Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Lancet. 2023 Aug 19;402(10402):656-666. doi: 10.1016/S0140-6736(23)00918-2.
A burgeoning mental health crisis is emerging globally, regardless of each country's human resources or spending. We argue that effectively responding to this crisis is impeded by the dominant framing of mental ill health through the prism of diagnostic categories, leading to an excessive reliance on interventions that are delivered by specialists; a scarcity of widespread promotive, preventive, and recovery-oriented strategies; and failure to leverage diverse resources within communities. Drawing upon a series of syntheses, we identify five principles to transform current practices; namely, address harmful social environments across the life course, particularly in the early years; ensure that care is not contingent on a categorical diagnosis but aligned with the staging model of mental illness; empower diverse front-line providers to deliver psychosocial interventions; embrace a rights-based approach that seeks to provide alternatives to violence and coercion in care; and centre people with lived experience in all aspects of care. We recommend four policy actions which can transform these principles into reality: a whole of society approach to prevention and care; a redesign of the architecture of care delivery to provide a seamless continuum of care, tailored to the severity of the mental health condition; investing more in what works to enhance the impact and value of the investments; and ensuring accountability through monitoring and acting upon a set of mental health indicators. All these actions are achievable, relying-for the most part-on resources already available to every community and country. What they do require is the acceptance that business as usual will fail and the solutions to transforming mental health-care systems are already present within existing resources.
全球范围内正出现一场日益严重的心理健康危机，无论各国的人力资源或支出如何。我们认为，通过诊断类别这一棱镜来主导对心理健康不良的描述，这一做法阻碍了对此危机的有效应对，导致过度依赖由专家提供的干预措施；缺乏广泛的促进、预防和以康复为导向的策略；未能利用社区内的各种资源。通过一系列综合研究，我们确定了五项原则来改变当前的做法；即解决贯穿整个生命周期的有害社会环境问题，特别是在早年；确保护理不是取决于分类诊断，而是与精神疾病的分期模式保持一致；授权多元化的一线服务提供者提供心理社会干预；采取基于权利的方法，寻求在护理中提供替代暴力和强制的方法；并将有过相关生活经历的人置于护理的各个方面的中心。我们建议采取四项政策行动，将这些原则变为现实：全社会参与预防和护理；重新设计护理提供的架构，提供无缝的连续护理，根据心理健康状况的严重程度进行定制；更多地投资于有效的措施，以提高投资的影响和价值；并通过监测和根据一系列心理健康指标采取行动来确保问责制。所有这些行动都是可行的，主要依赖于每个社区和国家已经拥有的资源。它们确实需要的是接受常规做法将失败的事实，以及认识到现有的资源中已经存在着改变精神卫生保健系统的解决方案。
