Tansella M, Thornicroft G
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Italy.
Psychol Med. 1998 May;28(3):503-8. doi: 10.1017/s0033291796005880.
The reform of mental health services needs to be guided by an overall conceptual framework. Such a framework is important to avoid many risks, including extrapolating from a specific service site to other services, without taking into account local and regional variables.
A conceptual framework, the 'matrix model', is proposed. This model has been developed using the most relevant information that is necessary for describing and interpreting mental health services data as well as patient-based information.
The 'matrix model' has two dimensions: the geographical, which refers to three levels (country, local and patient) and the temporal, which refers to three phases (inputs, processes and outcomes). Using these two dimensions a nine-cell matrix is constructed to bring into focus critical issues for mental health services. The relevance of each level and each phase is briefly presented.
The matrix is intended to assist clinicians, planners and researchers to deal with clinical phenomena, organizational issues, and research questions that share a degree of complexity that render inadequate analyses and the interventions made only at one level. The matrix model applies particularly to mental health systems of care that are provided with a public health framework, and is less useful for contexts that consist of clinicians offering only one-to-one treatments, within fragmented programmes of care.
精神卫生服务改革需要以一个整体概念框架为指导。这样一个框架对于避免诸多风险很重要，包括在未考虑当地和区域变量的情况下，从特定服务场所推断至其他服务。
提出一个概念框架，即“矩阵模型”。该模型是利用描述和解释精神卫生服务数据以及基于患者的信息所需的最相关信息开发而成。
“矩阵模型”有两个维度：地理维度，涉及三个层面（国家、地方和患者）；时间维度，涉及三个阶段（投入、过程和结果）。利用这两个维度构建一个九宫格矩阵，以聚焦精神卫生服务的关键问题。简要介绍了每个层面和每个阶段的相关性。
该矩阵旨在帮助临床医生、规划者和研究人员处理临床现象、组织问题以及具有一定复杂性的研究问题，这些问题使得仅在一个层面进行分析和干预是不够的。该矩阵模型特别适用于具有公共卫生框架的精神卫生护理系统，而对于由临床医生在零散的护理计划中仅提供一对一治疗的情况则不太适用。
