Climent C E, De Arango M V
Acta Psiquiatr Psicol Am Lat. 1981 Sep-Nov;27(4-5):257-74.
The paper describes the experience acquired during more than 8 years in carrying out primary mental health care in Cali, Colombia. It had already been shown that the use of trained paramedical personnel achieved some advantages to that of traditional approaches. The present programme is carried out in two different geographical areas (rural and urban) which provide care to about 10 per cent of their population. Although final clinical results are still not available, the basic approach entails the use of primary mental health agents (auxiliary nurses and health promotors) as the first step of assistance, ending in the top of the hierarchy, where a doctor and/or a trained nurse are responsible for the diagnoses. A trained psychiatrist acts only as a periodic consultant and as the main source for training. There is evidence to suggest that these primary mental health care agents have more time to talk to the patients and are more able to understand their local psycho-social circumstances. This system enables cheaper and more effective care services. Its advantages, risks and related problems are discussed, and mention is made for the need to maintain regular clinical assessment. The various training techniques are also discussed.
本文描述了在哥伦比亚卡利开展超过8年的初级精神卫生保健工作中所获得的经验。此前已经表明，使用经过培训的辅助医务人员比传统方法具有一些优势。目前的项目在两个不同的地理区域（农村和城市）开展，为约10%的人口提供护理服务。尽管最终的临床结果尚未得出，但基本方法是将初级精神卫生工作者（辅助护士和健康促进者）作为援助的第一步，最终由层级顶端的医生和/或经过培训的护士负责诊断。一名经过培训的精神科医生仅作为定期顾问和培训的主要资源。有证据表明，这些初级精神卫生保健工作者有更多时间与患者交谈，并且更能够理解他们当地的心理社会情况。该系统能够提供更廉价且更有效的护理服务。文中讨论了其优势、风险及相关问题，并提到了进行定期临床评估的必要性。还讨论了各种培训技术。
