A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial.

OBJECTIVE: This pilot randomized controlled trial evaluated the effectiveness of critical time intervention-task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. METHODS: A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N=60; Rio de Janeiro, N=50). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment-Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. RESULTS: At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. CONCLUSIONS: Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.

[Embodied narratives of overcoming: A pathway towards recovery?] / Narrativas corporizadas de superación: ¿un camino para la recuperación?

Narratives play a fundamental role in the recovery of persons with schizophrenia, mainly from the paradigmatic change engendered by the recovery movement. Rather than a methodological tool or a byproduct of recovery, narratives are integral components of this process. This article aims to analyze overcoming narratives, in the light of the corporeality paradigm, based on an emblematic case of a peer support worker. This is a qualitative study carried out in the context of a randomized clinical trial, and it is based on one in-depth interview and focus groups for the construction of the narrative. Thematic analysis was carried out and the following categories were identifed: sense of self and embodiment; experience of time and space; relationship with others; illness experience and overcoming. The embodied narratives of overcoming constitute in the register of a non-linear temporality, and it is based on a dialectical and dialogic process of construction/reconstruction of the sense of self and of the body itself. We propose that embodied narratives are considered as a methodological principle for narrative analysis on recovery, as well as an intrinsic dimension of the recovery journey; that is, as the center of gravity of the process of construction / reconstruction of the sense of self, embodiment and the sense of belonging to the world.

[Contributios to the study of stigma of mental illness in Brazil: a review of national literature].

The Movement of the Psychiatric Reform in Brazil begins in 1970, with complaints of mistreatment and violence of patients, lack of resources and poor working conditions. Considering this scenario, in 2001 was enacted Federal Law No. 10.216, which redirects the mental health care by prioritizing the treatment offers in community-based services and provides for the protection and rights of people with mental disorders. Despite this investment in a national mental health policy, cultural changes in society do not happen in immediate response to changes in legislation and therefore the effects of new mental health practices on the lives of users are not sufficiently known. Stigmatization processes are referred to and conceived as being among the greatest impediments in the progress of the assignment of another social space to madness and exercise as citizens, central projects of the Brazilian Psychiatric Reform. Therefore, given its negative impact on the welfare of the population, the development of strategies to assess and reduce the stigma is considered a public health priority. Nevertheless, until now, studies of stigma of mental illness have been especially scarce in Brazil and other Latin American countries. In order to investigate how the issue has been addressed in national literature, we propose to conduct a Brazilian literature review in national journals between 2001-2014. We conclude that more research is needed to investigate the stigma in the Brazilian context. There are even difficulties including delineate which relational dimensions of users should be concentrated every effort to overcome the stigmatization processes. Arises aim is to refine the analyzes that identify which efforts have been more successful in producing anti-stigma activities.

["I am nuts, but networking": the qualification process for peer support work with mental health users in the psychosocial care network of Rio de Janeiro]. / "Soy loco, pero estoy en red": el proceso de capacitación con usuarios de servicios de Salud Mental para el trabajo de ayuda entre pares en la red de atención psicosocial de Río de Janeiro.

Peer support work has been increasingly incorporated by community services network in the context of mental health care paradigm shift; however, it is a relatively new device in Latin America. In this article, we will describe the qualification process of peer support workers for implementing a psychosocial intervention in the city of Rio de Janeiro. We use the following methodological strategies based on a narrative, participative and dialogical perspective: focus groups, knowledge transmission through a short course; visits to mental health services and field reports. We used a narrative analysis, building the following thematic categories: experience of the recovery process; what helps and what hinders in the recovery process; the role of the family; the role of community mental health services; prejudice among society and family members; the role of peer support work; challenges. From the users' perspective, recovery is tied to ups and downs and family can either help or disturb this process. Prejudice constitutes the main barrier for recovery. To have a social role and participating in training activities facilitate recovery. Users pointed out that it is necessary to have professional support for peer support work.

"Soy loco, pero estoy en red": el proceso de capacitación con usuarios de servicios de Salud Mental para el trabajo de ayuda entre pares en la red de atención psicosocial de Río de Janeiro / [\"I am nuts, but networking\": the qualification process for peer support work with mental health users in the psychosocial care network of Rio de Janeiro].

Peer support work has been increasingly incorporated by community services network in the context of mental health care paradigm shift; however, it is a relatively new device in Latin America. In this article, we will describe the qualification process of peer support workers for implementing a psychosocial intervention in the city of Rio de Janeiro. We use the following methodological strategies based on a narrative, participative and dialogical perspective: focus groups, knowledge transmission through a short course; visits to mental health services and field reports. We used a narrative analysis, building the following thematic categories: experience of the recovery process; what helps and what hinders in the recovery process; the role of the family; the role of community mental health services; prejudice among society and family members; the role of peer support work; challenges. From the users’ perspective, recovery is tied to ups and downs and family can either help or disturb this process. Prejudice constitutes the main barrier for recovery. To have a social role and participating in training activities facilitate recovery. Users pointed out that it is necessary to have professional support for peer support work.

"Soy loco, pero estoy en red": el proceso de capacitación con usuarios de servicios de Salud Mental para el trabajo de ayuda entre pares en la red de atención psicosocial de Río de Janeiro. / ["I am nuts, but networking": the qualification process for peer support work with mental health users in the psychosocial care network of Rio de Janeiro].

Peer support work has been increasingly incorporated by community services network in the context of mental health care paradigm shift; however, it is a relatively new device in Latin America. In this article, we will describe the qualification process of peer support workers for implementing a psychosocial intervention in the city of Rio de Janeiro. We use the following methodological strategies based on a narrative, participative and dialogical perspective: focus groups, knowledge transmission through a short course; visits to mental health services and field reports. We used a narrative analysis, building the following thematic categories: experience of the recovery process; what helps and what hinders in the recovery process; the role of the family; the role of community mental health services; prejudice among society and family members; the role of peer support work; challenges. From the users perspective, recovery is tied to ups and downs and family can either help or disturb this process. Prejudice constitutes the main barrier for recovery. To have a social role and participating in training activities facilitate recovery. Users pointed out that it is necessary to have professional support for peer support work.