Bird Victoria Jane, Davis Syjo, Jawed Abeer, Qureshi Onaiza, Ramachandran Padmavati, Shahab Areeba, Venkatraman Lakshmi
Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
Schizophrenia Research Foundation, Chennai, India.
Front Psychiatry. 2022 Aug 1;13:807259. doi: 10.3389/fpsyt.2022.807259. eCollection 2022.
Globally, a treatment gap exists for individuals with severe mental illness, with 75% of people with psychosis failing to receive appropriate care. This is most pronounced in low and middle-income countries, where there are neither the financial nor human resources to provide high-quality community-based care. Low-cost, evidence-based interventions are urgently needed to address this treatment gap.
To conduct a situation analysis to (i) describe the provision of psychosocial interventions within the context of existing care in two LMICs-India and Pakistan, and (ii) understand the barriers and facilitators of delivering a new psychosocial intervention.
A situation analysis including a quantitative survey and individual interviews with clinicians, patients and caregivers was conducted. Quantitative survey data was collected from staff members at 11 sites (private and government run hospitals) to assess organizational readiness to implement a new psychosocial intervention. To obtain in-depth information, 24 stakeholders including clinicians and service managers were interviewed about the typical care they provide and/or receive, and their experience of either accessing or delivering psychosocial interventions. This was triangulated by six interviews with carer and patient representatives.
The results highlight the positive views toward psychosocial interventions within routine care and the enthusiasm for multidisciplinary working. However, barriers to implementation such as clinician time, individual attitudes toward psychosocial interventions and organizational concerns including the lack of space within the facility were highlighted. Such barriers need to be taken into consideration when designing how best to implement and sustain new psychosocial interventions for the community treatment of psychosis within LMICs.
在全球范围内，重度精神疾病患者存在治疗缺口，75%的精神病患者未能获得适当护理。这在低收入和中等收入国家最为明显，这些国家既没有资金也没有人力资源来提供高质量的社区护理。迫切需要低成本、基于证据的干预措施来解决这一治疗缺口。
进行一项情况分析，以（i）描述在两个低收入和中等收入国家（印度和巴基斯坦）现有护理背景下心理社会干预措施的提供情况，以及（ii）了解实施新的心理社会干预措施的障碍和促进因素。
进行了一项情况分析，包括定量调查以及对临床医生、患者和护理人员的个人访谈。从11个地点（私立和政府运营的医院）的工作人员收集定量调查数据，以评估组织实施新的心理社会干预措施的准备情况。为了获取深入信息，对24名利益相关者（包括临床医生和服务经理）进行了访谈，了解他们提供和/或接受的典型护理，以及他们获取或提供心理社会干预措施的经验。通过对护理人员和患者代表的六次访谈进行了三角验证。
结果突出了在常规护理中对心理社会干预措施的积极看法以及对多学科合作的热情。然而，也强调了实施方面的障碍，如临床医生的时间、个人对心理社会干预措施的态度以及组织方面的担忧，包括设施内空间不足。在设计如何最好地在低收入和中等收入国家实施和维持用于社区治疗精神病的新心理社会干预措施时，需要考虑这些障碍。
