King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, P.O. Box 27, London SE5 8AF, UK.
Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA4 7LP, UK.
Int J Environ Res Public Health. 2018 Apr 20;15(4):806. doi: 10.3390/ijerph15040806.
Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care.
自 20 世纪 60 年代以来，我们见证了社区心理健康服务的发展和壮大，它继续主导着精神卫生政策和实践。一些高收入国家已经实施了社区心理健康服务方案，但对包括大多数中低收入国家在内的许多其他国家来说，这仍然是一种愿望。尽管社区心理健康服务对许多服务使用者来说是积极的，但它也有严重的缺点。它本应导致更充分的社会融合的期望并没有实现，许多服务使用者仍然被隔离在庇护或监护环境中，社交联系有限，没有工作的前景。其他人则根本得不到服务或很少得到服务。在当今日益专业化的精神健康问题服务的复杂环境中，服务之间的可能接口数量正在增加。再加上现有的不平衡的供资系统和不断变化的背景，这些接口正在挑战我们开发符合服务使用者及其照顾者需求的有效护理途径。本文讨论了近年来社区心理健康服务的发展，并提出了“元社区心理健康服务”的概念。“元社区心理健康服务”在理解和治疗精神疾病方面包含了多元化，承认社区服务的复杂性，并反映了当前护理时代的现实和需求。
