海地地震后开展的以社区为基础的精神卫生服务试点倡议
A Pilot Initiative to Deliver Community-based Psychiatric Services in Rural Haiti After the 2010 Earthquake.
机构信息
Department of Psychiatry, University of California San Diego, La Jolla, CA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
Palo Alto Medical Foundation, Mountain View, CA.
出版信息
Ann Glob Health. 2015 Sep-Oct;81(5):718-24. doi: 10.1016/j.aogh.2015.08.028.
BACKGROUND
Worldwide, there is a gap between the burden of mental distress and disorder and access to mental health care. This gap is particularly large in low- and middle-income countries (LMICs). After the 2010 earthquake in Haiti, the international health care organizations Partners in Health and Zanmi Lasante worked to expand local mental health services in rural Haiti.
OBJECTIVE
The aims of this study are to describe clinical characteristics of the patients served during a pilot project to deliver community-based psychiatric services in rural Haiti and to show how this experience complements the Mental Health Gap Action Programme ("mhGAP"), a tool developed by the World Health Organization to support mental health care delivery by nonspecialists in LMICs.
METHODS
The pilot was conducted in March 2011. A visiting psychiatrist traveled to rural Haiti and paired with local clinicians to evaluate patients and to support quality improvement practices in psychiatric care. Patients received a standard neuropsychiatric evaluation. mhGAP was an important clinical reference. To assess the experience, we conducted a retrospective chart review of outpatient encounters.
FINDINGS
Sixty-five patients presented with a wide range of common psychiatric, neurologic, and general medical conditions. Forty-nine of these patients (75%) reported primary problems subsumed by an mhGAP module. Fifteen patients (23%) reported headache as their chief complain, a condition that is not currently covered by mhGAP. Surprisingly, only 3 patients (5%), reported earthquake-related distress.
CONCLUSIONS
Our clinical data reinforce the need for provision of standard psychiatric and neurologic services in LMICs. Such services ought to accompany interventions targeted specifically at disaster-related problems. Clinical situations falling outside existing mhGAP modules inspired the development of supplemental treatment protocols. These observations informed coordinated efforts at Zanmi Lasante to build a sustainable, integrated mental health system in Haiti that may be relevant to other resource-limited settings.
背景
在全球范围内，精神疾病的负担与精神卫生保健的可及性之间存在差距。这一差距在中低收入国家（LMICs）尤为明显。2010 年海地地震后，国际卫生保健组织“健康伙伴”（Partners in Health）和“Zanmi Lasante”努力在海地农村扩大当地精神卫生服务。
目的
本研究旨在描述在海地农村提供社区为基础的精神卫生服务试点项目中服务的患者的临床特征，并展示这一经验如何补充世界卫生组织（WHO）开发的精神卫生差距行动规划（“mhGAP”），这一工具旨在支持 LMICs 中的非专业人员提供精神卫生保健。
方法
该试点于 2011 年 3 月进行。一名出诊精神科医生前往海地农村，与当地临床医生合作评估患者，并支持精神保健质量改进实践。患者接受了标准的神经精神评估。mhGAP 是一个重要的临床参考。为了评估经验，我们对门诊就诊进行了回顾性病历审查。
发现
65 名患者表现出广泛的常见精神、神经和一般医疗状况。其中 49 名患者（75%）报告了主要问题，这些问题涵盖了 mhGAP 模块。15 名患者（23%）报告头痛是他们的主要抱怨，这一情况目前不在 mhGAP 范围内。令人惊讶的是，只有 3 名患者（5%）报告了与地震有关的困扰。
结论
我们的临床数据加强了在 LMICs 提供标准精神和神经服务的必要性。此类服务应伴随着针对与灾害有关问题的干预措施。现有 mhGAP 模块之外的临床情况激发了补充治疗方案的制定。这些观察结果为“Zanmi Lasante”协调努力提供了信息，以建立海地可持续的综合精神卫生系统，这可能与其他资源有限的环境相关。
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