RESUMO
INTRODUCTION: Housing is one of the main supports needed to guarantee community life of people who had long-term psychiatric hospitalizations. In Argentina, housing support experiences have been developed for decades, although their systematization is scarce. The objective of this paper is to describe three housing support experiences developed in the province of Buenos Aires, Argentina, which have continuity over time for more than 20 years. MATERIALS AND METHODS: Document analysis and interviews with workers from the three experiences were carried out, as part of a broader project on community life and neighborhood relations of people discharged after long-term psychiatric hospitalizations. The material was analyzed qualitatively, using a time dimension and a structure and functioning one which included financing, technical resources, housing devices and support provided. RESULTS: Although the types of support provided are somehow similar between the three experiences, heterogeneity in structure and functioning is observed. DISCUSSION AND CONCLUSIONS: Despite the fact that the human rights framework proposes the provision of flexible and adequate support according to the needs of people, it is worth reflection on whether the reduced systematization of experiences such as those presented is due to the difficulties of the heterogeneity mentioned, or is due to a scarce evaluation culture that obstacles the learning from those experiences.
Assuntos
Hospitalização , Habitação , Argentina , HumanosRESUMO
INTRODUCTION: The impact of the COVID-19 pandemic on health workers has been studied on an international level. However, mental health workers, who are also called upon to address such ailments both in the general population as well as in the health personnel, have not been asked about their experiences. METHODS: Seventy mental health workers in five regions of Argentina were interviewed between May and June 2020 regarding the subjective impact of changes in their work due to the pandemic. The responses were analyzed quantitatively and qualitatively. RESULTS: The results indicate emotions and experiences associated with a negative impact, in connection to feelings of tiresome, uncertainty, fear, anguish and anxiety and, to a lesser extent, some positive impacts are also described. More than a third of participants mentioned mixed feelings (i.e., being surprised, ambivalent, alert and sensitive). CONCLUSIONS: The personnel who are supposed to support the rest of the health workers are affected and experience having been relegated one more time to other aspects within the health care system. Focusing on learnings, having management roles, counting on colleagues, and agreeing with macro policies could be protective factors against the difficulties associated with the changes in work that the pandemic has imposed.
Assuntos
COVID-19 , Serviços de Saúde Mental , Ansiedade , Argentina/epidemiologia , Pessoal de Saúde , Humanos , Pandemias , SARS-CoV-2RESUMO
PURPOSE: There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes. METHODS: This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models. RESULTS: A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio. CONCLUSION: Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.
Assuntos
Hospitais Psiquiátricos , Transtornos Mentais/terapia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Análise Multinível , Alta do Paciente , Inquéritos e QuestionáriosRESUMO
A psychiatric reform is underway in Latin America and the Caribbean. Specifically in Argentina, a model of community mental health is being built, and prolonged psychiatric hospitalizations are still taking place, especially in neuropsychiatric hospitals. Therefore, it is necessary to closely monitor the psychiatric reform. One of the possible ways to monitor the reform is by analyzing society's attitudes towards prolonged psychiatric hospitalization as a mean of mental health treatment. Thus, an analytical observational study was conducted at the Buenos Aires Province, Argentina, in 2021, to analyze the behavior of neighbors of people who had prolonged psychiatric hospitalizations and who received housing support. Questionnaires were applied to neighbors and non-neighbors, addressing the behaviors toward prolonged psychiatric hospitalization as a mean of treatment, social distance toward people who were hospitalized, as well as specific interviews with key informants from neighborhoods where people with severe mental health disorders and who receive housing support live. Based on the answers of neighbors and non-neighbors, no statistically significant differences were identified in behaviors toward prolonged psychiatric hospitalization as a mean of treatment, nor for social distance in relation to people who were hospitalized. Key informants conditioned their assessment of prolonged hospitalization and valued the role of support teams in making community life viable.
La reforma psiquiátrica se encuentra en proceso en la región de América Latina y el Caribe. Específicamente en Argentina, el modelo de salud mental comunitaria está en construcción, siendo aún observable la presencia de internaciones psiquiátricas prolongadas, principalmente en hospitales neuropsiquiátricos. Resulta así necesario monitorear la reforma psiquiátrica, siendo una de las vías para ello el análisis de las actitudes de la sociedad hacia la internación psiquiátrica prolongada como modalidad de atención en salud mental. Así, se realizó un estudio observacional analítico en la Provincia de Buenos Aires, Argentina, en el año 2021, en donde se analizaron las actitudes de vecinos de personas que tuvieron internaciones psiquiátricas prolongadas y que recibían apoyos a la vivienda. Se hicieron cuestionarios a vecinos y no vecinos, indagándose por las actitudes hacia la internación psiquiátrica prolongada como modalidad de tratamiento, así como la distancia social hacia personas que tuvieron internaciones psiquiátricas, y también entrevistas a profundidad con informantes clave de barrios en donde habitan personas con problemáticas severas de salud mental y que reciben apoyos a la vivienda. No se identificaron diferencias estadísticamente significativas en las actitudes en relación a la internación psiquiátrica prolongada como modalidad de tratamiento de vecinos y no vecinos, ni tampoco respecto a la distancia social hacia personas que tuvieron internaciones psiquiátricas. Los informantes clave condicionaron su valoración sobre la internación prolongada, y valoraron el rol de los equipos de apoyo para posibilitar la vida en comunidad.
Uma reforma psiquiátrica está em curso na América Latina e Caribe. Especificamente na Argentina, um modelo de saúde mental comunitária está sendo construído, ainda acontecendo internações psiquiátricas prolongadas, principalmente em hospitais neuropsiquiátricos. Faz-se necessário, portanto, o acompanhamento da reforma psiquiátrica. Uma das formas de fazê-lo é analisando as atitudes da sociedade frente à internação psiquiátrica prolongada como forma de tratamento da saúde mental. Assim, foi realizado um estudo observacional analítico na Província de Buenos Aires, Argentina, no ano de 2021, onde foram analisadas as atitudes de vizinhos de pessoas que tiveram internações psiquiátricas prolongadas e que receberam apoio habitacional. Foram aplicados questionários a vizinhos e não vizinhos, questionando as atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, bem como a distância social em relação às pessoas que foram internadas, e também entrevistas específicas com informantes-chave de bairros onde vivem pessoas com problemas graves de saúde mental e que recebem apoio habitacional. Com base nas respostas de vizinho e não vizinhos, não foram identificadas diferenças estatisticamente significantes nas atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, nem em relação à distância social em relação às pessoas que foram internadas. Os informantes-chave condicionaram sua avaliação da hospitalização prolongada e valorizaram o papel das equipes de apoio na viabilização da vida comunitária.
Assuntos
Transtornos Mentais , Saúde Mental , Humanos , Argentina , Brasil , Transtornos Mentais/terapia , HabitaçãoRESUMO
The mental health users' movement is a worldwide phenomenon that seeks to resist disempowerment and marginalisation of people living with mental illness. The Latin American Collective Health movement sees the mental health users' movement as an opportunity for power redistribution and for autonomous participation. The present paper aims to analyze the users' movement in Argentina from a Collective Health perspective, by tracing the history of users' movement in the Country. A heterogeneous research team used a qualitative approach to study mental health users' associations in Argentina. The local impact of the Convention on the Rights of Persons with Disabilities and the regulations of Argentina's National Mental Health Law are taken as fundamental milestones. A strong tradition of social activism in Argentina ensured that the mental health care reforms included users' involvement. However, the resulting growth of users' associations after 2006, mainly to promote their participation through institutional channels, has not been followed by a more radical power distribution. Associations dedicated to the self-advocacy include a combination of actors with different motives. Despite the need for users to form alliances with other actors to gain ground, professional power struggles and the historical disempowerment of 'patients' stand as obstacles for users' autonomous participation.
Assuntos
Participação da Comunidade , Direitos Humanos , Saúde Mental , Argentina , Humanos , América Latina , Política , Pesquisa QualitativaRESUMO
Resumen: La reforma psiquiátrica se encuentra en proceso en la región de América Latina y el Caribe. Específicamente en Argentina, el modelo de salud mental comunitaria está en construcción, siendo aún observable la presencia de internaciones psiquiátricas prolongadas, principalmente en hospitales neuropsiquiátricos. Resulta así necesario monitorear la reforma psiquiátrica, siendo una de las vías para ello el análisis de las actitudes de la sociedad hacia la internación psiquiátrica prolongada como modalidad de atención en salud mental. Así, se realizó un estudio observacional analítico en la Provincia de Buenos Aires, Argentina, en el año 2021, en donde se analizaron las actitudes de vecinos de personas que tuvieron internaciones psiquiátricas prolongadas y que recibían apoyos a la vivienda. Se hicieron cuestionarios a vecinos y no vecinos, indagándose por las actitudes hacia la internación psiquiátrica prolongada como modalidad de tratamiento, así como la distancia social hacia personas que tuvieron internaciones psiquiátricas, y también entrevistas a profundidad con informantes clave de barrios en donde habitan personas con problemáticas severas de salud mental y que reciben apoyos a la vivienda. No se identificaron diferencias estadísticamente significativas en las actitudes en relación a la internación psiquiátrica prolongada como modalidad de tratamiento de vecinos y no vecinos, ni tampoco respecto a la distancia social hacia personas que tuvieron internaciones psiquiátricas. Los informantes clave condicionaron su valoración sobre la internación prolongada, y valoraron el rol de los equipos de apoyo para posibilitar la vida en comunidad.
Abstract: A psychiatric reform is underway in Latin America and the Caribbean. Specifically in Argentina, a model of community mental health is being built, and prolonged psychiatric hospitalizations are still taking place, especially in neuropsychiatric hospitals. Therefore, it is necessary to closely monitor the psychiatric reform. One of the possible ways to monitor the reform is by analyzing society's attitudes towards prolonged psychiatric hospitalization as a mean of mental health treatment. Thus, an analytical observational study was conducted at the Buenos Aires Province, Argentina, in 2021, to analyze the behavior of neighbors of people who had prolonged psychiatric hospitalizations and who received housing support. Questionnaires were applied to neighbors and non-neighbors, addressing the behaviors toward prolonged psychiatric hospitalization as a mean of treatment, social distance toward people who were hospitalized, as well as specific interviews with key informants from neighborhoods where people with severe mental health disorders and who receive housing support live. Based on the answers of neighbors and non-neighbors, no statistically significant differences were identified in behaviors toward prolonged psychiatric hospitalization as a mean of treatment, nor for social distance in relation to people who were hospitalized. Key informants conditioned their assessment of prolonged hospitalization and valued the role of support teams in making community life viable.
Resumo: Uma reforma psiquiátrica está em curso na América Latina e Caribe. Especificamente na Argentina, um modelo de saúde mental comunitária está sendo construído, ainda acontecendo internações psiquiátricas prolongadas, principalmente em hospitais neuropsiquiátricos. Faz-se necessário, portanto, o acompanhamento da reforma psiquiátrica. Uma das formas de fazê-lo é analisando as atitudes da sociedade frente à internação psiquiátrica prolongada como forma de tratamento da saúde mental. Assim, foi realizado um estudo observacional analítico na Província de Buenos Aires, Argentina, no ano de 2021, onde foram analisadas as atitudes de vizinhos de pessoas que tiveram internações psiquiátricas prolongadas e que receberam apoio habitacional. Foram aplicados questionários a vizinhos e não vizinhos, questionando as atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, bem como a distância social em relação às pessoas que foram internadas, e também entrevistas específicas com informantes-chave de bairros onde vivem pessoas com problemas graves de saúde mental e que recebem apoio habitacional. Com base nas respostas de vizinho e não vizinhos, não foram identificadas diferenças estatisticamente significantes nas atitudes em relação à internação psiquiátrica prolongada como forma de tratamento, nem em relação à distância social em relação às pessoas que foram internadas. Os informantes-chave condicionaram sua avaliação da hospitalização prolongada e valorizaram o papel das equipes de apoio na viabilização da vida comunitária.
RESUMO
Social inclusion is a key component of transformations in mental health care, because it takes into account the benefits of community life for both those with mental illness and the other members of the community. In order to understand the scope of inclusion within mental health, 45 participants of a community center linked to a psychiatric hospital discharge program which explicitly seeks to provide social inclusion were interviewed. The possible changes in social relationships between users and other community members based in their sustained daily interactions in the community center were explored. Results suggest that the building of social bonds, as part of informal support networks, is one of the benefits of attending the community center. Positive changes in ideas regarding people with "mental illness" were also observed, although these ideas seemed to be more connected to the notion of integration than to social inclusion.
Assuntos
Transtornos Mentais , Saúde Mental , Humanos , Relações Interpessoais , Apoio SocialRESUMO
INTRODUCCIÓN: La pandemia por la enfermedad por el nuevo coronavirus (COVID-19) impactó en la organización y el funcionamiento del sistema de salud en su conjunto; aunque es muy poco lo descrito sobre lo ocurrido en los servicios de salud mental donde, además de atender la demanda habitual, se debe atender a la población afectada emocionalmente por la pandemia. El objetivo de este estudio fue caracterizar el efecto de la pandemia por COVID-19 en la provisión de servicios de salud mental en Argentina. MÉTODOS: Se realizó un estudio observacional transversal. Se entrevistó a 76 trabajadores de servicios de salud mental de cinco jurisdicciones del país, entre el 8 de mayo y el 30 de junio de 2020. Se indagó por cambios en la demanda, en el proceso de atención y en la estructura de los servicios. El análisis de datos fue mixto. RESULTADOS: La focalización de los servicios de salud en la pandemia implicó una reducción de la disponibilidad de atención en salud mental. La demanda de atención se modificó, con cambios en los motivos de contacto con los servicios, que pasaron a ser más críticos. Se observó una reconcentración de la atención en salud mental en los hospitales neuropsiquiátricos. La oferta de atención disminuyó y las intervenciones grupales se vieron especialmente afectadas. DISCUSIÓN: La situación de los servicios de salud mental muestra el impacto de la COVID-19 en el acceso de la población a la atención por necesidades no vinculadas de manera directa con la enfermedad.
Assuntos
Argentina , Infecções por Coronavirus , Serviços de Saúde MentalRESUMO
RESUMEN Objetivo: evaluar la calidad de atención en servicios de internación psiquiátrica de hospitales generales desde los enfoques de derechos y comunitario. Métodos: estudio multicéntrico, observacional descriptivo. Se seleccionaron cuatro servicios de internación psiquiátrica de hospitales generales ubicados en centros urbanos de distinta población en Argentina. En cada uno de ellos se analizaron los registros estadísticos, se realizaron observaciones no participantes y se entrevistó a gestores, trabajadores y usuarios. La guía de observación y entrevista se elaboró a partir de la revisión de instrumentos de la OMS y del proyecto Idea. Los resultados se analizaron a partir de las categorías de enfoque de derechos y orientación comunitaria de los servicios. Resultados: respecto del enfoque de derechos se observa que el que requiere mayor desarrollo es el de capacidad jurídica. En relación a la orientación comunitaria, se observa un mayor desarrollo de esta perspectiva a través de la implementación de diversas estrategias y el trabajo con las familias como la más común. Conclusiones: en términos de procesos y resultados de la atención se observan algunas diferencias entre los servicios que cuentan con sala especializada y los que no, y que estos últimos requieren de otros estudios para poder ser analizados.
ABSTRACT Objective: To evaluate, based on the human rights and community care frameworks, the quality of hospitalization psychiatric services in general hospitals. Methods: Multisite, descriptive observational study. There were analyzed four psychiatric hospitalization services, located in general hospitals of urban districts with different sizes in Argentina. Data collection included analysis of statistical records, non-participant observations of services, and interviews with service managers, service staff and users. The observation and interview guides were based on two international tools: Idea project interview guide, and QRTK of the WHO. Results were analyzed using two main categories: human rights-based care approach and community orientation of care delivery. Results: Regarding human rights-based care, legal capacity is the right that requires more improvement in services. About community orientation of care, different strategies were observed, with the work with the families as the most common. Conclusions: One aspect that requires further research is the specific type of psychiatric hospitalization service in the general hospital, given the fact that some differences in process and results were observed between general and specialized wards.
RESUMO
RESUMEN La transformación de la atención en salud mental supone tomar como eje de trabajo la inclusión social, considerando tanto los beneficios que la vida comunitaria trae para las personas con trastorno mental, como los que podría tener para las demás personas de la comunidad. Con el fin de analizar los alcances de la inclusión en salud mental, se entrevistó a 45 asistentes a un centro comunitario vinculado a un programa de externación de un hospital psiquiátrico, el cual busca explícitamente propiciar la inclusión social. Se indagó sobre las posibles transformaciones en las relaciones sociales entre personas externadas y otros miembros de la población, a partir de la interacción cotidiana y sostenida en dicho centro. Los resultados sugieren que uno de los beneficios que encuentran los asistentes es el establecimiento de vínculos, ligados al apoyo informal. A su vez, se observan transformaciones positivas en las ideas respecto a las personas con "enfermedad mental", aunque las mismas parecieran estar más del lado de la integración que de la inclusión social.
ABSTRACT Social inclusion is a key component of transformations in mental health care, because it takes into account the benefits of community life for both those with mental illness and the other members of the community. In order to understand the scope of inclusion within mental health, 45 participants of a community center linked to a psychiatric hospital discharge program which explicitly seeks to provide social inclusion were interviewed. The possible changes in social relationships between users and other community members based in their sustained daily interactions in the community center were explored. Results suggest that the building of social bonds, as part of informal support networks, is one of the benefits of attending the community center. Positive changes in ideas regarding people with "mental illness" were also observed, although these ideas seemed to be more connected to the notion of integration than to social inclusion.