Burgess Rochelle Ann
London Metropolitan University; University of Kwa-Zulu Natal; London School of Economics.
Transcult Psychiatry. 2016 Dec;53(6):719-742. doi: 10.1177/1363461516679056.
The Movement for Global Mental Health's (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations in resource-poor countries like South Africa have pointed to the value of an integrated primary mental health care model and multidisciplinary collaboration to support mental health needs in underserved and underresourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the realities of the primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics, which shaped relationships within multidisciplinary teams; stigma, which limited the efficacy of task-shifting strategies; and the silencing of women's narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa.
全球精神卫生运动（MGMH）在扩大精神卫生服务可及性方面所做的努力取得了一定程度的成功。在南非等资源匮乏国家开展的调查表明，综合初级精神卫生保健模式以及多学科协作对于满足服务欠缺和资源不足社区的精神卫生需求具有重要价值。然而，仍有必要探讨这些政策在环境和关系复杂多样的社区日常实际情况中如何发挥作用。可以说，精神卫生政策及服务提供过程的实际情况最好通过人种志方法来审视，而这种方法在全球精神卫生领域仍未得到充分利用。本文报告了一项针对南非农村地区受艾滋病影响妇女的精神卫生服务案例研究的结果，该研究采用了动机人种志方法，以探究南非初级精神卫生保健模式及相关政策的实际情况。研究结果突出了影响初级精神卫生保健模式成效的三个关键象征性（无形）因素：权力动态，它塑造了多学科团队内部的关系；耻辱感，它限制了任务转移策略的成效；以及服务中女性痛苦经历叙述的失语。文中讨论了政策理想与实践现实之间由此产生的差距。本文最后针对巩固南非在提供初级精神卫生保健方面的现有成功经验提出了建议。
