观点:心理健康的责任:澳大利亚的经验。

IF 1 4区 医学 Q4 HEALTH POLICY & SERVICES
Sebastian Rosenberg, Luis Salvador-Carulla
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引用次数: 0

摘要

背景:澳大利亚是最早制定精神卫生国家政策的国家之一。所有这些政策的一个一贯特点是它们提到责任的重要性。这到底是什么意思,我们实现了吗?澳大利亚能看出是否有人在好转吗?本研究的目的:回顾澳大利亚的心理健康问责制,并质疑20年来澳大利亚关于心理健康问责制的言论是否已经实现。方法:本文首先考虑问责制的概念及其在心理健康中的应用。然后,我们利用现有的文献、报告和来自国家和州政府的经验数据来说明历史和当前的心理健康问责方法。我们对最新的一套国家指标进行了内容分析。本文还简要考虑了一些相关的国际进程,以比较澳大利亚在建立精神卫生问责制方面的进展。结果:澳大利亚的联邦政府系统允许相互竞争的问责方法,有多个重叠的数据集。未能形成明确的国家精神卫生问责办法。现有数据侧重于行政和保健服务指标,未能反映反映生活质量的更广泛的社会因素。尽管澳大利亚进行了20年的投资和努力,但仍被描述为结果盲目,无法证明每年在心理健康方面花费80亿美元的价值。讨论和限制:虽然可能有很多,但现有的行政数据提供的结果信息很少,澳大利亚可以据此真正评估精神疾病患者的健康和福利。国际社会的努力进展缓慢。对保健服务提供和使用的影响:即使在澳大利亚等高收入国家,精神卫生服务的资源也受到限制。各国不能继续投资于不能证明对精神疾病患者有良好效果或不物有所值的服务或规划。对卫生政策的影响:需要采取新办法,确保选定的问责制指标反映国家卫生和社会优先事项。这些优先事项必须对一系列利益攸关方和社区的心理健康状况有意义。他们必须推动与受精神障碍影响最严重的人有关的持续改善议程。这些办法在新出现的国际环境中应该是可行的。对进一步研究的影响:澳大利亚必须进一步制定与心理健康有关的卫生问责办法。应商定一套有限的新的首选国家精神卫生指标。应在国内和国际上对这些方法进行测试,以了解它们为精神卫生质量改进进程提供信息和推动的能力。结论:现有的问责制度不适合目的,不能启动必要的质量改进过程。在充足的资源、现实的目标和开放的文化的支持下,新的问责制可以推动精神卫生的真正质量改进进程,促进澳大利亚的司法比较,并有助于为国际精神卫生基准作出新的努力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
PERSPECTIVES: Accountability for Mental Health: The Australian Experience.

Background: Australia was one of the first countries to develop a national policy for mental health. A persistent characteristic of all these policies has been their reference to the importance of accountability. What does this mean exactly and have we achieved it? Can Australia tell if anybody is getting better?

Aims of the study: To review accountability for mental health in Australia and question whether two decades of Australian rhetoric around accountability for mental health has been fulfilled.

Methods: This paper first considers the concept of accountability and its application to mental health. We then draw on existing literature, reports, and empirical data from national and state governments to illustrate historical and current approaches to accountability for mental health. We provide a content analysis of the most current set of national indicators. The paper also briefly considers some relevant international processes to compare Australia's progress in establishing accountability for mental health.

Results: Australia's federated system of government permits competing approaches to accountability, with multiple and overlapping data sets. A clear national approach to accountability for mental health has failed to emerge. Existing data focuses on administrative and health service indicators, failing to reflect broader social factors which reveal quality of life. In spite of twenty years of investment and effort Australia has been described as outcome blind, unable to demonstrate the merit of USD 8bn spent on mental health annually.

Discussion and limitations: While it may be prolific, existing administrative data provide little outcomes information against which Australia can genuinely assess the health and welfare of people with a mental illness. International efforts are evolving slowly.

Implications for health care provision and use: Even in high income countries such as Australia, resources for mental health services are constrained. Countries cannot afford to continue to invest in services or programs that fail to demonstrate good outcomes for people with a mental illness or are not value for money.

Implications for health policies: New approaches are needed which ensure that chosen accountability indicators reflect national health and social priorities. Such priorities must be meaningful to a range of stakeholders and the community about the state of mental health. They must drive an agenda of continuous improvement relevant to those most affected by mental disorders. These approaches should be operable in emerging international contexts.

Implications for further research: Australia must further develop its approach to health accountability in relation to mental health. A limited set of new preferred national mental health indicators should be agreed. These should be tested, both domestically and internationally, for their capacity to inform and drive quality improvement processes in mental health.

Conclusion: Existing systems of accountability are not fit for purpose, incapable of firing necessary quality improvement processes. Supported by adequate resources, realistic targets and a culture of openness, new accountability could drive real quality improvement processes for mental health, facilitate jurisdictional comparisons in Australia, and contribute to new efforts to benchmark mental health internationally.

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来源期刊
CiteScore
2.20
自引率
6.20%
发文量
8
期刊介绍: The Journal of Mental Health Policy and Economics publishes high quality empirical, analytical and methodologic papers focusing on the application of health and economic research and policy analysis in mental health. It offers an international forum to enable the different participants in mental health policy and economics - psychiatrists involved in research and care and other mental health workers, health services researchers, health economists, policy makers, public and private health providers, advocacy groups, and the pharmaceutical industry - to share common information in a common language.
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