Implanting Rhizomes in Vermont: a Qualitative Study of How the Open Dialogue Approach was Adapted and Implemented.

The Open Dialogue approach was developed in Finland in the 1980s as a form of psychotherapy and a way to organize mental health systems. It has been adapted and implemented in several countries in recent years. This qualitative study sought to explore staff and developers' experiences with one adaptation of the Open Dialogue approach in the state of Vermont called the Collaborative Network Approach. In total twenty two staff members from two agencies participated in focus groups and three developers of the approach were interviewed. Three dominant topics emerged in the analysis process: impact of training; buy-in across levels; and shift in organizational culture. Findings revealed that 1) participants experienced the Collaborative Network Approach as positively impacting their clinical work, relationship with clients and families, and with colleagues; 2) buy-in across levels - colleagues, management and department of mental health - was perceived as crucial to the development and implementation of the approach; 3) the main challenges to full implementation were: inadequate billing structures, costly and lengthy training, and resistance to shift organizational culture to integrate the Collaborative Network Approach into agencies. We hope to have contributed to the field in a way that will support further efforts to develop and implement Open Dialogue-informed approaches by pointing to potential successes and challenges future program developers may face.

From manicomial logic to territorial logic: Impasses and challenges of psychosocial care.

The present study describes Psychosocial Care as a new paradigm currently operating within the Brazilian Psychiatric Reform, emphasising one of its key elements: the provision of mental care within a network and a territory. To this end, the social and cultural diversity of each territory is taken as fundamental aspects to enable appropriate care for mental suffering, overcoming exclusionist thinking patterns that recently have taken on worrying conservative manifestations, and eliminating misconceptions about what defines a mental health sufferer, as well as those who choose alternative ways of being.

Saúde mental e economia solidária: cartografias do seu discurso político / La salud mental y la economía solidaria: cartografía del discurso político / Mental health and solidarity economy: cartography of political discourse

O presente artigo se refere à composição do campo discursivo em torno da questão do trabalho, pelo aporte da economia solidária, como estratégia de atenção em saúde mental. Através da cartografia e de alguns operadores analíticos de Foucault (biopolítica, governamentabilidade, normalização), mapeamos a configuração de forças e enfrentamentos que agenciaram a constituição da política pública brasileira de saúde mental e economia solidária. Em nossas análises apontamos uma ambiguidade no conceito trabalho presente nos documentos, a polissemia de expressões utilizadas para designar o trabalhar, um significativo discurso de valorização da inserção, via emprego, no mercado formal de trabalho, e a insuficiência de estratégias políticas e legais que deem sustentabilidade material às experiências práticas. Em contrapartida, destacamos como a economia solidária na saúde mental também diferencia-se ao valorizar o trabalho como possibilidade de estar no social de forma mais integral que as simplificadas relações utilitárias e normalizantes que o capitalismo fortemente investe.

Este artículo se refiere a la composición de campo discursivo en torno a la cuestión del trabajo, la contribución de la economía social, como estrategia de atención a la salud mental. A través de la cartografía y algunos operadores de análisis de Foucault (biopolítica, gubernamentalidad, la normalización), estudiamos la configuración de fuerzas y enfrentamientos que agenciaram la formación de la política pública brasileña mentales salud y la economía solidaria. En nuestros análisis señalar una ambigüedad en este concepto de trabajo en los documentos, la polisemia de los términos utilizados para describir el trabajo, una inserción significativa mejora del habla, a través de empleo en el mercado laboral formal, y la falta de estrategias políticas y jurídicas que dan materiales de sostenibilidad a las experiencias prácticas. Por otro lado, se destaca cómo la economía solidaria en salud mental también es diferente a valorar el trabajo como una posibilidad para ser social de manera más integral que las relaciones utilitarias simplificados y la normalización de que el capitalismo en gran medida invierte.

This article refers to the composition of the discursive field around the labor question, of social economy contribution, as extended by the mental health strategy. Through mapping and some analytical operators of Foucault (biopolitics, governmentality, normalization), we mapped the configuration of forces and clashes that elaborated the formation of Brazilian public policy regarding mental health and solidarity economy. In our analysis we point out an ambiguity presented in the documents regarding this work concept, the polysemy of terms and expressions used to designate labor activity, a significant discourse on the appreciation of insertion in the formal labor market via employment, and the lack of political and legal strategies that give sustainability to practical experiences. However, we highlight how the solidarity economy in mental health also differs by valuing work as a possibility of being social in a more integral way than the utilitarian and normative relations that capitalism heavily invests.

Ritual de consumo do crack: aspectos socioantropológicos e repercussões para a saúde dos usuários / The ritual of crack consumption: socio-anthropological aspects and impacts on the health of users

O uso do crack tem promovido intensa discussão na sociedade. Pesquisas têm contribuído na caracterização dos usuários e nas consequências negativas do seu consumo. No entanto, poucos estudos têm se aprofundado nos contextos socioculturais em que o crack é consumido. Para tanto, o estudo tem como objetivo discutir o ritual de consumo do crack e suas repercurssões sociais e à saúde dos usuários. Trata-se de um estudo qualitativo desenvolvido nos Centros de Atenção Psicossocial Álcool e Drogas (Caps-ad). Os sujeitos foram selecidonados em dois grupos de informantes-chave: usuários de crack em acompanhamento e trabalhadores de saúde. Utilizou-se como técnica de coleta a entrevista semiestruturada. Os resultados demonstraram que o consumo de crack não está dissociado do modo de organização atual da sociedade. Há relação entre o uso desta substância e a organização social para o consumo. Os indivíduos buscam no crack fazer parte de um mercado consumidor, participando ativamente do que a sociedade concebe como novidade. As formas e as cenas de uso têm relação direta com a saúde dos usuários, necessitando que haja por parte dos serviços de saúde detecção, aproximação e intervenções de saúde nessas cenas de uso.

The use of crack cocaine has given rise to an intense discussion in society. Research has contributed to the characterization of users and the negative consequences of its use. However, few studies have conducted in-depth study of the social and cultural contexts in which crack cocaine is used. Thus, this study seeks to discuss the ritual of crack cocaine use and its social and health consequences for the user. It is a qualitative study developed in the Psychosocial Care Centers for Alcohol and Drugs (Portuguese acronym: Caps-ad). The individuals were selected in two groups of key-informants: crack cocaine users undergoing treatment and health professionals. Data was obtained by means of semi-structured interviews. The results revealed that the use of crack cocaine is not dissociated with the current organizational structure of society. There is a link between the use of this substance and the social organization for its use. By using crack cocaine, the individuals try to be part of a consumer market, actively participating in what society perceives as new. The forms and locations of use are directly related to users' health, making it necessary for healthcare services to detect, approach and make health interventions in these locations of use.

[The ritual of crack consumption: socio-anthropological aspects and impacts on the health of users]. / Ritual de consumo do crack: aspectos socioantropológicos e repercussões para a saúde dos usuários.

The use of crack cocaine has given rise to an intense discussion in society. Research has contributed to the characterization of users and the negative consequences of its use. However, few studies have conducted in-depth study of the social and cultural contexts in which crack cocaine is used. Thus, this study seeks to discuss the ritual of crack cocaine use and its social and health consequences for the user. It is a qualitative study developed in the Psychosocial Care Centers for Alcohol and Drugs (Portuguese acronym: Caps-ad). The individuals were selected in two groups of key-informants: crack cocaine users undergoing treatment and health professionals. Data was obtained by means of semi-structured interviews. The results revealed that the use of crack cocaine is not dissociated with the current organizational structure of society. There is a link between the use of this substance and the social organization for its use. By using crack cocaine, the individuals try to be part of a consumer market, actively participating in what society perceives as new. The forms and locations of use are directly related to users' health, making it necessary for healthcare services to detect, approach and make health interventions in these locations of use.