Illawarra Institute of Mental Health, University of Wollongong, Wollongong.
Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney.
Curr Opin Psychiatry. 2020 Jul;33(4):375-390. doi: 10.1097/YCO.0000000000000620.
The aim of this article is to provide a framework and analysis of a series of critical components to inform the future design, development, sustaining, and monitoring of community mental health services.
Many mental health services remain too hospital-centric, often without adequate outreach services. On the basis of outcome evidence, we need to shift the balance of mental health services from hospital-centered with community outreach when convenient for staff, to community-centered and mobile, with in-reach to hospital only when necessary. Too few training programs those with emphasize the macroskills of public advocacy, working with service users, families, social movements, and the media to improve mental health and wellbeing of regional and local communities.
We should adopt a health ecosystems approach to mental healthcare and training, encompassing nano to macrolevels of service in every region. Catchment mental health services should be rebuilt as community-centric mental health services, integrating all community and inpatient components, but led and integrated from community sites. Community psychiatrists and mental health professionals of the future will need to be well trained in the nano to macroskills required to take responsibility for the mental health and wellbeing of their catchment communities and to provide leadership in service-planning, management, and continuing revision on the basis of rigorous evaluation. These approaches should be the core of all training in psychiatry and all mental health professions prior to any subspecialization.
本文旨在提供一个框架和对一系列关键要素的分析，为未来社区心理健康服务的设计、开发、维持和监测提供信息。
许多心理健康服务仍然过于以医院为中心，通常没有足够的外展服务。基于结果证据，我们需要将心理健康服务的平衡从以医院为中心、以工作人员方便为基础的社区外展服务，转变为以社区为中心、移动性强的服务，只有在必要时才向医院提供内部服务。培训计划太少，这些计划强调公共宣传、与服务使用者、家庭、社会运动和媒体合作的宏观技能，以改善区域和当地社区的精神健康和福利。
我们应该采用健康生态系统方法来进行精神保健和培训，涵盖每个地区的纳米到宏观层面的服务。应将集水区心理健康服务重建为以社区为中心的心理健康服务，整合所有社区和住院部分，但由社区站点领导和整合。未来的社区精神科医生和精神健康专业人员需要接受纳米到宏观技能的良好培训，以便为其集水区社区的精神健康和福利负责，并在严格评估的基础上提供服务规划、管理和持续修订方面的领导。这些方法应该是所有精神病学和所有精神健康专业培训的核心内容，在任何亚专业之前。
