Monash University, School of Rural Health, Latrobe Regional Hospital, Traralgon, VIC, Australia 3844,
J Ment Health Policy Econ. 2022 Mar 1;25(1):11-19.
Mental disorders are amongst the highest contributors to the Global Burden of Disease. However, despite the universal reach of these disorders, there are vast disparities in the provision of mental health services both between and within nations. Marginalised groups such as rural communities, ethnic minorities, refugees and indigenous peoples are known to be at higher risk of experiencing mental disorders but do not receive adequate care for it.
The purpose of this paper is to describe lessons learnt in designing and setting up mental health services for two marginalised communities - one in rural India and the other in an Aboriginal community in South Eastern Australia.
Two case studies of setting up a mental health service are described and compared to identify key elements to consider when developing services for hard to reach and marginalised communities.
Four key elements were identified. They are: (i) Overcoming issues related to mental health literacy (Recognising mental illness and knowing where treatment is available) (ii) De-stigmatising the service (iii) Rendering the service culturally safe and (iv) Ensuring financial sustainability.
Marginalised communities commonly experience an unmet need for mental health services. This includes indigenous peoples around the world who continue to experience various forms of disadvantage. As a result, traditional mainstream services are needing to rethink the way they do business so as not to exclude those who need them the most. The involvement of suitable link persons can play a crucial role in addressing the unmet need for mental health services in these communities.
The increasing movement of population groups across geographical boundaries including refugees has resulted in major changes in the cultural make- up of populations over a short period of time. The elements generated from these models can be utilised in expanding mental health service provision to include such communities.
Clear policies need to be developed to address the unmet need of hard to reach and marginalised communities for appropriate and accessible mental health services. This paper offers some direction for policy development in this space.
Further research and trials of service models to address the unmet need for mental health services among marginalised communities can be informed by the lessons learnt from these experiences.
精神障碍是全球疾病负担的最大贡献者之一。然而，尽管这些障碍具有普遍性，但在国家之间和国家内部，精神卫生服务的提供存在巨大差距。农村社区、少数民族、难民和土著人民等边缘化群体被认为更容易患精神障碍，但他们没有得到足够的治疗。
本文旨在描述为两个边缘化社区——印度农村的一个社区和澳大利亚东南部的一个土著社区——设计和建立精神卫生服务的经验教训。
描述了两个建立精神卫生服务的案例研究，并进行了比较，以确定为难以接触和边缘化社区开发服务时需要考虑的关键因素。
确定了四个关键要素。它们是：（一）克服与心理健康素养相关的问题（认识精神疾病并知道在哪里可以获得治疗）；（二）使服务去污名化；（三）使服务具有文化安全性；（四）确保财务可持续性。
边缘化社区普遍存在对精神卫生服务的未满足需求。这包括世界各地的土著人民，他们仍然面临各种形式的劣势。因此，传统的主流服务机构需要重新思考他们的运营方式，以免将最需要服务的人排除在外。合适的联系人的参与可以在解决这些社区对精神卫生服务的未满足需求方面发挥关键作用。
人口群体在地理边界上的流动增加，包括难民，这导致在短时间内人口的文化构成发生了重大变化。这些模式产生的要素可以用于扩大精神卫生服务的提供，以包括这些社区。
需要制定明确的政策，以满足难以接触和边缘化社区对适当和可及的精神卫生服务的未满足需求。本文为这一领域的政策制定提供了一些方向。
从这些经验中吸取的教训可以为解决边缘化社区对精神卫生服务的未满足需求的服务模式的进一步研究和试验提供信息。
