Mental Health Screening of People Deprived of Liberty, Analyzed Through the Brief Jail Mental Health Screening (BJMHS) in Three Colombian Establishments / Tamizaje de Salud Mental de Personas Privadas de la Libertad, analizada por medio del Brief Jail Mental Health Screening (BJMHS) en tres establecimientos colombianos / Triagem de Saúde Mental de Pessoas Privadas de Liberdade, analisada através do Brief Jail Mental Health Screening (BJMHS) em três estabelecimentos colombianos

Introduction. People deprived of liberty, due to their condition and characteristics, suffer greater changes in their health than the general population, particularly in personality disorders,consumption of psychoactive substances, and suicidal tendencies. The prison system is aware of these risks, and universally, multiple approaches to the subject have been developed, as evidenced by the abundant literature, for its early detection. Objective. Apply the screening instrument, the Brief Jail Mental Health Screening (BJMHS) test, to a sample of people deprived of Liberty upon admission to three Colombian prisons, to establish the prevalence of mental health in these institutions. Methodology. The type of study was cross-sectional in a population of incarcerated individuals in three institutions, two Colombian prisons for men, and one for women, between 2019 and 2020. The final validated sample was 417 people, 22.3% women and 77.7% men, for mental health screening, applied to the admission of the population deprived of liberty in prisons. Results. The global prevalence of mental health was 46.0% with a 95% Confidence interval (41.3% to 50.8%) for the Buen Pastor prison; 46.2% with a 95% Confidence Interval (35.9% to 56.6%), for the Modelo prison 51.5% with a 95% Confidence interval (43.0% to 60.0%); and for the Picota prison with 42.0% with a 95% Confidence interval (34.9% to 49.1%). A greater impact on mental health was found in people accused or convicted of crimes against sexual freedom, integrity and training. against public safety, and against the family. Discussion. Given the unique conditions of the prison population and the universality of mental disorders, early detection of their functional level and degree of impairment is indispensable. Conclusion. The prevalence of mental health found in Colombian prisons has a similar magnitude to the same populations in various parts of the world, showing greater reliability in men than in women. Keywords: Mental Health; Prisoners; Mass Screening; Mental Status and Dementia Tests; Public Health Surveillance; Social Work, Psychiatric

Introducción. Las personas privadas de la libertad, por su misma condición y características, padecen mayores alteraciones en su salud que la población general, en particular con relación a los trastornos de la personalidad, consumo de sustancias psicoactivas, y tendencias suicidas. El sistema carcelario es conocedor de estos riesgos, y universalmente, se han desarrollado múltiples abordajes del tema como lo demuestra la abundante literatura, para su detección temprana. Objetivo. Establecer la prevalencia de salud mental y asociaciones de los factores de nivel educativo, edad, sexo, de la situación jurídica de las personas privadas de la libertad, a través del instrumento de tamizaje, Brief Jail Mental Health Screening (BJMHS) (Breve Evaluación de Salud Mental en la Cárcel), a una muestra de personas privadas de la libertad a su ingreso en tres centros carcelarios colombianos. Metodología. Estudio observacional de corte transversal en una población de tres cárceles de Colombia de los años 2019 y 2020, dos cárceles para varones, y una para mujeres. La muestra final validada, fue de 417 personas, 22.3% a mujeres y 77.7% a hombres, para el tamizaje en salud mental, aplicada al ingreso a los establecimientos carcelarios. Resultados. La prevalencia global de trastornos mentales fue de 46.0% con un Intervalo de Confianza de 95% (41.3% a 50.8%), para la cárcel Buen Pastor fue de 46.2% con un Intervalo de Confianza 95% (35.9% a 56.6%), para la cárcel Modelo 51.5% con un Intervalo de Confianza 95% (43.0% a 60.0%), y para la cárcel Picota con un 42.0% con un Intervalo de Confianza 95% (34.9% a 49.1%). Se encontró una mayor afectación en salud mental en personas sindicadas o condenadas por delitos contra la libertad, integridad y formación sexuales, contra la seguridad pública, y contra la familia. Discusión. Dadas las singulares condiciones de la población carcelaria y la universalidad de afectaciones mentales, es indispensable una detección temprana de su nivel funcional y grado de afectación. Conclusión. Se encontró una prevalencia de trastornos mentales en las cárceles de Colombia, de una magnitud consistente con similares poblaciones reportadas en la literatura universal, arrojando mayor relevancia en hombres que en mujeres. Palabras clave: Salud Mental; Tamizaje Masivo; Prisioneros; Pruebas de Estado Mental y Demencia; Vigilancia en Salud Pública; Asistencia Social en Psiquiatría

Introdução. Pessoas privadas de liberdade, pela mesma condição e características, sofrem maiores alterações em sua saúde do que a população em geral, principalmente em relação a transtornos de personalidade, consumo de substâncias psicoativas e tendências suicidas. O sistema penitenciário está ciente desses riscos e foram desenvolvidas, universalmente, múltiplas abordagens para a questão, como demonstrado pela abundante literatura, para detecção precoce. Objetivo. Estabelecer a prevalência da saúde mental e associações dos fatores escolaridade, faixa etária, sexo e situação jurídica de pessoas privadas de liberdade, através do instrumento de triagem Brief Jail Mental Health Screening (BJMHS) (Breve Triagem de Saúde Mental na Prisão), a uma amostra de pessoas privadas de liberdade ao serem admitidas em três presídios colombianos. Metodologia. Estúdio observacional de corte transversal em uma população de três prisões da Colômbia dos anos 2019 e 2020, dois prisões para varões, e um para mulheres. A amostra final validada, foi de 417 pessoas, 22.3% para mulheres e 77.7% para homens, para a triagem da saúde mental, aplicada ao ingresso nos estabelecimentos penitenciários. Resultados. A prevalencia global de transtornos mentais foi de 46.0% com um Intervalo de Confiança de 95% (41.3% a 50.8%); para o presídio Buen Pastor foi de 46.2% com um Intervalo de Confiança de 95% (35.9% a 56.6%); para o presídio Modelo 51.5% com um Intervalo de Confiança de 95% (43.0% a 60.0%); e para o presídio Picota 42.0% com um Intervalo de Confiança de 95% (34.9% a 49.1%). Foi encontrado um maior impacto na saúde mental em pessoas acusadas ou condenadas por crimes contra a liberdade, integridade e formação sexual, contra a segurança pública e contra a família. Discussão. Dadas as condições únicas da população prisional e a universalidade dos transtornos mentais, é essencial a detecção precoce do seu nível funcional e do seu grau de afetação. Conclusão. Foi encontrada uma prevalência de transtornos mentais nas prisões colombianas, de magnitude consistente com populações semelhantes relatadas na literatura universal, mostrando maior relevância em homens do que em mulheres. Palavras-chave: Saúde Mental; Prisioneiros; Programas de Rastreamento; Testes de Estado Mental e Demência; Vigilância em Saúde Pública; Serviço Social em Psiquiatria

Epidemiología de la morbilidad psiquiátrica en el Ecuador / Epidemiology of psychiatric morbidity in Ecuador

RESUMEN Fundamento: La presencia cada vez más creciente de personas con trastornos psiquiátricos atendidas en servicios de salud públicos del Ecuador, suscita el desarrollo de estudios epidemiológicos que permitan conocer cómo se distribuyen estos trastornos entre los diferentes grupos, para una planificación adecuada de servicios de salud mental; sin embargo, existen estudios disponibles con diferencias en el diseño, los instrumentos y la selección de la muestra, que afectan los resultados y sus conclusiones, como son el subregistro y el sobre diagnóstico de trastornos mentales. Objetivo: Analizar diferencias metodológicas entre los estudios de morbilidad psiquiátrica en población general, asimismo, los diferentes resultados obtenidos de estas investigaciones. Metodología: Estudio comparativo de investigaciones de morbilidad psiquiátrica en población general, basado en el análisis de publicaciones durante el período 2000 al 2019 en el Ecuador. Resultados: Se registraron trece estudios, cuatro encuestas y dos estudios nacionales sobre consumo de drogas, uno de prevalencia psiquiátrica, y seis de tamizaje de trastornos mentales, en poblaciones con edades de 13 a 75 años. Los instrumentos más utilizados fueron de tamizaje y la clasificación diagnóstica más utilizada fue el Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta versión (DSM-IV). La prevalencia empleada fue, puntual, último mes, anual y de vida. Los trastornos más frecuentes fueron la ansiedad, la depresión, el trastorno estrés postraumático y el de comportamiento debido al consumo de drogas. Conclusiones: Los estudios de morbilidad psiquiátrica realizados en Ecuador, son heterogéneos en el empleo de instrumentos, sujetos y cálculo de la muestra, así como sus resultados, por lo que es pertinente el desarrollo de investigaciones de este tipo, que se ajusten a la realidad y recursos del país, y que sus hallazgos, sean de utilidad en la planificación de servicios y políticas de salud mental en el Ecuador.

ABSTRACT Background: The growing presence of people with psychiatric disorders assisted in public health services in Ecuador, promotions the development of epidemiological studies that allow to know how these disorders are distributed among unlike groups, so for an adequate planning of mental health services; however, there are available studies with differences in the design, instruments and sample selection, which affect the results and conclusions, such as under-registration and over-diagnosis of mental disorders. Objective: To analyze methodological differences between studies of psychiatric morbidity of overall population, as well as the unlike results obtained from these investigations. Methodology: Comparative study of psychiatric morbidity research of overall population, based on the analysis of publications from 2000 to 2019 in Ecuador. Results: Thirteen studies were registered, four surveys and two national studies on drug use, one on psychiatric prevalence, and six on screening for mental disorders, in populations aged 13 to 75 years. Screening instruments were used the most, the same for the Diagnostic and Statistical Manual of Mental Disorders as the diagnostic classification, fourth version (DSM-IV). The prevalence used was point prevalence, last month, annual and of lifetime. The most frequent disorders were anxiety, depression, post-traumatic stress and behavior due to drug use. Conclusions: The studies on psychiatric morbidity conducted in Ecuador are heterogeneous in the use of instruments, subjects and sample calculation, as well as their results, so it is pertinent to develop researches from this nature adjusted to the country´s reality and resources, consequently, its findings be useful for the planning of mental health services and policies in Ecuador.

Improving access to cancer information and supportive care services: A systematic review of mechanisms applied to link people with cancer to psychosocial supportive care services.

OBJECTIVE: Previous research has described the low uptake of psychosocial support services in people living with cancer. While characteristics of individuals using services have been examined, mechanisms applied to link individuals to support services are less frequently considered. This review aims to identify the mechanisms used to link people with cancer to support services and assess their impact. METHODS: Systematic searches of Pubmed, CINAHL, EMBASE and PsycINFO were conducted up to May 2020. Studies reporting service use associated with mechanisms to link adults with cancer to support services targeting emotional, informational, practical or social support needs were eligible. Eligible study designs included controlled trials, pre-post designs and observational studies. Study quality was assessed and a narrative synthesis of findings undertaken. RESULTS: A total of 10 papers (from 8,037 unique titles) were eligible. Testing the feasibility of the linkage mechanism was the primary aim in five (50%) studies. Three linkage mechanisms were identified: (a) outreach from the support service; (b) clinician recommendation/referral; (c) mailed invitation. Outreach was the most successful in connecting people with cancer to services (52%-90% use); clinician recommendation/referral was least successful (3%-28%). The impact of different linkage mechanisms for different demographic groups was not assessed. CONCLUSIONS: Outreach from services shows the most potential for increasing access to support services. However, the limited number of studies and limitations in the types of support services people with cancer were linked to, demonstrated the need for further work in this area. Identifying mechanisms that are effective for underserved, high-needs patient groups is also needed.

Can targeting information on cancer-related psychosocial services by male gender and rurality improve attitude to service use in this difficult-to-engage population?

OBJECTIVE: Rural men affected by cancer are difficult to engage in psychosocial support services. This exploratory study tested whether exposure to printed brochures describing services, distinguished by a focus on rural men affected by cancer, resulted in more positive help-seeking attitudes than exposure to material focused on rural location only or generic cancer support material. METHODS: Targeted versions of a South Australian Cancer Council service brochure were developed to enhance cultural appropriateness, consistent with the Elaboration Likelihood Model. Rural men affected by cancer were recruited via supportive accommodation and randomized to receive one of the three brochures. The primary outcome was positive attitude to help-seeking at post-test (between 1 and 2 days). Negative attitudes to help-seeking, intention to seek help, perceived isolation, and service use were secondary outcomes; perceived information relevance at immediate post-test was also measured. RESULTS: Analysis (N = 114) indicated no detectable group differences (rurality/male gender, n = 33; rurality, n = 41; control, n = 40) on primary or secondary outcome measures (p > 0.05). Participants' existing service use was high, due to the recruitment methods. Support service information was primarily sourced from other people (e.g., friends/family, 22.22%; medical professionals, 27.27%). CONCLUSIONS: Existing service use rates suggest that ceiling effects obscured any potential benefit from demographic targeting of materials. Further research should consider building understanding about the acceptability of targeting techniques in this population, replication with materials designed with greater consumer input, and employ samples recruited outside a support service.

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa.

BACKGROUND: Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. METHODS: We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. RESULTS: The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). CONCLUSIONS: Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.

Reflexões sobre os conceitos de cidadania e sujeito em psicanálise na Atenção Psicossocial / Reflections on the concepts of citizenship and subject in psychoanalysis in Mental Health / Reflexiones sobre los conceptos de ciudadanía y sujeto en psicoanálisis en la Salud Mental

A captura da cidadania como princípio das práticas de saúde mental e discurso a ser incorporado subjetivamente pelo louco cria um impasse na própria atitude subversiva pretendida pela Reforma Psiquiátrica Brasileira. A Psicanálise sustenta o ato de escuta do sujeito, em uma posição de autoria, responsabilização pelo seu sofrimento e sustentação de seu desejo, estando aí uma possível contribuição da psicanálise para a luta antimanicomial. A partir de uma pesquisa analítica, de enfoque qualitativo, aborda-se os significantes de cidadania e de sujeito em psicanálise e quais as implicações práticas e políticas de tais concepções para o cotidiano dos Centros de Atenção Psicossocial. Aposta-se em uma contribuição teórica e política ao apontar as diferenças entre o trabalho orientado pela cidadania e aquele orientado pelos efeitos do inconsciente, sem objetivar, contudo, uma oposição entre essas perspectivas de trabalho.(AU)

The capture of citizenship as a principle of mental health practices and discourse to be subjectively incorporated by the crazy creates a standoff in the subversive attitude intended by the Brazilian Psychiatric Reform. Psychoanalysis supports the act of listening to the subject, in a position of authorship, responsibility for their suffering and support of their desire, being there a possible contribution of psychoanalysis to the antimanicomial fight. Based on an analytical research, with a qualitative focus, the article approaches the signifiers of citizenship and subject in psychoanalysis and what are the practical and political implications of such conceptions for the daily life of the Psychosocial Care Centers. It is based on a theoretical and political contribution in pointing out the differences between work oriented by citizenship and that guided by the effects of the unconscious, however, without objecting to an opposition between these perspectives of work.(AU)

La captura de la ciudadanía como principio de las prácticas de salud mental y discurso a ser incorporado subjetivamente por el loco crea una dificultad en la actitud subversiva pretendida por la Reforma Psiquiátrica Brasileña. El psicoanálisis sostiene el acto de escucha del sujeto, en una posición de autoría, responsabilización por su sufrimiento y sustentación de su deseo, estando ahí una posible contribución del psicoanálisis a la lucha antimanicomial. A partir de una investigación analítica, de enfoque cualitativo, se abordan los significantes de ciudadanía y de sujeto en psicoanálisis y cuáles las implicaciones prácticas y políticas de tales concepciones para el cotidiano de los Centros de Atención Psicosocial. Se apunta en una contribución teórica y política al apuntar las diferencias entre el trabajo orientado por la ciudadanía y aquel orientado por los efectos del inconsciente, sin embargo, sin objetivar una oposición entre esas perspectivas de trabajo.(AU)

Structured multi-disciplinary psychosocial care for cancer patients and the perceived quality of care from the patient perspective: a cluster-randomized trial.

PURPOSE: We examined whether multi-disciplinary stepped psychosocial care for cancer patients improves quality of care from the patient perspective. METHODS: In a university hospital, wards were randomly allocated to either stepped or standard care. Stepped care comprised screening for distress, consultation between doctor and patient, and the provision of psychosocial services. Quality of care was measured with the Quality of Care from the Patient Perspective questionnaire. The analysis employed mixed-effects multivariate regression, adjusting for age and gender. RESULTS: Thirteen wards were randomized, and 1012 patients participated (n = 570 in stepped care and n = 442 in standard care). Patients who were highly distressed at baseline had 2.3 times the odds of saying they had had the possibility to converse in private with doctors and/or psychologists/social workers when they were in stepped care compared to standard care, 1.3 times the odds of reporting having experienced shared decision-making, 1.1 times the odds of experiencing their doctors as empathic and personal, and 0.6 times the odds of experiencing the care at the ward to be patient oriented. There was no evidence for an effect of stepped care on perceived quality of care in patients with moderate or low distress. CONCLUSIONS: Stepped care can improve some aspects of perceived quality of care in highly distressed patients. TRIAL REGISTRATION: http://www.clinicaltrials.gov . NCT01859429.

Entre medicalização e recusas: crianças e adolescentes nos circuitos socioassistenciais-sanitários / Between medicalization and refusal: children and teens in the Social Assistance and Health circuits / Entre medicalización y rechazos: niños y adolescentes en los circuitos de la Asistencia Social y Salud

A despeito dos avanços legais e políticos no campo da infância e adolescência, encontramos lacunas importantes relativas ao funcionamento dos serviços. Em detrimento de medidas que preconizam o cuidado, o trabalho em rede e a afirmação dos direitos de crianças e adolescentes, acionam-se medidas que privilegiam o controle e colocam-nas na posição da carência, da anormalidade e do perigo. Assim, vimos que crianças e adolescentes tornam-se objeto de tutela ou ingressam em circuitos que os produzem como resíduos institucionais. Neste texto, examinamos duas situações analisadoras que concorrem para fazer funcionar os circuitos expulsivos/seletivos nos serviços assistenciais ou especializados: a medicalização de crianças e adolescentes como um modus operandi dos serviços de acolhimento institucional, e a seletividade na porta de entrada desses serviços, principalmente os dirigidos à crianças e adolescentes em situação de rua e/ou que fazem uso de drogas, ocasionando a emergência de serviços híbridos entre Saúde e Assistência Social. (AU)

Despite the legal and political advances in the infancy and teen fields, there are crucial gaps regarding how services work. To the detriment of measures that advocate care, network services, and the affirmation of the rights of children and teens, other measures are added that favor control and place this segment in a position of deprivation, abnormality, and danger. Thus, we see children and teens becoming objects of custody or entering circuits that present them as institutional by-products. In this text, we examine two analysis cases that compete to make the expulsion/selection circuits work within assistential or specialized services: the medicalization of children and teens as a modus operandi of institutional care services, and selectivity at the entry point for these services, especially those directed at children and teens who are homeless and/or using drugs, provoking the emergence of hybrid services involving Health and Social Welfare. (AU)

A pesar de los avances legales y políticos en los campos de la infancia y la adolescencia, existen lagunas cruciales con respecto al funcionamiento de los servicios. En prejuicio de las medidas que profesan el cuidado, el trabajo en red y la afirmación de los derechos de niños y adolescentes, se accionan medidas que privilegian el control y los colocan en posición de carencia, de anormalidad y peligro. Así, vimos que niños y adolescentes son convertidos en objeto de tutela o ingresan en circuitos que los producen como residuos institucionales. En este texto, examinamos dos situaciones analizadoras que concurren para hacer funcionar los circuitos expulsivos/selectivos en los servicios asistenciales o especializados: la medicalización de niños y adolescentes como un modus operandi de los servicios de acogida institucional y la selectividad en la puerta de entrada de esos servicios, (principalmente los dirigidos a niños y adolescentes en situación de calle y/o que hacen uso de drogas), ocasionando la emergencia de servicios híbridos entre Salud y Asistencia Social. (AU)

A clínica em (des)construção: a sala de espera como potência política para a reforma psiquiátrica / The clinic´s (de)construction: the waiting room as political potential for psychiatric reform

Este estudo objetiva apresentar uma experiência relativa a intervenções feitas em sala de espera, apontando sua potência política para o fortalecimento da Reforma Psiquiátrica Brasileira (RPB). A partir da inserção semiprofissional de estudantes de graduação em Psicologia de uma faculdade privada em Fortaleza/CE em um Centro de Atenção Psicossocial Álcool e outras Drogas (CAPSad), tomou-se a sala de espera como um dispositivo interventivo e analisador do serviço. Com base na demanda do campo e nas leituras sobre clínica ampliada, buscou-se produzir um espaço de escuta e acolhimento. Ademais, o trabalho fundamentou-se na perspectiva da Redução de Riscos e Danos (RRD), no sentido de ampliar o olhar sobre a questão das drogas e possibilitar outras formas de pensar e atuar no campo da saúde mental coletiva. As temáticas problematizadas tiveram efeitos tanto para os usuários e a equipe do serviço, como para os estagiários, pois a cada encontro construía-se em ato um espaço de empoderamento e controle social. Apesar das dificuldades infraestruturais, percebemos que o CAPS, impulsionado por uma equipe implicada política e eticamente, consegue funcionar, apostando nas potencialidades da comunidade, proporcionando coletivamente outras possibilidades de existência e se afastando da perspectiva reducionista de saúde como ausência de doença.

This study aims to present an experience concerning of interventions made in the waiting room, pointing out its political power to strengthen the Brazilian Psychiatric Reform (RPB). From the semiprofessional insertion of undergraduate students in Psychology from a private college in Fortaleza/CE in a Center for Psychosocial Care Alcohol and Other Drugs (CAPSad), the waiting room was taken as an intervention device and analyzer of the service. Based on the demand of the field and the readings on expanded clinic, it was sought to produce a space of listening and welcoming. In addition, the work was based on the perspective of Reducing Risk and Damage (DRR), in order to broaden the view on the issue of drugs and enable other ways of thinking and acting in the field of collective mental health. The problematized themes had effects both for the users and the staff of the service, as well as for the trainees, because at each meeting an area of empowerment and social control was built. Despite the infrastructural difficulties, we realize that the CAPS, driven by a team politically and ethically Anti-Asylum Campaign, manages to work, betting on the potentialities of the community, collectively providing other possibilities of existence and moving away from the perspective reductionist as absence of disease.

Bio-psycho-social-spiritual needs of adolescents and young adults with life-threatening illnesses: Implications for social work practice.

This paper explores the biopsychosocial and spiritual needs of adolescents and young adults (AYA) with life-threatening or terminal illnesses. AYA are situated between childhood and adulthood (ages 15-25) and have distinct biopsychosocial and spiritual needs unique to their developmental stage. Having a life-threatening or terminal illness directly challenges normal AYA developmental tasks and identity formation. AYA experience more troubling physical symptoms during the dying process compared to other age groups, which leads to significant psychological distress and an increased need for pharmacological treatments. In general, AYA desire to be fully informed and involved in the health care decision-making process, leading to ethical dilemmas when the AYA is a minor and their wishes differ from the wishes of their legal guardian(s). Social workers are especially well-equipped to serve this population due to aligning professional standards and ability to advocate for holistic care within interdisciplinary teams. Additional research is needed to tailor holistic interventions to meet the needs of this population.

Aspectos psicológicos a tener en cuenta en la atención de víctimas de la trata de personas / Psychological aspects to consider when attending victims of human trafficking

Resumen Este artículo describe los elementos básicos desde el punto de vista psicológico a quienes en algún momento pueden tener en su consulta pacientes que hayan sido víctimas del trata de personas. Para el logro de este objetivo, el contenido se desarrollará en varios niveles de acercamiento a esta problemática. En primer término, se contextualizará y describirá la realidad de la trata de personas en la actualidad, para presentar un referente macro de esta situación. Seguidamente, se abordará el deterioro y daño psicológico que padecen las víctimas durante el periodo de explotación y victimización. Luego, se revisarán los síntomas, conductas y reacciones que son más frecuentemente observados, una vez termina el cautiverio y la víctima se encuentra en un lugar de acogida. Posteriormente, se continuará con la descripción y análisis de los trastornos mentales más frecuentes que se pueden diagnosticar en esta población, teniendo como referencia las investigaciones más relevantes sobre este aspecto, prestando una especial atención a propuestas alternativas diagnósticas, que intentan explicar con mayor amplitud la complejidad de la sintomatología mental de las víctimas de la trata de personas. En la parte final, se realiza una breve reflexión crítica de la realidad actual, para posteriormente proponer alternativas que permitan en un futuro ofrecer a esta población una atención mucho más integral.

Abstract This article describes the basic psychological elements to mental health professionals who at some point must attend victims of human trafficking. To achieve this goal, the content will be developed at various levels of approach to this problem. The content will be developed at various levels. First, the global situation of human trafficking will be addressed. Second, the psychological damage in victims will be analyzed. Third, the most frequent mental disorders that they suffer will be described. And finally, new diagnostic proposals will be reviewed to describe the particular symptoms in these victims. In the final part, a critical reflection of the current problem is made. Subsequently some alternatives are proposed, to provide better care of the victims of human trafficking.

Effects of stepped psychooncological care on referral to psychosocial services and emotional well-being in cancer patients: A cluster-randomized phase III trial.

OBJECTIVE: Emotional distress in cancer patients often goes unnoticed in daily routine; therefore, distress screening is now recommended in many national guidelines. However, screening alone does not necessarily translate into better well-being. We examined whether stepped psychooncological care improves referral to consultation-liaison (CL) services and improves well-being. METHODS: In a cluster-randomized trial, wards were randomly allocated to stepped versus standard care. Stepped care comprised screening for distress, consultation between doctor and patient about the patient's need for CL services, and provision of CL service. Primary outcomes were referral to psychosocial services and emotional well-being half a year after baseline, measured with the Hospital Anxiety and Depression Scale. A secondary endpoint was uptake of outpatient health care. Analysis employed mixed-effects multivariate regression modeling. RESULTS: Thirteen wards were randomized; 1012 patients participated. With stepped care (N = 570; 7 wards), 22% of the patients were referred to CL services and 3% with standard care (N = 442; 6 wards; odds ratio [OR] 10.0; P < .001). Well-being 6 months after baseline was 9.5 after stepped care (N = 341) and 9.4 after standard care (N = 234, ß -0.3; P = .71). After stepped care, patients with psychiatric comorbidity went more often to psychotherapists (OR 4.0, P = .05) and to psychiatrists (OR 2.3, P = .12), whereas patients without comorbidity used psychiatrists less often (OR 0.4, P = .04) than in standard care. CONCLUSIONS: Stepped care resulted in better referral to CL services. The patients' emotional well-being was not improved, but uptake of outpatient psychiatric help was increased in patients with psychiatric comorbidity and decreased in patients without.

Saúde mental e atenção primária: compreendendo articulações e práticas na saúde da família no Ceará / Mental health and primary care: understanding articulates and care practices in the family health in Ceará

Este artigo, resultante de uma dissertação de mestrado em Saúde da Família, consiste de um esforço científico de compreensão das relações existentes entre o campo da Atenção Primária à Saúde e o campo da Saúde Mental nos territórios. Os cenários de pesquisa foram compostos por unidades de saúde vinculadas à Estratégia Saúde da Família nas cidades de Fortaleza e Iguatu, localizadas no estado do Ceará. Desse modo, os sujeitos da pesquisa foram profissionais da Estratégia Saúde da Família. A coleta de dados foi feita a partir de entrevistas semiestruturadas e a análise realizada por meio dos referenciais teóricos do Materialismo Histórico Dialético e a da Análise de Conteúdo. Entre alguns dos resultados alcançados, está a apresentação de quatro categorias que emergiram como temas centrais, sendo eles: Formação, Medicalização, Rede e Manicômios. Os resultados permitiram a construção de um panorama sobre os principais avanços e retrocessos existentes entre o campo de fronteira entre a saúde mental e a atenção primária, bem como assinalou a existência da necessidade de se repensar a orientação da atuação dos profissionais em questão com base nas contradições percebidas.

This article consists of a scientific effort to understand the relationship between the field of Primary Health Care and the field of Mental Health in the territories. The research scenarios were composed of health facilities linked to the Family Health Strategy in the cities of Fortaleza and Iguatu, located in State of Ceara. Thus, the research subjects were the professionals of Family Health Strategy. Data collection was done by semi-structured interviews. Data analysis was performed using the theoretical framework of Content Analysis and Dialectical Materialism History. The research followed all appropriate ethical procedures and recommended by current legislation. Some of the results achieved has been the structuring four categories emerged as central themes, namely: Education, Medicalization, Network and Asylums. We conclude that this research allowed that could build an overview of the main developments and existing setbacks between the border field between mental health and primary care, and pointed out the existence of the need to rethink the direction of professional activity concerned based on perceived contradictions.

Psychosocial staffing at National Comprehensive Cancer Network member institutions: data from leading cancer centers.

OBJECTIVE: The National Comprehensive Cancer Network (NCCN) is comprised of 25 National Cancer Institute-designated cancer centers and arguably could thus set the standard for optimal psychosocial staffing for cancer centers; therefore, information was sought from NCCN Member Institutions about their current staffing for psychosocial services. These findings are put into perspective given the limited existing literature and consensus reports. METHODS: The NCCN Best Practices Committee surveyed member institutions about their staffing for psychosocial services. The survey was administered electronically in the winter of 2012. RESULTS: The survey was completed by 20 cancer centers. Across institutions, case managers and mental health therapists, typically social workers, were utilized most frequently to provide psychosocial services (67% of full-time-equivalents (FTEs)), with other psychosocial professionals also represented but less consistently. Most psychosocial services are institutionally funded (ranging from 64 to 100%), although additional sources of support include fee for service and grant funding. Training of psychosocial providers is unevenly distributed across responding sites, ranging from 92% of institutions having training programs for psychiatrists to 36% having training programs for mental health therapists. CONCLUSIONS: There was variability among the institutions in terms of patient volume, psychosocial services provided, and psychosocial staff employed. As accreditation standards are implemented that provide impetus for psychosocial services in oncology, it is hoped that greater clarity will develop concerning staffing for psychosocial services and uptake of these services by patients with cancer.

Arte e saúde mental: uma experiência com a metodologia participativa da educação popular / Art and mental health: an experience with the participatory methodology of popular education / Arte y salud mental: una experiencia con la metodología participativa de la educación popular

Neste artigo, objetivamos relatar uma experiência de estágio desenvolvida em um Centro de Atenção Psicossocial da cidade de Campina Grande-PB. Recorremos aos pressupostos teóricos e metodológicos da Psicologia Social Comunitária, em diálogo com a metodologia participativa da Educação Popular e com os princípios norteadores da Reforma Psiquiátrica brasileira. Dentre as atividades de estágio, destacamos a facilitação de oficinas em um grupo de usuários. Por meio da utilização do método do Teatro do Oprimido e de diversas linguagens artísticas, incluindo os recursos audiovisuais, foi produzido, com a participação dos usuários em todo o processo, um documentário sobre suas histórias de vida, enfocando locais e tipos de tratamento a que foram submetidos, assim como projetos de futuro. Essa prática promoveu saúde e estimulou a autonomia e o protagonismo social dos usuários, que assumiram um lugar de criação.

In this article, we aim at reporting an experience of internship developed into a Center for Psychosocial Care in the city of Campina Grande, Paraíba State. We used the theoretical and methodological approaches of Community Social Psychology, together with the participatory methodology of Popular Education and also with the guiding principles of the Brazilian Psychiatric Reform. Among the activities of the internship we would like to emphasize the facilitation of workshops for a group of users. The method of the Theater of the Oppressed and other artistic languages were used, and visual aids resources were produced with the participation of the users throughout the process, a documentary about their life histories, focusing on places and types of treatment they had undergone, as well as their future projects. This practice promoted health, stimulated the autonomy and social leadership of users who assumed the role of creative producers of creation.

En ese artículo, objetivamos relatar una experiencia de práctica desarrollada en un Centro de Atención Psicosocial de la ciudad de Campina Grande-PB. Recurrrimos a los presupuestos teóricos y metodológicos de la Psicología Social Comunitaria, en diálogo con la metodología participativa de la Educación Popular y con los principios norteadores de la Reforma Psiquiátrica brasileña. Entre las actividades de práctica, destacamos la facilitación de oficinas en un grupo de usuarios. A través de la utilización del método del Teatro del Oprimido y de diversos lenguajes artísticos, incluyendo los recursos audiovisuales, fue producido, con la participación de los usuarios en todo proceso, un documentario acerca de sus historias de vida, enfocando locales y tipos de tratamiento a que fueron sometidos, así como proyectos de futuro. Dicha práctica promovió salud, estimuló la autonomía y el protagonismo social de los usuarios, que asumieron un lugar de creación.

Serviço social e saúde mental: atuação do assistente social em comunidade terapêutica / Social work and mental health: practice of the social worker in a social therapeutic community

O presente artigo tem como objetivo contribuir com as discussões acerca do trabalho profissional do assistente social, possibilitando reflexões sobre a interlocução teórica e prática. Atualmente, o assistente social encontra-se inserido em diversos espaços sócio-ocupacionais, entre eles a saúde mental. Iremos abordar de forma específica a atuação com adolescentes dependentes químicos em uma comunidade terapêutica. A reflexão aqui apresentada diz respeito à prática do assistente social e aà descrição de estratégias e intervenções utilizadas nessa realidade, na qual a atuação do profissional de serviço social é de grande importância e, ao mesmo tempo, desafiadora.

This article aims to contribute to the discussions about the professional work of the social worker, enabling reflections on the theoretical and practical dialogue. Currently, the social worker is inserted in several occupational social spaces, including mental health. We will specifically address the work with chemically dependent adolescents in a therapeutic community. The reflection presented here concerns the practice of social workers and the description of strategies and interventions used in this reality, in which the role of the social service professional is very important and, at the same time, challenging.

Representaciones sociales sobre el alcoholismo en personas que asisten al grupo GOA del Hospital Psiquiátrico Dr. Néstor Sequeiros / Social representations about alcoholism in people attending the group GOA Psychiatric Hospital Dr. Nestor Sequeiros

Para conocer las Representaciones Sociales (RS) sobre el alcoholismo que tienen los miembros del Grupo Operativo de Alcoholismo (GOA) del Hospital Psiquiátrico Dr. Néstor Sequeiros de San Salvador de Jujuy, y con la finalidad de promover estrategias de intervención alternativas para la mejora de la calidad de vida de los sujetos que padecen alcoholismo, se realizó un estudio descriptivo de carácter cualitativo orientado a comprender la estructura y cualidades de dicha representación. El mismo tuvo como objetivo principal describir las Representaciones Sociales sobre el Alcoholismo que construyen las personas que asisten al GOA. Se trabajó con una muestra intencional de 11 miembros que asisten regularmente y se participó en ocho encuentros del grupo. La muestra de 11 miembros estuvo constituida por 3 personas de sexo femenino y 8 de sexo masculino, de entre 23 y 54 años de edad. Para el relevamiento durante el trabajo de campo se aplicaron las técnicas de observación participante y entrevistas semiestructuradas presenciales. Las técnicas mediante las cuales se pudo establecer y caracterizar diferentes perfiles representacionales fueron el análisis del discurso y el análisis de contenido (utilizando el método comparativo constante). Finalmente, se observó que el grupo GOA cumple una función crucial en la recuperación y en el acompañamiento de la persona que padece alcoholismo y sus familiares, considerándolo como un espacio de contención en el cual los miembros van transformando su identidad, resignificando su historia y teniendo como principal meta construir un proyecto de vida sin alcohol

SUMMARY: For knowing Social Representations (SR) of alcoholism that members of the Alcoholism Operative Group (GOA) Psychiatric Hospital Dr. Nestor Sequeiros of San Salvador de Jujuy , and in order to promote alternative intervention strategies to improve quality of life of individuals suffering from alcoholism , a descriptive qualitative study aimed at understanding the structure and qualities of such representation was made. The same main objective was to describe the social representations on Alcoholism building people attending GOA. We worked with a purposive sample of 11 members who attend regularly and participated in eight group meetings. The sample of 11 members was constituted by 3 people female and 8 male, between 23 and 54 years old. For the survey during the fieldwork techniques of participant observation and semi-structured interviews were face to face. The techniques by which it was established and characterize different profiles were representational discourse analysis and content analysis (using constant comparative method). Finally , we observed that the GOA group plays a crucial role in recovery and in accompanying the person with alcoholism and their families , seeing it as an area of contention in which members are transforming their identity, their history and taking resignifying; its main goal is to build a life without alcohol

Um olhar sobre a patologização da infância a partir do CAPSI / A look at children pathologization through the CAPSi / Una mirada sobre la patologización de la infancia a partir del CAPSi / Un regard vers la pathologisation de l'enfance à partir du CAPSi

A infância, no decorrer da história, foi ocupando lugar na produção do saber e do poder psiquiátrico, tornando-se alvo de investimentos das políticas públicas. No Brasil, a institucionalização do Sistema Único de Saúde (SUS), do Estatuto da Criança e do Adolescente (ECA) e da Reforma Psiquiátrica constitui-se um marco para a reorganização do cuidado em saúde mental para crianças e adolescentes. A compreensão da produção da infância passa pelos processos de desinstitucionalização das práticas de cuidado, do reconhecimento da criança como sujeito e a potência de criação de cada encontro. Este artigo problematiza a produção da infância a partir das práticas de cuidado no Centro de Atenção Psicossocial para infância e adolescência (CAPSi). Utilizamos a cartografia como estratégia metodológica, enfatizando o estudo da dimensão processual da subjetividade e de seu processo de produção. Acompanhamos as atividades em um CAPSi por quatro meses, realizando observações das ações desenvolvidas nesse serviço e grupos focais com os integrantes da equipe. Observamos que a patologização é um dos modos pelos quais a infância é produzida no CAPSi. Os processos de psiquiatrização e patologização da infância no percurso das crianças pelo CAPSi são percebidos nas diversas marcas impressas em seus processos de subjetivação. Uma dessas marcas ocorre pelo processo de atribuição de um diagnóstico às crianças. Afirmar o lugar do CAPSi como agenciador de novos encontros configura-se uma estratégia para que outras experiências sejam possíveis. O CAPSi é um lugar de encontro onde diversas instituições se cruzam, permitindo que o encontro das crianças se dê com cada uma dessas instituições que atravessam as práticas, tensionando a noção de identidade infantil como uma entidade criança, imóvel e universal. Isso permite que a criança seja um campo de forças e intensidades, inventando a sua experiência com o sofrimento e as práticas de cuidado.

Childhood, throughout history, has been taking place in the production of knowledge and psychiatric power, becoming a target for public policies investments. The institutionalization of the Unified Health System (SUS), the Statute of Child and Adolescent (ECA) and the Psychiatric Reform are, in Brazil, landmarks for the reorganization of mental health care for children and adolescents. The understanding of the production of childhood undergoes processes of deinstitutionalization of care practices, the recognition of children as individuals and the power of creating each meeting. This article problematizes the childhood production from care practices in a Psychosocial Care Center for children and adolescents (CAPSi). The research instrument used was the cartography, emphasizing the study of the procedural dimension of subjectivity and its production process. The activities in a CAPSi were followed for four months, conducting observations of the actions developed in this service and focus groups with team members. The pathologization is one of the ways in which childhood is produced in the CAPSi as it was observed in the study. The processes of childhood psychopathologization and pathologization are perceived in different marks printed in the processes of the children's subjectification. One of these marks occurs in the process of assigning a diagnosis to the children. Affirming that CAPSi is an agent for new meetings may be seen as a strategy, so that other experiences may become possible. CAPSi as the meeting place and a place where several institutions intersect allows the children's meeting to deal with each of these institutions that cross the practices, stressing the notion of child identity as an infant, static, and universal entity. This allows children to be a field of forces and intensities, inventing their experience through suffering and care practices.

En el transcurrir de la historia la infancia estuvo ocupando sitio en la producción del saber y del poder psiquiátrico, tornándose objetivo de investimentos de las políticas públicas. En Brasil, la institucionalización del Sistema Único de Salud (SUS), del Estatuto del Niño y del Adolescente (ECA) y de la Reforma Psiquiátrica, se constituye en punto de referencia para la reorganización del cuidado en salud mental de niños y adolescentes. La comprensión de la producción de la infancia pasa por los procesos de desinstitucionalización de las prácticas de cuidado, el reconocimiento del niño como sujeto, y la potencia de la creación de cada encuentro. Este artículo problematiza la producción de la infancia a partir de las prácticas de cuidado en el Centro de Atención Psicosocial para la infancia y adolescencia (CAPSi). Utilizamos la cartografía como estrategia metodológica, enfatizando el estudio de la dimensión procesual de la subjetividad y su proceso de producción. Seguimos las actividades en un CAPSi a lo largo de cuatro meses realizando observaciones de las acciones desarrolladas en ese servicio y grupos focales con los integrantes del equipo. Observamos que la patologización es uno de los modos por los cuales la infancia está producida en el CAPSi. Los procesos de psiquiatrización y patologización de la infancia en el recurrido de los niños por el CAPSi son percibidos en las diversas marcas que impresas en sus procesos de subjetivación. Una de esas marcas se da por el proceso de asignación de un diagnóstico a los niños. Afirmar la posición del CAPSi como administrador de nuevos encuentros se configura una estrategia para que otras experiencias sean posibles. El CAPSi es un sitio de encuentro donde diversas instituciones se cruzan permitiendo que el encuentro de los niños se dé con cada una de esas instituciones que cruzan las prácticas tensionando la noción de identidad infantil como una entidad niña, inmóvil y universal. Eso permite que el niño sea un campo de fuerzas e intensidades y que invente su experiencia con el sufrimiento y las prácticas del cuidado.

L'enfance, au cours de l'histoire, a eu de la place dans la production du savoir et du pouvoir psychiatrique en devenant la cible d'investissements des politiques publiques. Au Brésil, l'institutionalisation du Systhème Unique de Santé (SUS), du Statut de l'Enfant et de l'Adolescent (ECA) et de la réforme psychiatrique constitue un point fort de la réorganisation du soin de la santé mentale pour les enfants et les adolescents. La compréhension de la production de l'enfance passe par des processus de désinstitutionalisation des pratiques de soin, de la reconnaissance de l'enfant comme sujet, et la puissance de création de chaque rencontre. Cet article met em question la production de l'enfance à partir des pratiques de soin dans le Centre d'Attention Psychosocial pour l'enfance et l'adolescence (CAPSi). Nous avons utilisé la cartographie comme stratégie méthodologique en signalant l'étude de la dimension procédural de la subjectivité et de son processus de production. Nous avons accompagné les activités dans un CAPSi pendant quatre mois en y remarquant les actions développées et des groupes avec l'équipe. Nous avons remarqué que la pathologisation est l'un des modes par lequels l'enfance est produite dans le CAPSi. Les processus de psychiatrisation et celui de la pathologisation de l'enfance dans le parcours des enfants par le CAPSi sont aperçus dans des diverses marques imprimées dans leurs processus de subjectivation. L'une de ces marques se produit par le processus d'attribution d'un diagnostic aux enfants. Affirmer la place du CAPSi en tant qu'organisateur de nouvelles rencontres représente une stratégie pour que de nouvelles expériences soient possibles. Le CAPSi est un lieu de reencontre et où des plusieures institutions se croisent en permettant la reencontre des enfants avec chacune de ces institutions qui traversent les pratiques en tension avec la notion d'identité infantile comme une entité enfant, immobile et universel. Cela permet ainsi que l'enfant soit um champ de forces et d'intensités, en inventant son expérience avec la souffrance et les pratiques de soin.