創新的心理健康方法.pdf

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1、Julian Eaton,BSc,MSc,MBBS,MRCPsychMental Health Director CBM GlobalAssistant Professor London School of Hygiene and Tropical MedicineKeynote PresentationWhy the Eye:Innovative Mental Health Approaches Mental health and visual impairment Increased prevalence of mental conditions in people losing visi

2、on or with vision loss Mainly common mental conditions,some other symptoms Widely varying prevalence of comorbidity in research Better mental health improves not only quality of life,but social and physical outcomes Increase in physical problems in people with MH diagnosisMental health and visual im

3、pairment 2 Mechanisms A grief reaction Profound change in lifestyle,self-sufficiency and functioning Loss of employment,social role,status Biological mechanisms Coping and resilienceTrania J-F,Ballard E,Peac J.Stigma of persons with disabilities in Afghanistan:Examining the pathways from stereotypin

4、g to mental distress.Social Science&Medicine 2016;153:258265 Structural equation modelling indicates the effect of Disability on Mental Distress largely mediated by Social ExclusionWhy are the links between eye care,stigmaand mental health important?To ensure health programmes meet peoples needsTo i

5、mprove social and health outcomesEnsure services receive the resources they deserve for comprehensive approaches to be deliveredTo support people to thrive!Integrating into existing systemsTargeting key stakeholdersCommunity anti-stigma workLinking to specialist servicesAccessible treatment/therapeu

6、tic skills in local servicesRecognising mental ill health and comm skillsLancet 2008,after Alma AtaResearch evidenceKey messagesPriority for people affectedShould be part of comprehensive programmingNegative impact on overall outcomes,and prognosisWe can intervene at different points in the cycleKey

7、 considerationsIntegrated within front-line servicesMainstreaming and referralThink beyond the individual to care-givers,especially for childrenMental health care and stigma work are linked,but draw on distinct evidence-based interventions1.Community level carePrevention and promotion,including addr

8、essing community-based stigmaEarly identification and initial treatment within eye care services.Group and peer-based supportReferral to appropriate mental health care where needed.Link to other services for livelihoods etcAnti-stigma activities during field work.Link to holistic health promotion ac

9、tivitiesLinks to peer support groups for social supportMobilisecommunities2.Individual treatment and supportPrevention and promotion,including addressing community-based stigmaEarly identification and initial treatment within eye care services.Group and peer-based supportReferral to appropriate ment

10、al health care where needed.Link to other services for livelihoods etcEarly identificationGive front line workers skills to recognise mental health issues and know next steps for referralLay and peer counselling following trainingFloyd-Richard M,Gurung S.Stigma reduction through group counselling of

11、 persons affected by leprosy-a pilot study.Lepr Rev,2000;71:499504Link people together3.Linking with specialist services and other sectorsPrevention and promotion,including addressing community-based stigmaEarly identification and initial treatment within NTD services.Group and peer-based supportRef

12、erral to appropriate mental health care where needed.Link to other services for livelihoods etcEnsure access to specialist support where neededPrimary care-based treatment interventions(for general clinicians)Link to mental health services(for referral and supervision)Improve liaison between wider h

13、ealth and mental health systemsThe move to a more inclusive world Building a movement across interest groups is key Vision 2020 and NTD work Translate research to WHO endorsed guidance Part of a growing recognition of holistic care that we can capitalize on!CBM Global:www.cbm-global.orgTwitter:julian_eatoncbm_globalE-mail:julian.eatoncbm-global.org