No Health Without Mental Health

IF 9 Q1 PSYCHIATRY
C. Vladu, A. Novac, Adrian Preda, R. Bota
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Postmodernism and neo-pragmatism have brought us deconstruction. 2 It applies to many a change that modern research and new demands of society have exerted on contempo- rary psychiatry. Public opinion about mental illness has changed. New patient populations have emerged. The emphasis on multidiscipli- nary approaches has often lagged behind. Today the complexity of psychiatry among all other medical specialties is rarely recognized. A rather reductionistic over-identification with neuroscience has often been professed and a simplistic acceptance that a part is in fact the whole has been too often purported. Yet unquestionable remains the fact that psychi- atric morbidity and disability outweigh the burden of other medical conditions and that our patients are the same people seen in pri- mary care settings for most medical condi- tions. As a consequence, a heavy burden is paid by the world community. It is then on this note that the World Psychiatric Association Congress in Bucharest, Romania, June 24-27, entitled: Primary Care Mental Health: Innovation and Transdisciplinarity, stands out among most other international conferences of the past year. Recognizing the urgency to addressissues of health policy globally, the 2015 World Psychiatric Association International Congress presented the following resolutions, which were approved by the participants and will be forwarded to the United Nations: 3 «WHEREAS, cardiovascular and mental dis- orders lead in the global burden of non-commu- nicable diseases; WHEREAS, most mental disor- ders are attended to in primary care; WHEREAS, mental disorders account for 30-45% of the global burden of disability; WHEREAS, 50% of mental disorders exist by age 14, and 75% by age 24; WHEREAS, these disorders result in billions of dollars of negative economic consequences across low-, middle-, and high-income nations; WHEREAS, significant global health systems fragmentation diminishes access to care and its effectiveness; WHEREAS, more research into the brain and into the determinants of health is needed; WHEREAS, effective treatments for mental disorders exist for most cases; and WHEREAS, the collaboration and integration of primary care, mental health, and public health is proven to enhance access, quality, and sus- tainability [...] NOW BE IT RESOLVED THAT United Nations member states adopt collaborative and integrat- ed care as a means toward achieving total health for all in the 21 st Century; and be if fur- ther resolved that [...] this goal be included in the updated United Nations Sustainable Development Goals; and be it further resolved that, United Nations member states allocate the necessary human, financial, and technological resources for training, education, and imple- mentation of this resolution [sic]». Many topics presented at the Congress were pertinent to health policy. Therefore, our team further interviewed many presenters and inquired about the foremost urgent aspects that need to be addressed in the process of integrating mental health into primary care. The points below summarize the comments and our observations i) Psychiatric disorders account for a signif- icant share of the global burden of dis- ease. Psychiatric illness are characterized by very high comorbidity with medical and other psychiatric disorders. Therefore, they constitute a major public health burden. ii) Current health systems are unprepared to address the ever-increasing needs of patients suffering from mental illness. Financial resources allocated for mental health are far from being proportional with the burden and prevalence of the mental disorders. Striving for adequate resources is of utmost importance. iii) The modern health care emphasis on bio- logical formulations for urgent or acute care is poorly fitted to address the needs of most psychiatric patients, who suffer from chronic conditions with important psychosocial determinants. 4 To improve the somatic and mental health outcomes of the people suffering with mental ill- ness the future systems of care should consider the needs of chronic care and the psychosocial context. iv) The complexity, chronicity and comorbid- ity of most psychiatric conditions requires a reconceptualization of mental health and illness across the levels of individual patient care, community care, health care organizations and policies, emphasizing the bi-directional relation- ships between mental and somatic ill- ness. v) As reflected in most of the presentations [Mental Illness 2016; 8:6609] Correspondence: Robert G. Bota, UC Irvine Health Neuropsychiatric Center, 101 The City Drive South, Orange, CA 92868, USA. Tel.: +1.714.456.2056. E-mail: rbota@uci.edu Key words: psychiatry; mental health; WPA. Contributions: the authors contributed equally. Conflict of interest: the authors declare no poten- tial conflict of interest. Received for publication: 20 May 2016. Accepted for publication: 20 May 2016. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). ©Copyright C. Vladu et al., 2016 Licensee PAGEPress, Italy Mental Illness 2016; 8:6609 doi:10.4081/mi.2016.6609 of the WPA 2015 in Bucharest and given the precarious state of the health care services provided to the mentally ill world- wide, there is an urgent need to re-con- ceptualize and reform the health delivery systems for the mentally ill. The new approach should be guided by principles of social justice and dignity. Patients with psychiatric disorders should be given the same priority and importance as patients with all other medical conditions. vi) The fragmentation of most current health care services decreases the quality of care for patients with mental illness. By inte- grating psychiatric and other medical services future care services will foster health, improve efficiency, decrease waste and improve the overall experience of patients. 3 vii) A new approach to psychiatry should include the entire spectrum of services from primary prevention to treatment and rehabilitation services for the mentally ill. viii) Sustained integration and coordination of services between family medicine, pri- mary health care teams and the psychi- atric care at the front end is needed. ix) As it is known that stable long-term func- tioning teams of professionals produce better treatment outcomes, a new approach should rely on such teams, enabling the provision of continuous and tailored care to mentally ill. x) The PHC/community care teams should have an increasingly developed role; the WHO chronic care model should be applied and tools to activate communities should be used. 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引用次数: 2

Abstract

Mental Illness 2016; volume 8:6609 No health without mental health Cristina Vladu, Andrei Novac, Adrian Preda, Robert G. Bota University of California, Irvine, CA, USA Two hundred years ago, the term psychiatry was introduced (psyche-soul and iatros-physi- cian) to designate a medical specialty that would attend to those with mental illness. 1 At that time psychiatric conditions were recog- nized as being at the border of medicine, phi- losophy and theology. We are now ushering in an era in which psychiatry and primary care are creating a new alliance. We live in a world of postmodern psychiatry in which numerous previous structures and roles are being chal- lenged. Postmodernism and neo-pragmatism have brought us deconstruction. 2 It applies to many a change that modern research and new demands of society have exerted on contempo- rary psychiatry. Public opinion about mental illness has changed. New patient populations have emerged. The emphasis on multidiscipli- nary approaches has often lagged behind. Today the complexity of psychiatry among all other medical specialties is rarely recognized. A rather reductionistic over-identification with neuroscience has often been professed and a simplistic acceptance that a part is in fact the whole has been too often purported. Yet unquestionable remains the fact that psychi- atric morbidity and disability outweigh the burden of other medical conditions and that our patients are the same people seen in pri- mary care settings for most medical condi- tions. As a consequence, a heavy burden is paid by the world community. It is then on this note that the World Psychiatric Association Congress in Bucharest, Romania, June 24-27, entitled: Primary Care Mental Health: Innovation and Transdisciplinarity, stands out among most other international conferences of the past year. Recognizing the urgency to addressissues of health policy globally, the 2015 World Psychiatric Association International Congress presented the following resolutions, which were approved by the participants and will be forwarded to the United Nations: 3 «WHEREAS, cardiovascular and mental dis- orders lead in the global burden of non-commu- nicable diseases; WHEREAS, most mental disor- ders are attended to in primary care; WHEREAS, mental disorders account for 30-45% of the global burden of disability; WHEREAS, 50% of mental disorders exist by age 14, and 75% by age 24; WHEREAS, these disorders result in billions of dollars of negative economic consequences across low-, middle-, and high-income nations; WHEREAS, significant global health systems fragmentation diminishes access to care and its effectiveness; WHEREAS, more research into the brain and into the determinants of health is needed; WHEREAS, effective treatments for mental disorders exist for most cases; and WHEREAS, the collaboration and integration of primary care, mental health, and public health is proven to enhance access, quality, and sus- tainability [...] NOW BE IT RESOLVED THAT United Nations member states adopt collaborative and integrat- ed care as a means toward achieving total health for all in the 21 st Century; and be if fur- ther resolved that [...] this goal be included in the updated United Nations Sustainable Development Goals; and be it further resolved that, United Nations member states allocate the necessary human, financial, and technological resources for training, education, and imple- mentation of this resolution [sic]». Many topics presented at the Congress were pertinent to health policy. Therefore, our team further interviewed many presenters and inquired about the foremost urgent aspects that need to be addressed in the process of integrating mental health into primary care. The points below summarize the comments and our observations i) Psychiatric disorders account for a signif- icant share of the global burden of dis- ease. Psychiatric illness are characterized by very high comorbidity with medical and other psychiatric disorders. Therefore, they constitute a major public health burden. ii) Current health systems are unprepared to address the ever-increasing needs of patients suffering from mental illness. Financial resources allocated for mental health are far from being proportional with the burden and prevalence of the mental disorders. Striving for adequate resources is of utmost importance. iii) The modern health care emphasis on bio- logical formulations for urgent or acute care is poorly fitted to address the needs of most psychiatric patients, who suffer from chronic conditions with important psychosocial determinants. 4 To improve the somatic and mental health outcomes of the people suffering with mental ill- ness the future systems of care should consider the needs of chronic care and the psychosocial context. iv) The complexity, chronicity and comorbid- ity of most psychiatric conditions requires a reconceptualization of mental health and illness across the levels of individual patient care, community care, health care organizations and policies, emphasizing the bi-directional relation- ships between mental and somatic ill- ness. v) As reflected in most of the presentations [Mental Illness 2016; 8:6609] Correspondence: Robert G. Bota, UC Irvine Health Neuropsychiatric Center, 101 The City Drive South, Orange, CA 92868, USA. Tel.: +1.714.456.2056. E-mail: rbota@uci.edu Key words: psychiatry; mental health; WPA. Contributions: the authors contributed equally. Conflict of interest: the authors declare no poten- tial conflict of interest. Received for publication: 20 May 2016. Accepted for publication: 20 May 2016. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). ©Copyright C. Vladu et al., 2016 Licensee PAGEPress, Italy Mental Illness 2016; 8:6609 doi:10.4081/mi.2016.6609 of the WPA 2015 in Bucharest and given the precarious state of the health care services provided to the mentally ill world- wide, there is an urgent need to re-con- ceptualize and reform the health delivery systems for the mentally ill. The new approach should be guided by principles of social justice and dignity. Patients with psychiatric disorders should be given the same priority and importance as patients with all other medical conditions. vi) The fragmentation of most current health care services decreases the quality of care for patients with mental illness. By inte- grating psychiatric and other medical services future care services will foster health, improve efficiency, decrease waste and improve the overall experience of patients. 3 vii) A new approach to psychiatry should include the entire spectrum of services from primary prevention to treatment and rehabilitation services for the mentally ill. viii) Sustained integration and coordination of services between family medicine, pri- mary health care teams and the psychi- atric care at the front end is needed. ix) As it is known that stable long-term func- tioning teams of professionals produce better treatment outcomes, a new approach should rely on such teams, enabling the provision of continuous and tailored care to mentally ill. x) The PHC/community care teams should have an increasingly developed role; the WHO chronic care model should be applied and tools to activate communities should be used. Screening tools should be given to cover the most prevalent psychi- [page 55]
没有心理健康就没有健康
精神疾病2016;没有精神健康就没有健康克里斯蒂娜·弗拉杜,安德烈·诺瓦克,阿德里安·普雷达,罗伯特·g·博塔美国加州大学欧文分校200年前,精神病学这个术语被引入(精神-灵魂和医生-医生),用来指定一种专门治疗精神疾病患者的医学专业。那时,精神疾病被认为是医学、哲学和神学的边缘学科。我们现在正迎来一个精神病学和初级保健正在建立新联盟的时代。我们生活在一个后现代精神病学的世界里,许多以前的结构和角色正在受到挑战。后现代主义和新实用主义给我们带来了解构。它适用于现代研究和社会的新要求给当代精神病学带来的许多变化。公众对精神疾病的看法已经改变。新的患者群体已经出现。对多学科方法的强调常常落后。今天,在所有其他医学专业中,精神病学的复杂性很少得到承认。人们常常宣称对神经科学有一种相当简化的过度认同,而且过于简单化地接受部分实际上就是整体。然而,不容置疑的事实是,精神疾病的发病率和残疾超过了其他医疗条件的负担,我们的病人和大多数医疗条件下在初级保健机构看到的人是一样的。结果,国际社会承担了沉重的负担。正是基于这一点,6月24日至27日在罗马尼亚布加勒斯特召开的题为“初级保健精神卫生:创新和跨学科”的世界精神病学协会大会在过去一年的大多数国际会议中脱颖而出。认识到解决全球卫生政策问题的紧迫性,2015年世界精神病学协会国际大会提出了下列决议,经与会者批准并将提交联合国:3“鉴于,心血管和精神疾病是全球非传染性疾病负担的主要原因;鉴于,大多数精神障碍在初级保健中得到治疗;鉴于,精神障碍占全球残疾负担的30-45%;鉴于,50%的精神障碍在14岁时存在,75%在24岁时存在;鉴于,这些疾病在低收入、中等收入和高收入国家造成数十亿美元的负面经济后果;鉴于,全球卫生系统严重碎片化削弱了获得医疗服务的机会及其有效性;鉴于,需要对大脑和健康的决定因素进行更多的研究;鉴于,大多数情况下存在有效的精神障碍治疗方法;鉴于,初级保健、精神卫生和公共卫生的合作和整合已被证明可以提高可及性、质量和可持续性[…]现在决心联合国会员国采用协作和综合保健作为在21世纪实现人人享有全面健康的一种手段;如果他们下定决心……将这一目标纳入最新的联合国可持续发展目标;并进一步决定,联合国会员国拨出必要的人力、财政和技术资源,用于培训、教育和执行本决议。大会提出的许多议题都与卫生政策有关。因此,我们的团队进一步采访了许多演讲者,并询问了在将精神卫生纳入初级保健的过程中需要解决的最紧迫的方面。以下几点总结了这些评论和我们的观察:1)精神疾病占全球疾病负担的很大一部分。精神疾病的特点是与医学和其他精神疾病有很高的合并症。因此,它们构成了重大的公共卫生负担。(二)目前的卫生系统没有准备好应对精神疾病患者日益增长的需求。分配给精神卫生的财政资源与精神障碍的负担和流行程度远远不成比例。争取充足的资源是至关重要的。(三)现代卫生保健强调紧急或急性护理的生物配方,很难满足大多数精神病患者的需要,这些患者患有慢性疾病,具有重要的社会心理决定因素。为了改善患有精神疾病的人的身体和精神健康结果,未来的护理系统应该考虑慢性护理的需要和社会心理环境。
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Mental Illness
Mental Illness PSYCHIATRY-
CiteScore
1.10
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3
审稿时长
10 weeks
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