效地利用医疗保健服务。提倡将精神健康护理实践置于积极健康范式中。举例来说，提出了一些以解决方案为重点的精神健康评估问题，以对比当前的精神健康评估模式，当前的模式不是“全面的”，主要只关注问题和风险的识别，以及在个体中寻找病理。
