Kidia Khameer, Machando Debra, Mangezi Walter, Hendler Reuben, Crooks Megan, Abas Melanie, Chibanda Dixon, Thornicroft Graham, Semrau Maya, Jack Helen
Kushinga, Harare, Zimbabwe; Arnhold Institute for Global Health, Icahn School of Medicine, New York, NY, USA.
Kushinga, Harare, Zimbabwe.
Lancet Psychiatry. 2017 Nov;4(11):876-886. doi: 10.1016/S2215-0366(17)30128-1. Epub 2017 Jun 15.
There has been little external analysis of Zimbabwe's mental health system. We did a systems analysis to identify bottlenecks and opportunities for mental health service improvement in Zimbabwe and to generate cost-effective, policy-relevant solutions. We combined in-depth interviews with a range of key stakeholders in health and mental health, analysis of mental health laws and policies, and publicly available data about mental health. Five themes are key to mental health service delivery in Zimbabwe: policy and law; financing and resources; criminal justice; workforce, training, and research; and beliefs about mental illness. We identified human resources, rehabilitation facilities, psychotropic medication, and community mental health as funding priorities. Moreover, we found that researchers should prioritise measuring the economic impact of mental health and exploring substance use, forensic care, and mental health integration. Our study highlights forensic services as a central component of the mental health system, which has been a neglected concept. We also describe a tailored process for mental health systems that is transferable to other low-income settings and that garners political will, builds capacity, and raises the profile of mental health.
针对津巴布韦心理健康系统的外部分析很少。我们进行了一次系统分析，以确定津巴布韦心理健康服务改善的瓶颈和机遇，并提出具有成本效益且与政策相关的解决方案。我们结合了对健康和心理健康领域一系列关键利益相关者的深入访谈、对心理健康法律和政策的分析以及公开可得的心理健康数据。五个主题对津巴布韦的心理健康服务提供至关重要：政策与法律；融资与资源；刑事司法；劳动力、培训与研究；以及对精神疾病的看法。我们确定人力资源、康复设施、精神药物和社区心理健康为资金优先事项。此外，我们发现研究人员应优先衡量心理健康的经济影响，并探索物质使用、法医护理和心理健康整合。我们的研究强调法医服务是心理健康系统的核心组成部分，而这一直是一个被忽视的概念。我们还描述了一个适用于心理健康系统的定制流程，该流程可移植到其他低收入环境中，并能赢得政治意愿、建设能力以及提高心理健康的关注度。
