经济学人下载:心理疾病治疗 身体与灵魂

Treating mental illness
心理疾病治疗

Body and soul
身体与灵魂

A professional schism hinders Britain's mental-health system
一个专业性的分裂阻碍英国心理健康系统

THE day after Mandy Peck tried to electrocute herself in the bath her family took her to a mental-health centre in Chelmsford and asked for help. They were told that there were no beds available and sent home. Two days later Ms Peck jumped to her death from a multi-storey car park. She left a daughter behind.
在曼迪·派克试图在浴室用电击自杀的第二天，她的家人将她送至且切姆斯福德的一家心理健康中心寻求帮助。他们被告知中心没有空余床位，随即回家。两天之后，派克于一个多层停车场跳楼自杀。她死后还留下了一个女儿。

Ms Peck would not have been turned away had she arrived at hospital with a broken leg. Yet the National Health Service (NHS) often fails those suffering from a broken spirit. The numbers are fuzzy, but about one Briton in four suffers a mental-health problem at some time in their life, ranging from mild anxiety to severe schizophrenia. Less than a third of those receive treatment. That is in part because many sufferers are ashamed to seek help, but it is also due to funding gaps and disorganisation within the NHS. The result is a system in crisis, says Sue Bailey, a former president of the Royal College of Psychiatrists.
如果派克到达医院时是腿部骨折的话，她就不会被医院拒收了。然而英国的国民医疗保健制度（NHS）总是放弃了那些饱受残缺心灵折磨的人们。尽管没有确切数据，但平均每四个英国人中就有一个人在他们生命中的某个时期受到心理健康问题的困扰，这些问题小到轻微的焦虑症，大到严重的精神分裂。可是不到三分之一的人选择接受心理治疗。因为从某种程度来讲很多病人都羞于寻求这方面的帮助，但这也归咎于NHS内部的资金缺口和杂乱无章。英国皇家精神科医学院的前任院长苏·贝利称这样的结果使整个制度陷入危机。

This failure is costly. Mental-health problems cause more suffering in Britain than physical illness, poverty or unemployment, according to Richard Layard, an economist and author of a book on happiness. People with severe mental illnesses have higher rates of physical illness than the general public. According to the King's Fund, a think-tank, this costs the NHS between ￡8 billion ($13 billion) and ￡13 billion each year. Sufferers are also more likely to commit crime; mental illness has become the most common reason to claim disability benefits. Researchers at the OECD, a club of rich countries, reckon getting mentally-ill people back to work could increase employment in Britain by nearly 5%.
这个失败的代价很高。据着有一本关于幸福的书的经济学家理查德·莱亚德称，心理健康问题在英国给人们带来的痛苦多过生理疾病、贫困或失业。有严重心理疾病的人们比一般人有更高的生理疾病得病率。据智囊团君主基金分析，这个每年耗费了NHS80亿英镑（约合130亿美元）到13亿英镑。同时患有心理疾病的患者犯罪几率更高；心理疾病已经成为索赔伤残补助的最常见的理由。经合组织（OECD，发达国家组成的俱乐部）的研究人员估算如果将那些有心理疾病的人送回去工作，那么英国的就业率可以提高将近5%。

Part of the problem is money. The consequences of mental illness cost the British economy over ￡100 billion a year, according to the Centre for Mental Health, a think-tank, yet the NHS spends just ￡11.3 billion on the problem. Some, like Mr Layard, see misplaced priorities. Doctors spend about ￡3.5 billion a year treating the depression and anxiety disorders suffered by some 6m British adults—a vast amount less than is spent treating the physical ailments of roughly 500,000 patients in the last year of their lives.
这问题有一部分原因是因为钱。根据智囊团心理健康中心调查，心理疾病致使英国经济一年花费至少1000亿英镑，但NHS为此只花费了113亿。一些像莱亚德一样的人了解其中的轻重缓急。一些医生一年花费35亿英镑治疗大约600万患有抑郁和情绪障碍的英国成年人，这巨额费用中大部分都用来治疗50万弥留病人的生理疾病。

Recent cuts to health spending have fallen hardest on mental-health care, just as doctors say demand is rising. The number of NHS beds for patients with mental illness has declined by over 30% since 2003. Many facilities are now full. As a result patients are having to travel long distances or wait months for care. To free up room, a mental-health centre in London has discharged patients to bed-and-breakfasts. Others are not so lucky: sufferers picked up by police are often diagnosed in jail cells. This week Norman Lamb, the minister for care, said that services for young people are “stuck in the dark ages”.
最近健康消费的削减使心理健康护理的境况跌入谷底，正如医生所说，人们对于心理健康的需求正在提升。NHS提供给心理疾病患者的床位自2003年起已经减少了至少30%。很多设备现在也没有空余的了。因此病人必须长途跋涉去别的地方或者排队等待数月来寻求治疗。为了腾出空间，伦敦一家心理健康中心向出院病人提供住宿和早餐。其他的病人就没那么幸运了。一些病人经常碰到警察，被带回监狱诊断。本周医疗部长诺曼·兰布称，对于年轻人来讲，心理健康服务“仍就停留在黑暗时期”。

A second challenge arises from the way the NHS is structured. Mental-health care is staffed and funded separately from physical care—treatment is focused on the mind or body, but rarely on both at once. Yet research shows depressed people are more likely than others to develop heart and lung disease, and to suffer from strokes. Mental illness also appears to make diseases more lethal. On average men with mental-health problems die 20 years earlier than those without them (most from causes other than suicide), says the British Medical Association.
第二个挑战来自NHS的制度结构。心理健康保健的提供和资助都与生理健康保健是分开的。因为治疗通常针对精神或身体，但鲜少两者兼顾。但研究显示抑郁的人比其他人更易患心脏和肺部的疾病，且更易患中风。患上心理疾病似乎也更易患上绝症。通常患上心理疾病的人比那些没有患心理疾病的人少活20年（大多心理疾病会导致患者死于除自杀之外的原因）。英国医学会如是说。

The government is alive to these problems. Britain's spending on mental health may be inadequate, but it compares favourably with that of other rich countries. From April ministers have promised to limit the long waiting times that prevent many people using mental-health services. And in 2012 the government pledged to give mental health care equal priority to physical care, enshrining this principle as part of the Health and Social Care Act. But critics complain that the promise has yet to deliver much practical change.
政府已经意识到这些问题。英国对于心理健康的支出或许不够，但与其它富有国家相比算是不错的了、自4月部长们已经承诺会限制阻止很多人使用心理健康服务的长时间等待。2012年政府保证给予心理健康保健与生理保健平等优先权，并将这一原则作为健康与社会保健法案的一部分。但批评家们抱怨承诺并未带来很多实际变化。

Reform advocates would like better integration between mental- and physical-health care. “Liaison psychiatry” involves placing mental-health specialists in hospitals to work alongside doctors. The Centre for Mental Health found that one such initiative in Birmingham reduced the length of hospital stays and the number of readmissions and improved the health and well-being of patients. The centre calculated that the programme saved four times its costs. Yet such services are often meagre.
改革倡议者想要心理和生理保健更好的一体化。“联络精神病学”涉及到心理健康专家在医院和医生一起工作。心理健康中心发现,伯明翰的一项此类实验减少了病人住院时间长度和再次入院的次数，并且提高病人的健康和幸福感。中心计算得出这项计划花费只占成本四分之一，但这类服务还不完善。

It would be better and cheaper to keep sufferers out of hospital altogether, says Emma Stanton, who runs Beacon UK, a mental-health consultancy. Ms Stanton recommends treatment at home through teams of doctors, nurses and social workers. Instead of swallowing antidepressants, health bosses would like sufferers of mild conditions to receive help under a programme called Improving Access to Psychological Therapies (IAPT), which aims to expand the use of treatments such as cognitive behavioural therapy. This helps individuals challenge the gloomy thinking that can lead to anxiety and depression. The National Institute for Health and Care Excellence (NICE), which evaluates treatments, considers it good value. Yet David Clark, an adviser for IAPT, says it reaches only a fraction of those who need it. He would like its budget doubled.
心理健康咨询公司英国灯塔的运营者艾玛·斯坦顿称，将患者在院外集中是个更好且更实惠的方法。斯坦顿推荐在家通过治疗团队的医生、护士以及社会工作者治疗的方法。与服用抗抑郁药相比卫生官员们更希望中等程度的病患接受一个名为“使更多人获得心理治疗”（IAPT）的项目的帮助。这个项目旨在扩大认知行为疗法的使用。这能帮助个人挑战可能会导致焦虑和抑郁的悲观想法。国家健康和护理研究所（NICE）评估此项治疗并且认为物有所值、但IAPT的顾问大卫·克拉克称项目预算只够一小部分需要它的人接受治疗。他希望预算可以翻倍。

Convincing politicians to cough up more funds will be tough. Some critics fear that beefing up treatment of the most common mental-health problems risks saddling the system with overwhelming costs. Fortunately there is a lot that can be achieved without more cash. Many mental-health services still do not meet the standards recommended by NICE, and communication between services is poor. Elaborate therapies are not always necessary—one effective treatment for those suffering mental illness is keeping them in a job. Other types of therapy, say advocates, should pay for themselves by saving health-care costs and increasing productivity. Improving Britons' mental health is not only humane, but economical.
说服政客们挤出更多的资金是艰难的。一些批评家担心加强治疗最常见的心理健康问题会有成本过高使体系不堪重负的风险。幸运的是有很多事情无需更多金钱便可做到。很多心理健康服务不符合NICE推荐的标准，并且服务之间的交流也很贫乏。复杂的治疗并不总是必要的——对于病患来说，一个有效的治疗方法就是让他们保持工作。提倡者称，其他的治疗方式应该通过节约健康保健成本和提高生产力来为病患支付。提高英国心理健康不仅是关乎人道，也关系到经济。