McEvoy Phil, Williamson Tracey, Kada Raphael, Frazer Debra, Dhliwayo Chardworth, Gask Linda
Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom.
University of Salford, School of Nursing, Midwifery, Social Work & Social Sciences, Mary Seacole Building, Frederick Road Campus, Salford, M6 6PU, United Kingdom.
BMC Health Serv Res. 2017 Aug 14;17(1):557. doi: 10.1186/s12913-017-2509-4.
The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for 'under-served' ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one 'under-served' population, an Orthodox Jewish community in the North West of England.
A combination of qualitative and quantitative data were drawn upon including naturally occurring data, observational notes, e-mail correspondence, routinely collected demographic data and clinical outcomes measures, as well as written feedback and recorded discussions with 12 key informants.
Improvements in access to mental health care for some people from the Orthodox Jewish community were achieved through the collaborative efforts of a distributed leadership team. The members of this leadership team were a self-selecting group of stakeholders which had a combination of local knowledge, cultural understanding, power to negotiate on behalf of their respective constituencies and expertise in mental health care. Through a process of dialogic engagement the team was able to work with the community to develop a bespoke service that accommodated its wish to maintain a distinct sense of cultural otherness.
This critical reflection illustrates how dialogic engagement can further the mechanisms of candidacy, concordance and recursivity that are associated with improvements in access to care in under-served sections of the population, whilst simultaneously recognising the limits of constructive dialogue. Dialogue can change the dynamic of community engagement. However, the full alignment of the goals of differing constituencies may not always be possible, due the complex interaction between the multiple positions and understandings of stakeholders that are involved and the need to respect the other'-s' autonomy.
英国国家医疗服务体系（NHS）已大幅扩大了针对有常见心理健康问题人群的基层医疗中循证心理干预措施的供应。然而，尽管有额外资源，但对于“服务不足”的少数族裔和宗教群体而言，服务的可及性仍远低于抵消因他们不同的服务接触情况所造成的健康不平等所需的水平，从而导致负面健康结果。本文对一项旨在改善英国西北部一个东正教犹太社区这一“服务不足”人群获得NHS资助的基层医疗心理健康服务机会的倡议进行批判性反思。
采用定性和定量数据相结合的方式，包括自然产生的数据、观察记录、电子邮件通信、常规收集的人口统计数据和临床结果指标，以及与12名关键 informant 的书面反馈和记录讨论。
通过一个分布式领导团队的共同努力，东正教犹太社区的一些人获得心理健康护理的机会得到了改善。这个领导团队的成员是一个自我挑选的利益相关者群体，他们兼具当地知识、文化理解、代表各自选区进行谈判的权力以及心理健康护理方面的专业知识。通过对话参与过程，该团队能够与社区合作开发一种定制服务，满足其保持独特文化差异性的愿望。
这一批判性反思说明了对话参与如何能够推进与改善服务不足人群的护理可及性相关的候选资格、一致性和递归性机制，同时认识到建设性对话的局限性。对话可以改变社区参与的动态。然而，由于所涉及的利益相关者的多种立场和理解之间的复杂相互作用以及尊重他人自主权的必要性，不同选区的目标可能并不总是能够完全一致。
