London School of Hygiene & Tropical Medicine, London, UK; Centre for the Control of Chronic Conditions, Guragon, India; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India.
Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China.
Lancet. 2016 Dec 17;388(10063):3074-3084. doi: 10.1016/S0140-6736(16)00160-4. Epub 2016 May 18.
This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate.
本综述系列文章首次系统地评估了中国和印度成年人未满足的精神卫生需求。研究证据表明，针对常见精神障碍和物质使用障碍的服务覆盖率非常低。有效的服务覆盖率甚至更低，即使是针对精神分裂症和癫痫等严重障碍也是如此。两国各地的情况差异很大，由于精神卫生资源分布不均，以及各州和各省之间精神卫生政策执行情况存在差异，两国农村地区的治疗缺口最大。精神卫生人力和财力资源严重不足，两国的国家卫生保健预算中分配给精神卫生的资金均不足 1%。尽管中国和印度都通过以社区为基础的精神卫生保健国家方案重新作出承诺，但中国在实现服务覆盖方面的进展要大得多。要提高覆盖率，需要解决与污名化以及不同精神障碍解释模型相关的供应方和需求方障碍。通过在协作性分级照护框架中与社区工作人员共同分担任务，是一种成熟的扩大服务范围的方法，特别是通过将其纳入国家重点卫生方案。印度和中国需要通过积极与社区接触来增加对服务的需求，加强服务使用者的领导能力，并确保精神卫生方案的内容和实施具有文化和背景适宜性。
