Department of Psychiatry, Yale School of Medicine, Yale New Haven Psychiatric Hospital, New Haven, Connecticut (Li, Rohrbaugh); Psychiatry Department, Second Xiangya Hospital of Central South University, Changsha, China (Deng, Liu).
Psychiatr Serv. 2019 Aug 1;70(8):674-680. doi: 10.1176/appi.ps.201800549. Epub 2019 Apr 30.
Psychosocial rehabilitation has been established as a critical component of client-centered recovery-oriented services for people with serious mental illness. Despite its importance, the implementation of mental health rehabilitation services in low- or middle-income countries has not been well studied. In this study, the authors document the regional challenges of planning and implementing mental health rehabilitation services in clubhouses in Hunan Province in the People's Republic of China.
Participants were purposively selected and consisted of diverse stakeholders, including rehabilitation directors and psychiatric hospital leaders in Hunan Province, China. Information was collected from 33 individuals by using three focus groups, 23 semistructured interviews of key informants, and participant observation. Interview transcripts were coded and analyzed by using standard qualitative methods.
Implementation challenges were characterized by four themes: skepticism toward psychosocial rehabilitation services, resource shortage, insufficient system integration and incentives, and stigma of mental illness.
Psychosocial rehabilitation is an emerging public health priority in China. This study on clubhouses in Hunan Province used qualitative methods to inform future directions for service development and research. Early identification of regional implementation challenges is a first step in assessing the applicability of psychosocial rehabilitation services locally in Hunan Province. Successful implementation of clubhouse psychosocial rehabilitation services will benefit not only from strong government commitment but also from developing standard evaluations of evidence-based practices, tackling stigma, and addressing low resource investment.
心理社会康复已被确立为以客户为中心、以康复为导向的严重精神疾病患者服务的重要组成部分。尽管其重要性不言而喻，但心理健康康复服务在中低收入国家的实施情况尚未得到充分研究。在这项研究中，作者记录了中国湖南省会所式心理健康康复服务规划和实施所面临的区域性挑战。
参与者是通过有目的选择的，包括来自中国湖南省的康复主任和精神病院领导在内的各种利益相关者。通过三个焦点小组、23 次关键知情人的半结构化访谈和参与式观察，收集了 33 名参与者的信息。使用标准的定性方法对访谈记录进行编码和分析。
实施挑战的特征是四个主题：对心理社会康复服务的怀疑、资源短缺、系统整合和激励措施不足、以及精神疾病的污名。
心理社会康复是中国新兴的公共卫生重点。这项关于湖南省会所的研究使用了定性方法为服务发展和研究提供了未来的方向。早期识别区域性实施挑战是评估心理社会康复服务在湖南省当地适用性的第一步。成功实施会所式心理社会康复服务不仅需要政府的大力支持，还需要开发基于证据的实践的标准评估、解决污名问题，以及解决资源投入不足的问题。
