TEDGlobal 2012
Vikram Patel: Mental health for all by involving all
維克蘭˙帕特爾: 全民投入心理衛生
Filmed:
Readability: 5.8
1,103,181 views
全球有將近四億五千萬人受到心理疾病的影響。在富庶的國家，只有大約一半的患者能受到妥善的醫療照護；然而在開發中國家，有近90% 的患者受不到任何醫療照護是因為心理醫師的嚴重不足。講員維克蘭˙帕特爾指出了一個具有高度可行性的方式 -- 訓練社區的成員來提供心理保健的措施，讓一般人也能對他人進行醫療照護的能力。
Vikram Patel - Mental health care advocate
Vikram Patel helps bring better mental health care to low-resource communities -- by teaching ordinary people to deliver basic psychiatric services. Full bio
Vikram Patel helps bring better mental health care to low-resource communities -- by teaching ordinary people to deliver basic psychiatric services. Full bio
Double-click the English transcript below to play the video.
00:16
I want you to imagine this for a moment.
0
433
2771
請大家想像一下這樣的情境
00:19
Two men, Rahul and Rajiv,
1
3204
2895
有兩個人, 名叫 拉胡跟拉吉
00:21
living in the same neighborhood,
2
6099
1858
住在同一個區域
00:23
from the same educational background, similar occupation,
3
7957
3295
有相同的教育背景, 從事相似的職業
00:27
and they both turn up at their local accident emergency
4
11252
2768
兩個人同樣的都出現在同一個區域急救中心
00:29
complaining of acute chest pain.
5
14020
2816
主訴症狀都是劇烈的胸痛
00:32
Rahul is offered a cardiac procedure,
6
16836
3124
拉胡被施以心血管的療程
00:35
but Rajiv is sent home.
7
19960
2811
而拉吉被告知直接回家
00:38
What might explain the difference in the experience
8
22771
2510
這兩個幾乎相同的人,
00:41
of these two nearly identical men?
9
25281
3252
為什麼會有截然不同的醫療待遇呢?
00:44
Rajiv suffers from a mental illness.
10
28533
3487
拉吉的症狀是心理疾病所造成的
00:47
The difference in the quality of medical care
11
32020
3099
在醫療照護方面的品質落差
00:51
received by people with mental illness is one of the reasons
12
35119
2861
是造成心理疾病患者的壽命比較短,
00:53
why they live shorter lives
13
37980
1915
的眾多原因之一
00:55
than people without mental illness.
14
39895
1583
相較於沒有心理疾病的人
00:57
Even in the best-resourced countries in the world,
15
41478
2670
就算是在世界上資源充分的國家裡
01:00
this life expectancy gap is as much as 20 years.
16
44148
4770
這樣的壽命差異仍可以高達20年
01:04
In the developing countries of the world, this gap
17
48918
1925
若是在開發中的國家, 這項差異
01:06
is even larger.
18
50843
2625
還會更大
01:09
But of course, mental illnesses can kill in more direct ways
19
53468
2859
當然了, 心理疾病也可能更直接致命
01:12
as well. The most obvious example is suicide.
20
56327
3361
最常見的例子就是自殺
01:15
It might surprise some of you here, as it did me,
21
59688
2655
你可能會大吃一驚, 就如同我當時
01:18
when I discovered that suicide is at the top of the list
22
62343
2937
發現自殺是造成年輕人死亡清單中
01:21
of the leading causes of death in young people
23
65280
2565
榜上有名的
01:23
in all countries in the world,
24
67845
1648
在全世界的每個國家都是如此
01:25
including the poorest countries of the world.
25
69493
3392
包括世界上最貧窮的那些國家
01:28
But beyond the impact of a health condition
26
72885
2834
心理疾病除了影響人的健康
01:31
on life expectancy, we're also concerned
27
75719
2370
影響人的壽命, 我們更關切的是
01:33
about the quality of life lived.
28
78089
2694
對生活品質的影響
01:36
Now, in order for us to examine the overall impact
29
80783
2249
我們為了要調查心理疾病對健康的整體影響
01:38
of a health condition both on life expectancy
30
83032
2373
包括壽命(餘命), 還有
01:41
as well as on the quality of life lived, we need to use
31
85405
3158
生活的品質, 我們採用了
01:44
a metric called the DALY,
32
88563
1386
一個量表, 縮寫字首是DALY
01:45
which stands for a Disability-Adjusted Life Year.
33
89949
4287
全名是失能修正餘命年數
01:50
Now when we do that, we discover some startling things
34
94236
2521
透過這樣的研究, 我們發現一些驚人的事實
01:52
about mental illness from a global perspective.
35
96757
2822
是關於心理疾病, 從全球的觀點來看
01:55
We discover that, for example, mental illnesses are
36
99579
3264
我們發現到, 比方說, 心理疾病
01:58
amongst the leading causes of disability around the world.
37
102843
4588
是造成失能的主要原因之一
02:03
Depression, for example, is the third-leading cause
38
107431
2735
以精神抑鬱來說, 是失能的第三主因
02:06
of disability, alongside conditions such as
39
110166
2972
前兩名分別是
02:09
diarrhea and pneumonia in children.
40
113138
3352
兒童的痢疾(腹瀉)與肺炎
02:12
When you put all the mental illnesses together,
41
116490
2104
綜觀所有心理疾病
02:14
they account for roughly 15 percent
42
118594
2262
約佔全球疾病負擔
02:16
of the total global burden of disease.
43
120856
3206
15%之多
02:19
Indeed, mental illnesses are also very damaging
44
124062
4511
很明顯, 心理疾病對於人的生活構成很大的傷害
02:24
to people's lives, but beyond just the burden of disease,
45
128573
5445
除了造成疾病負擔外
02:29
let us consider the absolute numbers.
46
134018
2712
我們也來看看一些實際的數據
02:32
The World Health Organization estimates
47
136730
2059
世界衛生組織(WHO)估計
02:34
that there are nearly four to five hundred million people
48
138789
3105
大約有四到五億人
02:37
living on our tiny planet
49
141894
2183
在這個地球上
02:39
who are affected by a mental illness.
50
144077
1661
正受到心理疾病的影響
02:41
Now some of you here
51
145738
1719
在座各位
02:43
look a bit astonished by that number,
52
147457
2598
看起來對這樣的數字有些吃驚
02:45
but consider for a moment the incredible diversity
53
150055
2493
但若試想一下, 心理疾病有如此多的種類
02:48
of mental illnesses, from autism and intellectual disability
54
152548
3154
從童年期的自閉症及智能障礙
02:51
in childhood, through to depression and anxiety,
55
155702
2681
到成年期的抑鬱與焦慮
02:54
substance misuse and psychosis in adulthood,
56
158383
2281
藥物濫用與精神失調
02:56
all the way through to dementia in old age,
57
160664
1636
一直到老年期的失智症
02:58
and I'm pretty sure that each and every one us
58
162300
2954
我非常肯定, 今天在這裡的每一個人
03:01
present here today can think of at least one person,
59
165254
3352
至少都能夠想出一個人,
03:04
at least one person, who's affected by mental illness
60
168606
3322
至少有一個人, 曾受到心理疾病的影響
03:07
in our most intimate social networks.
61
171928
4431
就在我們最親近的社交圈裡
03:12
I see some nodding heads there.
62
176359
3205
我看到有些人在點頭
03:15
But beyond the staggering numbers,
63
179564
2970
除了這些令人驚愕的統計數字之上
03:18
what's truly important from a global health point of view,
64
182534
3009
從全球健康的觀點來看, 更關鍵的是什麼?
03:21
what's truly worrying from a global health point of view,
65
185543
2545
更值得擔憂的是什麼?
03:23
is that the vast majority of these affected individuals
66
188088
3168
就是這些受到心理疾病影響的個人, 絕大部分
03:27
do not receive the care
67
191256
2009
都沒有接受治療照護
03:29
that we know can transform their lives, and remember,
68
193265
2466
我們明明知道治療照護可以改變這些人的人生
03:31
we do have robust evidence that a range of interventions,
69
195731
3061
也清楚一些醫療措施明確證實
03:34
medicines, psychological interventions,
70
198792
2452
像是藥物, 心理方面的措施
03:37
and social interventions, can make a vast difference.
71
201244
3488
社會方面的措施, 可以產生重大的改善
03:40
And yet, even in the best-resourced countries,
72
204732
2251
但是, 就算是在資源最豐富的國家裡
03:42
for example here in Europe, roughly 50 percent
73
206983
2935
例如在歐洲這裡, 仍然有將近一半的
03:45
of affected people don't receive these interventions.
74
209918
3117
受心理疾病影響的人, 沒有受到任何措施的協助
03:48
In the sorts of countries I work in,
75
213035
2317
在我工作的那些國家裡
03:51
that so-called treatment gap
76
215352
2150
這種所謂的醫療缺口
03:53
approaches an astonishing 90 percent.
77
217502
4887
逼近到驚人的90%
03:58
It isn't surprising, then, that if you should speak
78
222389
3212
如果你跟一個受到心理疾病所苦的人談談
04:01
to anyone affected by a mental illness,
79
225601
2431
不出人意表地，你往往會聽到
04:03
the chances are that you will hear stories
80
228032
2812
他們的故事裡充滿了
04:06
of hidden suffering, shame and discrimination
81
230844
4050
壓抑的苦痛, 恥辱, 還有歧視
04:10
in nearly every sector of their lives.
82
234894
2949
發生在他們生活的每環節
04:13
But perhaps most heartbreaking of all
83
237843
2710
但或許最讓人心碎的
04:16
are the stories of the abuse
84
240553
2689
是那些關於被虐待的故事
04:19
of even the most basic human rights,
85
243242
2532
連最基本的人權都被剝奪
04:21
such as the young woman shown in this image here
86
245774
2857
如同這張照片裡的年輕女子的遭遇
04:24
that are played out every day,
87
248631
2064
令人遺憾的, 每天
04:26
sadly, even in the very institutions that were built to care
88
250695
3944
都在發生, 就在這些專門為照護
04:30
for people with mental illnesses, the mental hospitals.
89
254639
3835
心理疾病患者的機構,精神專科醫院裡面
04:34
It's this injustice that has really driven my mission
90
258474
3028
就是這種不公義, 驅使我投入了一個願景
04:37
to try to do a little bit to transform the lives
91
261502
2392
試著改變這些人的生活
04:39
of people affected by mental illness, and a particularly
92
263894
2746
幫助這些受到心理疾病影響的人, 特別著重在
04:42
critical action that I focused on is to bridge the gulf
93
266640
3849
一個關鍵環節, 就是彌補其間的鴻溝
04:46
between the knowledge we have that can transform lives,
94
270489
2786
一方面是改變他們生活所需的知識,
04:49
the knowledge of effective treatments, and how we actually
95
273275
2442
有效療法的知識, 另一方面在於如何實際地
04:51
use that knowledge in the everyday world.
96
275717
3422
在日常生活裡運用這些知識
04:55
And an especially important challenge that I've had to face
97
279139
3159
而我們所要面對的一個特別重要的挑戰
04:58
is the great shortage of mental health professionals,
98
282298
2925
就是心理衛生專業人員的嚴重不足
05:01
such as psychiatrists and psychologists,
99
285223
1672
例如精神病學家與心理學家
05:02
particularly in the developing world.
100
286895
2788
特別是在開發中世界
05:05
Now I trained in medicine in India, and after that
101
289683
2685
我在印度接受醫學教育的, 後來
05:08
I chose psychiatry as my specialty, much to the dismay
102
292368
3419
我選擇了精神病學作為專科, 違背了
05:11
of my mother and all my family members who
103
295787
2228
我母親和家庭成員的期待,
05:13
kind of thought neurosurgery would be
104
298015
1703
他們多少會覺得這麼聰明的孩子,
05:15
a more respectable option for their brilliant son.
105
299718
3169
應該選擇神經外科才比較有出息
05:18
Any case, I went on, I soldiered on with psychiatry,
106
302887
2734
不管怎麼說, 我還是堅持, 投入了精神病學
05:21
and found myself training in Britain in some of
107
305621
2295
並且有幸到英國
05:23
the best hospitals in this country. I was very privileged.
108
307916
2375
最頂尖的醫院裡接受訓練
05:26
I worked in a team of incredibly talented, compassionate,
109
310291
3543
與一群非常具有天份, 非常熱情的成員共事
05:29
but most importantly, highly trained, specialized
110
313834
3251
更重要的, 是受過高度的專業訓練的
05:32
mental health professionals.
111
317085
2191
心理健康方面的專業人士
05:35
Soon after my training, I found myself working
112
319276
1972
受完訓練之後, 我開始的第一項工作
05:37
first in Zimbabwe and then in India, and I was confronted
113
321248
2443
是在辛巴威, 然後回到印度. 那時我面對的
05:39
by an altogether new reality.
114
323691
2860
是一個全然陌生的現實狀況
05:42
This was a reality of a world in which there were almost no
115
326551
3346
在這個現實狀況中，幾乎找不到任何的
05:45
mental health professionals at all.
116
329897
2365
精神衛生專業人員。
05:48
In Zimbabwe, for example, there were just about
117
332262
2034
例如: 在辛巴威，大約只有
05:50
a dozen psychiatrists, most of whom lived and worked
118
334296
3060
十幾個精神病醫生，其中大多在哈拉雷市(Harare)居住
05:53
in Harare city, leaving only a couple
119
337356
2126
和執業(行醫), 只剩下一兩個
05:55
to address the mental health care needs
120
339482
2393
去服務住在農村的900 萬人
05:57
of nine million people living in the countryside.
121
341875
3668
的精神衛生保健需要
06:01
In India, I found the situation was not a lot better.
122
345543
3617
在印度，我發現情況也好不到哪裡去
06:05
To give you a perspective, if I had to translate
123
349160
2423
打個比方比較好理解，如果我用
06:07
the proportion of psychiatrists in the population
124
351583
2208
精神科醫生在人口中所占的比例來說明
06:09
that one might see in Britain to India,
125
353791
2382
如果以英國的比例來套用到印度
06:12
one might expect roughly 150,000 psychiatrists in India.
126
356173
5609
那麼印度應該大約有150,000 個精神病醫生。
06:17
In reality, take a guess.
127
361782
3031
在現實中，大家猜一猜。
06:20
The actual number is about 3,000,
128
364813
2565
實際的精神病醫生的數目約3000個，
06:23
about two percent of that number.
129
367378
2464
只有英國的2%
06:25
It became quickly apparent to me that I couldn't follow
130
369842
2497
很快地我就認清了沒有辦法按照
06:28
the sorts of mental health care models that I had been trained in,
131
372339
3061
先前我所學的那些精神健康護理模式
06:31
one that relied heavily on specialized, expensive
132
375400
2939
其中高度依賴專業且所費不貲的
06:34
mental health professionals to provide mental health care
133
378339
2532
精神衛生專業人員來提供心理衛生保健
06:36
in countries like India and Zimbabwe.
134
380871
2460
在印度和辛巴威這樣的國家。
06:39
I had to think out of the box about some other model
135
383331
2653
我必須跳脫既有的框架, 想出其他模式的
06:41
of care.
136
385984
1623
護理服務。
06:43
It was then that I came across these books,
137
387607
3113
就在那時候, 我偶然看到這些書，
06:46
and in these books I discovered the idea of task shifting
138
390720
3243
在這些書中發現了所謂 "任務轉移" 的想法
06:49
in global health.
139
393963
2068
可用在全球保健上。
06:51
The idea is actually quite simple. The idea is,
140
396031
2276
這種想法實際上很簡單。就是
06:54
when you're short of specialized health care professionals,
141
398307
3014
當你缺乏專門的醫護專業人員的時候
06:57
use whoever is available in the community,
142
401321
3049
就直接從社區裡找可用的人選
07:00
train them to provide a range of health care interventions,
143
404370
2937
培訓他們來提供一個特定範圍的各種保健措施
07:03
and in these books I read inspiring examples,
144
407307
2868
其中有些很具啟發性的例子
07:06
for example of how ordinary people had been trained
145
410175
2936
例如, 如何培訓一般人
07:09
to deliver babies,
146
413111
1353
去接生嬰兒
07:10
diagnose and treat early pneumonia, to great effect.
147
414464
3631
學會診斷和治療早期肺炎，以發揮大效用。
07:13
And it struck me that if you could train ordinary people
148
418095
2751
這讓我目瞪口呆，如果你可以訓練普通百姓
07:16
to deliver such complex health care interventions,
149
420846
2224
來提供如此複雜的衛生保健措施，
07:18
then perhaps they could also do the same
150
423070
2073
那麼, 也許一般人也可以做到相同的地步
07:21
with mental health care.
151
425143
1992
在精神衛生保健這方面。
07:23
Well today, I'm very pleased to report to you
152
427135
2869
今天，我很高興向各位報告
07:25
that there have been many experiments in task shifting
153
430004
3112
有許多關於"任務轉移" 的實驗被執行
07:29
in mental health care across the developing world
154
433116
2771
在精神衛生保健這方面, 在開發中世界的許多地方
07:31
over the past decade, and I want to share with you
155
435887
2063
在過去十年裡，我想在這裡與你們分享
07:33
the findings of three particular such experiments,
156
437950
2697
這三個特別的實驗
07:36
all three of which focused on depression,
157
440647
2087
這三個都是以抑鬱症為主題
07:38
the most common of all mental illnesses.
158
442734
2435
這是所有的精神疾病中, 最常見的。
07:41
In rural Uganda, Paul Bolton and his colleagues,
159
445169
3342
在烏干達的鄉下、 保羅·博爾頓(Paul Bolton)和他的同事們，
07:44
using villagers, demonstrated that they could deliver
160
448511
3844
與一些村民合作，證明了他們可以提供
07:48
interpersonal psychotherapy for depression
161
452355
2355
抑鬱症的人際心理治療方式
07:50
and, using a randomized control design,
162
454710
2672
而且, 透過隨機對照組的實驗設計
07:53
showed that 90 percent of the people receiving
163
457382
2245
觀察到了接受這種治療的人, 有90%
07:55
this intervention recovered as compared
164
459627
1960
的治癒率, 相較之下
07:57
to roughly 40 percent in the comparison villages.
165
461587
3541
那些對照組的村莊, 大約是40%。
08:01
Similarly, using a randomized control trial in rural Pakistan,
166
465128
4140
在巴基斯坦鄉下，也進行了類似的隨機對照試驗
08:05
Atif Rahman and his colleagues showed
167
469268
2340
據阿替夫·拉赫曼(Atif Rahman)和他的同事們發現到
08:07
that lady health visitors, who are community maternal
168
471608
2735
女性健康訪視員, 就是社區內孕產婦的保健員
08:10
health workers in Pakistan's health care system,
169
474343
2789
是屬於巴基斯坦的衛生保健系統的一部份，
08:13
could deliver cognitive behavior therapy for mothers
170
477132
2217
可以為有抑鬱症狀的母親, 提供認知行為療法
08:15
who were depressed, again showing dramatic differences
171
479349
2508
結果也再次展示了很大的差異
08:17
in the recovery rates. Roughly 75 percent of mothers
172
481857
2847
以治癒率來看。採用村莊大約是75%的治癒率
08:20
recovered as compared to about 45 percent
173
484704
2565
相較於只有45%的治癒率
08:23
in the comparison villages.
174
487269
2284
在對照組的村莊。
08:25
And in my own trial in Goa, in India, we again showed
175
489553
3086
而我自己的試驗，在印度的果阿(Goa)，我們再一次顯示
08:28
that lay counselors drawn from local communities
176
492639
2528
培訓來自當地社區的輔導員
08:31
could be trained to deliver psychosocial interventions
177
495167
2684
來提供心理社會干預措施
08:33
for depression, anxiety, leading to 70 percent
178
497851
2582
針對抑鬱，焦慮，可得70%
08:36
recovery rates as compared to 50 percent
179
500433
2083
的治癒率, 相較
08:38
in the comparison primary health centers.
180
502516
3206
在那些對照組的初級保健中心的50%。
08:41
Now, if I had to draw together all these different
181
505722
1969
現在，如果我必須總結這些各式各樣的
08:43
experiments in task shifting, and there have of course
182
507691
2532
任務轉移的實驗，當然在此之外
08:46
been many other examples, and try and identify
183
510223
2374
還有許多其他的例子，嘗試著歸納出
08:48
what are the key lessons we can learn that makes
184
512597
2018
一些關鍵要素, 讓我們可以學習並促成
08:50
for a successful task shifting operation,
185
514615
3078
任務轉換的成功運作
08:53
I have coined this particular acronym, SUNDAR.
186
517693
3856
我創造了這個特別的首字母縮寫詞，SUNDAR
08:57
What SUNDAR stands for, in Hindi, is "attractive."
187
521549
4234
這個字在印度語的意思是 "吸引力"。
09:01
It seems to me that there are five key lessons
188
525783
2215
我用這個字來代表五個主要關鍵要素
09:03
that I've shown on this slide that are critically important
189
527998
2599
列在這張投影片上，對於有效進行任務轉移
09:06
for effective task shifting.
190
530597
2183
是非常重要的
09:08
The first is that we need to simplify the message
191
532780
3026
第一個是, 我們需要簡化用詞
09:11
that we're using, stripping away all the jargon
192
535806
2384
拿掉那些學界裡慣用的術語
09:14
that medicine has invented around itself.
193
538190
3321
只有醫學院的人才聽得懂的
09:17
We need to unpack complex health care interventions
194
541511
2957
我們還需要解構整個複雜的保健干預措施
09:20
into smaller components that can be more easily
195
544468
2228
分成較小的元件，可以更容易地
09:22
transferred to less-trained individuals.
196
546696
2655
轉移給受過簡易訓練的個人。
09:25
We need to deliver health care, not in large institutions,
197
549351
2567
我們所要提供的衛生保健, 並不是在大型機構，
09:27
but close to people's homes, and we need to deliver
198
551918
2226
而是要貼近人們的家園，我們提供衛生保健的方式
09:30
health care using whoever is available and affordable
199
554144
2772
是運用所有可得的與可負擔的,
09:32
in our local communities.
200
556916
2381
在地的資源
09:35
And importantly, we need to reallocate the few specialists
201
559297
2880
也很重要的是，要重新配置這些數量有限的專家
09:38
who are available to perform roles
202
562177
2068
讓他們扮演的角色
09:40
such as capacity-building and supervision.
203
564245
3478
負責建立生產力還有監導
09:43
Now for me, task shifting is an idea
204
567723
2332
現在對我來說，轉移任務是一個
09:45
with truly global significance,
205
570055
2959
具有真正影響全球的想法
09:48
because even though it has arisen out of the
206
573014
2533
因為即使它源自於
09:51
situation of the lack of resources that you find
207
575547
3498
開發中國家資源缺乏的情境下
09:54
in developing countries, I think it has a lot of significance
208
579045
2959
但我認為它對於資源較充足的國家來說
09:57
for better-resourced countries as well. Why is that?
209
582004
2881
也是非常重要的。為什麼呢？
10:00
Well, in part, because health care in the developed world,
210
584885
3520
嗯，有部份原因, 是因為在已開發世界
10:04
the health care costs in the [developed] world,
211
588405
2475
的衛生保健費用
10:06
are rapidly spiraling out of control, and a huge chunk
212
590880
2577
快速攀升直超出控制, 其中的一大部分
10:09
of those costs are human resource costs.
213
593457
3420
是人力資源成本。
10:12
But equally important is because health care has become
214
596877
2486
但同樣重要的是，因為衛生保健已發展成
10:15
so incredibly professionalized that it's become very remote
215
599363
3837
如此令人難以置信地專業化, 以至於變成和
10:19
and removed from local communities.
216
603200
2755
當地社區越離越遠, 甚至完全脫節.
10:21
For me, what's truly sundar about the idea of task shifting,
217
605955
3722
對我來說，任務轉移這想法真正順達(有吸引力)的
10:25
though, isn't that it simply makes health care
218
609677
1646
並不僅僅是讓衛生保健
10:27
more accessible and affordable but that
219
611323
3158
更容易取得且更能夠負擔
10:30
it is also fundamentally empowering.
220
614481
2556
而是能夠從根本上授權
10:32
It empowers ordinary people to be more effective
221
617037
3632
它使普羅大眾能夠更有效的
10:36
in caring for the health of others in their community,
222
620669
2823
在他們的社區照顧大眾的健康，
10:39
and in doing so, to become better guardians
223
623492
1489
也因為如此做, 能成為在地人的健康導師
10:40
of their own health. Indeed, for me, task shifting
224
624981
3282
所以, 對於我來說，任務轉移
10:44
is the ultimate example of the democratization
225
628263
2687
是民主化的最典型的例子
10:46
of medical knowledge, and therefore, medical power.
226
630950
5249
把醫學知識, 連帶著醫療能量, 都民主化了
10:52
Just over 30 years ago, the nations of the world assembled
227
636199
3451
30 多年前(1978年)，世界各國聚集在
10:55
at Alma-Ata and made this iconic declaration.
228
639650
2973
在阿拉木圖(哈薩克共和國城市)開會, 作出這樣的宣言
10:58
Well, I think all of you can guess
229
642623
1605
嗯，我想大家都猜得到
11:00
that 12 years on, we're still nowhere near that goal.
230
644228
3715
已經超過了宣言期限12年了, 我們還離這目標很遙遠
11:03
Still, today, armed with that knowledge
231
647943
2665
不過如今呢, 透過基本知識的裝備訓練
11:06
that ordinary people in the community
232
650608
2656
讓在社區的一般人
11:09
can be trained and, with sufficient supervision and support,
233
653264
3163
在充分的監督和支援下
11:12
can deliver a range of health care interventions effectively,
234
656427
3272
可以有效地提供一系列保健干預措施
11:15
perhaps that promise is within reach now.
235
659699
3881
或許當初的宣言有達成的可能了
11:19
Indeed, to implement the slogan of Health for All,
236
663580
3644
事實上，為了落實"全民健康" 這個口號
11:23
we will need to involve all
237
667224
1786
我們必須讓全民都能
11:24
in that particular journey,
238
669010
1659
參與這個特別的過程
11:26
and in the case of mental health, in particular we would
239
670669
2946
而在心理保健方面，我們特別需要讓
11:29
need to involve people who are affected by mental illness
240
673615
2903
受精神疾病影響的人, 還有他們的照護者
11:32
and their caregivers.
241
676518
1454
都參與進來
11:33
It is for this reason that, some years ago,
242
677972
2536
這也是為什麼在幾年前
11:36
the Movement for Global Mental Health was founded
243
680508
1918
全球精神衛生運動開始推動
11:38
as a sort of a virtual platform upon which professionals
244
682426
4023
扮演一種虛擬平臺的角色,
11:42
like myself and people affected by mental illness
245
686449
2807
讓像我這樣的專業人員, 和受精神疾病影響的人
11:45
could stand together, shoulder-to-shoulder,
246
689256
2712
能並肩而站
11:47
and advocate for the rights of people with mental illness
247
691968
2486
宣揚心理疾病患者的權利
11:50
to receive the care that we know can transform their lives,
248
694454
3217
一個得到改善生活照護的權力
11:53
and to live a life with dignity.
249
697671
3009
並且有尊嚴地活下去
11:56
And in closing, when you have a moment of peace or quiet
250
700680
3517
最後，當你有片刻的寧靜時
12:00
in these very busy few days or perhaps afterwards,
251
704197
2826
在這幾個忙碌的日子, 或是在往後
12:02
spare a thought for that person you thought about
252
707023
2754
花些心思在那個你想到的, 受心理疾病影響的人
12:05
who has a mental illness, or persons that you thought about
253
709777
2577
或是那群你想到的
12:08
who have mental illness,
254
712354
1588
受心理疾病影響的人們
12:09
and dare to care for them. Thank you. (Applause)
255
713942
3804
勇於關心他們吧.謝謝（掌聲）
12:13
(Applause)
256
717746
4064
（掌聲）
ABOUT THE SPEAKER
Vikram Patel - Mental health care advocateVikram Patel helps bring better mental health care to low-resource communities -- by teaching ordinary people to deliver basic psychiatric services.
Why you should listen
In towns and villages that have few clinics, doctors and nurses, one particular need often gets overlooked: mental health. When there is no psychiatrist, how do people get care when they need it? Vikram Patel studies how to treat conditions like depression and schizophrenia in low-resource communities, and he's come up with a powerful model: training the community to help.
Based in Goa for much of the year, Patel is part of a policy group that's developing India's first national mental health policy; he's the co-founder of Sangath, a local NGO dedicated to mental health and family wellbeing. In London, he co-directs the Centre for Global Mental Health at the London School of Hygiene & Tropical Medicine. And he led the efforts to set up the Movement for Global Mental Health, a network that supports mental health care as a basic human right.
From Sangath's mission statement: "At the heart of our vision lies the ‘treatment gap’ for mental disorders; the gap between the number of people with a mental disorder and the number who receive care for their mental disorders."
Vikram Patel | Speaker | TED.com