(1.21)--经济学人智库报告_精神健康和社会融入.pdf
Sponsored byAn Economist Intelligence Unit briefing paperMENTAL HEALTH AND INTEGRATIONPROVISION FOR SUPPORTING PEOPLE WITH MENTAL ILLNESS:A COMPARISON OF 15 ASIA-PACIFIC COUNTRIES仅供“全球精神健康”在线课程学生参考使用1 The Economist Intelligence Unit Limited 2016Mental health and integration Provision for supporting people with mental illness:A comparison of 15 Asia-Pacific countriesContentsExecutive summary 2About this research 51.Introduction:Asia-Pacifics mental health challenge 7 Box:A data caveat 132.The Asia-Pacific Mental Health Integration index and its results 14 Box:Similarities and differences between the Europe and Asia-Pacific indices 173.Index rankings 18 The leaders:New Zealand and Australia 18 Box:New Zealands“Like Minds,Like Mine”20 years of combatting stigma 21 High income Asia:Taiwan,Singapore,South Korea,Japan and Hong Kong 23 Box:The protean challenge of stigma 28 Upper middle income countries:Malaysia,China and Thailand 29 Box:Chinas programme 686finding the human resources for community care 34 Lower middle income countries:India,the Philippines,Indonesia,Vietnam and Pakistan 36 Box:The rural-urban divide 404.Conclusion:The keys to transformation 42Appendix 1:Overview of index results 44Appendix 2:Index methodology 45仅供“全球精神健康”在线课程学生参考使用2 The Economist Intelligence Unit Limited 2016Mental health and integration Provision for supporting people with mental illness:A comparison of 15 Asia-Pacific countriesExecutive summaryMental illness is the second largest contributor to years lost due to disability(YLDs)in the Asia-Pacific region.Nowhere,though,do more than half of those affected receive any medical treatment.This is not some temporary crisis.It is business as usual.Across the region,policy makers and health systems are taking note.In 2010,Japan declared mental illness to be one of just five priority diseases;China passed its first ever mental health law in 2012;Indonesia significantly modernised its legislation in 2014 and India adopted its first mental health policy the same year.Meanwhile,at the international level,APEC and ASEAN have also begun to engage with the issue.All fifteen states and jurisdictions1called countries here for simplicitycovered in this study aspire to treat those living with mental illness outside of institutions and to support their integration into the community.This EIU study,sponsored by Janssen Asia Pacific,examines how well countries in the region are currently doing in this regard.To do so,it draws on an Index measuring performance across a range of areas relative to integration,as well as interviews with 19 local and international experts in mental healthcare and substantial desk research.Its key findings include:Mental illness places a huge health and economic burden on Asia-Pacific:The use of metrics introduced in the 1990s has revealed the previously masked toll of mental illness.On average,it causes more than one-fifth of YLDs in the 15 Index countries and 9.3%of disability adjusted life years(DALYsa joint measure of YLDs and early deaths).Between now and 2030 it will reduce economic growth in India and China by$11 trillion.In Australia and New Zealand it currently knocks 3.5%and 5%respectively off GDP.Because the effect of suicidea particularly large problem in South Korea and Japanis not included in these calculations,the real human and financial cost of mental illness is likely far worse.The relative impact of mental illness is growing:As measured in age-standardised DALYs,the absolute burden of mental illness is changing little in every Index country with no clear connection between economic growth and individual risk.Nevertheless,faster progress against other kinds of disease has increased the proportion of the health burden for which mental illness is responsible,raising its public health importance.Too few are being treated.In countries such as Australia and Singapore,under half of those 仅供“全球精神健康”在线课程学生参考使用3 The Economist Intelligence Unit Limited 2016Mental health and integration Provision for supporting people with mental illness:A comparison of 15 Asia-Pacific countrieswith a mental illness receive medical care and in India and China,only around a tenth.These are in line with global estimates for developed and developing countries.Worse still,such treatment is often insufficient.In Australia,just 16%of those with anxiety disorders receive“adequate”treatment.The ideal is patient-focussed,community-based,integrated service provision;the reality is not:Treatment now aims to support those living with mental illness to“recover.”This,in essence,means their being able to live a meaningful lifeas defined by themin the community.This requires integrated medical,social,housing and employment services.Although such an approach has been recognised as best practice for several decades,including now by authorities in all Index countries,in a majority of countries most care remains hospital based.Our Index shows that countries fall into four groups on mental health integration:National scores are hugely diverse:on employment opportunities,two countries earned 100 out of 100 and three got zero.Overall,though,four clear groupings emerge:(1)New Zealand and Australia;(2)high income Asian countries(Taiwan,Singapore,South Korea,Japan,Hong Kong);(3)upper middle income countries(Malaysia,China,Thailand);and(4)lower middle income countries(India,the Philippines,Vietnam,Indonesia,Pakistan).The membership of these groups shows a clear link between success in this area and levels of economic development,but a closer look indicates that much more is involved.New Zealand and Australia:In addition to devoting substantial resources to mental health,these countries perform well because of a very long history of consistent efforts to implement community-based care that has allowed them to build up the necessary infrastructure,practice and personnel.More importantly,both have seen a marked cultural shift in this area,with stigma against those living with mental illness decreasing and non-government and non-clinical stakeholders having a substantial role in policy-setting and delivery of relevant services.Both countries,though,are still working on weaknesses,such as access for socially-marginalised groups and rural dwellers.High income Asian countries:These countries have advanced health systems and governments with the technical capacity needed for high quality social services.They have also,for most of the last decade,been trying to implement community-based provision for those living with mental illness.These services,however,are still relatively under-developed and under-staffed.A major reason is the time it takes health systems to increase budgets,build up trained human resources,align diverse policies across multiple government sectors in the same direction and coordinate multidisciplinary service.However,the high levels of institutionalisation in Japan,South Korea and to some extent Taiwan,show the difficulty of overcoming entrenched economic interests and clinical practice.Finally,progress against stigma has been slowand may still be reversiblewhile the role of patient advocacy is slight.Concerns about suicide rates,however,should keep policy focused on mental health.Upper middle income countries:These countries have also shown much greater commitment to community-based care,but began more recently than high income countries.Moreover,Malaysia and China have expanded community-based,integrated medical services for those living with mental illness while hospital-based services in Malaysia and Thailand are more often in general rather than specialist psychiatric institutions.Development of necessary general and mental health care facilities and personnel,though,are still much less advanced than in high income countries and the needs greater,including huge treatment gaps,too few clinicians,few or no non-medical services and little coordination between those which do exist and healthcare providers.The ideal is patient-focussed,community-based,integrated service provision;the reality is not仅供“全球精神健康”在线课程学生参考使用4 The Economist Intelligence Unit Limited 2016Mental health and integration Provision for supporting people with mental illness:A comparison of 15 Asia-Pacific countriesLower middle income countries:Here,the challenges are huge:little available medical treatment for those living with mental illness,including an entirely inadequate number of mental health professionals;a nearly complete lack of non-medical services;the concentration of most mental healthcare in large hospitals which are often dilapidated and,in some countries,the scene of human rights abuses;budgets insufficient for pressing health needs but health systems which lack the technical capacity to fully spend them.On the other hand,experts interviewed for this study point to signs of improvement and the enactment of important new legislation and programmes.Several challenges are common to countries in all groups,although they take different forms:l Data:In developing states,even basic information on prevalence is guesswork.More economically advanced ones have this data,but little information on outcomes.l The rural-urban divide:In many developing states,rural service provision is either sparse or non-existent,forcing those in need of care either to go without or face expensive and potentially difficult journeys to major centres.Provision is better in wealthier countries but lower usage rates of mental health services in rural areas and higher ones for suicide indicate improvement is needed.l Stigma:Stigma against those living with mental illness,especially severe conditions such as schizophrenia,is pervasive and takes a wide range of shapes,from being placed in chains to perceived unfair treatment by friends.Too often,there is an underlying belief that those affected by these diseases are morally tainted and dangerousif not physically then socially.Addressing this will involve substantial cultural change and a more prominent human rights perspective in the discussion of mental health.Failure to address it,though,will undermine all progress towards community integration.仅供“全球精神健康”在线课程学生参考使用5 The Economist Intelligence Unit Limited 2016Mental health and integration Provision for supporting people with mental illness:A comparison of 15 Asia-Pacific countriesThe Economist Intelligence Unit(EIU)undertook a study aimed at assessing the degree of commitment of 15 countries within the Asia-Pacific region to integrating those with mental illness into their communities.The research was commissioned and funded by Janssen Asia Pacific,a division of Johnson&Johnson Pte.Ltd.This report focuses on the results of this benchmarking study,called the Asia-Pacific Mental Health Integration Index.Drawing on lessons from the EIUs 2014 European Mental Health Integration Index,this edition index compares the level of effort in each of the countries on indicators associated with integrating individuals suffering from mental illness into society.Data for the Index was collected between March and May 2016.The set of 18 indicators were grouped into four categories:l Environment for those with mental illness in leading a full life l Access for people with mental illness to medical help and servicesl Opportunities,specifically job-related,available to those with mental illness,andl Governance of the system,including human rights issues and efforts to combat stigmaA full description of the Index methodology appears in the Appendix to this report.During construction of the Index,the EIU consulted a number of experts from across the world.For their time and advice throughout this project,we would like to extend our special thanks to the following:l Chee Ng,Director,Asia-Australia Mental Health Partnership,University of Melbourne,Australial Jack Heath,CEO,SANE Australial Hong Ma,Professor,Institute of Mental Health,Peking University,Chinal Pallab K.Maulik,Deputy Director and Head of Research and Development,The George Institute for Global Health,Indial Tadashi Takeshima,Former Director Mental Health Policy and Administration,NCNP Japan,JapanIn addition to the benchmarking study,the EIU carried out extensive desk research for this report and conducted several in-depth interviews with experts.We would also like to thank the following people for their participation:l Nor Hayati Ali,Consultant Psychiatrist(Community and Rehabilitation Psychiatry)with the Ministry of Health Malaysia l Shu-Sen Chang,National Taiwan University,TaiwanAbout this research仅供“全球精神健康”在线课程学生参考使用6 The Economist Intelligence Unit Limited 2016Mental health and integration Provision for supporting people with mental illness:A comparison of 15 Asia-Pacific countriesl Sung-Ku Choi,Director,The National Center for Mental Health,South Koreal Judi Clements,Chair of the Multi-Agency Group,former Chief Executive,Mental Health Foundation of New Zealand,New Zealandl Daniel Fung,President,Singapore Association for Mental Health,Singaporel Patanon Kwansanit,Head of International Mental Health Unit,Department of Mental Health,Thai Ministry of Health,Thailandl Cynthia R.Leynes,Department of Psychiatry&Behavioral Medicine,University of the Philippines College of Medicine,and Past President,Philippine Psychiatric Association,Philippinesl Harry Minas,Head,Global and Cultural Mental Health Unit,Centre for Mental Health,Melbourne School of Population and Global Health,Australia l Thanh Tam Nguyen,Country Director of Basic Needs Vietnam,Founder&CEO of Mental Health and Community Development(MHCD),Vietnaml Hugh Norriss,former Director of Strategy,Advocacy and Research,Mental Health Foundation of New Zealand,New Zealandl Vikram Patel,Public Health Foundation of India,Indial Siham Sikander,Human Development Research Foundation,Pakistanl Atsuro Tsutsumi,Associate Professor,Organisation of Global Affairs,Kanazawa University,Japanl Dan Yu,Chief Officer,The Mental Health Association of Hong Kong,Hong Kongl Nova Riyanti Yusuf,former Indonesian MP and leading proponent of countrys new mental health law,IndonesiaThe EIU bears sole responsibility for the content of this report.The findings and views expressed do not necessarily reflect the views of the sponsor.None of the experts interviewed for this report received financial compensation for participating in the interview programme.Paul Kielstra was the author of the report and Gareth Nicholson was the editor.The Index was devised and constructed by an EIU research team led by Trisha Suresh.Aneliya Muller,Anna Cummins and Ira Martina Drupady supported with research and data collection.仅供“全球精神健康”在线课程学生参考使用7 The Economist Intelligence Unit Limited 2016Mental health and integration Provision for supporting people with mental illness:A comparison of 15 Asia-Pacific countriesIntroduction:Asia-Pacifics mental health challenge1A huge problem becomes too visible to ignore“In both developed and developing Asia-Pacific countries,people have begun to understand the importance of men
