Harvard University, Cambridge, MA, United States.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States.
Front Public Health. 2022 Dec 8;10:992222. doi: 10.3389/fpubh.2022.992222. eCollection 2022.
INTRODUCTION: The mental health crisis has caused widespread suffering and has been further exacerbated by the COVID-19 pandemic. Marginalized groups are especially affected, with many concerns rooted in social determinants of mental health. To stem this tide of suffering, consideration of approaches outside the traditional biomedical model will be necessary. Drawing from task-sharing models of mental health care that have been pioneered in low-resource settings, community-initiated care (CIC) represents a potentially promising collection of approaches. This landscape analysis seeks to identify examples of CIC that have been implemented outside of the research context, with the aim of identifying barriers and facilitators of scale up. METHODS: A narrative review approach was used for this landscape analysis in which the PubMed database was searched and further supplemented with Google Scholar. Promising programs were then discussed over multiple rounds of meetings with the research team, consisting of collaborators with varied experiences in mental health. Using the selection criteria and feedback derived from group meetings, a final list of programs was identified and summarized according to common characteristics and features. RESULTS: The initial PubMed search yielded 16 results, supplemented by review of the first 100 entries in Google Scholar. Through 5 follow-up meetings among team members, consensus was reached on a final list of 9 programs, which were grouped into three categories based on similar themes and topics: (1) approaches for the delivery of psychosocial interventions; (2) public health and integrative approaches to mental health; and (3) approaches for addressing youth mental health. Key facilitators to scale up included the importance of sustainable financing and human resources, addressing social determinants and stigma, engaging diverse stakeholders, leveraging existing health infrastructure, using sustainable training models, ensuring cultural relevance and appropriateness, and leveraging digital technologies. DISCUSSION: This landscape analysis, though not an exhaustive summary of the literature, describes promising examples of efforts to scale up CIC outside of the research context. Going forward, it will be necessary to mobilize stakeholders at the community, health system, and government levels to effectively promote CIC.
简介:心理健康危机造成了广泛的痛苦,而 COVID-19 大流行使情况进一步恶化。弱势群体受影响尤其严重,许多担忧源于心理健康的社会决定因素。为了遏制这种痛苦,有必要考虑传统生物医学模式之外的方法。借鉴在资源匮乏环境中首创的精神卫生保健任务分担模式,社区启动的关怀(CIC)代表了一组有希望的方法。本景观分析旨在确定在研究背景之外实施的 CIC 示例,目的是确定扩大规模的障碍和促进因素。 方法:本景观分析采用叙述性综述方法,在 PubMed 数据库中进行检索,并通过 Google Scholar 进一步补充。然后,通过与研究团队的多次会议讨论有前途的项目,研究团队成员具有不同的精神卫生经验。使用从小组会议中得出的选择标准和反馈,根据共同的特征和特点,确定并总结最终的项目清单。 结果:最初的 PubMed 搜索产生了 16 个结果,并通过对 Google Scholar 前 100 项的审查进行了补充。通过团队成员之间的 5 次后续会议,就最终的 9 个项目清单达成共识,这些项目根据类似的主题和话题分为三个类别:(1)实施心理社会干预的方法;(2)公共卫生和综合心理健康方法;(3)解决青年心理健康问题的方法。扩大规模的关键促进因素包括可持续供资和人力资源的重要性、解决社会决定因素和耻辱问题、吸引不同利益攸关方、利用现有卫生基础设施、使用可持续培训模式、确保文化相关性和适当性以及利用数字技术。 讨论:本景观分析虽然不是文献的详尽总结,但描述了在研究背景之外扩大 CIC 的有希望的例子。今后,有必要动员社区、卫生系统和政府各级的利益攸关方,有效促进 CIC。
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