Hirdes John P, van Everdingen Coline, Ferris Jason, Franco-Martin Manuel, Fries Brant E, Heikkilä Jyrki, Hirdes Alice, Hoffman Ron, James Mary L, Martin Lynn, Perlman Christopher M, Rabinowitz Terry, Stewart Shannon L, Van Audenhove Chantal
School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
Psychiatry and Neuropsychology Department, Maastricht University, Maastricht, Netherlands.
Front Psychiatry. 2020 Jan 17;10:926. doi: 10.3389/fpsyt.2019.00926. eCollection 2019.
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.
在整个生命历程中，精神疾病患者的生活受到心理、生物、社会、经济和环境因素的影响。因此，简单的预防策略、临床治疗、治疗干预或政策选择作为应对精神疾病挑战的单一解决方案不太可能成功。精神疾病患者在整个医疗保健连续体的多个环境中接受服务和支持，而这些服务往往是分散的、不协调的，且反应不足。适当的评估是卫生系统必须采用的一项重要工具，以应对精神疾病患者的优势、偏好和需求。然而，标准方法往往侧重于测量精神症状，而没有从更广泛的角度来解决诸如成长、发展和衰老；身体健康和残疾；社会关系；经济资源；住房；物质使用；与刑事司法系统的接触；耻辱感；以及康复等问题。使用多种工具组合来涵盖更多领域既不切实际、不一致且不完整，同时还带来了相当大的评估负担。interRAI心理健康工具由来自35个以上国家的100多名研究人员、临床医生和政策专家组成的网络开发。这包括针对住院精神病学、社区心理健康、急诊科、流动危机团队和长期护理机构中的成年人的评估系统，以及针对警察的筛查系统。还有一套类似的工具可用于儿童/青少年心理健康。这些工具构成了一个综合的心理健康信息系统，因为它们共享一种通用的评估语言、概念基础、临床重点、数据收集方法、数据元素和护理计划协议。这些工具的关键应用包括护理计划、结果测量、质量改进和资源分配。本文回顾了这些工具的组成和心理测量特性，并使用与无家可归者相关的例子来说明这些评估系统的各种应用。
