Senior Research Fellow, Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK.
Professor of Health and Social Care Policy, Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science; and Policy Innovation and Evaluation Research Unit, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, UK.
J Health Serv Res Policy. 2020 Jul;25(3):172-180. doi: 10.1177/1355819619878756. Epub 2019 Nov 26.
To explore whether the Screen and Treat Programme to support United Kingdom citizens potentially affected by terrorist attacks in Tunisia (2015), Paris (2015) and Brussels (2016) was effective in identifying and referring people to mental health services, to examine the programme's acceptability to users and to understand how agencies involved worked together.
Individuals offered screening by the programme (n = 529) were invited to participate in the study and were sent a questionnaire. Follow-up interviews were conducted with questionnaire respondents who consented and with employees of agencies involved in the programme's planning and delivery. Seventy-seven people affected by the attacks completed questionnaires, 35 of those were also interviewed, and 1 further person only participated in an interview. Eleven people from agencies organizing and delivering the programme and five clinician-managers were also interviewed.
Most service users said the attacks had a major impact on their lives. Many reported anxiety, depression, difficulty going out or travelling, sleep problems, panic attacks, flashbacks and hyper-vigilance. A third had reduced their working hours and a similar proportion had taken sick leave. Two-thirds sought help from their General Practitioner (GP) before being contacted by the programme, but almost all thought their GP had not been helpful in dealing with post-traumatic stress disorder (PTSD) or referring to appropriate care. Several people were prescribed psychotropic medication; only a few were referred to mental health professionals. Many participants used help offered by organizations external to National Health Service, with mixed experiences. Waiting times for treatment varied from no delay to a few months. Most interviewees thought the programme should have started sooner and provided more information about sources of support. Most users found treatment received via the programme helpful. Professionals involved in organizing and delivering the programme thought that bureaucratic delays in setting it up were key limitations on effectiveness. Clinician interviewees thought an outreach approach was needed to identify at-risk individuals.
Users who took part in the programme were satisfied with their treatment, although many thought it should have been offered sooner. Funding and data sharing between agencies were the main barriers to timely contact with affected individuals. Self-referral, GP identification of PTSD and GP referral to appropriate care were regarded as ineffective, suggesting that people affected by similar future incidents should be supported better and assisted more promptly to access treatment.
探索 2015 年在突尼斯、2015 年在巴黎和 2016 年在布鲁塞尔为可能受恐怖袭击影响的英国公民提供的“Screen and Treat 计划”是否能有效识别和转介人们接受心理健康服务，研究该计划对用户的可接受性，并了解参与的机构如何合作。
参与该计划筛查的个人（n=529）被邀请参与研究，并收到了一份问卷。对同意参与调查的问卷回复者和参与该计划规划和实施的机构员工进行了随访访谈。共有 77 名受袭击影响的人完成了问卷，其中 35 人接受了访谈，另有 1 人仅接受了访谈。还对 11 名负责组织和实施该计划的机构人员以及 5 名临床经理进行了访谈。
大多数服务使用者表示袭击对他们的生活产生了重大影响。许多人报告说他们有焦虑、抑郁、难以外出或旅行、睡眠问题、惊恐发作、闪回和过度警觉。三分之一的人减少了工作时间，比例相似的人请了病假。在被该计划联系之前，有三分之二的人先去看了全科医生（GP），但几乎所有人都认为他们的 GP 在处理创伤后应激障碍（PTSD）或转介到适当的护理方面没有帮助。一些人被开了精神药物；只有少数人被转介到心理健康专业人员。许多参与者使用了外部 NHS 组织提供的帮助，体验好坏参半。治疗的等待时间从无延迟到几个月不等。大多数受访者认为该计划应该更早开始，并提供更多关于支持来源的信息。大多数使用者认为通过该计划接受的治疗很有帮助。参与组织和实施该计划的专业人员认为，该计划在建立过程中的官僚延误是影响其有效性的关键限制因素。临床医生受访者认为需要采取一种外展方法来识别高危个体。
参与该计划的使用者对他们的治疗感到满意，尽管许多人认为它应该更早提供。机构之间的资金和数据共享是与受影响个人及时联系的主要障碍。自我转介、全科医生识别 PTSD 和全科医生转介到适当的护理被认为是无效的，这表明应更好地支持受类似未来事件影响的人，并更迅速地协助他们获得治疗。
