Outcome of Voluntary vs Involuntary Admissions in Greece over 2 years after Discharge: A Cohort Study in the Psychiatric Hospital of Attica "Dafni".

The increasing rates of involuntary hospitalization constitute a major ethical issue in psychiatric practice. The present cohort study endeavours to investigate the relationship between patients' legal status (involuntary vs voluntary) and the outcome of their hospitalization, over 2 years after discharge. All individuals admitted in the 3rd Psychiatric Department of the Psychiatric Hospital of Attica during February 2015-February 2017 took part in the study. 64.7% of patients were compulsory admitted. Findings indicate a statistically significant improvement in global functioning and symptomatology levels from admission to discharge for all treated patients, independently of their legal status. However, readmission rates over 2 years after discharge were high (34.8% vs. 21.9% in voluntary and involuntary patients, respectively). In conclusion, psychiatric admission, irrespectively of legal status leads to clinical improvement.

Increased use of coercive procedures and prolonged hospitalization in compulsory admitted psychotic patients, who refuse antipsychotic medication.

Objective: Current Danish legislation imposes that compulsory admitted psychotic patients have the right to refuse antipsychotic medication, which markedly delays pertinent medical treatment.Material and methods: In a retrospective, observational cohort study, we analyzed data from a 1-year period on 34 consecutively admitted patients with schizophrenia, who had been compulsory admitted due to need of treatment, or because they were judged to constitute an acute danger to themselves or others. We compared the use of other coercive procedures and hospitalization time.Results: Twenty-three patients accepted to commence antipsychotic treatment immediately, and 11 patients submitted an official complaint, which significantly delayed initiation of antipsychotic treatment (1 day ±0.9 versus 14 days ±10.1, p = 0.002). The 11 complaining patients were subjected to 6.8 times more coercive procedures of forced sedative medication compared to the 23 patients without delay (2.7 ± 2.3 episodes versus 0.4 ± 0.7 episodes, p = 0.007). Moreover, the treatment-delay prolonged duration of hospitalization by a factor 2.3 (73.3 ± 28.3 days versus 31.7 ± 22.0 days, p < 0.001).Conclusion: The current legislation intends to preserve patient rights and promote voluntary treatment alliance but may instead lead to prolonged hospitalization and increased use of other coercive measures such as forced sedative medication. Modification of current legislation may therefore be considered.

[On the issue of standards of organization of hospital psychiatric care].

In the conditions of reforming psychiatric service in the Russian Federation, the procedure of organizing psychiatric care of patients in hospital, the effectiveness of treatment of patients in psychiatric hospital during 2015-2017 were analyzed. The article presents the results of study of organization of psychiatric care of patients in specialized hospital on the basis of Psychiatric clinical hospital № 13. The analysis covered number of patients treated in hospital by nosological forms; number of patients by gender. The age categories of mental patients and the format of professional status of patients were considered. The main indicators of psychiatric hospital activity were investigated: average duration of stay of patient in hospital, annual bed using, bed turnover, number of bed days. The attention was paid to primary output of patients with disabilities, number of re-hospitalizations and compulsory hospitalization. The analysis of financing of inpatient psychiatric care of treated patients for the study period of time was implemented. The vector of providing psychiatric care to patients at the stage of out-patient and hospital-replacing cases.

Profiles of the Patient Who Had Compulsory Hospitalization in a District Psychiatric Hospital.

OBJECTIVE: It aims to examine the profiles of patients who were treated with compulsory hospitalization between 2011 and 2015 in a district psychiatric hospital. METHOD: In this retrospective and cohort study, hospital records gathered from 202 adult patients who were treated with compulsory hospitalization in units with a bed between 2011 and 2015 in a district psychiatric hospital were examined. In this study, profiles and socio-demographic features of the patients with compulsory hospitalization were evaluated by 23 closed-end and open-ended questions prepared by researchers. In data analysis, Monte Carlo Chi-square test and number-percentage distribution were used. FINDINGS: 57.4% of examined cases was female and mean average was 38.88±13.06. Of examined cases, 18.8% was people graduated from high school or university and it was detected that 81.7% didn't have any regular job during the compulsory hospitalization. Of which 55.9% has not gotten married and 12.4% was divorced, 48.0% of the population has been living with their parents, sibling or/and their relatives and 17.8% has been living alone or in the nursing home. Of which 59.9% of the cases which were diagnosed with psychosis, 38.1% with psychotic relapse, 22.8% with medication regulation, 22.8% with excitation (expansiveness) and 15.8% having the risk of self-mutilation and damage his/her environment were admitted to compulsory hospitalization. Of these cases, the relative or custodian of 74.2%, employee of nursing home of 9.4%, law-enforcement officers of 5.4% and medical staff of 4.0% gave hospitalization approval. While not having any history for alcohol-substance abuse, it was established that 10.9% of the population had a problematic juridical records. Of the cases, hospitalization of 75.7% came to end with recovery/discharge and 20.3% was over with the demand of his/her relative/custodian, 1.5% of the cases escaped from the hospital. CONCLUSION: Patients whose majority was female, person who has never gotten married or was divorced and has low educational level don't have any regular job and live with their relatives. In addition, their relatives made the majority of these patients admit to hospital because of the history of psychotic diagnose and psychotic relapses. According to these results, it is recommended that patients will receive an effective treatment in order to protect the right to decide their own treatment.

Does Assertive Community Treatment Reduce the Use of Compulsory Admissions?

BACKGROUND: The growing number of compulsory admissions in Denmark and other countries is a compelling challenge. We hypothesized that Assertive Community Treatment (ACT) may have the quality to reduce the use of several type of coercion including compulsory admissions. Although ACT is not designed for coercion prevention, it may prove efficient in averting major crisis among the included patients. Studies in Denmark showed that ACT has a major and significant advantage in reducing number and length of admissions. METHODS/DESIGN: We collected service data from National Case Register at three psychiatric hospitals, which constitutes the inpatient and outpatient mental health services in the North Denmark Region. Data included psychiatric and somatic service use among 240 patients starting in ACT. Primary measure concerned the extent to which ACT might reduce compulsory admissions. RESULTS: During a five years period patients allocated to ACT show decreasing admission trends. In comparison with all other psychiatric service users, we found a significant difference in trends concerning voluntary admissions and involuntary admissions according to the dangerous criterion, and decrease in number of contacts to Psychiatric Emergency Room (PER) CONCLUSION: An assertive approach undoubtedly reduces hospitalization including some involuntary admissions. ACT is preferable from both team and patient perspectives, and further caused reduction of PER visits compared to standard treatment. PERSPECTIVES: The criterion of Severe Mental Illness (SMI) may be revised to facilitate ACT to be offered to a larger group of SMI patients. In addition, introduction of Crisis Intervention Teams should be considered and allocated to PER.

The Chinese Mandarin Version of the Crisis Triage Rating Scale for Taiwanese with Mental Illness to Compulsory Hospitalization.

BACKGROUND: A controversial issue of the need to protect human rights and ensure public safety still remains a conflict in Taiwan. The purpose of this study was to translate the Crisis Triage Rating Scale to Chinese Mandarin (CMCTRS). METHOD: A cross-sectional design with convenient sampling was employed in this study. The CMCTRS was tested on 302 Taiwanese individuals with mental illness who were admitted to the emergency room (ER) of a psychiatric center. A higher score indicated a greater need for mandatory psychiatric admission. Psychiatrists rated the patients' status according to three scale criteria and six action plans of recommendations. RESULTS: Five specialists evaluated the content validity index to be 0.8. A total of 210 participants (69.5%) were deemed suitable for compulsory hospitalization or admission for observation in ER. The optimal cut-off score was 8, with a Youden Index of 1.46, a sensitivity of 0.748, and a specificity of 0.712 in deciding the need for hospitalization or observation. CONCLUSIONS: The CMCTRS exhibited an acceptable criterion validity with psychiatrists in a population of 302 patients at the ER of a psychiatric center. A cut-off point of 8 is recommended for determining hospitalization or a minimum 24 h stay at emergency for observation.

Japanese local government management of compulsory hospitalization for patients with mental disorders and comorbid COVID-19.

Administering medical treatment or managing quarantine for a patient is particularly difficult when a patient harming others or causing self-harm because of severe depression, a manic state, or psychomotor agitation is also infected with COVID-19. Kanazawa University Hospital is the only facility able to manage such difficult cases occurring in Ishikawa prefecture, a local administrative area in Japan. The hospital has arranged a negative pressure apparatus in a psychiatric ward with two protection rooms. This report describes an urgently established but viable system in one prefecture of Japan for treating COVID-19-infected patients with severe psychiatric symptoms during the COVID-19 pandemic.

Legal Issues in Quarantine and Isolation for Control of Emerging Infectious Diseases.

The Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea in 2015 has drawn public attention regarding the legal regulation of infectious disease control in Korea. This paper discusses the interpretive and legislative concerns regarding the Infectious Disease Prevention and Control Act, its ordinance and enforcement regulations, as well as public statements from the relevant administrative agency. Future improvements are also proposed.

Preventing Compulsory Admission to Psychiatric Inpatient Care: Perceived Coercion, Empowerment, and Self-Reported Mental Health Functioning after 12 Months of Preventive Monitoring.

OBJECTIVE: To evaluate the effects of a preventive monitoring program targeted to reduce compulsory rehospitalization and perceived coercion in patients with severe mental disorder. We analyze patient outcomes in terms of perceived coercion, empowerment, and self-reported mental health functioning at 12 months. METHODS: The program consists of individualized psychoeducation, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 psychiatric inpatients who had had compulsory admission(s) during the past 24 months were included in the trial. T1-assessment 12 months after baseline was achieved for 182 patients. RESULTS: Study participants reported lower levels of perceived coercion, negative pressures, and process exclusion, a higher level of optimism, and a lesser degree of distress due to symptoms, interpersonal relations, and social role functioning (significant time effects). However, improvements were not confined to the intervention group, but seen also in the treatment-as-usual group (no significant group or interaction effects). Altered perceptions were linked to older age, shorter illness duration, female sex, non-psychotic disorder, and compulsory hospitalization not due to risk of harm to others. CONCLUSION: Our findings suggest that changes in the subjective perspective were fueled primarily by participation in this study rather than by having received the specific intervention. The study contributes to a better understanding of the interaction between "objective" measures (compulsory readmissions) and patients' perceptions and highlights the need for treatment approaches promoting empowerment in individuals with a history of involuntary psychiatric hospitalizations.

O manejo da internação psiquiátrica compulsória por profissionais de saúde em seu cotidiano / La gestión de la hospitalización psiquiátrica obligatoria por profesionales de salud en su curso diario / The management of compulsory psychiatric hospitalization by health professionals in their daily practice

Resumo As internações psiquiátricas compulsórias (IPC) têm sido amplamente discutidas, ressaltando tensões entre seu aumento expressivo e o que preconiza a reforma psiquiátrica. O objetivo deste artigo é compreender os sentidos produzidos com equipes de saúde mental sobre IPC e seus desafios cotidianos. Para tanto, criamos seis grupos focais com profissionais de um hospital psiquiátrico. Os encontros foram audiogravados e as transcrições analisadas qualitativamente, com destaque aos sentidos construídos sobre IPC e seus desafios no cotidiano. Nossa análise aponta que, embora os profissionais façam uso dos mesmos recursos terapêuticos, a IPC se diferencia no cotidiano pela forma como é feita a admissão, que implica em baixa adesão e prorrogação da internação pela interferência do judiciário. Concluímos que o uso de IPC, para sanar questões sociais, persiste, e que o diálogo entre a justiça e a saúde é fundamental para recuperação dos princípios éticos e humanos que orientam a reforma psiquiátrica.

Resumen Las hospitalizaciones psiquiátricas obligatorias (IPC) han sido ampliamente discutidas, destacando las tensiones entre su aumento significativo y lo que aboga la reforma psiquiátrica. El objetivo de este artículo es comprender los significados que se producen con los equipos de salud mental sobre el IPC y sus desafíos diarios. Para ello, creamos seis grupos focales con profesionales de un hospital psiquiátrico. Los encuentros fueron registrados en audio y las transcripciones analizadas cualitativamente, con énfasis en los significados construidos sobre el IPC y sus desafíos en la vida diaria. Nuestro análisis muestra que, aunque los profesionales hacen uso de los mismos recursos terapéuticos, el IPC se diferencia en la vida diaria por la forma en que se realiza el ingreso, lo que implica una baja adherencia y extensión de la hospitalización por la interferencia del poder judicial. Concluimos que el uso de los IPC, para solucionar problemas sociales persiste, y que el diálogo entre justicia y salud es fundamental para recuperar los principios éticos y humanos que orientan la reforma psiquiátrica.

Abstract Compulsory psychiatric hospitalizations (CPH) have been widely discussed, highlighting tensions between their expressive increase and what the psychiatric reform advocates. This article aims to understand the meanings that are produced with mental health teams about CPH and its daily challenges. For this matter, we performed six focus groups with professionals from a psychiatric hospital. The meetings were audiotaped and the transcripts were qualitatively analyzed, highlighting the meanings constructed about CPH and its daily challenges. Our analysis shows that, although the professionals use the same therapeutic resources, the CPH differs in daily life by the way in which admission is made, which implies a low adherence and prolongation of hospitalization due to the judiciary system's interference. We conclude that the use of CPH to resolve social issues persists and that the dialogue between the justice and health is fundamental in order to recover the ethical and human principles that guide the psychiatric reform.

O olhar da Medusa: reflexões sobre crack e internação compulsória / The gaze of Medusa: thoughts on crack and compulsory hospitalization / La mirada de la Medusa: reflexiones sobre crack e internación obligatoria

Este ensaio trata de uma discussão teórico-crítica sobre o dispositivo de internação compulsória, especificamente nos casos relacionados ao uso de crack. A construção teórica partirá de algumas reflexões sobre o olhar do outro como parte integrante desse fenômeno, através de uma analogia com o mito da Medusa. A análise terá como base a perspectiva existencialista de Jean-Paul Sartre, trazendo para a discussão o contexto neoliberalista, liberdade, campo dos possíveis, má-fé, estigma e o ser-para-outro. Dessa discussão, emerge o questionamento da internação compulsória como medida de tratamento para pessoas que fazem uso de crack. Essas pessoas, sob o olhar do outro, já têm suas possibilidades barradas em função do uso da substância, sendo que a imposição desse tratamento culmina em seu assujeitamento e objetificação

This essay is about a theoretical-critical discussion about the compulsory hospitalization device, specifically in cases related to the use of crack. The theoretical development will start from some thoughts about the gaze of the other as an integrating part of this phenomena, through the analogy with the Medusa myth. The analysis will have as a basis the existentialist perspective of Jean-Paul Sartre, bringing to the discussion the neoliberalist context, freedom, possible fields, bad faith, stigma and being-for-others. From this discussion, the debate of compulsory hospitalization as an action of treatment for people who use crack emerges. These people, under the gaze of the other, already have their opportunities restrained as a result of the use of the substance, since the imposition of this treatment culminates in their antipersonification and objectification

Este ensayo trata de una discusión teórico-crítica sobre el dispositivo de internación obligatoria, específicamente en los casos relacionados con el uso de crack. La construcción teórica partirá de algunas reflexiones sobre la mirada del otro como parte integrante de ese fenómeno, a través de una analogía con el mito de la Medusa. El análisis tendrá como base la perspectiva existencialista de Jean-Paul Sartre, trayendo para la discusión el contexto neoliberalista, libertad, campo de los posibles, mala fe, estigma y el ser-para-otro. De esta discusión, emerge el cuestionamiento de la internación obligatoria como medida de tratamiento para personas que hacen uso de crack. Esas personas, bajo la mirada del otro, ya tienen sus posibilidades barradas en función del uso de la sustancia, siendo que la imposición de ese tratamiento culmina en su sometimiento y objetivación.

Internação compulsória de pessoas em uso de drogas e a Contrarreforma Psiquiátrica Brasileira / Compulsory Hospitalization of people in drug use and the Brazilian Psychiatric Counter-Reformation

Resumo Este artigo desenvolve uma reflexão crítica ao atual movimento ligado às iniciativas de Internação Compulsória (IC) como abordagem e proposta de tratamento às pessoas em uso de drogas, em um contexto de novos desafios que se apresentam à continuidade da Reforma Psiquiátrica Brasileira (RP). Analisamos o dispositivo da IC enquanto produtor de regimes de visibilidade, percebendo que a sua prática e legitimação com a população usuária de crack estão associadas a elementos de atualização de movimentos históricos presentes desde o século XIX, conforme apresentado por Foucault, movimentos esses de articulação entre os poderes jurídico e médico, produzindo práticas que se legitimam através da apropriação dessa população como o novo sujeito Anormal sobre o qual se pretende intervir. Essa manobra abre também brechas para utilização de mecanismos referentes à IC presentes na lei da RP desvinculados de outros termos, principalmente os que buscam preservar e sustentar os direitos das pessoas que são assistidas pelas políticas de saúde mental, contrariando os aspectos progressistas contidos em sua origem. Consideramos as iniciativas de intensificação dos processos de IC expressões de ação do biopoder, com relevância na produção de políticas e de subjetividades contemporâneas de resistência à continuidade e ampliação da Reforma Psiquiátrica Brasileira.

Abstract This article develops a critical reflection to the current motion linked to the Compulsory Hospitalization (CH) initiatives, as an approach and treatment proposal for the people in drugs use, in a context of the new challenges that arise facing the continuity of the Brazilian Psychiatric Reform (BPR). We analyzed the CH device while visibility regimen producer, perceiving that its practice and legitimation along the cocaine crack user population is associated to elements of historical motions updating, present since XIX century, as presented by Foucault. These motions of articulation among the medical and legal powers produce practices that legitimate itself, by the appropriation of this population as the new Abnormal subject over whom it is intended to intervene. This maneuver also opens breaches for the utilization of mechanisms referring to the CH present in the BPR law non linked to the other terms, mainly those which are targeting to preserve and sustain the people's rights who are covered and assisted by the Mental Health politics, and uphold the rights of people who are assisted by mental health policies, counteracting the progressive aspects belonging to its origin. We consider the initiatives of CH processes intensification, action expressions of the biopower, with relevance in the production of politics and contemporary subjectivities of resistance against the continuation and expansion of the Brazilian Psychiatric Reform (BPR).

A internação compulsória como estratégia de governamentalização de adolescentes usuários de drogas / The compulsory hospitalization as a governmentalization strategy for the adolescent drug users / El internamiento como estrategia de gobernamentalización de adolescentes consumidores de drogas

Resumo Este artigo tem como objetivo problematizar a internação compulsória de adolescentes usuários de drogas em um serviço de saúde mental de Porto Alegre/RS a partir da noção de Biopolítica, proposta por Michel Foucault. Assim, primeiramente, descrevemos o processo de internação compulsória e os percursos dos jovens no serviço para depois avançarmos na análise da internação compulsória como uma estratégia de governamentalização da vida. Esta análise leva para a desnaturalização das ações contemporâneas do Estado direcionadas aos adolescentes usuários de drogas e aos atravessamentos dos interesses de mercado que operam no contexto dessa política. Por fim, apontamos a suspensão dos elementos universais que permeiam a temática das drogas como possibilidade de ruptura dos padrões de cuidado até então colocados no campo da saúde.

Abstract This article aims to discuss the compulsory hospitalization of adolescent drug users in a mental health service in the city of Porto Alegre/RS from the notion of Bio-politics, proposed by Michel Foucault. So, first, we describe the process of compulsory hospitalization and the passages of young people in the service, and thus we move to the analysis of compulsory hospitalization as a strategy of governmentalization of life. This analysis leads to the denaturalization of contemporary state actions directed to adolescent's drug users and the crossings market interests operating in the context of this policy. Finally, we point to the suspension of the universal elements that permeate the theme of drugs as a possibility to break off the standards of care placed in the health field.

Resumen Ese artículo tiene como objetivo problematizar el internamiento forzado de adolescentes consumidores de drogas en un servicio de salud mental de Porto Alegre/RS a partir de la noción de la Biopolítica, propuesta por Michel Foucault. Así, primero, describimos el proceso de internamiento forzado y el camino de los jóvenes en el servicio investigado como un fenómeno inherente al campo de la problemática de las racionalidades del gobierno de las conductas. Análisis que desnaturaliza las acciones de hoy día del Estado dirigidas a los adolescentes consumidores de drogas al discutir los intereses del mercado que operan en el contexto de esa política. Por último, apuntamos la suspensión de los elementos universales que permean la temática como posibilidad de rotura de los patrones de cuidado hasta el momento colocados en el campo.

Vivências de profissionais de saúde em um manicômio judiciário e a visão sobre os pacientes / Health professionals experiences in a judicial asylum and their view about the patients / Experiencias de profesionales de la salud en un manicomio judicial y la visión sobre los pacientes

Objetivo: compreender as vivências de profissionais de saúde do Hospital de Custódia e Tratamento Jorge Vaz (HCTJV) e a visão destes sobre os pacientes. Método: estudo exploratório e descritivo com abordagem qualitativa, fundamentado pelo método dialético, com profissionais de saúde que trabalham no manicômio judiciário. Os dados foram produzidos por meio de entrevistas e submetidos à técnica de Análise de conteúdo. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, Protocolo nº 65593. Resultados: os profissionais de saúde vivenciam o trabalho sob a lógica do tratamento e da segregação das pessoas, ora pacientes psiquiátricos ora criminosos, refletindo a dubiedade da instituição. A percepção dos trabalhadores da saúde sobre os pacientes evidenciou três caracterizações: pacientes com transtornos mentais, criminosos e portadores de capacidade e incapacidade. Conclusão: os profissionais associam a caracterização dos pacientes à sua condição social. A loucura associada ao crime e ao perigo é reproduzida como estigma, refletindo na forma como é dispensado o cuidado em saúde.(AU)

Objective: to understand the experiences of healthcare professionals in Custody and Treatment Hospital Jorge Vaz (HCTJV) and their view about the patients. Method: exploratory and descriptive study with a qualitative approach, based on the dialectical method, with health professionals working in the judicial asylum. Data were produced through interviews and submitted to the technique of content analysis. The research project was approved by the Research Ethics Committee, Protocol Number 65593. Results: health professionals experience working under the logic of treatment and segregation of people, psychiatric or criminal patients, reflecting the ambiguity of the institution. The perception of health workers about patients showed three characterizations: patients with mental disorders, criminals and people with ability and disability. Conclusion: the professionals associate characterization of patients to their social condition. The madness associated with crime and danger is reproduced as stigma, reflecting the way how health care is dispensed.(AU)

Objetivo: comprender las experiencias de profesionales de salud del Hospital de Custodia y Tratamiento Jorge Vaz (HCTJV) y la visión de estos sobre los pacientes. Método: estudio exploratorio y descriptivo con enfoque cualitativo, fundamentado por el método dialéctico, con profesionales de salud que trabajan en el manicomio judicial. Los datos fueron producidos por medio de entrevistas, sometidos a la técnica de Análisis de contenido. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, Protocolo nº 65593. Resultados: los profesionales de salud viven el trabajo sobre la lógica del tratamiento y de la segregación de las personas, tanto pacientes psiquiátricos como criminosos, reflejando la ambigüedad de la institución. La percepción de los trabajadores de la salud sobre los pacientes mostró tres caracterizaciones: pacientes con trastornos mentales, criminosos y portadores de capacidad e incapacidad. Conclusión: los profesionales asocian la caracterización de los pacientes a su condición social. La locura asociada al crimen y al peligro es reproducida como estigma, reflejando en la forma como es dispensado el cuidado en salud.(AU)

Representações midiáticas da internação compulsória de usuários de drogas / Media representations of compulsory hospitalization of drug users / Representaciones de los medios de la hospitalización obligatoria de los consumidores de drogas

O presente artigo teve intuito de refletir sobre a expansão da proposta da internação compulsória como estratégia de tratamento aos usuários de drogas, em que se percebeu a importância que os meios de comunicação apresentam ao explicitar e fomentar algumas propostas. Para isso, foi realizada a análise do discurso acerca do tema internação compulsória de usuários de drogas produzidos pelo jornal Zero Hora, destacando alguns discursos que possibilitam a expressão dessa prática e de seus enlaces. O artigo tem como perspectiva de análise a Psicologia Social Crítica e a Hermenêutica de Profundidade que discorreu acerca das influencias ideológicas, da comunicação de massa, dos poderes envolvidos e da relação de dominação que se apresenta. Enquanto escolha do material para análise, foram utilizadas as reportagens do jornal, com disponibilidade online, referentes ao ano de 2013. Conclui-se que os discursos e a expansão do tema pela mídia possibilitaram compreender a relação que a história da loucura apresenta com os discursos acerca dos usuários de crack, em que há uma repetição do olhar e formas diferentes de estigmatizar esse novo protagonista.

The present article aims to reflect about the expansion of compulsory hospitalization and treatment strategies for drug users, to which was noticed the importance that media presents to explicit and promote some of the proposals. For this purpose, a communication analysis was executed based on the compulsory hospitalization theme which was produced by "Zero Hora Newspaper", highlighting some of the discourse that grant the expression regarding this practice and their enlaces. This article is based on a Critic Social Psychology and Depth Hermeneutics, discoursing about the ideological influences, the power involved and the power relation sit presents. Newspapers reports published during the year of 2013 with online availability were used for these analyses. This article concludes that the materials and theme expansions provided from the media allows the understanding regarding the relationship between the history of madness presented with the discourse concerning crack cocaine users, showing a repetition relating the attention that it is given, however with only the leading role changed, spanning different forms of stigmatizing the drug users place in society.

El objetivo de este artículo es reflexionar sobre la propuesta de hospitalización preceptiva para consumidores de drogas, en el que se realizado acerca de la importancia que los medios tienen al promover algunas propuestas de la hospitalización preceptiva. Para ello, se realizó el análisis de lo discurso sobre el tema de la hospitalización preceptiva de los consumidores de drogas producidos por el periódico Zero Hora, destacando algunos discursos que permiten la expresión de esta práctica y sus enlaces. El artículo se basa en la Psicología Social Crítica y la Hermenéutica Profundidad, disertando de la influencia ideológica de los medios de comunicación, los poderes implicados y la relación de dominación que se presenta. Si bien la elección del material para el análisis, se utilizaron los informes de prensa, con la disponibilidad en línea para el año 2013. Llegamos a la conclusión de que los discursos y la ampliación del tema por los medios de comunicación han permitido la comprensión de la relación que presenta la historia de la locura con discursos acerca de los consumidores decrack, en los que hay una repetición de la expresión dada, pero sólo con el cambio de los protagonistas, y diferentes formas de estigmatizar el lugar del usuario de drogas.

O tratamento da dependência química e o ordenamento jurídico brasileiro / Treatment for chemical dependence and the brazilian legal system / Le traitement de la dépendance chimique et le système juridique brésilien / El tratamiento de la dependencia química y el sistema jurídico brasileño

Este artigo procura relembrar a trajetória de exclusão provocada pelos tratamentos de dependência química no Brasil e apresenta as formas atuais de tratamentos que objetivam a reinserção social do usuário. Ademais, demonstra que o não cumprimento da política pública sobre o assunto, crenças irreais da população sobre uma forma milagrosa de cura e desconhecimento sobre a legislação e formas alternativas de tratamento, retomam, com novas roupagens, a segregação das pessoas que sofrem com a dependência química, permitindo internações desnecessárias, por ordem judicial e sem o devido processo legal.

This article seeks to re-discuss the process of exclusion caused by drug addiction treatments in Brazil and describes current forms of treatment that focus on the social integration of users. Furthermore, the authors show that failure to comply with public policies in the area, unrealistic beliefs of the population in miraculous cures and their unfamiliarity with alternative forms of treatment and the legislation, are repeating, in new garb, the age-old segregation of persons suffering from such dependence. Among other realities are frequent and unnecessary hospitalization, sometimes by court order and without due process of law.

Cet article vise à rappeler le cheminement vers l'exclusion provoquée par les types de traitement des toxicomanes au Brésil et présente les traitements actuels qui ont comme but l'intégration sociale de l'utilisateur. En outre, il démontre que la non-conformité avec les réglementations, les croyances irréalistes de la population sur une façon miraculeuse de guérison, la méconnaissance des lois et d'autres formes de traitement, reprennent, sous autre forme, la ségrégation des toxicomanes. Ces phénomènes finissent par légitimer des hospitalisations inutiles par ordonnance du tribunal et sans actions judiciaire correcte.

Este artículo busca recordar la trayectoria de exclusión causada por los tratamientos de dependencia química en Brasil y presenta las formas actuales de tratamientos que tienen como objetivo la reinserción social del usuario. Además, demuestra que el incumplimiento de la legislación sobre el tema, creencias irreales de la población en una forma milagrosa de cura y desconocimiento sobre la legislación y las formas alternativas de tratamiento, retoman con una nueva apariencia, la segregación de las personas que sufren de dependencia química, permitiendo internaciones desnecesarias, por orden judicial y sin el debido proceso jurídico.

Sobre jovens drogaditos: as histórias de ninguém / Acerca de jóvenes drogadictos: las historias de nadie / About young drug users: the stories of no one

O presente estudo parte do crescente processo de judicialização do cuidado em saúde mental de jovens usuários de drogas e tem por objetivo problematizar a forma como, na relação entre os campos da Saúde Mental e da Justiça, vai se desenvolvendo uma biopolítica voltada para o governo da população de "adolescentes drogaditos". Para tanto, realizamos a análise de processos judiciais de internação compulsória de jovens por uso de drogas. Fundamentamo-nos nas ferramentas teóricas e metodológicas da Psicologia Social, dentro de uma perspectiva pós-estruturalista, especialmente no que se refere ao pensamento de Michel Foucault, na forma como o autor desenvolveu uma análise dos discursos e da emergência dos saberes na sua articulação com mecanismos e tecnologias de poder. A partir dessa perspectiva, evidenciamos a forma como essa biopolítica, embora aja em nome da garantia de direitos, opera produzindo vulnerabilidades.

El presente estudio parte del creciente proceso de judicialización del cuidado en salud mental de jóvenes usuarios de drogas y tiene por objeto problematizar la forma como, en la relación entre los campos de la Salud Mental y la Justicia, se va desarrollando una biopolítica orientada al gobierno de la población de "adolescentes drogadictos". Se ha llevado a cabo el análisis de procesos judiciales de internamiento forzoso de jóvenes por uso de drogas. El estudio está fundamentado en las herramientas teóricas y metodológicas de la Psicología Social, dentro de una perspectiva postestructuralista, especialmente en lo que atañe al pensamiento de Michel Foucault y la forma como desarrolló el análisis de los discursos y la emergencia de los saberes en su articulación con mecanismos y tecnologías de poder. A partir de éstos, se evidencia cómo dicha biopolítica, aunque actúe a nombre de la garantía de los derechos, opera produciendo vulnerabilidad.

The present study addresses the increasing process of judicialization of mental health care of young drug users, and aims at problematizing the way in which a biopolitics directed towards the government of the population of 'addicted teenagers' has been developed in the relationship between the fields of Mental Health and Justice. The development of this research is based on the analysis of lawsuits of adolescents that had been ordered the protective measure of psychiatric hospitalization for treatment for drug addiction. We have based our study on the theoretical and methodological tools of Social Psychology, especially with regard to the work of Michel Foucault, in the way that this author developed an analysis of both discourses and the emergence of knowledges in their articulation with power mechanisms and technologies. By analyzing these documents, we have attempted to identify that this biopolitics, in spite of guaranteeing rights, operates by producing vulnerabilities.

Internamentos não voluntários civis por razão de transtorno psíquico na Catalunha: uma análise das decisões judiciais à luz da bioética / Civil non-voluntary hospitalizations by reason of mental disorders at Catalonia: an analysis of judicial decisions in light of bioethics

O internamento não voluntário por razão de transtorno psíquico é uma providência de caráter terapêutico que deveria assegurar tanto o direito do enfermo, de ser tratado dignamente, quanto a segurança dos demais indivíduos que o direito deve proteger. Entretanto, alguns investigadores têm chamado a atenção para a ocorrência de internamentos não completamente fundamentados em necessidades terapêuticas. Assim, este estudo teve como objeto a investigação da jurisprudência das Audiências Provinciais da Comunidade Autônoma da Catalunha, Espanha, sobre os pedidos de internamento não voluntário de pessoas portadoras de transtornos psíquicos. Os objetivos da pesquisa consistiram em descrever as variáveis apresentadas nas resoluções judiciais de 2ª Instância relacionadas aos internamentos não voluntários por razão de transtorno psíquico e analisar o posicionamento dos juízes à luz dos princípios bioéticos. Empregaram-se como método a estatística descritiva e a categorização por ideias centrais, de acordo com o Discurso do Sujeito Coletivo. Os juízes de 2ª Instância da Catalunha vêm se deparando com recursos impetrados por pessoas que pleiteiam o internamento de seus familiares próximos, alegando a internação como medida de proteção da própria pessoa que, na grande maioria dos casos, é diagnosticada como esquizofrênica. Foram identificadas 15 ideias centrais nas decisões judiciais, analisadas de acordo com os princípios da bioética principialista. O princípio da beneficência parece suplantar todos os outros nas decisões judiciais. Concluiu-se que não só o Poder Judiciário, mas também a sociedade, a medicina e o Estado têm papéis relevantes a serem desempenhados na abordagem dessa questão.

Non voluntary hospitalizations due to mental disorders are a therapeutic measure that should ensure either the right of the patient to be treated with dignity, as well as the safety of the other individuals who have the right to be protected. However, some researchers have called attention to the occurrence of hospitalizations not completely based on therapeutic needs. Thus, this study had as its investigation object the jurisprudence of the Catalonia/Spain Independent Community Court on the demands of non voluntary hospitalization of people with mental disorders. This research aimed to describe the variables presented in the resolutions of second instance Courts related to non voluntary hospitalizations due to mental disorders and to analyze the judges' position in the light of bioethical principles. Descriptive statistics and categorization of central ideas were employed as the analysis method, according to the Collective Subject Speech. The judges of Catalonia are facing the demand of people aiming at hospitalizing their family members claiming that hospitalization is a protection measure to the patient, whom, in most cases, is diagnosed with schizophrenia. Fifteen central ideas were identified on judicial decisions, analyzed according to the bioethical principles of principlism. The principle of beneficence seems to outshine all the others in judicial decisions. Authors concluded that not only the Justice System, but the society, medicine and the State play important roles in the approach to this issue.

Crack e internação compulsória no Brasil: intervenção do estado na autonomia dos usuários / Crack Cocaine and involuntary hospitalization in Brazil: state intervention in users' autonomy

RESUMO Uma reflexão a respeito da internação compulsória de usuários adultos de crack, à luz da abordagem da bioética da proteção revela que a política de atenção aos usuários de crack deve ter como escopo as políticas sociais, ao invés da centralidade dos recursos médicos, uma vez que grande parte das questões associadas ao consumo não se encontra nesse âmbito, mas entrelaçadas às questões sociais, educacionais e jurídicas. Desta maneira, acionar políticas emergenciais pautadas na internação involuntária provoca a retomada de modelos de intervenção amplamente criticados por profissionais da área da saúde, por pesquisadores da área de ciências humanas e sociais, perpetuando um retrocesso.

ABSTRACT A discussion about the compulsory hospitalization of crack cocaine adult users, under the light of protection bioethics approach shows that crack cocaine users' protection policy should be scoped to social policies, rather than the centrality of medical resources, since most of consumption associated issues is not in that context, but intertwined with social, educational and legal ones. Thus, trigger emergency policies guided by the involuntary hospitalization causes the resumption of intervention models widely criticized by health professionals, for researchers in humanities and social sciences, perpetuating a setback.

Reforma psiquiátrica nas medidas de segurança: a experiência goiana do Paili / Psychiatric reform of the security measures: the experience of Paili in Goiás

A Lei nº 10.216/2001 humaniza o atendimento à saúde mental, transferindo o foco do tratamento para serviços comunitários e abertos. A Lei da Reforma Psiquiátrica ou Lei Antimanicomial, como é conhecida, alcança a internação compulsória determinada pela justiça criminal como medida de segurança. Agora, deve o juiz preferir o tratamento ambulatorial, somente optando pela internação "quando os recursos extra-hospitalares se mostrarem insuficientes", caso em que será precedida de "laudo médico circunstanciado que caracterize os seus motivos". A figura da periculosidade perde força. A medida de segurança não tem natureza retributiva. A permanência do paciente em cadeia pública ou em manicômio judiciário configura crime de tortura (Lei nº 9.455/97). O Programa de Atenção Integral ao Louco Infrator contempla a execução das medidas de segurança de acordo com a Lei nº 10.216, acolhendo os seus pacientes nos serviços de saúde. Com autonomia, as equipes de saúde colocam em prática a melhor terapêutica, sem a necessidade de prévia deliberação judicial. O Programa leva a pessoa submetida à medida de segurança para o ambiente universal do Sistema Único de Saúde, o que favorece sobremaneira a inclusão à família e à sociedade, funcionando como experiência exitosa no resgate da dignidade dos pacientes submetidos à medida de segurança.