RESUMEN
OBJECTIVE: to analyze Cognitive Stimulation techniques effectiveness in the community and at home, in people with stabilized mental illness and their families. METHOD: an Integrative Literature Review, with inclusion criteria for primary studies that assess the Cognitive Stimulation techniques effectiveness in people with stable mental illness, older than 18 years, in the community and at home. Six articles were selected. RESULTS: improvement of cognitive abilities such as attention, work memory and executive functions was observed. No conceptual differences or results were found among Cognitive Stimulation programs for people with different pathologies; computer tools are increasingly being used; sample size is limiting gain analysis; the nurse's role has not been clarified; family gains were not studied. FINAL CONSIDERATIONS: the results obtained in this review reveal the need to know more about the theme.
Asunto(s)
Cognición/fisiología , Trastornos Mentales/terapia , Servicios Comunitarios de Salud Mental/métodos , Servicios Comunitarios de Salud Mental/tendencias , Humanos , Trastornos Mentales/psicologíaRESUMEN
Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalization and community-based care. This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru. The authors conducted a thematic analysis by using public records and semistructured interviews with stakeholders. The authors found evidence of supported employment programs for vulnerable populations, including people with disabilities, but found that the programs did not include people with severe mental illnesses. Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services: rigid labor markets, insufficient advocacy, public subsidies that create conflicting incentives, lack of deinstitutionalized models, and lack of reimbursement for evidence-based psychiatric rehabilitation interventions. Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programs to facilitate community integration and functional recovery. Because these countries have other supported employment programs for people with nonpsychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.
Asunto(s)
Servicios Comunitarios de Salud Mental , Empleos Subvencionados , Trastornos Mentales/rehabilitación , Enfermos Mentales , Rehabilitación Psiquiátrica , Rehabilitación Vocacional , Colombia , Servicios Comunitarios de Salud Mental/métodos , Servicios Comunitarios de Salud Mental/normas , Costa Rica , Empleos Subvencionados/métodos , Empleos Subvencionados/normas , Humanos , Perú , Rehabilitación Psiquiátrica/métodos , Rehabilitación Psiquiátrica/normas , Rehabilitación Vocacional/métodos , Rehabilitación Vocacional/normasRESUMEN
BACKGROUND: Evidence about the effectiveness of psychosocial interventions to reduce the incidence of depression and anxiety and promote subjective well-being in older people is limited, particularly in Latin-American countries. This study thus aims to assess a program specifically designed to address this issue in persons aged 65 to 80 and attending primary health care centres. METHOD: Older people who use primary care centres are to be randomly assigned to the program or to a control group. Only independent users will be included; those having had a major depressive disorder or an anxiety disorder in the last 6 months will be excluded. The program is group based; it includes cognitive stimulation, expansion of social support networks and cognitive behaviour strategies. Depressive and anxiety symptoms and disorders, as well as psychological well-being, will be assessed using standardised instruments, once before implementing the program and later, after 18 and 36 weeks. DISCUSSION: Primary care is a setting where interventions to improve mental health can be beneficial. Providing evidence-based programs that work with older people is a priority for public mental health. TRIAL REGISTRATION: A protocol for this study has been registered prospectively at ISRCTN registry on 25 July 2018. Identifier: ISRCTN32235611 .
Asunto(s)
Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Atención Primaria de Salud/métodos , Psicoterapia de Grupo/métodos , Anciano , Anciano de 80 o más Años , Ansiedad/psicología , Servicios Comunitarios de Salud Mental/métodos , Depresión/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: Youths are using emergency departments (EDs) for behavioral health services in record numbers, even though EDs are suboptimal settings for service delivery. In this article, the authors evaluated a mobile crisis service intervention implemented in Connecticut with the aim of examining whether the intervention was associated with reduced behavioral health ED use among those in need of services. METHODS: The authors examined two cohorts of youths: 2,532 youths who used mobile crisis services and a comparison sample of 3,961 youths who used behavioral health ED services (but not mobile crisis services) during the same fiscal year. Propensity scores were created to balance the two groups, and outcome analyses were used to examine subsequent ED use (any behavioral health ED admissions and number of behavioral health ED admissions) in an 18-month follow-up period. RESULTS: A pooled odds ratio of 0.75 (95% confidence interval [CI]=0.66-0.84) indicated that youths who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health ED visit compared with youths in the comparison sample. The comparable result for the continuous outcome of number of behavioral health ED visits yielded an incidence risk ratio of 0.78 (95% CI=0.71-0.87). CONCLUSIONS: Using comparison groups, the authors provided evidence suggesting that community-based mobile crisis services, such as Mobile Crisis, reduce ED use among youths with behavioral health service needs. Replication in other years and locations is needed. Nevertheless, these results are quite promising in light of current trends in ED use.
Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Intervención en la Crisis (Psiquiatría)/métodos , Servicios de Urgencia Psiquiátrica/métodos , Trastornos Mentales/terapia , Prevención del Suicidio , Adolescente , Niño , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Connecticut , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Servicio de Urgencia en Hospital , Femenino , Humanos , Modelos Logísticos , Masculino , Trastornos Mentales/diagnóstico , Unidades Móviles de Salud , Ensayos Clínicos Controlados no Aleatorios como Asunto , Servicio de Psiquiatría en Hospital , Escalas de Valoración Psiquiátrica , Suicidio/psicología , Resultado del TratamientoRESUMEN
Due to the need to transform psychiatric care and transcend from a model focused on clinical care towards a community model, Mentalmente Sanos (Mentally Healthy) emerges as an initiative from the academy under the teaching services agreement between the Universidad del Valle and the State Social Enterprises Health Network E.S.E Ladera. This support group, created in 2009 by people with mental disabilities who participate freely and voluntarily, promotes processes of social inclusion and social skills in everyday life. It convenes students and professors of Occupational therapy, Medicine and Psychiatry. Methodologically speaking, it is a space of joint construction based on the approach of the capacities and the community. Activities are planned and developed weekly ensuring the participation of all parties involved, taking into account their interests, concerns and capacities. Mentalmente Sanos, besides enabling social inclusion processes and the implementation of a community approach, is an opportunity to reflect on the construction of the individual from a social model of disability and the importance of linking institutional actors to ensure the implementation of community care strategies.
Debido a la necesidad de reformar la asistencia psiquiátrica y trascender de un modelo centrado en la asistencia clínica a un modelo más comunitario, surge Mentalmente Sanos como una iniciativa desde la academia bajo el convenio de docencia servicio entre la Universidad del Valle y la Red de Salud ESE Ladera. Este grupo de apoyo, conformado desde el 2009 por personas con discapacidad mental que participan de manera libre y voluntaria, funciona con el fin de promover procesos de inclusión social y habilidades sociales en vida cotidiana. Cuenta con la participación de estudiantes y docentes de terapia ocupacional, medicina y psiquiatría. Metodológicamente, es un espacio de construcción conjunta, se trabaja desde dos enfoques, el de las capacidades y el comunitario. Las actividades se planean y desarrollan semanalmente garantizando la participación de todos, teniendo en cuenta los intereses, inquietudes y capacidades. Mentalmente Sanos, además de posibilitar procesos de inclusión social y la puesta en marcha de un abordaje con la comunidad, se convierte en una oportunidad para reflexionar en torno a la construcción del sujeto desde un modelo social de la discapacidad y la importancia de la vinculación de los actores institucionales para garantizar la implementación de estrategias de atención comunitaria.
Asunto(s)
Servicios Comunitarios de Salud Mental , Trastornos Mentales/terapia , Adulto , Colombia , Servicios Comunitarios de Salud Mental/métodos , Servicios Comunitarios de Salud Mental/organización & administración , Participación de la Comunidad/métodos , Psiquiatría Comunitaria , Femenino , Humanos , Comunicación Interdisciplinaria , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Terapia Ocupacional/métodos , Terapia Ocupacional/organización & administración , Inclusión Social , Estigma Social , Apoyo SocialRESUMEN
INTRODUCTION: People with mental illness are more likely to smoke and less likely to receive tobacco treatment than the general population. The Addressing Tobacco Through Organizational Change (ATTOC) approach supports organizational change to increase tobacco treatment in this population. We describe preliminary study feasibility and baseline behaviors and attitudes among clients and staff regarding tobacco treatment, and assesse correlates of treatment of smoking. METHODS: Preliminary accrual, engagement, and baseline data are reported from a cluster-randomized trial comparing ATTOC to usual care. Feasibility, thus far, was the rate of site and participant accrual and engagement (eg, participants remaining in the trial). Correlates of assessing smoking, advising cessation, and providing treatment were assessed. RESULTS: Site and participant accrual is 80% (8/10) and 86% (456/533), and engagement is 100% and 82%. "Staff asking about smoking" was reported by 63% of clients and 38% of staff; "staff advising cessation" was reported by 57% of clients and 46% of staff; staff report "assisting clients with any medication" at most 22% of the time, whereas at most 18% of clients report receiving a cessation medication; 59% of clients want tobacco treatment, but 36% of staff think that it is part of their job. "Staff assisting with medications" is related to more training, believing treating smoking is part of their job, and believing patients are concerned about smoking (ps < .05). CONCLUSIONS: This trial of training in tobacco treatment within mental health care is feasible thus far; self-reported rates of tobacco treatment are low and associated with clinician attitudes and barriers. IMPLICATIONS: Evaluation of ways to help address tobacco use treatment in community mental health care is feasible and needed, including the use of technical assistance and training guided by an organizational change approach.
Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Trastornos Mentales/terapia , Salud Mental , Innovación Organizacional , Cese del Hábito de Fumar/métodos , Uso de Tabaco/terapia , Adulto , Análisis por Conglomerados , Estudios de Factibilidad , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Cese del Hábito de Fumar/psicología , Uso de Tabaco/psicología , Resultado del TratamientoRESUMEN
This study describes a model to intervene in communities affected by the political violence impacting the Ayacucho region of Peru since 1980s. Many community members still experience psychosocial consequences to this day due primarily to grief. Thirty-eight professionals from different sectors in the area received specialized training and implemented five community projects that were accompanied and monitored in the field by a team of community psychologists. This article is grounded on the principles of participation, building community capacity, and community strengthening. We present the analysis of five community action plans implemented over a period of 14 months. The results show a process of internal strengthening of community services and the identification of new social and community resources among the people involved in the action plans. The implications of capacity building for improving community mental health are discussed.
Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Servicios Comunitarios de Salud Mental/organización & administración , Participación de la Comunidad/métodos , Violencia , Adulto , Creación de Capacidad , Relaciones Comunidad-Institución , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Perú , Política , Desarrollo de Programa , Violencia/psicologíaRESUMEN
The February 2010 earthquake and tsunamis destroyed 80% of the coastal town of Dichato, Chile, displacing over 400 families for nearly 4 years. The coalition Recupera Chile (RC) participated in the town's integrated recovery process from January 2011 to the present with a focus on children's mental health. The multidisciplinary RC coalition emphasized community-led post-disaster recovery, economic capacity rebuilding, and community health promotion (www.recuperachile.org). RC's child health team fostered partnerships between the local elementary school, health clinic, Universidad de Concepcion, and Boston Children's Hospital. The team responded to priorities identified by the town with a three-pronged approach of (1) case management, (2) resource development, and (3) monitoring and evaluation. This work resulted in the development of a model school-based program: La Escuela Basada en Realidad, which encompassed (1) health and mental health, (2) language and literacy, and (3) love of the sea. Post-disaster programs targeting mental health require a multi-year approach that extends beyond the completion of the physical reconstruction. Recovery is an organic process that cannot be prescripted and depends on solutions that emerge from the community. Finally, partnerships between schools and universities can foster resiliency and sustainability of programs for children and families. (Disaster Med Public Health Preparedness. 2017;11:633-636).
Asunto(s)
Servicios de Salud del Niño/tendencias , Planificación en Desastres/métodos , Recuperación de la Salud Mental , Instituciones Académicas/organización & administración , Factores de Tiempo , Adolescente , Niño , Chile , Servicios Comunitarios de Salud Mental/métodos , Servicios Comunitarios de Salud Mental/normas , Terremotos/estadística & datos numéricos , Promoción de la Salud/métodos , HumanosRESUMEN
This article reports on the experience of a matrix approach to mental health in primary health care. Professionals who work in the Family Health Support Nuclei, Núcleos de Apoio à Saúde da Família, pointed to challenges of this approach, especially regarding the difficulties of introducing pedagogic actions in the health field and problems related to work relationships. As the matrix approach and its practice are new aspects of the Brazilian Unified Health System, the academic knowledge must walk hand in hand with everyday professional practice to help improve the quality of the services offered in this context.
Asunto(s)
Servicios Comunitarios de Salud Mental/organización & administración , Salud de la Familia , Programas Nacionales de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Brasil , Servicios Comunitarios de Salud Mental/métodos , Humanos , Atención Primaria de Salud/métodosRESUMEN
In this article we discuss the historical and theoretical-methodological aspects of the Community Psychology that has been developed in the state of Ceará, in northeastern Brazil, based on the praxis initiated by Professor Cezar Wagner de Lima Góis and further developed by the Community Psychology Nucleus (NUCOM) at the Federal University of Ceará. Important aspects of the beginning of this Community Psychology are presented, highlighting its academic and social perspectives. NUCOM is a space for the development of teaching, research, and outreach activities, which allows the systematization and deepening of this proposal for a different Community Psychology. Community Psychology is constituted by five theoretical-methodological marks: Popular Education, Biodance, Carl Rogers' Humanistic Approach, Cultural-Historical Psychology, and Liberation Psychology. Finally, the article describes the methods comprising this proposal for working in communities, which are sustained by pillars such as participation and problematizing dialogue.
Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Relaciones Comunidad-Institución , Psicología Social/métodos , Brasil , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Modelos Psicológicos , Pobreza , Psicología Social/educación , Psicología Social/historia , UniversidadesRESUMEN
In this article, we problematize the approximation between Community Psychology and the idea of Deep America, considering it capable of contributing through mediations and translations in the construction of knowledge and the recreation of social, ethnic, and human life as local diversity. We want to clarify the matter from Liberation and Southern epistemologies' point of views, and to present experiences that confirm this Community Psychology method. We talk about coloniality, connecting it to the Community Psychology method and emphasizing the importance of the social-psychological/ethnic mediation, of view interpretation, and the aspects that constitute mediation: dialogic, experiential, and participant. Finally, we briefly report some facilitation and research experiences performed by us in Ceará, mainly in the capital, Fortaleza, and in Sobral County.
Asunto(s)
Antropología Cultural , Servicios Comunitarios de Salud Mental/métodos , Psicología Social/métodos , Adolescente , Adulto , Brasil , Participación de la Comunidad , Femenino , Humanos , Relaciones Interprofesionales , Masculino , América del Norte , Pobreza , Población Urbana , Violencia , Adulto JovenRESUMEN
This study presents a qualitative evaluation of mental health services, having as a goal to understand in what measure the care practices of a community mental health service in Fortaleza, Ceará (Brazil), have an impact in the strengthening of people diagnosed with mental disorders. Interviews were made mediated by self-photography, a focus group, and in-depth interviews, organizing the contents in categories obtained by the critical hermeneutics method. The results indicate that those care practices promote strengthening processes, because care is not limited in its activities, and is respectful of the existential territory supporting the expressions of pain, of discontent, of the possibility of being and, wishing for different things, and are distanced from the ideology of submission and resignation.
Asunto(s)
Antropología Cultural , Servicios Comunitarios de Salud Mental/métodos , Trastornos Mentales/terapia , Psicología Social/métodos , Brasil , Hermenéutica , Humanos , Relaciones Interprofesionales , Entrevistas como Asunto , Fotograbar , Relaciones Profesional-PacienteRESUMEN
Este estudo se propôs a caracterizar os usuários de um serviço de saúde mental, que oferece um espaço terapêutico à população infantil e suas famílias. Com base em fichas de acompanhamento de 137 crianças que frequentaram o espaço em 2013, foram analisadas as seguintes variáveis: sexo; idade;motivos de procura; configuração familiar e frequência no projeto. Os resultados mostraram que a maioria das crianças é do sexo masculino (55,5%), entre as idades de quatro a dez anos (63,2%) e pertence a famílias nucleares (47,0%). Dentre as famílias quefrequentaram o projeto, 48,2% não expressaram demandas. Em contrapartida, dentre as famílias que trouxeram queixas, a mais frequente referida por 24,1% das famílias foi problemas de comportamento. O presente trabalho revela concordâncias com outros estudos de caracterização da população infantojuvenil que frequenta serviços de saúde mental. Ao mesmo tempo, faz novas contribuições ao trazer dados sobre os arranjos familiares dos frequentadores e sobre o padrão de frequência dos mesmos. Finalmente, é necessário repensar as práticas de saúde, tanto no sentido de oferecer espaços de promoção da saúde e o desenvolvimento infantil, quanto na necessidade de que os serviços sejam capazes de atender diversas queixas, cuidando da criança e sua família e possibilitando o diálogo com instituições de educação
This study aimed to characterize the users of a mental health service, which provides a therapeutic space to the child population and their families. Based on 137 attendances sheets of children who attended the space in 2013, the following variables were analyzed: sex; age; reasons demands; family configurationand frequency in the project. The results showed that most children are male (55,5%) among 4 to 10 years old (63,2%) and belongs to nuclear families (47,0%). Among the families who attended the project, 48,2% did not express demands. By contrast, those who had demands attested behavior problems as the most prevalent issue (24,1%). This research reveals agreements with other characterization studies of the child and adolescent population that attend mental health services. At the same time make new contributions to bring data about the living arrangements of the assisted families as well their frequency patterns. Finally we need to rethink about the health practices, both to provide health promotion spaces and child development and the need for services to be able to meet several complaints, taking care of the children and their families and enabling the dialogue with educational institutions
Este estudio tuvo como objetivo caracterizar a los usuarios de un servicio de salud mental que ofrece un ambiente terapéutico para la población infantil y sus familias. Con base en los registros de acompañamiento de 137 niños que asistieron al espacio en 2013, se analizaron las siguientes variables: sexo; edad; motivos para frecuentar el proyecto; configuración de la familia y la frecuencia en el proyecto. Los resultados mostraron que la mayoría de los niños es del sexo masculino (55,5%), tiene edades entre 4 y 10 años (63,2%) y pertenece a familias nucleares (47,0%). Entre las familias que estuvieron en el proyecto, 48,2% no expresaron demandas. En contrapartida, la queja más frecuente, entre las familias que las tenían, referida por 24,1% de ellasfue problemas de comportamiento. Este trabajo mostró concordancia con otros estudios de caracterización de la población infantojuvenil que frecuenta los servicios de salud mental. Al mismo tiempo realiza nuevos aportes al traer datos sobre las configuraciones familiares de los usuarios y la asiduidad de los mismos. Finalmente, es necesario repensar las prácticas de salud, tanto en el sentido de ofrecer espacios para la promoción de la salud y el desarrollo infantil, como para la necesidad de que los servicios sean capaces de atender diversas quejas, cuidando al niño y a su familia, posibilitando, así, el diálogo con instituciones de educación
Asunto(s)
Humanos , Salud Mental , Servicios Comunitarios de Salud Mental/métodos , Servicios de Salud del Niño , Servicios de Salud ComunitariaRESUMEN
Este estudo se propôs a caracterizar os usuários de um serviço de saúde mental, que oferece um espaço terapêutico à população infantil e suas famílias. Com base em fichas de acompanhamento de 137 crianças que frequentaram o espaço em 2013, foram analisadas as seguintes variáveis: sexo; idade;motivos de procura; configuração familiar e frequência no projeto. Os resultados mostraram que a maioria das crianças é do sexo masculino (55,5%), entre as idades de quatro a dez anos (63,2%) e pertence a famílias nucleares (47,0%). Dentre as famílias quefrequentaram o projeto, 48,2% não expressaram demandas. Em contrapartida, dentre as famílias que trouxeram queixas, a mais frequente referida por 24,1% das famílias foi problemas de comportamento. O presente trabalho revela concordâncias com outros estudos de caracterização da população infantojuvenil que frequenta serviços de saúde mental. Ao mesmo tempo, faz novas contribuições ao trazer dados sobre os arranjos familiares dos frequentadores e sobre o padrão de frequência dos mesmos. Finalmente, é necessário repensar as práticas de saúde, tanto no sentido de oferecer espaços de promoção da saúde e o desenvolvimento infantil, quanto na necessidade de que os serviços sejam capazes de atender diversas queixas, cuidando da criança e sua família e possibilitando o diálogo com instituições de educação
This study aimed to characterize the users of a mental health service, which provides a therapeutic space to the child population and their families. Based on 137 attendances sheets of children who attended the space in 2013, the following variables were analyzed: sex; age; reasons demands; family configuration and frequency in the project. The results showed that most children are male (55,5%) among 4 to 10 years old (63,2%) and belongs to nuclear families (47,0%). Among the families who attended the project, 48,2% did not express demands. By contrast, those who had demands attested behavior problems as the most prevalent issue (24,1%). This research reveals agreements with other characterization studies of the child and adolescent population that attend mental health services. At the same time make new contributions to bring data about the living arrangements of the assisted families as well their frequency patterns. Finally we need to rethink about the health practices, both to provide health promotion spaces and child development and the need for services to be able to meet several complaints, taking care of the children and their families and enabling the dialogue with educational institutions.
Asunto(s)
Humanos , Salud Mental , Servicios Comunitarios de Salud Mental/métodos , Servicios de Salud Comunitaria , Servicios de Salud del NiñoRESUMEN
BACKGROUND: Mexican American farmworkers experience high rates of mental health conditions; however, it is difficult for them to access care. Patient-centred care is a systems-wide approach to improving the delivery of services for diverse populations in the primary care setting. AIM: We describe the application of community-based participatory research methods to assess and address gaps in perceptions of mental health care between providers and migrant workers living in a US-Mexico Border community. SETTING: A federally qualified health centre (FQHC) serving a community of approximately 60 000 agricultural workers who live in Yuma County and harvest vegetables during the winter season. DESIGN: We conducted patient focus groups (n = 64) and FQHC staff interviews (n = 16) to explore attributes and dimensions of patient-centred mental health care. RESULTS: Patients and staff both prioritized increased access to mental health care and patient-centred care, while patients were more concerned with interpersonal care and providers with coordination of care. All participants stressed the relationship between life events and mental health and the centrality of family in care. Patients also emphasized the importance of a good attitude, the ability to solve problems, positive family relationships and reliance on faith. Patients suggested that the FQHC inform patients about mental health resources, provide community informational talks to address stigma, and offer support groups. DISCUSSION: The participatory approach of this qualitative study resulted in a wealth of data regarding patient preferences that will enable the FQHC to develop protocols and training to provide patient-centred mental health-care services for their community.
Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Investigación Participativa Basada en la Comunidad , Agricultores , Americanos Mexicanos , Atención Dirigida al Paciente/métodos , Arizona , Centros Comunitarios de Salud Mental , Investigación Participativa Basada en la Comunidad/métodos , Grupos Focales , HumanosRESUMEN
BACKGROUND: Worldwide, there is a gap between the burden of mental distress and disorder and access to mental health care. This gap is particularly large in low- and middle-income countries (LMICs). After the 2010 earthquake in Haiti, the international health care organizations Partners in Health and Zanmi Lasante worked to expand local mental health services in rural Haiti. OBJECTIVE: The aims of this study are to describe clinical characteristics of the patients served during a pilot project to deliver community-based psychiatric services in rural Haiti and to show how this experience complements the Mental Health Gap Action Programme ("mhGAP"), a tool developed by the World Health Organization to support mental health care delivery by nonspecialists in LMICs. METHODS: The pilot was conducted in March 2011. A visiting psychiatrist traveled to rural Haiti and paired with local clinicians to evaluate patients and to support quality improvement practices in psychiatric care. Patients received a standard neuropsychiatric evaluation. mhGAP was an important clinical reference. To assess the experience, we conducted a retrospective chart review of outpatient encounters. FINDINGS: Sixty-five patients presented with a wide range of common psychiatric, neurologic, and general medical conditions. Forty-nine of these patients (75%) reported primary problems subsumed by an mhGAP module. Fifteen patients (23%) reported headache as their chief complain, a condition that is not currently covered by mhGAP. Surprisingly, only 3 patients (5%), reported earthquake-related distress. CONCLUSIONS: Our clinical data reinforce the need for provision of standard psychiatric and neurologic services in LMICs. Such services ought to accompany interventions targeted specifically at disaster-related problems. Clinical situations falling outside existing mhGAP modules inspired the development of supplemental treatment protocols. These observations informed coordinated efforts at Zanmi Lasante to build a sustainable, integrated mental health system in Haiti that may be relevant to other resource-limited settings.
Asunto(s)
Servicios Comunitarios de Salud Mental/métodos , Atención a la Salud/métodos , Desastres , Terremotos , Trastornos Mentales/terapia , Población Rural , Trastorno Bipolar/terapia , Demencia/terapia , Depresión/terapia , Países en Desarrollo , Haití , Cefalea/terapia , Humanos , Neurología , Proyectos Piloto , Psiquiatría , Trastornos Psicóticos/terapia , Mejoramiento de la Calidad , Estudios Retrospectivos , Convulsiones/terapia , Estrés Psicológico/terapiaRESUMEN
BACKGROUND: Although alcohol consumption is recognized as a global problem, little research to date explores treatment options for alcohol use disorders in developing nations. Given the scarce mental health resources available in Saint Vincent and the Grenadines, community self-help programming for alcohol use disorders could potentially provide an important complement to the existing mental health services. OBJECTIVE: The aim of this study was to gather baseline data on knowledge and attitudes toward alcohol consumption among community members, and subsequently, to pilot self-help rehabilitation programs for alcohol use disorders, while determining factors that affect the feasibility and sustainability of such programs. METHODS: Focus groups were conducted in 3 communities to discuss community perceptions of alcohol use and the feasibility of self-help programs. Focus group findings guided the development and implementation of the self-help groups. A postintervention focus group was held to determine the effectiveness and community-wide effect of the self-help programs. FINDINGS: Focus group participants agreed that alcohol consumption was a problem in Saint Vincent, leading to underage drinking and violence. Suggestions to encourage self-help meeting attendance included organizing group activities and providing visuals to illustrate alcohol's effects on health. Self-help group members were surveyed about their group experience. Of the 35 members surveyed, 77% said the group was very helpful, and 91% indicated that they would attend again. Postintervention focus group participants stated that individuals had reduced alcohol consumption after attending at least 1 self-help meeting. CONCLUSIONS: Elements that contributed to the sustainability of self-help groups included strong local leadership from district health nurses as well as willingness of participants to seek support. However, efforts need to be made to increase community awareness of alcohol use disorders and its associated dangers. Our results suggested self-help programs to address alcohol use disorders are a feasible intervention in Saint Vincent that warrants further development, dissemination, and exploration.