Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, 333 Exhibition Street, Melbourne, VIC, Australia.
Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Health Policy Plan. 2019 Nov 1;34(Supplement_2):ii93-ii103. doi: 10.1093/heapol/czz108.
People-centred mental healthcare is an influential concept for health system strengthening and sustainable development that has been developed and promoted primarily in Western contexts. It characterizes service users, families and communities as active participants in health system development. However, we have limited understanding of how well people-centred mental healthcare aligns with the multiplicity of peoples, cultures, languages and contexts in low- and middle-income countries (LMICs). Timor-Leste, a lower-middle income country in South-East Asia, is in the process of strengthening its National Mental Health Strategy 2018-22 to align with people-centred mental healthcare. To support the implementation of this Strategy, this study investigated the acceptability and feasibility of people-centred mental health services in Timor-Leste. In-depth semi-structured individual (n = 57) and group interviews (n = 15 groups) were conducted with 85 adults (≥18 years). Participants were service users, families, decision-makers, service providers and members of civil society and multilateral organizations across national and sub-national sites. Government and non-government mental health and social care was also observed. Framework analysis was used to analyse interview transcripts and observation notes. The study found that the ecology of mental healthcare in Timor-Leste is family-centred and that government mental health services are largely biomedically oriented. It identified the following major challenges for people-centred mental health services in Timor-Leste: different sociocultural perceptions of (in)dividual personhood, including a diminished status of people with mental illness; challenges in negotiating individual and family needs; a reliance on and demand for biomedical interventions; and barriers to health service access and availability. Opportunities for people-centred mental healthcare are better available within the social and disability sectors, which focus on social inclusion, human rights and peer support. Accounting for local cultural knowledge and understandings will strengthen design and implementation of people-centred mental healthcare in LMIC settings.
以人为本的精神卫生保健是一个有影响力的概念，它主要在西方背景下发展和推广，旨在加强卫生系统和实现可持续发展，将服务使用者、家庭和社区视为卫生系统发展的积极参与者。然而，我们对以人为本的精神卫生保健在中低收入国家（LMICs）的多样性的人民、文化、语言和背景下的契合程度了解有限。东帝汶是东南亚的一个中低收入国家，正在加强其 2018-2022 年国家精神卫生战略，使其与以人为本的精神卫生保健保持一致。为了支持该战略的实施，本研究调查了以人为本的精神卫生服务在东帝汶的可接受性和可行性。与 85 名成年人（≥18 岁）进行了深入的半结构化个人访谈（n=57）和小组访谈（n=15 组）。参与者包括服务使用者、家庭、决策者、服务提供者以及国家和国家以下各级的民间社会和多边组织的成员。还观察了政府和非政府的精神卫生和社会保健。采用框架分析法分析访谈记录和观察笔记。研究发现，东帝汶精神卫生保健的生态是以家庭为中心的，政府精神卫生服务主要是生物医学导向的。它确定了以人为本的精神卫生服务在东帝汶面临的以下主要挑战：对（个体）人格的不同社会文化观念，包括精神疾病患者地位的降低；协商个人和家庭需求的挑战；对生物医学干预的依赖和需求；以及获得卫生服务的障碍和可用性。以人为本的精神卫生保健在社会和残疾部门有更好的机会，这些部门注重社会包容、人权和同伴支持。考虑到当地的文化知识和理解，将加强以人为本的精神卫生保健在 LMIC 环境中的设计和实施。
