Freeman Melvyn
University of Stellenbosch, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa.
Int J Ment Health Syst. 2022 Aug 11;16(1):38. doi: 10.1186/s13033-022-00547-6.
Policy makers intent on improving population mental health are required to make fundamental decisions on where to invest resources to achieve optimal outcomes. While research on the effectiveness and efficiency of interventions is critical to such choices, including clinical outcomes and return on investment, in the "real world" of policy making other concerns invariably also play a role. Politics, history, community awareness and demands for care, understanding of etiology, severity of condition and local circumstances are all critical. Policy makers should not merely rely on previous allocations, but need to take active decisions regarding the proportion of resources that should be allocated to particular interventions to achieve optimum outcomes. Given that scientific evidence is only one of the reasons informing such decisions, it is necessary to have clear and informed reasons for allocations and for making cases for new mental health investments.
Investment allocations are unlikely to ever be an exact science. Alternatives therefore need to be rationally weighed up and reasoned decisions made based on this. Using prevalence data and the distribution of mental health resources in South Africa as a backdrop and proxy, investment proposals are made for LMICs with due consideration given to inter alia the social determinants of mental health, the needs and potential benefits of investments in people with severe verses common mental disorder, mental health promotion and disease prevention and to other areas that may impact on population mental health, such as management.
Based on a range of arguments, it is proposed that mental health investments should follow the following approach. A mental health-in-all-policies method must be adopted. There should be no more than a 20% gap in the humane and human rights oriented care, treatment and rehabilitation of people with severe mental disorder. A minimum additional amount of 10% of the amount spent on severe mental disorder should be allocated to treating people with common mental disorder. Screening for mental disabilities should take place within all chronic care services. A minimum of 3% of the budget spent on severe mental disorder should be spent on promotion and prevention programmes. An additional 1% of the allocation for severe mental disorder should be provided for managing/driving the mental health programme.
旨在改善民众心理健康的政策制定者需要做出根本性决策，决定将资源投入到何处以实现最佳效果。虽然对干预措施的有效性和效率进行研究对于此类选择至关重要，包括临床结果和投资回报率，但在政策制定的“现实世界”中，其他因素也必然会发挥作用。政治、历史、社区意识以及对护理的需求、对病因的理解、病情的严重程度和当地情况都至关重要。政策制定者不应仅仅依赖先前的资源分配，而需要积极决定应将多少资源分配给特定干预措施以实现最佳效果。鉴于科学证据只是做出此类决策的原因之一，因此有必要为资源分配以及为新的心理健康投资提供明确且有充分依据的理由。
投资分配不太可能成为一门精确的科学。因此，需要对各种选择进行合理权衡，并在此基础上做出合理决策。以南非的患病率数据和心理健康资源分布为背景及参考，为低收入和中等收入国家提出投资建议，同时充分考虑心理健康的社会决定因素、对患有严重精神障碍与常见精神障碍者进行投资的需求和潜在益处、心理健康促进和疾病预防以及其他可能影响民众心理健康的领域，如管理。
基于一系列论点，建议心理健康投资应遵循以下方法。必须采用“将心理健康纳入所有政策”的方法。在针对严重精神障碍患者的人道且基于人权的护理、治疗和康复方面，差距不应超过20%。应将用于严重精神障碍治疗费用的至少10%额外分配用于治疗常见精神障碍患者。应在所有慢性护理服务中开展精神残疾筛查。应将用于严重精神障碍治疗预算的至少3%用于促进和预防项目。应为管理/推动心理健康项目额外提供1%的严重精神障碍治疗拨款。
