Minoletti Alberto, Galea Sandro, Susser Ezra
School of Public Health, Medical Faculty, University of Chile, Santiago de Chile, Chile.
Department of Epidemiology, Columbia University, New York, NY, USA.
Public Health Rev. 2012;34(2). doi: 10.1007/BF03391681.
Mental disorders are highly prevalent in Latin American countries and exact a serious emotional toll, yet investment in public mental health remains insufficient. Most countries of the region have developed national and local initiatives to improve delivery of mental health services over the last 22 years, following the technical leadership of the Pan American Health Organization/World Health Organization (PAHO/WHO). It is especially notable that PAHO/WHO facilitated the development of national policies and plans, as well as local programs, to deliver specialized community care for persons with severe mental disorders. Nevertheless, at present, the majority of Latin American countries maintain a model of services for severe mental disorders based primarily on psychiatric hospitals that consume most of the national mental health budget. To accelerate the pace of change, this article emphasizes the need to develop cross-country regional initiatives that promote mental health service development, focusing on severe mental disorders. As one specific example, the authors describe work with RedeAmericas, which has brought together an interdisciplinary group of international investigators to research regional approaches and train a new generation of leaders in public mental health. More generally, four regional strategies are proposed to complement the work of PAHO/ WHO in Latin America: 1) to develop multi-country studies on community services, 2) to study new strategies and interventions in countries with more advanced mental health services, 3) to strengthen advocacy groups by cross-country interchange, and 4) to develop a network of well-trained leaders to catalyze progress across the region.
精神障碍在拉丁美洲国家极为普遍，造成了严重的情感伤害，但对公共心理健康的投入仍然不足。在泛美卫生组织/世界卫生组织（PAHO/WHO）的技术引领下，该地区大多数国家在过去22年里制定了国家和地方举措，以改善心理健康服务的提供。尤其值得注意的是，PAHO/WHO推动了国家政策和计划以及地方项目的制定，以便为严重精神障碍患者提供专门的社区护理。然而，目前大多数拉丁美洲国家仍维持着一种主要基于精神病医院的严重精神障碍服务模式，而这些医院消耗了大部分国家心理健康预算。为加快变革步伐，本文强调需要制定跨国区域举措，以促进心理健康服务发展，重点关注严重精神障碍。作为一个具体例子，作者介绍了与美洲网络（RedeAmericas）的合作，该网络汇聚了一组跨学科的国际研究人员，以研究区域方法并培养新一代公共心理健康领域的领导者。更广泛地说，提出了四项区域战略，以补充PAHO/WHO在拉丁美洲的工作：1）开展关于社区服务的多国研究；2）在心理健康服务较为先进的国家研究新战略和干预措施；3）通过跨国交流加强宣传团体；4）建立一个训练有素的领导者网络，以推动整个地区取得进展。
