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Treating mental illness

心理疾病治療

Body and soul

身體與靈魂

A professional schism hinders Britain's mental-health system

一個專業性的分裂阻礙英國心理健康系統

THE day after Mandy Peck tried to electrocute herselfin 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 Peckjumped to her death from a multi-storey car park. She left a daughter behind.

在曼迪·派克試圖在浴室用電擊自殺的第二天，她的家人將她送至且切姆斯福德的一家心理健康中心尋求幫助。他們被告知中心沒有空余床位，隨即回家。兩天之后，派克于一個多層停車場跳樓自殺。她死后還留下了一個女兒。

Ms Peck would not have been turned away had she arrived at hospital with a broken leg. Yet theNational Health Service (NHS) often fails those suffering from a broken spirit. The numbers arefuzzy, 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 receivetreatment. That is in part because many sufferers are ashamed to seek help, but it is also dueto funding gaps and disorganisation within the NHS. The result is a system in crisis, says SueBailey, a former president of the Royal College of Psychiatrists.

如果派克到達醫院時是腿部骨折的話，她就不會被醫院拒收了。然而英國的國民醫療保健制度(NHS)總是放棄了那些飽受殘缺心靈折磨的人們。盡管沒有確切數據，但平均每四個英國人中就有一個人在他們生命中的某個時期受到心理健康問題的困擾，這些問題小到輕微的焦慮癥，大到嚴重的精神分裂。可是不到三分之一的人選擇接受心理治療。因為從某種程度來講很多病人都羞于尋求這方面的幫助，但這也歸咎于NHS內部的資金缺口和雜亂無章。英國皇家精神科醫學院的前任院長蘇·貝利稱這樣的結果使整個制度陷入危機。

This failure is costly. Mental-health problems cause more suffering in Britain than physicalillness, poverty or unemployment, according to Richard Layard, an economist and author of abook on happiness. People with severe mental illnesses have higher rates of physical illnessthan 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. Researchersat the OECD, a club of rich countries, reckon getting mentally-ill people back to work couldincrease employment in Britain by nearly 5%.

這個失敗的代價很高。據著有一本關于幸福的書的經濟學家理查德·萊亞德稱，心理健康問題在英國給人們帶來的痛苦多過生理疾病、貧困或失業。有嚴重心理疾病的人們比一般人有更高的生理疾病得病率。據智囊團君主基金分析，這個每年耗費了NHS80億英鎊(約合130億美元)到13億英鎊。同時患有心理疾病的患者犯罪幾率更高;心理疾病已經成為索賠傷殘補助的最常見的理由。經合組織(OECD，發達國家組成的俱樂部)的研究人員估算如果將那些有心理疾病的人送回去工作，那么英國的就業率可以提高將近5%。

Part of the problem is money. The consequences of mental illness cost the British economyover ￡100 billion a year, according to the Centre for Mental Health, a think-tank, yet the NHSspends 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 disorderssuffered by some 6m British adults—a vast amount less than is spent treating the physicalailments of roughly 500,000 patients in the last year of their lives.

這問題有一部分原因是因為錢。根據智囊團心理健康中心調查，心理疾病致使英國經濟一年花費至少1000億英鎊，但NHS為此只花費了113億。一些像萊亞德一樣的人了解其中的輕重緩急。一些醫生一年花費35億英鎊治療大約600萬患有抑郁和情緒障礙的英國成年人，這巨額費用中大部分都用來治療50萬彌留病人的生理疾病。

Recent cuts to health spending have fallen hardest on mental-health care, just as doctors saydemand is rising. The number of NHS beds for patients with mental illness has declined byover 30% since 2003. Many facilities are now full. As a result patients are having to travel longdistances or wait months for care. To free up room, a mental-health centre in London hasdischarged patients to bed-and-breakfasts. Others are not so lucky: sufferers picked up bypolice are often diagnosed in jail cells. This week Norman Lamb, the minister for care, said thatservices for young people are “stuck in the dark ages”.

最近健康消費的削減使心理健康護理的境況跌入谷底，正如醫生所說，人們對于心理健康的需求正在提升。NHS提供給心理疾病患者的床位自2003年起已經減少了至少30%。很多設備現在也沒有空余的了。因此病人必須長途跋涉去別的地方或者排隊等待數月來尋求治療。為了騰出空間，倫敦一家心理健康中心向出院病人提供住宿和早餐。其他的病人就沒那么幸運了。一些病人經常碰到警察，被帶回監獄診斷。本周醫療部長諾曼·蘭布稱，對于年輕人來講，心理健康服務“仍就停留在黑暗時期”。

A second challenge arises from the way the NHS is structured. Mental-health care is staffedand funded separately from physical care—treatment is focused on the mind or body, but rarelyon both at once. Yet research shows depressed people are more likely than others to developheart and lung disease, and to suffer from strokes. Mental illness also appears to make diseasesmore lethal. On average men with mental-health problems die 20 years earlier than thosewithout them (most from causes other than suicide), says the British Medical Association.

第二個挑戰來自NHS的制度結構。心理健康保健的提供和資助都與生理健康保健是分開的。因為治療通常針對精神或身體，但鮮少兩者兼顧。但研究顯示抑郁的人比其他人更易患心臟和肺部的疾病，且更易患中風。患上心理疾病似乎也更易患上絕癥。通常患上心理疾病的人比那些沒有患心理疾病的人少活20年(大多心理疾病會導致患者死于除自殺之外的原因)。英國醫學會如是說。

The government is alive to these problems. Britain's spending on mental health may beinadequate, but it compares favourably with that of other rich countries. From April ministershave promised to limit the long waiting times that prevent many people using mental-healthservices. And in 2012 the government pledged to give mental health care equal priority tophysical care, enshrining this principle as part of the Health and Social Care Act. But criticscomplain that the promise has yet to deliver much practical change.

政府已經意識到這些問題。英國對于心理健康的支出或許不夠，但與其它富有國家相比算是不錯的了、自4月部長們已經承諾會限制阻止很多人使用心理健康服務的長時間等待。2012年政府保證給予心理健康保健與生理保健平等優先權，并將這一原則作為健康與社會保健法案的一部分。但批評家們抱怨承諾并未帶來很多實際變化。

Reform advocates would like better integration between mental- and physical-health care. “Liaison psychiatry” involves placing mental-health specialists in hospitals to work alongsidedoctors. The Centre for Mental Health found that one such initiative in Birmingham reduced thelength 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. Yetsuch services are often meagre.

改革倡議者想要心理和生理保健更好的一體化。“聯絡精神病學”涉及到心理健康專家在醫院和醫生一起工作。心理健康中心發現,伯明翰的一項此類實驗減少了病人住院時間長度和再次入院的次數，并且提高病人的健康和幸福感。中心計算得出這項計劃花費只占成本四分之一，但這類服務還不完善。

It would be better and cheaper to keep sufferers out of hospital altogether, says EmmaStanton, who runs Beacon UK, a mental-health consultancy. Ms Stanton recommendstreatment at home through teams of doctors, nurses and social workers. Instead of swallowingantidepressants, health bosses would like sufferers of mild conditions to receive help under aprogramme called Improving Access to Psychological Therapies (IAPT), which aims to expandthe use of treatments such as cognitive behavioural therapy. This helps individuals challengethe gloomy thinking that can lead to anxiety and depression. The National Institute for Healthand Care Excellence (NICE), which evaluates treatments, considers it good value. Yet DavidClark, an adviser for IAPT, says it reaches only a fraction of those who need it. He would like itsbudget doubled.

心理健康咨詢公司英國燈塔的運營者艾瑪·斯坦頓稱，將患者在院外集中是個更好且更實惠的方法。斯坦頓推薦在家通過治療團隊的醫生、護士以及社會工作者治療的方法。與服用抗抑郁藥相比衛生官員們更希望中等程度的病患接受一個名為“使更多人獲得心理治療”(IAPT)的項目的幫助。這個項目旨在擴大認知行為療法的使用。這能幫助個人挑戰可能會導致焦慮和抑郁的悲觀想法。國家健康和護理研究所(NICE)評估此項治療并且認為物有所值、但IAPT的顧問大衛·克拉克稱項目預算只夠一小部分需要它的人接受治療。他希望預算可以翻倍。

Convincing politicians to cough up more funds will be tough. Some critics fear that beefing uptreatment of the most common mental-health problems risks saddling the system withoverwhelming costs. Fortunately there is a lot that can be achieved without more cash. Manymental-health services still do not meet the standards recommended by NICE, andcommunication between services is poor. Elaborate therapies are not always necessary—oneeffective treatment for those suffering mental illness is keeping them in a job. Other types oftherapy, say advocates, should pay for themselves by saving health-care costs and increasingproductivity. Improving Britons' mental health is not only humane, but economical.

說服政客們擠出更多的資金是艱難的。一些批評家擔心加強治療最常見的心理健康問題會有成本過高使體系不堪重負的風險。幸運的是有很多事情無需更多金錢便可做到。很多心理健康服務不符合NICE推薦的標準，并且服務之間的交流也很貧乏。復雜的治療并不總是必要的——對于病患來說，一個有效的治療方法就是讓他們保持工作。提倡者稱，其他的治療方式應該通過節約健康保健成本和提高生產力來為病患支付。提高英國心理健康不僅是關乎人道，也關系到經濟。

【重點解析】

1.ask for 請求;索取;詢問

例句:That was Nicholas's cue to ask for anotherchocolate chip cookie.

那表示尼古拉斯還想要一塊巧克力曲奇。

2.arrive at 到達;得出;抵達

例句:The Prime Minister is scheduled to arrive atnoon.

首相定于中午到達。

3.range from 范圍從;范圍從到

例句:Prices range from 119 to 199, depending on the particular configuration.

價格因具體配置而異，從119美元至199美元不等。

4.according to 根據;按照;依照

例句:The route that the boatmen choose varies according to the water level.

船夫選擇的路線會隨水位的變化而有所不同。