Caribbean mental health professionals support climate resilience through community engagement, disaster response, and research.

Mental health professionals (MHPs) have roles supporting mitigation, preparation, and recovery in the global climate crisis. This commentary describes initiatives in the Caribbean to address climate-related threats to individuals and communities focussing on the role of MHPs in supporting community-based projects, regional public health disaster responses, and climate research.

Application of cinematographic vignettes to teaching in Mental Health / Aplicación de viñetas cinematográficas a la docencia en Salud Mental.

In this work some ideas about the possible relationships between cinema and psychopathology are presented. To carry out this task, the results of an experience carried out at the IUSAM-APdeBA are described, where a particular way of telling patient stories is explored, which is the cinematographic story. One of the many possible varieties of communicating clinical cases, in addition to the classic written and oral forms, is the audiovisual format. It is known that it is not easy to find good patient stories; even more so in these times where the possibilities of communicating real cases have been restricted by ethical-legal regulations. It has been observed that the audiovisual clinical vignettes extracted from the cinematographic stories can be a very useful tool for the purposes of discussion, exchange and teaching in psychopathology.

En este trabajo se presentan algunas ideas en torno a las relaciones posibles entre cine y psicopatología. Para llevar adelante esta tarea se describen los resultados de una experiencia realizada en el IUSAM-ApdeBA donde se explora un modo particular de contar historias de pacientes que es el relato cinematográfico. Una de las tantas variedades posibles de comunicar casos clínicos, además de las clásicas forma escrita y la oral, es el formato audiovisual. Es sabido que no resulta fácil encontrar buenas historias de pacientes, más aun en estos tiempos donde las posibilidades de comunicar casos reales se ha visto restringido por normativas ético-legales. Se ha podido observar que las viñetas clínicas audiovisuales extraídas de los relatos cinematográficos pueden resultar una herramienta de gran utilidad para fines de discusión, intercambio y docencia en psicopatología.

Adaptación y validación del Inventario de Burnout de Maslach en profesionales argentinos de la salud mental / Adaptation and validation of the Maslach Burnout Inventory in Argentinian mental health professionals

Objetivo: el objetivo de este estudio instrumental fue adaptar la versión española del Inventario de Burnout de Maslach (MBI-HSS) en una muestra (n = 544) de psicólogos y psiquiatras argentinos de entre 23 y 71 años de edad. Métodos: para evaluar la estructura interna del instrumento se realizó un análisis factorial confirmatorio (AFC) por medio del método de estimación de Máxima Verosimilitud robusto. La consistencia interna se calculó mediante el coeficiente de confiabilidad compuesta (fc). Resultados: el modelo inicial mostró índices de ajuste aceptables (CFI = .87, TLI = .86; RMSEA = .06; SRMR = .07). Tras la eliminación del ítem 12 del análisis, el ajuste del modelo mejoró satisfactoriamente (CFI = .91, TLI = .90, RMSEA = .05, SRMR = .06) confirmándose la estructura trifactorial. El cálculo de consistencia interna arrojó valores considerados muy buenos (fc > .70). Conclusión: se concluye que el MBI-HSS es una escala fiable y válida para la evaluación del Burnout en psicólogos y psiquiatras argentinos. Se discuten los resultados y sus posibles implicaciones en futuras investigaciones.

Objective: The aim of this instrumental study was to adapt the Spanish version of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) in a sample (n = 544) of Argentinian psychologists and psychiatrists aged 23 to 71. Method: A confirmatory factor analysis (CFA) was conducted to evaluate the internal structure of the instrument using the robust maximum likelihood estimation. Additionally, the internal consistency was calculated using the composite reliability (CR) coefficient. Results: The original structure provided an acceptable ût to the data (CFI = .87, TLI = .86, RMSEA = .06, SRMR = .07). However, the three-factor model had a closer fit to the data after excluding item 12 from the analysis (CFI = .91, TLI = .90, RMSEA = .05, SRMR = .06). The internal consistency yielded very good values (CR > .70). Conclusion: It is concluded that the MBI-HSS is a reliable and valid scale to measure burnout in Argentinian psychologists and psychiatrists. The results and their possible implications for future investigations are discussed in this paper.

Salud mental de la niñez: significados y abordajes de profesionales en Medellín, Colombia / Childhood Mental Health: Professional Meanings and Approaches in Medellín, Colombia

Resumen La ley 1616 de 2013 en Colombia busca garantizar el derecho a la salud mental, principalmente a niños, niñas y adolescentes; y se sustenta en una concepción de salud mental que integra diferentes disciplinas. Objetivo: explorar los significados de salud mental de la niñez y alternativas de abordaje que tienen algunos profesionales vinculados a la atención de niños y niñas en la ciudad de Medellín, Colombia. Metodología: investigación cualitativa en la que participaron 16 profesionales. Se llevaron a cabo entrevistas semiestructuradas y un grupo focal. La información fue transcrita y procesada mediante el programa Atlas.ti, siguiendo las orientaciones metodológicas de la teoría fundamentada para el análisis de información. Resultados: los significados de salud mental de la niñez de los profesionales entrevistados se han construido a partir de su formación académica, sin embargo, el rol que ejercen se encuentra delimitado por condiciones institucionales, políticas, económicas y sociales. Coexisten discursos biomédicos, socioeconómicos y de derechos sobre la salud mental de los niños. Discusión: existen barreras para la atención integral e integrada de la salud mental de los niños y niñas, tales como la falta de articulación institucional, las condiciones de vida precarias de la población vulnerable y las limitaciones del sistema de salud. Se considera necesario avanzar en la construcción de un concepto de salud mental adecuado a las características y contextos de desarrollo de la niñez.

Abstract Colombian Law 1616 of 2013 seeks to guarantee the mental health right by giving priority to children and adolescents; it is based on a concept of mental health that integrates different disciplines. Objective: to explore the meanings and alternatives of approach in the children mental health professionals related to the attention of children in Medellin, Colombia. Methodology: qualitative research in which 16 professionals participated; semi-structured interviews and a focus group were carried out. The information was transcribed and processed in Atlas ti., following the methodological guidelines of the grounded theory for the analysis of the information. Results: Findings suggest that mental health professionals' meanings are built according to their academic training, nevertheless their role is limited by institutional, political, economic and social conditions. Biomedical, socioeconomic and right discourses coexist on children mental health meanings. Discussion: there are barriers to comprehensive and integrated services in mental health, such as the lack of institutional articulation, the vulnerable population precarious living conditions, and the limitations of the Colombian health system. It is necessary to advance in the construction of a mental health concept, appropriate to the characteristics and contexts of childhood development.

Diseño y evaluación de un adiestramiento para profesionales de ayuda sobre identificación y manejo de riesgo suicida en estudiantes universitarios / Design and Evaluation of a Suicide Intervention Skills Training for Mental Health Professionals who Work with College Students

Este artículo describe el diseño, implementación y evaluación de un adiestramiento para profesionales de ayuda que trabajan en instituciones de educación superior en Puerto Rico. Está dirigido al desarrollo de destrezas y conocimiento en la evaluación y el manejo del riesgo suicida en estudiantes universitarios-as. Se realizó un diseño cuasiexperimental de medidas repetidas con 39 profesionales de las disciplinas de consejería, psicología y trabajo social. Se encontraron diferencias estadísticamente significativas entre la pre y posprueba, t (38) = -9.281, p = 0. Los resultados sugieren que un adiestramiento basado en la evidencia que utilice como guía las competencias e incorpore el uso de ejercicios prácticos aumenta el conocimiento y destrezas de intervención de profesionales de la salud mental en la evaluación y manejo de riesgo suicida.

This article describes the design, implementation and evaluation of a suicide risk assessment and management training for professionals working in institutions of higher education in Puerto Rico. We conducted a quasiexperimental design with 39 professionals in counseling, psychology and social work. Statistically significant differences were found between pre and post-tests, t (38) = -9.281, p = 0. Results suggest that an evidence-based training that follows the core competencies and includes practical exercises, increases the knowledge and intervention skills of mental health professionals in the assessment and management of suicide risk.

Percepção de profissionais de saúde de CAPS I quanto a demandas relativas ao consumo de crack / Perception of health professionals from Psychosocial Care Centers (CAPS I) regarding the demands related to the use of crack

Pesquisa qualitativa que analisa dois grupos focais realizados em 2009 com vinte trabalhadores de dois CAPS I da região de Porto Alegre, para verificar a sua percepção diante do aumento de demandas que a expansão do crack tende a gerar sobre as redes locais de saúde mental. Propôs-se que debatessem o que lhes parecia fonte de sobrecarga e insatisfação em geral e, especificamente, em função das demandas de usuários de crack. Os resultados mostram forte preocupação com a instabilidade dos contratos de trabalho, levando à falta de projeção no futuro. Além disso, o acúmulo de tarefas para suprir carências das equipes, justificando-se o limitado interesse em planejar ações de longo prazo e a opção por tarefas menos complexas. Consideraram-se problemas na rotina de trabalho as ordens judiciais e a interferência de agentes públicos, pedido expresso de hospitalização, familiares sem postura cooperativa, querelantes e usuários desmotivados para o tratamento ou reingressando no serviço. As equipes parecem estar no centro um conflito entre a impossibilidade de se evitar o surgimento de demandas da população usuária das redes locais de saúde, o que se evidencia no contexto do uso de crack, e os limites da gestão, ampliando o desgaste e a sobrecarga percebidos.

This paper presents qualitative research analyzing two focus groups with twenty workers in Psychosocial Care Centers (CAPS I) in Porto Alegre, southern Brazil, in 2009. They were invited to discuss overwork and dissatisfaction with work in general and also recent demands of crack cocaine users on the local mental health networks. Workers in both groups reported a strong concern about the instability of employment contracts, leading to limited ability to plan their futures. In addition, the accumulation of tasks to replace absenteeism in teams leads to a limited interest in long-term action planning and the option for less complex tasks. Court orders, the interference of public officials and requests of hospitalization, are considered unfavorable routine conditions in the perception of health workers, as well as uncooperative and quarrelsome family members and unmotivated users for resuming treatment. The teams seem to be the center of a conflict between the impossibility of avoiding the emergence of demands of crack users who apply to local health networks and the limits established by management, increasing dissatisfaction and perceived overwork.

O estigma atribuído pelos psiquiatras aos indivíduos com esquizofrenia / Psychiatrists' stigma towards individuals with schizophrenia

CONTEXTO: A literatura acerca da maneira como a população geral estigmatiza indivíduos com distúrbios mentais aumentou consideravelmente nas últimas décadas. Mas a dúvida sobre se os psiquiatras também estigmatizam seus pacientes ainda permanece. OBJETIVO: O presente estudo visou avaliar as atitudes de psiquiatras brasileiros em relação aos indivíduos com esquizofrenia. MÉTODOS: Dos cerca de 6.000 participantes do Congresso Brasileiro de Psiquiatria em 2009, 1.414 psiquiatras concordaram em participar do estudo. Entrevistas face a face foram realizadas utilizando um questionário que avaliava o estigma em três dimensões: estereótipos, distância social e preconceito, todas relacionadas a alguém com esquizofrenia. Opinião sobre medicações psicotrópicas e tolerância aos efeitos colaterais também foram avaliadas. Dados sociodemográficos e profissionais foram coletados. RESULTADOS: Psiquiatras brasileiros tenderam a estereotipar negativamente pessoas com esquizofrenia. Estereótipos negativos correlacionaram-se com uma melhor opinião sobre medicações psicotrópicas e com maior tolerância a efeitos colaterais. Idade maior correlacionou-se com estereótipos positivos e com menor preconceito. CONCLUSÃO: Os psiquiatras estigmatizam indivíduos com esquizofrenia e possivelmente têm certa dificuldade em admitir esse fato. Campanhas antiestigma para profissionais de saúde mental devem ser promovidas.

BACKGROUND: Literature on how the general population stigmatizes individuals with mental disorders has increased considerably over the last decades. But the question remains if psychiatrists also stigmatize their patients. OBJECTIVE: The present study aimed to assess Brazilian psychiatrists' attitude towards individuals with schizophrenia. METHODS: Out of the approximately 6,000 participants of the 2009 National Psychiatry Congress in Brazil, 1,414 psychiatrists agreed to undergo the survey. Face-to-face interviews were conducted using a questionnaire that assessed stigma in three dimensions: stereotypes, social distance and prejudice towards a person with schizophrenia. Their opinion on psychotropic drugs and tolerance of side-effects were also assessed. Socio-demographic and professional data were collected. RESULTS: Brazilian psychiatrists tend to negatively stereotype individuals with schizophrenia. More negative stereotypes correlated with a positive opinion on psychotropic drugs and with a higher tolerance of side-effects. Higher age was correlated with positive stereotyping and with less prejudice. DISCUSSION: Psychiatrists stigmatize individuals with schizophrenia and possibly find it difficulty admit this fact. Anti-stigma campaigns among mental health professionals should be promoted.