1Department of Health Sciences, University of York, Heslington, York, UK.
Int J Soc Psychiatry. 2014 Mar;60(2):155-61. doi: 10.1177/0020764012471924. Epub 2013 Feb 10.
In response to the significant contribution of mental health problems to the global burden of disease, the World Health Organization (WHO, 2008) renewed its call for the integration of mental health services within primary care. The operationalization of this within resource-constrained settings such as rural Malawi, however, presents a challenge, not least the cultural acceptance of approaches to responding to psychological distress.
This study reports on the development, implementation and evaluation of a mental health care training programme for 271 health surveillance assistants (HSAs) designed to overcome such challenges.
A structured evaluation of the impact of training on HSAs' provision of mental health care was undertaken.
Result's demonstrated a statistically significant positive effect on HSAs' knowledge and confidence in providing care and analysis of patient records revealed considerable mental health care and health promotion activity wherein HSAs initiated a new dialogue with the community on mental health and human rights concerns.
The HSAs' focus on the psychosocial concerns of individuals' 'distress' and 'risk' prepared the way for a practical set of culturally sensitive and therapeutic interventions and offers a potential path towards increasing the capacity of primary care mental health provision that is responsive to local understandings and experiences of distress.
鉴于心理健康问题对全球疾病负担的重大贡献，世界卫生组织（WHO，2008 年）再次呼吁将心理健康服务纳入初级保健。然而，在资源有限的环境中（如马拉维农村地区）实施这一服务面临挑战，尤其是在心理困扰应对方法的文化接受方面。
本研究报告了为克服这些挑战而针对 271 名卫生监督助理员（HSA）开发、实施和评估心理健康护理培训计划的情况。
对培训对 HSA 提供精神卫生保健的影响进行了结构化评估。
结果显示培训对 HSA 提供护理的知识和信心有统计学上的积极影响，对患者记录的分析显示 HSA 开展了大量的精神卫生保健和健康促进活动，其中 HSA 与社区就精神卫生和人权问题展开了新的对话。
HSA 关注个人“痛苦”和“风险”的社会心理问题，为一套实用的、对文化敏感的治疗干预措施奠定了基础，为提高初级保健精神卫生服务能力提供了一种可能途径，这种服务能力对当地对痛苦的理解和体验做出回应。
