What are the arguments for community-based mental health care?
    Quels sont les arguments en faveur des soins et des services de santé mentale de proximité ?

    Año de publicación: 2003

    Mental disorders are responsible for about 12 - 15 % of the world’s total disability – more than cardiovascular diseases, and twice as much as cancer. Their impact on daily life is even more extensive, accounting for more than 30% of all years lived with disability.

    Findings:

    There are no persuasive arguments or data to support a hospital-only approach. Nor is there any scientific evidence that community services alone can provide satisfactory comprehensive care. Instead, the weight of professional opinion and results from available studies support balanced care. Balanced care is essentially community-based, but hospitals play an important backup role. This means that mental health services are provided in normal community settings close to the population served, and hospital stays are as brief as possible, arranged promptly and employed only when necessary. It is important to coordinate the efforts of various mental health services, whether governmental, nongovernmental or private, and to ensure that the interfaces between them function properly. Cost–effectiveness studies on deinstitutionalization and of community mental health care teams have demonstrated that quality of care is closely related to expenditure. Community-based mental health services generally cost the same as the hospital-based services they replace.

    Policy considerations:

    The priorities and policy goals for a particular country depend largely on the financial resources available. • Low-resource countries should focus on establishing and improving mental health services within primary care settings, using specialist services as a backup. • Medium-resource countries should also seek to provide related components such as outpatient clinics, community mental health care teams, acute inpatient care, long-term community-based residential care and occupational care. • In addition to such measures, high-resource countries should provide forms of more differentiated care such as specialized ambulatory clinics and community mental health care teams, assertive community treatment, and alternatives to acute inpatient care, long-term community residential care and vocational rehabilitation.
    Les troubles mentaux sont à l’origine d’environ 12 %–15 % de l’ensemble des incapacités dans le monde, soit plus que les maladies cardiovasculaires et deux fois plus que le cancer. Leurs effets sur la vie quotidienne sont plus importants encore, puisqu’ils représentent plus de 30 % de toutes les années d’incapacité. Ce rapport constitue la réponse du Réseau HEN à une question d’un décideur. Il fournit une synthèse des meilleures Informations factuelles, incluant un sommaire des principaux résultats et choix de politiques en la matière. Le Réseau HEN, mis en place et coordonné par le Bureau régional de l’OMS pour l’Europe, est un service d’information pour les décideurs dans les domaines de la santé publique et des services de santé de la Région. D’autres personnes ou groupes concernés peuvent également bénéficier du Réseau HEN.

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