Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa; Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; King's Global Health Institute, King's College London, London, UK.
Epidemiol Psychiatr Sci. 2020 Feb 7;29:e101. doi: 10.1017/S2045796020000141.
Against the backdrop of mounting calls for the global scaling-up of mental health services - including quality care and prevention services - there is very little guidance internationally on strategies for scaling-up such services. Drawing on lessons from scale-up attempts in six low- and middle-income countries (LMICs), and using exemplars from the front-lines in South Africa; we illustrate how health reforms towards people-centred chronic disease management provide enabling policy window opportunities for embedding mental health scale-up strategies into these reforms. Rather than going down the oft-trodden road of vertical funding for scale-up of mental health services, we suggest using the policy window that stresses global policy shifts towards strengthening of comprehensive integrated primary health care systems that are responsive to multimorbid chronic conditions. This is indeed a substantial opportunity to firmly locate mental health within these horizontal health systems strengthening funding agendas. While this approach will promote systems more enabling of scaling up of mental health services, implications for donor funders and researchers alike is the need for increased time commitments, resources and investment in local control.
在全球范围内扩大精神卫生服务（包括优质护理和预防服务）的呼声日益高涨的背景下，国际上几乎没有关于扩大这类服务的战略的指导。本研究从六个中低收入国家（LMICs）的扩大规模尝试中汲取经验教训，并以南非的一线实例为例，说明了向以患者为中心的慢性病管理进行卫生改革如何为将精神卫生扩大规模战略纳入这些改革提供有利的政策窗口机会。我们建议利用这一政策窗口，强调全球政策向加强全面综合初级卫生保健系统的转变，以应对多种慢性疾病，而不是走为扩大精神卫生服务提供垂直资金的老路。这确实是一个将精神卫生纳入这些横向卫生系统强化供资议程的重要机会。虽然这种方法将促进更有利于扩大精神卫生服务的系统，但对捐助者和研究人员来说，都意味着需要增加时间承诺、资源和投资，以实现地方控制。
