| 引用本文：Sophie Plagerson.精神卫生与社会发展整合的理论与实践[J].中国卫生政策研究,2014,7(5):19-26 |
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| 精神卫生与社会发展整合的理论与实践 |
| 投稿时间：2014-02-14 修订日期：2014-03-15 PDF全文浏览 HTML全文浏览 |
| Sophie Plagerson |
| 约翰内斯堡大学非洲社会发展中心 南非约翰内斯堡 2006 |
| 摘要:许多中低收入国家对精神卫生区别对待，将其作为一种专业性的卫生政策。尽管全球精神卫生工作取得重大进展，但与之有关的政策和实践与社会发展整合的程度有限，并且往往落后于全球更广义的卫生发展。这种差距的出现是由于忽略了社会发展对精神卫生服务的影响，而这种影响既可能是积极的，也可能是消极的。本文旨在分析当前精神卫生需要克服的一系列理论和实践挑战，探索富有成效的社会发展和精神卫生整合的政策。从理论角度出发，本文力求证明社会发展与精神卫生模式之间存在兼容性，能力方法可以为精神卫生和社会发展整合提供框架。然而，近期有关幸福能力导向的言论一直在讨论精神卫生所带来的潜在危害性后果。有关政策和实践部分，本文建议采用横向和纵向整合战略。横向战略需要精神卫生与初级卫生保健相结合，精神卫生服务的提供与服务包的扩展更加统一。纵向整合是指精神卫生与其它相关政策领域（尤其是社会、经济和政治领域）之间的结合。精神卫生的实证研究强调了社会发展理论的诸多方面可以在某种形式上对其实践产生影响：一是避免那些受心理疾病影响或存在患病风险的弱势人群遭到排斥；二是强调了执行过程是成功政策的重要组成部分；三是通过聚焦个人，尽力避免社会发展中的不均衡。 |
| 关键词:精神卫生 抑郁症 卫生政策 社会发展 能力 |
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| Integrating mental health and social development in theory and practice |
| Sophie Plagerson |
| Centre for Social Development in Africa, University of Johannesburg, Johannesburg 2006, South Africa |
| Abstract:In many low and middle income countries, attention to mental illness remains compartmentalized and consigned as a matter for specialist policy. Despite great advances in global mental health, mental health policy and practice dovetail only to a limited degree with social development efforts. They often lag behind broader approaches to health and development. This gap ignores the small but growing evidence that social development unavoidably impacts the mental health of those affected, and that this influence can be both positive and negative. This article examines the theoretical and practical challenges that need to be overcome for a more effective integration of social development and mental health policy. From a theoretical perspective, this article demonstrates compatibility between social development and mental health paradigms. In particular, the capability approach is shown to provide a strong framework for integrating mental health and development. Yet, capability-oriented critiques on 'happiness’ have recently been applied to mental health with potentially detrimental outcomes. With regard to policy and practice, horizontal and vertical integration strategies are suggested. Horizontal strategies require stronger devolution of mental health care to the primary care level, more unified messages regarding mental health care provision and the gradual expansion of mental health packages of care. Vertical integration refers to the alignment of mental health with related policy domains (particularly the social, economic and political domains). Evidence from mental health research reinforces aspects of social development theory in a way that can have tangible implications on practice. First, it encourages a focus on avoiding exclusion of those affected by or at risk of mental illness. Secondly, it underscores the importance of the process of implementation as an integral component of successful policies. Finally, by retaining a focus on the individual, it seeks to avoid uneven approaches to development. |
| Key words:Mental health Depression Health policy Social development Capabilities |
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