McAllister Ashley, Hackett Maree L, Leeder Stephen R
School of Public Health, University of Sydney, NSW, Australia; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden,
School of Public Health, University of Sydney, NSW, Australia; Neurological and Mental Health Division, The George Institute for Global Health, University of Sydney, NSW, Australia.
Public Health Res Pract. 2017 Apr 27;27(2):2721715. doi: 10.17061/phrp2721715.
Mental illnesses have many distinctive features that make determining eligibility for disability income support challenging - for example, their fluctuating nature, invisibility and lack of diagnostic clarity. How do policy makers deal with these features when designing disability income support? More specifically, how do mental illnesses come to be considered eligible disabilities, what tools are used to assess mental illnesses for eligibility, what challenges exist in this process, and what approaches are used to address these challenges? We aimed to determine what evidence is available to policy makers in Australia and Ontario, Canada, to answer these questions.
Ten electronic databases and grey literature in both jurisdictions were searched using key words, including disability income support, disability pension, mental illness, mental disability, addiction, depression and schizophrenia, for articles published between 1991 and June 2013. This yielded 1341 articles, of which 20 met the inclusion criteria and were critically appraised.
Limited evidence is available on disability income support design and mental illnesses in the Australian and Ontarian settings. Most of the evidence is from the grey literature and draws on case law. Many documents reviewed argued that current policy in Australia and Ontario is frequently based on negative assumptions about mental illnesses rather than evidence (either peer reviewed or in the grey literature). Problems relating to mental illnesses largely relate to interpretation of the definition of mental illness rather than the definition itself.
The review confirmed that mental illnesses present many challenges when designing disability income support and that academic as well as grey literature, especially case law, provides insight into these challenges. More research is needed to address these challenges, and more evidence could lead to policies for those with mental illnesses that are well informed and do not reinforce societal prejudices.
精神疾病具有许多独特特征，这使得确定其是否符合残疾收入支持资格具有挑战性——例如，其波动性、隐匿性以及诊断的不明确性。政策制定者在设计残疾收入支持时如何应对这些特征？更具体地说，精神疾病是如何被认定为符合资格的残疾的，使用了哪些工具来评估精神疾病的资格，这一过程中存在哪些挑战，以及采用了哪些方法来应对这些挑战？我们旨在确定澳大利亚和加拿大安大略省的政策制定者可获得哪些证据来回答这些问题。
使用关键词，包括残疾收入支持、残疾抚恤金、精神疾病、精神残疾、成瘾、抑郁症和精神分裂症，在两个辖区的十个电子数据库和灰色文献中搜索1991年至2013年6月发表的文章。这产生了1341篇文章，其中20篇符合纳入标准并进行了严格评估。
在澳大利亚和安大略省的背景下，关于残疾收入支持设计和精神疾病的证据有限。大多数证据来自灰色文献并借鉴了判例法。许多审查的文件认为，澳大利亚和安大略省目前的政策常常基于对精神疾病的负面假设而非证据（无论是同行评审的还是灰色文献中的证据）。与精神疾病相关的问题主要涉及对精神疾病定义的解释而非定义本身。
该综述证实，在设计残疾收入支持时，精神疾病带来了许多挑战，学术文献以及灰色文献，尤其是判例法，为洞察这些挑战提供了依据。需要更多研究来应对这些挑战，更多的证据可能会促成针对精神疾病患者的明智政策，且不会强化社会偏见。
