Mr. Grant is with the Faculty of Medicine, University of Toronto, Toronto. Dr. Simmons is with Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia. She is also with the Centre for Youth Mental Health, University of Melbourne, where Dr. Davey is affiliated.
Psychiatr Serv. 2018 May 1;69(5):508-516. doi: 10.1176/appi.ps.201700292. Epub 2018 Jan 16.
To provide evidence for wider use of peer workers and other nonprofessionals, the authors examined three approaches to mental health service provision-peer support worker (PSW) programs, task shifting, and mental health first-aid and community advocacy organizations-summarizing their effectiveness, identifying similarities and differences, and highlighting opportunities for integration. Relevant articles obtained from PubMed, MEDLINE, and Google Scholar searches are discussed. Studies indicate that PSWs can achieve outcomes equal to or better than those achieved by nonpeer mental health professionals. PSWs can be particularly effective in reducing hospital admissions and inpatient days and engaging severely ill patients. When certain care tasks are given to individuals with less training than professionals (task shifting), these staff members can provide psychoeducation, engage service users in treatment, and help them achieve symptom reduction and manage risk of relapse. Mental health first-aid and community organizations can reduce stigma, increase awareness of mental health issues, and encourage help seeking. Most PSW programs have reported implementation challenges, whereas such challenges are fewer in task-shifting programs and minimal in mental health first-aid. Despite challenges in scaling and integrating these approaches into larger systems, they hold promise for improving access to and quality of care. Research is needed on how these approaches can be combined to expand a community's capacity to provide care. Because of the serious shortage of mental health providers globally and the rising prevalence of mental illness, utilizing nontraditional providers may be the only solution in both low- and high-resource settings, at least in the short term.
为了提供更多使用同伴工作者和其他非专业人员的证据，作者研究了三种心理健康服务提供方式——同伴支持工作者（PSW）计划、任务转移和心理健康急救和社区宣传组织——总结了它们的有效性，确定了相似点和不同点，并强调了整合的机会。讨论了从 PubMed、MEDLINE 和 Google Scholar 搜索中获得的相关文章。研究表明，PSW 可以取得与非同伴心理健康专业人员相当或更好的结果。PSW 特别可以在减少住院和住院天数以及使重病患者参与治疗方面发挥作用。当将某些护理任务分配给接受的培训不如专业人员多的人员（任务转移）时，这些工作人员可以提供心理教育，使服务使用者参与治疗，并帮助他们减轻症状和管理复发风险。心理健康急救和社区组织可以减少污名化，提高对心理健康问题的认识，并鼓励寻求帮助。大多数 PSW 计划都报告了实施方面的挑战，而任务转移计划中的此类挑战较少，心理健康急救中的挑战则更少。尽管在扩大这些方法并将其整合到更大的系统中存在挑战，但它们有希望改善获得护理的机会和提高护理质量。需要研究如何将这些方法结合起来，以扩大社区提供护理的能力。由于全球精神卫生提供者严重短缺，以及精神疾病的患病率不断上升，在低资源和高资源环境中，至少在短期内，利用非传统提供者可能是唯一的解决方案。
