People brought to the emergency department under involuntary assessment orders: A scoping review.

BACKGROUND: Some people with mental health problems arrive to the Emergency Department (ED) under involuntary assessment orders (IAOs) and can have complex medical and socioeconomic factors, which may impact on the delivery of care in the ED. Therefore, this scoping review aimed to identify, evaluate and summarise the current literature regarding the demographic characteristics, clinical characteristics and outcomes for people brought to the ED under IAOs. METHOD: A scoping review was undertaken guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines and the Arksey and O'Malley framework. RESULTS: In total 21 articles were included in this review. People under IAOs most commonly present to EDs with suicidal ideation/intent, with interagency involvement noted when responding to these people in the pre-hospital setting. Most people arriving to ED under IAOs were reported to experience length of staylonger than four hours. CONCLUSION: This review highlights the limited information pertaining to people brought to EDs under an IAO. High levels of mental health problems and extended length of stay for people under IAOs suggests the need for interagency collaboration to inform the development and implementation of models of care that incorporates social determinants of health and are tailored to this complex population.

Sobre dias em que me senti sem ar: desassossegos do pesquisar / On days when i felt breathless: unrest of search / Sobre días que me sentí sin aliento: disurbios de investigación

Resumo Conceitos como o de alteridade, encontro de saberes, polifasia cognitiva, o princípio de familiaridade e de representações sociais operaram na complexa tarefa de compreender como os encontros entre profissionais e usuários sustentavam e/ou transformavam as práticas de acolhimento. Entretanto, a experiência da minha pesquisa de doutorado me levou a questionar os próprios conceitos utilizados da Teoria das Representações Sociais. Ao final do ensaio, após discutir aspectos teórico-metodológicos, o princípio de familiaridade e a questão da tensão e dos afetos nas representações sociais, espero evidenciar como o movimento provocado pelo encontro com usuários e profissionais de uma Rede de Atenção Psicossocial levou-me a questionar pontos essenciais da teoria: o papel domesticador das representações, a forma ainda estática de evidenciar os fenômenos, a separação entre um sujeito que representa e o objeto representado e a dificuldade em usar suas ferramentas conceituais para acompanhar processos me fazem repensar meu lugar e minha função de pesquisador.

Abstract Concepts such as alterity, encounter of knowledge, cognitive polyphasia, the principle of familiarity and the very concept of social representations operated in the complex task of understanding how the encounters between professionals and users supported and / or transformed user embracement practices. However, the experience of my doctoral research led me to question the very concepts used in the Theory of Social Representations. At the end of the essay, after discussing theoretical and methodological aspects, the principle of familiarity and the issue of tension and affects in social representations, I hope to show how the movement caused by the encounter with users and professionals of a Psychosocial Care Network, led me to question essential points of the theory: the domesticating role of representations, the still static way of showing phenomena, the separation between a subject that represents and the object represented and the difficulty in using their conceptual tools to accompany processes makes me rethink my place and role as a researcher.

Resumen Conceptos como la alteridad, el encuentro de saberes, la polifasia cognitiva, el principio de familiaridad y el concepto mismo de representaciones sociales operaron en la compleja tarea de comprender cómo los encuentros entre profesionales y usuarios apoyaron y / o transformaron las prácticas de acogimiento. Sin embargo, la experiencia de mi investigación doctoral me llevó a cuestionar los propios conceptos utilizados en la Teoría de las Representaciones Sociales. Al final del ensayo, después de discutir aspectos teóricos y metodológicos, el principio de familiaridad y el tema de tensión y afectos en las representaciones sociales, Espero mostrar cómo el movimiento provocado por el encuentro con usuarios y profesionales de una Red de Atención Psicosocial, me llevó a cuestionar puntos esenciales de la teoría: el rol domesticador de las representaciones, la forma todavía estática de mostrar los fenómenos, la separación entre un sujeto que representa y el objeto representado y la dificultad para utilizar sus herramientas conceptuales para acompañar procesos, me hace repensar mi lugar y rol como investigador.

O direito à internação psiquiátrica no sistema de saúde brasileiro: as representações sociais do Tribunal de Justiça de São Paulo / The right to psychiatric admission in the Brazilian health system: the São Paulo Court of Justice' social representations

Este artigo teve como objetivo analisar as representações sociais do Tribunal de Justiça de São Paulo sobre o direito à internação psiquiátrica no sistema de saúde brasileiro. Os dados foram coletados do sítio eletrônico do tribunal paulista, a partir de 184 acórdãos de ações julgadas em segunda instância, proferidos em razão de recursos de apelação e publicados no período de janeiro de 1998 a dezembro de 2012, referentes às internações psiquiátricas pleiteadas no Sistema Único de Saúde e no sistema de saúde suplementar. Os métodos empregados para análise dos resultados foram a estatística descritiva e o discurso do sujeito coletivo. Aplicou-se, ainda, a Teoria das Representações Sociais como referencial teórico de interpretação dos discursos elaborados. No Sistema Único de Saúde, a internação reclamada em juízo foi a compulsória, representada, majoritariamente, como medida de proteção da dignidade da pessoa com transtorno mental e, minoritariamente, como violência contra essa mesma dignidade. No sistema suplementar, a representação judicial assumiu o enfoque consumerista, consubstanciado na abusividade da cláusula limitativa da internação psiquiátrica e no direito superior à vida. O direito à saúde, vislumbrado nas decisões judiciais, resumiu-se ao direito de acesso aos serviços de saúde e ao direito à doença. A compreensão do Poder Judiciário, nos dois sistemas investigados, foi a do direito à saúde como o direito ao bem de saúde pleiteado em juízo, o que coloca muitos desafios para os sistemas de saúde e para o Poder Judiciário frente à consolidação dos ideais da reforma psiquiátrica estatuída pela Lei n. 10.216/2001.

The current research sought to present the social representations of judges from the São Paulo Court of Justice about the law regarding psychiatric admissions. Data were collected through the court website, from 184 judgments including all the decisions published between January 1998, and December 2012, regarding psychiatric admissions claimed to both the Brazilian Public Health System, and the private insurance health system. As methods, the author used descriptive statistics and the collective subject speech. The Social Representations Theory was applied as a theoretical framework to interpret the collected speeches. Considering Brazilian Public Health System, the admissions claimed on the court were compulsory and judges presented the psychiatric admissions, mostly, as a protection measure of people with mental disorders dignity and, at a lower degree, as a violence against this same dignity. With respect to the private insurance health system, the judicial representation was related to the consumerist approach, supported by the abuse of a clause restricting the time for psychiatric admissions and its contradiction with the right to life. The right to health was characterized in the decisions as the right of access to health services and the right to be ill. The comprehension of the judges in both investigated systems related the right to health to the right to a health as a good claimed in court, imposing many challenges to health systems and the Judiciary Power in order to consolidate the principles of the psychiatric reform brought by Law n. 10.216/2001.

Psychiatric commitment under the criminal law in China: An empirical perspective.

This article examines the legislation and practice of compulsory treatment in China. Part I traces the Chinese history of criminal commitment law, explains the research methodology, and highlights some general empirical findings. Part II provides a comprehensive empirical analysis of compulsory treatment law in China, it covers both substantial issues such as criteria of compulsory treatment and procedural issues such as the commitment hearing, enforcement, and discharge of compulsory treatment. It also explores the compulsory treatment law from the human rights protection perspective. Our primary objective is to present the empirical findings to enable the legislative and other involved government agencies to make informed decisions about the future evolution of Chinese law in this area.

An end to coercion: rights and decision-making in mental health care.

The United Nations Convention on the Rights of Persons with Disabilities requires a paradigm shift from a medical model of disability to a social model that emphasizes overcoming the barriers to equality created by attitudes, laws, government policies and the social, economic and political environment. The approach adopted by the social model recognizes that people with psychosocial disabilities have the same right to take decisions and make choices as other people, particularly regarding treatment, and have the right to equal recognition before the law. Consequently, direct or supported decision-making should be the norm and there should be no substitute decision-making. Although recent mental health laws in some countries have attempted to realize a rights-based approach to decision-making by reducing coercion, implementing the Convention on the Rights of Persons with Disabilities can be challenging because it requires continuous refinement and the development of alternatives to coercion. This article reviews the impact historical trends and current mental health frameworks have had on the rights affected by the practice of involuntary treatment and describes some legal and organizational initiatives that have been undertaken to promote noncoercive services and supported decision-making. The evidence and examples presented could provide the foundation for developing a context-appropriate approach to implementing supported decision-making in mental health care.

La Convention des Nations Unies relative aux droits des personnes handicapées nécessite un changement radical pour passer d'un modèle médical du handicap à un modèle social mettant l'accent sur la levée des obstacles en matière d'égalité, créés par des attitudes, des lois, des politiques gouvernementales ainsi que l'environnement social, économique et politique. L'approche adoptée par le modèle social reconnaît que les personnes présentant un handicap mental ont le même droit de prendre des décisions et de faire des choix que les autres, notamment en matière de traitement, et ont droit à une reconnaissance égale devant la loi. Par conséquent, la prise de décision directe ou accompagnée doit être la norme et il ne doit exister aucune prise de décision substitutive. Bien que certains pays aient récemment cherché, à travers des lois sur la santé mentale, à instaurer une approche fondée sur les droits en matière de prise de décision en réduisant la coercition, la mise en œuvre de la Convention relative aux droits des personnes handicapées peut poser problème, car elle exige une amélioration continue et l'élaboration de solutions autres que la coercition. Cet article examine l'impact que les tendances historiques et les cadres actuels en matière de santé mentale ont eu sur les droits lésés par la pratique du traitement involontaire et décrit plusieurs initiatives législatives et organisationnelles qui ont été prises pour promouvoir les services non coercitifs et la prise de décision accompagnée. Les données et les exemples présentés peuvent servir de fondement à l'élaboration d'une approche adaptée au contexte pour mettre en place la prise de décision accompagnée en matière de soins de santé mentale.

La Convención de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad requiere un cambio de paradigma, de un modelo médico de discapacidad a un modelo social que haga hincapié en la superación de las barreras a la igualdad creadas por las actitudes, las leyes, las políticas gubernamentales y el entorno social, económico y político. El enfoque adoptado por el modelo social reconoce que las personas con discapacidad psicosocial tienen el mismo derecho a tomar decisiones y a elegir como cualquier otra persona, especialmente en lo que se refiere al tratamiento, y tienen derecho a un reconocimiento igualitario ante la ley. Por lo tanto, la toma de decisiones directa o apoyada debería ser la norma y no debería haber un responsable sustituto de la toma de decisiones. Aunque las recientes leyes sobre salud mental de algunos países han tratado de aplicar un enfoque basado en los derechos para la adopción de decisiones mediante la reducción de la coerción, la implementación de la Convención sobre los Derechos de las Personas con Discapacidad puede ser un reto, ya que requiere un continuo perfeccionamiento y el desarrollo de alternativas a la coerción. Este artículo evalúa el impacto que las tendencias históricas y los marcos actuales de salud mental han tenido sobre los derechos afectados por la práctica del tratamiento involuntario y describe algunas iniciativas legales y organizativas que se han emprendido para promover servicios no coercitivos y apoyar la toma de decisiones. La evidencia y los ejemplos presentados podrían servir de base para desarrollar un enfoque apropiado al contexto para la implementación de la toma de decisiones apoyada en la atención de la salud mental.

Ethnic variations in compulsory detention under the Mental Health Act: a systematic review and meta-analysis of international data.

BACKGROUND: Evidence suggests that black, Asian and minority ethnic (BAME) groups have an increased risk of involuntary psychiatric care. However, to our knowledge, there is no published meta-analysis that brings together both international and UK literature and allows for comparison of the two. This study examined compulsory detention in BAME and migrant groups in the UK and internationally, and aimed to expand upon existing systematic reviews and meta-analyses of the rates of detention for BAME populations. METHODS: For this systematic review and meta-analysis, we searched five databases (PsychINFO, MEDLINE, Cochrane Controlled Register of Trials, Embase, and CINAHL) for quantitative studies comparing involuntary admission, readmission, and inpatient bed days between BAME or migrant groups and majority or native groups, published between inception and Dec 3, 2018. We extracted data on study characteristics, patient-level data on diagnosis, age, sex, ethnicity, marital status, and occupational status, and our outcomes of interest (involuntary admission to hospital, readmission to hospital, and inpatient bed days) for meta-analysis. We used a random-effects model to compare disparate outcome measures. We assessed explanations offered for the differences between minority and majority groups for the strength of the evidence supporting them. This study is prospectively registered with PROSPERO, number CRD42017078137. FINDINGS: Our search identified 9511 studies for title and abstract screening, from which we identified 296 potentially relevant full-text articles. Of these, 67 met the inclusion criteria and were reviewed in depth. We added four studies after reference and citation searches, meaning 71 studies in total were included. 1 953 135 participants were included in the studies. Black Caribbean patients were significantly more likely to be compulsorily admitted to hospital compared with those in white ethnic groups (odds ratio 2·53, 95% CI 2·03-3·16, p<0·0001). Black African patients also had significantly increased odds of being compulsorily admitted to hospital compared with white ethnic groups (2·27, 1·62-3·19, p<0·0001), as did, to a lesser extent, south Asian patients (1·33, 1·07-1·65, p=0·0091). Black Caribbean patients were also significantly more likely to be readmitted to hospital compared with white ethnic groups (2·30, 1·22-4·34, p=0·0102). Migrant groups were significantly more likely to be compulsorily admitted to hospital compared with native groups (1·50, 1·21-1·87, p=0·0003). The most common explanations for the increased risk of detainment in BAME populations included increased prevalence of psychosis, increased perceived risk of violence, increased police contact, absence of or mistrust of general practitioners, and ethnic disadvantages. INTERPRETATION: BAME and migrant groups are at a greater risk of psychiatric detention than are majority groups, although there is variation across ethnic groups. Attempts to explain increased detention in ethnic groups should avoid amalgamation and instead carry out culturally-specific, hypothesis-driven studies to examine the numerous contributors to varying rates of detention. FUNDING: University College London Hospitals National Institute for Health Research (NIHR) Biomedical Research Centre, NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, and NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust.

Involuntary psychiatric admission based on risk rather than need for treatment: report from the Dublin Involuntary Admission Study (DIAS).

Aims Involuntary psychiatric admission in Ireland is based on the presence of mental disorder plus serious risk to self/others and/or need for treatment. This study aimed to examine differences between use of risk and treatment criteria, about which very little is known. Methods We studied 2,940 admissions, of which 423 (14.4%) were involuntary, at three adult psychiatry units covering a population of 552,019 people in Dublin, Ireland. Results Involuntary patients were more likely than voluntary patients to be male, unmarried and have schizophrenia or a related disorder. Involuntary admission based on the 'risk criterion' (rather than the 'treatment criterion' or both) was associated with a shorter period as an involuntary patient for patients with diagnoses other than schizophrenia. Conclusion If inpatient units are intended as treatment centres rather than risk management units, the balance between considerations of risk and treatment requires careful re-examination in the setting of involuntary psychiatric care.

Evaluating the effects of community treatment orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study.

INTRODUCTION: Supervised community treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of community treatment orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of sociospatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data. METHODS AND ANALYSIS: Four years of data from the Mental Health Services Dataset (MHSDS) will be analysed using multilevel models. Models based on all patients eligible for CTOs will be used to explore variation in their use. A subset of CTO-eligible patients comprising a treatment group (CTO patients) and a matched control group (non-CTO patients) will be used to examine variation in the association between CTO use and study outcomes. Primary outcome will be total time in hospital. Secondary outcomes will include time to first readmission and mortality. Outputs from these models will be used to populate predictive models of healthcare resource use. ETHICS AND DISSEMINATION: Ethical approval has been granted by the National Health Service Data Access and Advisory Group and Warwick University. To ensure patient confidentiality and to meet data governance requirements, analyses will be carried out in a secure microdata laboratory using de-identified data. Study findings will be disseminated through academic channels and shared with mental health policy-makers and other stakeholders.

Demographic and clinical characteristics of patients involuntarily hospitalized in an Italian psychiatric ward: a 1-year retrospective analysis.

BACKGROUND: In Italy, psychiatric compulsory treatments are regulated by Law 180 of 13-5-1978 that establishes three criteria: 1) acute psychiatric conditions requiring urgent treatment, 2) patient's refusal of treatment, 3) inpatient treatment is necessary and cannot be postponed. AIM: To highlight demographic and clinical risk factors for involuntary treatments. METHODS: We retrospectively collected all hospitalizations in the Service of Psychiatric Diagnosis and Treatment of a northern Italian town from 1-1-2015 to 31-12-2015. We statistically compared demographic and clinical variables related to voluntarily and involuntarily admitted patients and their hospitalizations. RESULTS: We divided our sample into patients voluntarily hospitalized (PVH=236) and involuntarily (PIH=160) according to their voluntary (VH= 304) and involuntary (IH=197) hospitalizations. PIH were older than PVH and, more frequently, lived alone and were unemployed (p<0.001). "Acute worsening of psychopathology" for IH and "Suicidality" for VH were the prevalent reasons (p<0.001). IH was longer than VH (p<0.001). Among PIH, the most frequent diagnoses were "Schizophrenia and Other Psychosis" (ICD-9-CM) and "Ineffective Impulse Control + Disturbed Personal Identity" (NANDA-I) (p<0.001). During hospitalizations, PIH more often than PVH presented aggressive behavior (p<0.001). At discharge, PIH were more frequently sent to another psychiatric ward or protected facility with long-acting injectable antipsychotics (p<0.001). CONCLUSIONS: Our involuntarily admitted patients were affected by severe psychiatric disorders with social maladjustment and required complex therapeutic and rehabilitative programs to counteract aggressive behaviour, poor therapeutic compliance and prolonged hospitalizations. The assessment of patients' characteristics can help clinicians recognize who are at risk for compulsory treatment and prevent it.

Juridicização engajada da adolescência: sobre um caso de internação psiquiátrica compulsória / Engaged juridicization of adolescence: about a case of psychiatric compulsory admission

Resumo Com o objetivo de compreender um caso de internação psiquiátrica compulsória (IPC) infantojuvenil, foi desenvolvida uma etnografia com agentes institucionais dos setores educação, justiça e saúde nos poderes executivo e judiciário. A metodologia de pesquisa consistiu em (1) entrevistas com defensoras, psicólogas, psiquiatras e peritos; (2) análise documental de ata escolar, autos processuais e prontuário médico. Frisamos que algumas pesquisas têm se centrado em "adolescentes drogaditos" internados compulsoriamente, apontando para uma "judicialização do cuidado em saúde mental". Desse modo, visou-se responder à seguinte questão de pesquisa: as IPC às quais Clara fora submetida também poderiam ser compreendidas como parte desse processo? Procurou-se mostrar que a jovem é caracterizada pelas versões institucionais como uma "adolescente-psiquiátrica" por alguns, e "um risco para si e para terceiros" por outros. Assim, torna-se um "caso emblemático" para uma rede de cuidados, após episódios de "agressão", "tentativas de suicídio" e "fugas" que suscitaram audiências, encaminhamentos, internações e abrigamentos. Por fim, os resultados apontam para um processo de juridicização engajada da adolescência.

Abstract With the objective of understanding a case of psychiatric compulsory admission (IPC) of a child/adolescent, an ethnography was developed with institutional agents from the education, justice and health sectors, in the executive and judicial branches. The research methodology consisted of (1) interviews with public defenders, psychologists, psychiatrists and experts; and (2) documentary analysis of school minutes, procedural records and medical records. We emphasize that some researches have been focused on "teenage drug abuse" compulsorily hospitalized, pointing to a "judicialization of mental health care". In this way, the aim was to answer the following research question: could the IPCs to which Clara had been submitted also be understood as part of this process? It was sought to show that the girl is characterized by the institutional versions as a "psychiatric-teenager" by some, and "a risk for herself and for others" by others. Thus, it becomes an "emblematic case" for a network of care, after episodes of "aggression", "suicide attempts" and "escapes" that aroused hearings, referrals, hospitalizations and shelterings. Finally, the results point to a process of engaged juridicization of adolescence.

Judicialização da saúde e internações compulsórias de jovens usuários de drogas ­ um estudo em Espírito Santo do Pinhal/SP / Health judicialization and compulsory hospitalization of young drug users ­ case study of the Municipality of Espírito Santo do Pinhal, State of São Paulo

O artigo tem por objetivo analisar processos de internação compulsória de jovens e adultos usuários de drogas relativos aos anos de 2009 a 2014 na cidade de Espírito Santo do Pinhal (SP). Tratou-se de um estudo longitudinal retrospectivo, de caráter exploratório documental. O presente trabalho revelou que, em 99 processos, as famílias buscam na Justiça a internação compulsória de seus familiares. As internações de adolescentes via ação judicial são feitas em clínicas particulares pagas pelo município, enquanto os adultos são internados pelo Sistema Único de Saúde. Não há transferência de recursos estaduais, e os recursos federais não cobrem os gastos. Não há políticas públicas para esse fim, e há necessidade de fortalecimento dos Centros de Atenção Psicossocial para promoção da sustentabilidade e do equilíbrio social.(AU)

This article has the objective of analyzing the processes of compulsory admissions of young drug users, from the years 2009 to 2014 in the Municipality of Espírito Santo do Pinhal, State of São Paulo. This was a longitudinal retrospective study of exploratory and documental character. It revealed that, in 99 processes, families resort to Justice to get compulsory confinement for their children. Adolescent hospitalizations by a judicial decision, are done in private clinics, paid by the county, while adults are hospitalized through the Brazilian National Health System network. There is no transfer of state or federal resources for these expenses. Due to the lack of public policies it becomes necessary to strengthen the Psychosocial Care Centers to foster sustainability and social equilibrium.(AU)

Percepções acerca da responsabilidade civil do psiquiatra por erro de diagnóstico na internação compulsória / Insights about civil liability of psychiatrists for misdiagnosis in involuntary commitment

O presente artigo tem como objetivo fazer uma abordagem sobre responsabilidade civil do psiquiatra por erro de diagnóstico na internação compulsória. Ainda que o internamento compulsório seja determinado por ordem judicial, não se deve desconsiderar que o mesmo exige laudo médico devidamente motivado. O diagnóstico que serve de base para a decisão judicial deve ser sério e minucioso, a fim de que possa ser não somente o indicador do transtorno mental que acomete o indivíduo, mas também para que possa apontar o tratamento mais adequado, principalmente se houver indicação de internação.(AU)

This article aims at addressing civil liability of psychiatrists for misdiagnosis in involuntary commitment. Even when hospitalization is determined by court order, one cannot disregard the fact that it requires proper justification through medical reporting. The diagnosis that is the basis for court decision must be serious and thorough, so that it can be not only the indicator of mental disorders affecting the patient, but also point at the most appropriate treatment, especially when hospitalization is recommended.(AU)

O psicodiagnóstico no trabalho em equipe multiprofissional em unidade de internação psiquiátrica de crianças e adolescentes em hospital geral / Psychological assessment: its role in the multidisciplinary team in a Children's and Adolescents' Psychiatric Unit of a general hospital

O psicodiagnóstico, ferramenta de uso exclusivo do psicólogo, possibilita o acesso a características emocionais e aspectos cognitivos do paciente de forma relativamente breve e consistente. Mostra-se um recurso importante para auxílio diagnóstico e planejamento terapêutico no hospital geral. Diante disso, realizou-se um levantamento de psicodiagnósticos executados pelo Serviço de Psicologia no ano de 2015, solicitados pela equipe da Psiquiatria da Infância e Adolescência de um hospital geral universitário, a fim de descrever a demanda da psicologia frente à equipe multiprofissional e suscitar questões sobre esse processo. Os resultados apontam para heterogeneidade de transtornos específicos e escassez de instrumentos de avaliação de personalidade validados para essa população. Conclui-se sobre a importância do psicodiagnóstico para auxílio na elaboração do Plano de Tratamento Singular e para acompanhamento sistemático de doenças que tendem a ser crônicas.

Through psychological assessment, psychologists are able to evaluate emotional and cognitive features in a relative small amount of time. It is a valuable tool to help multidisciplinary assistant team in formulating a diagnosis and planning treatment. This article reveals the demand of the Psychology Service of a university general hospital considering the needs of the Children and Adolescents Psychiatric Unit. The results show a variety of diagnosis and the shortage of psychological tools and tests for this specific age. The conclusion highlights the importance of the psychological assessment as a tool for writing the Individualized Treatment Plan as well as to keep track of illnesses that tend to be chronic.