Markers of predicting discharge from forensic psychiatric hospitals in Czechia.

BACKGROUND: Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies. METHODS: The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life. RESULTS: The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions. CONCLUSION: Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.

Exploratory analysis on payment mechanisms to Community Mental Health Centers in Chile using mixed grounded theory. / Análisis exploratorio sobre los mecanismos de pago a centros de salud mental comunitaria en Chile usando teoría fundamentada mixta.

Introduction: Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile's National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health. Methods: A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration. Results: Seven payment mechanisms implemented heterogeneously in the country's CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified. Conclusions: A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.

Introducción: La investigación sobre desinstitucionalización psiquiátrica ha descuidado el hecho que las reformas en este campo se anidan en un sistema de salud que se ha sometido a reformas financieras. Esta subordinación podría introducir incentivos desalineados con las nuevas políticas de salud mental. Según el Plan Nacional de Salud Mental de Chile, este sería el caso en los centros de salud mental comunitaria. El objetivo es comprender cómo el mecanismo de pago al centro de salud mental comunitaria es un potencial incentivo para la salud mental comunitaria. Métodos: Este es un estudio mixto cuantitativo-cualitativo convergente, que utiliza la teoría fundamentada. Recolectamos datos administrativos de producción entre 2010 y 2020. Siguiendo la teoría de mecanismo de pago, entrevistamos a 25 expertos de los ámbitos pagador, proveedor y usuario. Integramos los resultados a través de la codificación selectiva. Este artículo presenta los resultados relevantes de la integración selectiva mixta. Resultados: Reconocimos siete mecanismos de pago implementados heterogéneamente en los centros de salud mental comunitaria del país. Estos, responden a tres esquemas supeditados a límites de tarifa y presupuesto público prospectivo. Se diferencian en la unidad de pago. Se asocian con la implementación del modelo de salud mental comunitaria afectando negativamente a los usuarios, los servicios provistos, los recursos humanos disponibles, la gobernanza adoptada. Identificamos condiciones de gobernanza, gestión y unidad de pago que favorecerían el modelo de salud mental comunitaria. Conclusiones: Un conjunto desarticulado de esquemas de pago implementados heterogéneamente, tiene efectos negativos para el modelo de salud mental comunitaria. Es necesario y posible formular una política de financiación explícita para la salud mental complementaria a las políticas existentes.

A Paradigm Shift on Deinstitutionalization and Dementia Care: A Narrative Review.

This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.

The transition towards community-based mental health care in the European Union: Current realities and prospects.

The shift of mental health care from mental institutions to community-based services has been implemented differentially throughout the EU. However, because a comprehensive overview of the current mental health provision in member states is lacking, it is challenging to compare services across nations. This study investigates the extent of implementation of community-based mental health services within the EU using data collected from the WHO Mental Health Atlas. Results show that, although great cross-country variation exists in the implementation of community-based services, mental hospitals remain the prominent model of care in most countries. A few countries endorsed a balanced care model, with the co-occurrence of community services and mental hospitals. However, missing data, low quality of data and different service definitions hamper the possibility of a thorough analysis of the status on deinstitutionalization. Although policies on the closing and downsizing of mental institutions have been endorsed by the EU, the strong presence of mental hospitals slows down the shift towards community-based mental health care. This study highlights the need for an international consensus on definitions and a harmonization of indicators on mental health services. Together with the commitment of member states to improve the quality of data reporting, leadership must emerge to ensure quality monitoring of mental health-related data, which will help advance research, policies and practices.

Improving Quality of Life and Reducing Behavioral Problems of People With Intellectual and Developmental Disabilities Through Deinstitutionalization.

ANTECEDENTS: People with intellectual and developmental disability (IDD) with extensive support needs are more likely to live in segregated and highly institutionalized environments. The aim of this study was to analyze changes in functioning and quality of life for people with IDD and extensive support needs after transitioning to ordinary homes in the community. METHOD: The sample included 54 adults with IDD and extensive support needs, who were assessed at three time points: before transition, six months later, and one year after transition. The Resident Choice Scale, San Martin Quality of Life Scale, Active Support Participation Measure, and the Behavior Problem section of the Inventory for Client and Agency Planning were administered. Partial least squares-structural equation modeling (PLS-SEM) and t-tests for repeated measures were carried out. RESULTS: There were significant improvements in decision-making, participation and independence in daily activities and quality of life, as well as a reduction in the presence and intensity of behavioral problems. CONCLUSIONS: The benefits found in this study support transformation processes towards more inclusive services and professional practices that foster people's rights and feeling of belonging to the community.

Deinstitutionalisation and the move to community care: comparing the changing dimensions of mental healthcare after 1922 in the Republic of Ireland and England.

The advent of deinstitutionalisation and the introduction of community care in the latter part of the twentieth century have revolutionised mental-health service provision across Europe, although implementation, timing and services have varied widely in different countries. This article compares the changing dimensions of mental-health provision in post-independence Ireland with that in England, and will shed light on the current state of mental healthcare in both countries. The article calls for more research into the impact of deinstitutionalisation, such as the challenges faced in the community for those in need of continuing care.

Uncertainty Work: Dealing with a Psychiatric Crisis in Two European Community Mental Health Teams.

The quest for how to deal with a crisis in a community setting, with the aim of deinstitutionalizing mental health care, and reducing hospitalization and coercion, is important. In this article, we argue that to understand how this can be done, we need to shift the attention from acute moments to daily uncertainty work conducted in community mental health teams. By drawing on an empirical ethics approach, we contrast the modes of caring of two teams in Utrecht and Trieste. Our analysis shows how temporality structures, such as watchful waiting, are important in dealing with the uncertainty of a crisis.

The deinstitutionalization of children and adolescents in El Salvador's child protection system.

BACKGROUND: In 2010, El Salvador introduced legislation aimed at reforming the country's Child Protective System (CPS), with a focus on promoting deinstitutionalization. OBJECTIVE: The study aim was to explore the impact of deinstitutionalization on the Salvadoran CPS. PARTICIPANTS AND SETTING: The study was conducted in El Salvador, granting authors unique access to key informants with extensive experience in the country's CPS. Unlike the United States, which is divided into states, El Salvador is divided into departments, and CPS providers were recruited from all 14 departments. Focus groups were facilitated in the East, West, and Central zones to ensure representation from all regions. METHODS: Qualitative semi-structured interviews (n = 26) were conducted in June/July of 2019, which were then followed by focus groups (n = 4) in August 2019. The analysis of the data employed a combination of deductive and inductive thematic coding methods. RESULTS: CPS providers offered valuable insights, categorized into five main themes: (1) Strengths of El Salvador's CPS, (2) Deinstitutionalization policy encompassing socioenvironmental contextual factors, (3) Challenges in the deinstitutionalization process, including insufficient follow-up on deinstitutionalized children, (4) Recommendations from participants, highlighting the importance of enhancing stakeholder coordination/collaboration, and (5) The necessity for a paradigm shift, emphasizing the need to redefine the social contract on protecting children from child maltreatment. CONCLUSIONS: The Salvadoran CPS requires substantial systemic changes. Encouragingly, key informants have demonstrated a commitment to reform not only the deinstitutionalization process but also the broader CPS system in El Salvador including case management and quality of care in institutional settings.

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention.

BACKGROUND: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. OBJECTIVE: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. METHODS: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. DISCUSSION: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community. TRIAL REGISTRATION: NCT05605392.

Políticas e práticas de saúde mental na atenção básica: cenários a partir da perspectiva de trabalhadoras da saúde no jardim ângela, distrito do município de São Paulo / Mental health policies and practices in primary care: scenarios from the perspective of health workers of jardim ângela, a district of São Paulo city

Movimentos históricos pela reforma psiquiátrica configuraram a Saúde Mental enquanto campo de saberes e práticas. Isso possibilitou o enfrentamento ao paradigma psiquiátrico, outrora absoluto, sobre o fenômeno da loucura, e instaurou um processo social complexo de mudanças em conceitos, estruturas de serviços e práticas no contexto da assistência às pessoas em sofrimento psíquico. O cuidado em saúde mental na Atenção Básica está previsto em documentos do Ministério da Saúde. Esta previsibilidade do âmbito político-jurídico, entretanto, parece não encontrar correspondência no âmbito técnico assistencial, onde atuam as trabalhadoras, que por sua vez estão submetidas a exigências de produtividade em meio a aumentos de procura por atendimentos e inseguranças no manejo das demandas por saúde mental. Nesse contexto, nota-se que há um descompasso entre o que a política pública propõe e o que o serviço consegue realizar. Um olhar sobre as perspectivas e entendimentos que emergem no entre desses dois âmbitos pode indicar cenários sobre os quais seja possível a proposição de caminhos alternativos de enfrentamento aos atuais desafios. O presente trabalho é resultado de uma pesquisa realizada no território de MBoi Mirim, Distrito do Jardim Ângela, em uma Unidade Básica de Saúde na região sul do município de São Paulo. Trata-se de pesquisa qualitativa que objetiva identificar, a partir da perspectiva de trabalhadoras de saúde, cenários que se manifestam nos âmbitos das políticas e práticas no contexto da assistência às demandas por saúde mental na Atenção Básica. O trabalho foi teoricamente orientado pelas contribuições epistêmicas do campo da Saúde Mental, enquanto campo de saber e prática, tem o Grupo Focal como principal instrumento de escuta das trabalhadoras e a Análise de Conteúdo como meio de interpretar. Ofertar atendimento às demandas por saúde mental no contexto da Atenção Básica ainda é um desafio que está para além das complexidades próprias dessas demandas. Este é um terreno repleto de ambiguidades e contradições, atravessado por questões que, por um lado, apontam para concepções e práticas dos trabalhadores que atuam nesse nível de atenção no Sistema Único de Saúde (SUS) sobre o fenômeno da loucura e, por outro, dizem sobre a natureza de certas políticas públicas de saúde mental, cujos programas são implantados e implementados visando atender a projetos de governos, de viés ideológico, sem entregar, de fato, o que prometem ao usuário dos serviços.

Deinstitutionalization, community-based care and incarceration of people with severe mental illness: Out of sight, out of mind?

Although the international literature points to a number of benefits from deinstitutionalization, such as limiting coercion, more cost-effectiveness of care systems, and better use of community care, it may be helpful to take a broader perspective on where coercion and institutionalization of people with severe mental illnesses (SMI) and/or substance use disorders frequently occur: in prisons and jails. In this comment, we propose to move beyond the inpatient/outpatient dichotomy.

Gaps in the Dynamics and Performance of the Psychiatric Care Deinstitutionalization.

This study objective to verify the existence of gaps in the dynamics and performance of fulfillment of the deinstitutionalization of psychiatric care in the Czech Republic (CZ) and the Slovak Republic (SR) in the period between 2010 and 2020. The introduction of this the study is a search for expert knowledge in the field of deinstitutionalization of psychiatric care. The study uses the method of multi-criteria comparison of TOPSIS variants and a cluster analysis. The results 22 variants range from (ci 0.6716-0.2571) and confirm that there are large differences between CZ and SR in performance gaps (fulfillment) of deinstitutionalization goals. The SR variants are clearly better than the CZ variants, although during the years studied, the CZ variants are improving, and the size of the gap compared to the SR variants is decreasing. In the first year of the evaluated period (2010), the performance gap was 56% and in the last year (2020), the performance gap was only 31%. The conclusion of the study confirms that the measures associated with the deinstitutionalization of psychiatric care are linked to the time they were introduced and the overall implementation period of the reform.

Current services and outcomes of formerly institutionalised and never-institutionalised US adults with intellectual and developmental disabilities: A propensity score matching analysis.

BACKGROUND: Deinstitutionalization research shows better services and outcomes relative to institutional life but has not compared formerly institutionalised and never-institutionalised service users. METHODS: We used propensity score matching (PSM) to match formerly institutionalised and never-institutionalised participants on six personal characteristics. Data came from the 2018 to 2019 National Core Indicators In-Person Survey. We excluded current institution residents, and states with 25% + of missing data on former institutionalisation. RESULTS: Overall, 15.5% of participants in the 29-state full sample had lived in an institution for 1 year or more. Findings from the PSM sample showed that former-institution residents were more likely to use congregate living arrangements and less likely to live with family. They experienced more loneliness, less support-related choice, and had a consistent pattern of disability service-focused social connections. CONCLUSIONS: Many former institution residents remain disadvantaged relative to matched peers. There is a need to identify factors to enhance services and outcomes following deinstitutionalization.

The impact of the Mental Health Act revision for deinstitutionalization in Korea on the crime rate of people with schizophrenia.

This study examined changes in the crime rates of people with schizophrenia in Korea in comparison with the general population after the Mental Health Act revision for deinstitutionalization in 2017. The crime rates of people with schizophrenia and the general population were calculated from 2012 to 2021 using the Korean National Police Agency crime statistics. The effects of the law revision in 2017 on the crime rates were assessed using the interrupted time series and difference-in-difference analyses. The crime rates of people with schizophrenia tended to be lower than the general population except for murder and arson, which were 5.3 and 11.4 times, respectively, that of the general population. While no significant effect of the revision was found in the interrupted times series analysis, the difference-in-differences analysis indicated that the total crime rates and the rates of violence and public order crime increased among people with schizophrenia compared with the general population. The revision of the Mental Health Act for deinstitutionalization did not lead to an increase in the murder rate of people with schizophrenia as is commonly thought. However, the increases in overall crime and violence rates of people with schizophrenia suggest that the deinstitutionalized patients may not have been successfully relocated into the community. The increase in crime after the revision should be interpreted as a call for well-resourced community care rather than the reason for re-transfer of patients to hospitals.

The recovery and resilience plan on the long-term care system. Towards a deinstitutionalization?

Introduction: After the crisis caused by Covid-19, among other socioeconomic problems, the fragility of the organizations that make up the Spanish Long-Term Care System was revealed. These events prompted the Recovery and Resilience Plan (RRP). The aim of this study is to estimate the socioeconomic impact on Long-Term Care (LTC) of the investment delivered by the RRP. In addition, to fulfil our main aim, a secondary and necessary aim was to calculate the most current social accounting matrix (SAM) of the Spanish economy. Methods: We analyse the components of the demand linked to the RRP investment allocated to LTC, and subsequently, based on Input-Output methodology, we calculate a social accounting matrix (SAM) of the Spanish economy to estimate the overall economic return. Results: The results obtained using the SAM model proposed herein evidence the multiplier effect of the RRP invested in LTC. Every euro allocated to the RRP generates 4 euros in income for Households, Firms and the External Sector, 3.4 euros in industrial output, and returns 0.6 euros in taxes and social contributions to the Government. This also entails creating 26,410 direct and indirect jobs as well as 10,059 induced ones. Discussion: Given the severe recession scenario triggered by the consequences of COVID-19, the results of this study highlight the significant multiplier effect that RRP investment may generate to alleviate the downturn in the Spanish economy and, more specifically, in the Spanish LTC System.

Vivências de trabalho precoce de adolescentes em medida socioeducativa / Experience of child labor of adolescents complying with a social-educational measure / Vivencias de trabajo infantil de adolescentes en medidas socioeducativas

Este artigo tem como objetivo analisar a vivência de trabalho precoce de adolescentes e jovens em cumprimento de medida socioeducativa, no estado da Paraíba. Os instrumentos utilizados foram um Questionário Mosquito Diagnóstico e uma Entrevista Semiestruturada. A análise foi realizada com o software Iramuteq, (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), através da Análise Hierárquica Descendente, que gerou seis classes: significado do trabalho; infância e escola; condições objetivas de vida; trabalho, drogas e ato infracional; consequências do trabalho infantil; e trabalho infantojuvenil. A perspectiva teórica utilizada foi a psicologia histórico-cultural e os dados discutidos a partir do conceito de vivência. Conclui-se que as vivências e situações sociais de desenvolvimento foram caracterizadas pelo trabalho precoce que oportunizou o envolvimento com atos infracionais e as instituições responsáveis pela garantia de direitos em vez de garantir a proteção social, criminalizaram por meio de medidas socioeducativas.(AU)

This article aims to analyze the experience of child labor of adolescents and youngsters that are complying a social-educational measure, in the State of Paraíba. The instruments utilized were a Questionnaire Mosquito Diagnóstico and a Semi-Structured Interview. The analysis was performed by using the Iramuteq software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), by using Descending Hierarchical Analysis, which generated six classes: meaning of labor; childhood and school; objective conditions of life; labor, drugs, and act of infraction; consequences of child labor; and child labor. The theoretical perspective used was historical-cultural psychology and the data were discussed from the concept of experience. It was concluded that the experiences and social situations of development were characterized by child labor, which enabled the involvement with acts of infraction; and the institutions responsible for guaranteeing rights, instead of guaranteeing social protection, criminalized by using social-educational measures.(AU)

Este artículo tiene como objetivo analizar la vivencia precoz de adolescentes y jóvenes que cumplen medidas socioeducativas en el estado de Paraíba (Brasil). Los instrumentos utilizados fueron un Cuestionario Mosquito Diagnóstico y una entrevista semiestructurada. El análisis se realizó con el software Iramuteq (Interface de R pour les Multidimensionnelles Analyzes de Textes et de Questionnaires), mediante análisis jerárquico descendente, que generó seis clases: Significado del trabajo; Infancia y escuela; Condiciones objetivas de vida; Trabajo, drogas y acto de infracción; Consecuencias del trabajo infantil; y Trabajo infantojuvenil. La perspectiva teórica que se utilizó fue la psicología histórico-cultural, y los datos se discutieron desde el concepto de vivencia. Se concluye que las vivencias y situaciones sociales de desarrollo se caracterizaron por trabajo infantil que permitió la participación en infracciones y que las instituciones responsables de garantizar los derechos en lugar de la protección social los criminalizaron mediante medidas socioeducativas.(AU)

O trabalho de cuidadores em serviços residenciais terapêuticos: revisão de escopo / Work process of caregivers in residential therapeutic services: scope review / El trabajo de los cuidadores en los servicios residenciales terapêuticos: revisión del alcance

Objetivo: mapear produções nacionais e internacionais, relacionadas ao processo de trabalho de cuidadores em Serviços Residenciais Terapêuticos. Método: revisão de escopo realizada em bases de dados selecionadas e no buscador Google Acadêmico, de agosto a setembro de 2019. Resultados: foram identificadas 452 referências nas bases PUBMED e LILACS/BVS e 8.910 referências no Google Acadêmico. Após critérios de inclusão e exclusão, 10 artigos compuseram o estudo. Com base na Teoria de Processo de Trabalho em Saúde, três categorias foram definidas para análise da amostra encontrada. Conclusão: identificou-se que a equipe de cuidadores concentra sua ação sobre o objeto de trabalho, referido predominantemente como as pessoas moradoras da casa, utilizando instrumentos, ainda pouco elaborados, para a finalidade de ampliar autonomia e a gestão de conflitos no desafio da (re)inserção social e comunitária

Objective: to map national and international productions, related to the work process of caregivers in Therapeutic Residential Services. Method: scoping review conducted in selected databases and Google Academic search engine, from August to September 2019. Results: 452 references were identified in the PUBMED and LILACS/BVS databases and 8,910 references in Google Scholar. After inclusion and exclusion criteria, 10 articles composed the study. Based on the Health Work Process Theory, three categories were defined for analysis of the sample found. Conclusion: it was identified that the team of caregivers focus their action on the object of work, predominantly referred to as the people living in the house, using tools, still little developed, for the purpose of expanding autonomy and conflict management in the challenge of social and community (re)insertion

Objetivos: mapear producciones nacionales e internacionales, relacionadas con el proceso de trabajo de cuidadores en Servicios Residenciales Terapéuticos. Método: revisión de alcance realizada en bases de datos seleccionadas y en el motor de búsqueda Google Scholar, de agosto a septiembre de 2019. Resultados: se identificaron 452 referencias en las bases de datos PUBMED y LILACS/BVS y 8.910 referencias en Google Académico. Después de los criterios de inclusión y exclusión, 10 artículos compusieron el estudio. Con base en la Teoría del Proceso de Trabajo en Salud, se definieron tres categorías para análisis de la muestra encontrada. Conclusión: se identificó que el equipo de cuidadores centra su acción en el objeto de trabajo, predominantemente referido a las personas que viven en la casa, utilizando instrumentos, aún poco desarrollados, con el propósito de ampliar la autonomía y la gestión de conflictos en el desafío de la (re)inserción social y comunitaria

O cuidado às pessoas em sofrimento psíquico e suas repercussões na família / El cuidado a las personas en sufrimiento psíquico y sus repercusiones en la familia / Care for people with psychological distress and its repercussions on the family

RESUMO Objetivo: compreender como o cuidado cotidiano das pessoas em sofrimento psíquico repercute na vida do familiar cuidador e mensurar o seu nível de sobrecarga. Método: trata-se de um estudo exploratório e descritivo, de abordagem mista. A coleta de dados foi realizada utilizando-se entrevista semiestruturada e aplicação da escala Zarit Burden Interview com quinze familiares de pessoas em sofrimento psíquico que são acompanhadas numa unidade do Centro de Atenção Psicossocial III de um município da Região Metropolitana de Salvador. Os dados foram coletados entre os meses de fevereiro e agosto de 2021 e organizados e analisados segundo a Técnica de Análise de Conteúdo Temática e discutidos com base na literatura. Resultados: com a correlação das variáveis foi possível inferir o nível de sobrecarga objetiva e subjetiva, além dos sentimentos expressos por esses familiares. Seis familiares tiveram avaliação, a partir da escala ZBI, de sobrecarga moderada a severa, com pontuações variando entre 43 e 54. A partir das unidades de significado emergiram três categorias temáticas que permitiram ilustrar, conforme o infográfico, a representação de como o cuidado cotidiano das pessoas em sofrimento psíquico repercute na vida do familiar cuidador. Considerações finais: apreendeu-se que o cuidado às pessoas em sofrimento psíquico tem sido realizado predominantemente por mulheres negras, refletindo as desigualdades de gênero e raça, envolve sentimentos e expectativas ambivalentes, níveis diferenciados de sobrecarga e necessidade de suporte social e do Estado.

RESUMEN Objetivo: comprender cómo el cuidado cotidiano de las personas en sufrimiento psíquico repercute en la vida del familiar cuidador y medir su nivel de sobrecarga. Método: se trata de un estudio exploratorio y descriptivo, de abordaje mixto. La recolección de los datos fue realizada utilizando entrevista semiestructurada y aplicación de la escala Zarit Burden Interview con quince familiares de personas en sufrimiento psíquico que son acompañadas en una unidad del Centro de Atención Psicosocial III de un municipio de la Región Metropolitana de Salvador/Brasil. Los datos fueron recogidos entre los meses de febrero y agosto de 2021. Organizados y analizados según la Técnica de Análisis de Contenido Temático y discutidos con base en la literatura. Resultados: con la correlación de las variables fue posible inferir el nivel de sobrecarga objetiva y subjetiva, además de los sentimientos expresados por esos familiares. Seis familiares tuvieron evaluación, a partir de la escala ZBI, de sobrecarga moderada a severa, con puntuaciones variando entre 43 y 54. A partir de las unidades de significado surgieron tres categorías temáticas que permitieron ilustrar, conforme el infográfico, la representación de cómo el cuidado cotidiano a las personas en sufrimiento psíquico repercute en la vida del familiar cuidador. Consideraciones finales: se comprendió que el cuidado a las personas en sufrimiento psíquico se ha realizado predominantemente por las mujeres negras, reflejando las desigualdades de género y raza; implica sentimientos y expectativas ambivalentes; niveles diferenciados de sobrecarga y necesidad de apoyo social y del Estado.

ABSTRACT Objective: to understand how the daily care of people in psychological distress affects the life of the family caregiver and to measure the level of caregiver burden. Method: this is an exploratory and descriptive study with a mixed approach. Data was collected using a semistructured interview and the Zarit Burden Interview with 15 family members of people in psychological distress who were followed up at a CAPS III unit in a city in the metropolitan region of Salvador. Data were collected between February and August 2021, organized and analyzed using the Thematic Content Analysis technique and discussed based on existing literature. Results: the correlation of the variables revealed the level of objective and subjective burden, in addition to the feelings expressed by these family members. Six family members had moderate to severe burden according to the ZBI scale, with scores ranging from 43 to 54. The units of meaning gave rise to three thematic categories, which were presented in the infographic and illustrate how the daily care of people with psychological distress affects the lives of family caregivers. Final considerations: the study revealed that care for people in psychological distress has been carried out mainly by black women, reflecting gender and race inequalities, and that this care involves ambivalent feelings and expectations, varying levels of burden, and the need for social and state support.

Vagalumes e biografemas: poéticas e políticas públicas no desligamento institucional por maioridade / Fireflies and biographems: poetics and public policies regarding institutional removal due to adulthood / Luciérnagas y biografemas: poéticas y políticas públicas en desconexión institucional debido a la edad adulta

Este artigo versa sobre o processo de desligamento institucional por maioridade de jovens que residem em serviços de acolhimento. Aposta-se em uma política do sensível para visibilizar os encontros e desencontros que acontecem entre as e os jovens e as políticas públicas brasileiras. Para tanto, realizaram-se encontros com jovens que já haviam passado pelo processo de desligamento e com jovens que logo completariam 18 anos e teriam de sair das instituições de acolhimento. Para tornar visíveis essas existências, investiu-se na escrita de biografemas, inspirados na obra de Roland Barthes. Os conceitos de necropolítica e vidas precárias foram fundamentais para compreender as omissões do Estado no momento do desligamento. Verificou-se que o Estado pode maximizar a precariedade de algumas vidas, especialmente daquelas marcadas por características de raça, gênero e classe culturalmente marginalizados. Contudo, é também o encontro com as políticas públicas que garante melhores condições de vida para alguns, facilitando o acesso à universidade e ao mercado de trabalho. A pesquisa aponta que, diante do abandono, as e os jovens se fazem vagalumes, produzindo luminosidades em meio à escuridão e reivindicando o direito à vida.(AU)

This article discusses the process of institutional removal of young people that reside in foster care institutions for reaching adulthood. It relies on a politics of the sensitive to make visible the encounters and mismatches that take place between young people and Brazilian public policies. To do so, meetings were held with young people who had already experienced the removal process and with young people who would soon turn 18 and would have to leave the host institutions. To make these existences visible, this study invested in the writing of biographems, inspired by the works of Roland Barthes. The concepts of necropolitics and precarious lives were fundamental to understand the omissions of the State at the time of removal. It was also found that the State can maximize the precariousness of some lives, especially those marked by culturally marginalized race, gender, and class characteristics. However, it is also the encounter with public policies that ensures better living conditions for some, facilitating access to the university and the labor market. This research points out that, in the face of abandonment, young people become fireflies, producing luminosity amid the darkness and claiming the right to life.(AU)

Este artículo aborda el proceso de desconexión institucional justificado por la edad adulta de los jóvenes que residen en los servicios de acogida. Utilizamos una política sensible para hacer visibles las reuniones y los desajustes que tienen lugar entre los jóvenes y las políticas públicas brasileñas. Con este fin, se celebraron reuniones con los jóvenes que ya habían pasado por el proceso de desconexión institucional y también con los jóvenes que pronto cumplirían los 18 años y tendrían que abandonar las instituciones de acogida. Para hacer visibles estas existencias, se redactaron biografemas, inspirados en el trabajo de Roland Barthes. Los conceptos de necropolítica y vida precaria fueron fundamentales para comprender las omisiones del Estado en el momento de la desconexión. Se encontró que el Estado puede maximizar la precariedad de algunas vidas, principalmente de aquellas marcadas por características de raza, género y clase culturalmente marginadas. Sin embargo, el encuentro con las políticas también puede garantizar mejores condiciones de vida para algunos, facilitándoles el acceso a la universidad y al mercado laboral. Esta investigación señala que, ante el abandono, los jóvenes se convierten en luciérnagas, produciendo luminosidad en medio de la oscuridad y reclamando el derecho a la vida.(AU)

Os espaços de convivência na clínica com adolescentes na atenção psicossocial: contribuições da psicanálise / Los espacios de convivencia en la clínica con adolescentes en atención psicosocial: aportes desde el psicoanálisis / Living spaces in the clinic with adolescents in psychosocial care: contributions from psychoanalysis / Les espaces de vie en la clinique auprès des adolescents en prise en charge psychosociale: apports de la psychanalyse

Este artigo tem por objetivo compartilhar os resultados de uma pesquisa de mestrado desenvolvida na atenção psicossocial, a partir dos "Espaços de Convivência", dispositivo de cuidado destinado ao atendimento intensivo de adolescentes em grave sofrimento psíquico. Apresentam-se notas referentes às possibilidades de se tomar a convivência como ferramenta da clínica no tempo da adolescência. Para isso, faz-se uso de uma cena, que é material disparador para a construção de um Estudo Clínico. Essa cena destaca os efeitos da convivência para o sujeito a partir das tensões entre potencialidades e problemáticas desenroladas nas relações entre pares. As conclusões destacam a necessidade de um espaço-tempo protegido em que o se demorar em estar junto viabilize o enlace entre os sujeitos

Este artículo tiene como objetivo compartir los resultados de una investigación de maestría desarrollada en atención psicosocial, a partir de los "Espacios de Convivencia", dispositivo de atención destinado a la atención intensiva de adolescentes en sufrimiento psíquico severo. Se presentan notas sobre las posibilidades de utilizar la convivencia como herramienta clínica durante la adolescencia. Para ello, se usa una escena, la cual es el material disparador para la construcción de un Estudio Clínico. Esta escena destaca los efectos de la convivencia para el sujeto, a partir de las tensiones entre potencialidades y problemas desplegados en las relaciones entre pares. Las conclusiones destacan la necesidad deun espacio-tiempo protegido en el que darse tiempo para estar juntos posibilite el vínculo entre los sujetos

This article aims to share the results of a master's research developed in psychosocial care, from the "Spaces of Coexistence", a care device intended for the intensive care of adolescents in severe psychological distress. Notes are presented regarding the possibilities of using coexistence as a clinical tool during adolescence. For this, it makes use of a scene, which is triggering material for the construction of a Clinical Study. This scene highlights the effects of coexistence for the subject, from the tensions between potentialities and problems unfolded in the relationships between peers. The conclusions highlight the need for a protected space-time in which taking time to be together makes possible the bond between the subjects

Cet article vise à partager les résultats d'une recherchede master développée en prise en charge psychosociale, basée sur les Espaces de Coexistence, un dispositif de soin destiné à la prise en charge intensive d'adolescents en détresse psychologique sévère. Des notes sont présentées sur les possibilités d'utilisation de la coexistence comme outil clinique pendant l'adolescence. Pour cela, on se sert d'une scène, qui est un élément déclencheur pour la construction d'une Étude Clinique. Cette scène met en évidence les effets de la coexistence pour le sujet, à partir des tensions entre les potentialités et les problèmes déployés dans les relations entre pairs. Les conclusions mettent en évidence le besoin d'un espace-temps protégé dans lequel le fait de rendre plus de temps ensemble rend possible le lien entre les sujets