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BMC Health Serv Res ; 22(1): 33, 2022 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-34986862


BACKGROUND: In January 2019, care pathways within specialist mental health and substance abuse treatment services were officially launched in Norway. The care pathway introduced timeframes for assessment and treatment, allowing a maximum of 6 weeks to finish assessment and provide the patient with a diagnosis, in addition to allowing a maximum of 6 weeks from diagnosis to the first evaluation. The different action points required coding. The system was based on goals to improve services by focusing on user participation, coordinated patient flow, avoidance of unnecessary waiting time, improvement of equal access to services regardless of geographic location, and increased emphasis on physical health and lifestyle. The purpose of our study was to examine how mental health professionals made sense of care pathways and furthermore, how issues of trust affected the process of implementation. METHODS: Our multiple case study included four outpatient clinics for adults in four community mental health centres (CMHCs) in different parts of Norway. Qualitative data were collected through in-depth individual and focus group interviews and analysed using systematic text condensation. The informants were treatment personnel and leaders in four different outpatient clinics for adults. RESULTS: The results indicated four distinct themes or reactions to the care pathway and its implementation: 1) lack of clarity regarding the overall goals and content of the care pathway; 2) the increased burden of coding, registration and administrative work, which professionals experienced as a stressor; 3) an IT and medical record system that did not correspond to the coding of the care pathway; and 4) an unrealistic distinction between assessment and treatment. These themes/reactions increased the health professionals' distrust towards the care pathway, and a process of sensemaking encouraged them to reduce the importance of the care pathway system and its implementation. CONCLUSION: Theories of trust help in understanding how mental health professionals interpret care pathway implementation. Distrust and resistance towards the care pathways overshadow some of the overall quality goals of the care pathway, a view that was indeed shared by mental health professionals.

Vías Clínicas , Servicios de Salud Mental , Adulto , Centros Comunitarios de Salud Mental , Personal de Salud , Humanos , Investigación Cualitativa , Confianza
BMC Health Serv Res ; 22(1): 23, 2022 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-34983526


BackgroundEmployees' perceptions of organizational climate for implementation of new methods are important in assessing and planning for implementation efforts. More specifically, feedback from employees' points to which implementation strategies to select, adopt, and tailor in building positive climate for implementation of new evidence-based practices within the organization. Implementation climate can be measured with the Implementation Climate Scale (ICS). The purpose of this study was to investigate the psychometric properties of the Norwegian version of the ICS in outpatient mental health clinics.MethodsThe ICS was administered to 383 clinicians within 47 different child and adult mental health clinics across the country. We conducted confirmatory factor analysis to assess the psychometric functioning of the ICS. Cronbach's alpha was examined to assess internal consistency. We also examined criterion related validity of the scale by comparing it with an alternative measure of implementation climate (concurrent validity) and by examining correlations with clinicians' intentions to use evidence-based practices.ResultsResults supported the 6-factor structure and the internal consistency reliability of the ICS. One exception was poor functioning of the Reward scale. Concurrent validity was stronger at the group than at the individual level, and assessment of associations with clinicians' intentions to use evidence- based practices showed positive correlations.ConclusionsThe Norwegian version of the ICS is a promising tool for assessing implementation climate which can provide organizations with specific feedback concerning which aspects of the implementation climate to attend to. Due to poor functioning of the Reward scale, adaptations and further testing of this is recommended.

Servicios de Salud Mental , Salud Mental , Adulto , Niño , Práctica Clínica Basada en la Evidencia , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
Esc. Anna Nery Rev. Enferm ; 26: e20210294, 2022. tab, graf
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1346043


Resumo Objetivo analisar as potencialidades das intervenções grupais em Centros de Atenção Psicossocial Álcool e Drogas na perspectiva dos profissionais. Método pesquisa-intervenção de abordagem qualitativa. Participaram 30 profissionais de saúde mental de quatro Centros de Atenção Psicossocial Álcool e Drogas da região central do Brasil. Os dados foram coletados por meio de instrumentos autoaplicáveis e rodas de conversa com roteiro semiestruturado. Para a análise dos dados, utilizou-se a Análise de Conteúdo, modalidade Temática, com o auxílio dosoftware ATLAS.ti. Resultados a categoria temática Potencialidades das intervenções grupais contemplou quatro subcategorias que abordaram aspectos relacionados à estrutura física, aos recursos materiais, aos aspectos dos usuários, aos profissionais e aos processos de trabalho. Considerações finais e as implicações para a prática a potência da prática com grupos estava presente em grande parte dos atendimentos nos serviços pesquisados com a identificação de inúmeros fatores terapêuticos aos usuários. As intervenções aumentaram a fluidez dos processos de trabalho, razão pela qual necessitam ser mais difundidas e implementadas pelas equipes multidisciplinares nos serviços de saúde mental.

Resumen Objetivo analizar el potencial de las intervenciones grupales en los Centros de Atención Psicosocial por Alcohol y Drogas, desde la perspectiva de los profesionales. Método investigación de intervención con enfoque cualitativo. Participaron treinta profesionales de la salud mental de cuatro Centros de Atención Psicosocial por Alcohol y Drogas de la región central de Brasil. Los datos se recolectaron a través de instrumentos autoadministrados y ruedas de conversación, con un guión semiestructurado. Para el análisis de los datos se utilizó el Análisis de Contenido, modalidad temática, con la ayuda del software ATLAS.ti. Resultados la categoría temática Potenciales de intervenciones grupales incluyó cuatro subcategorías que abordaron aspectos relacionados con la estructura física, recursos materiales, aspectos de usuarios, profesionales y procesos de trabajo. Consideraciones finales e implicaciones para la práctica el poder de la práctica con grupos estuvo presente en gran parte de las consultas en los servicios encuestados, identificando numerosos factores terapéuticos para los usuarios. Las intervenciones aumentaron la fluidez de los procesos de trabajo, por lo que necesitan ser más generalizadas e implementadas por equipos multidisciplinares en los servicios de salud mental.

Abstract Objective to analyze the potential of group interventions in Psychosocial Care Centers for Alcohol and Drugs from the perspective of professionals. Method intervention-research of qualitative approach. Thirty mental health professionals from four Psychosocial Care Centers for Alcohol and Drugs in the central region of Brazil participated. The data was collected through self-applied instruments and conversation rounds with a semi-structured script. For data analysis, we used Content Analysis, Thematic modality, with the help of the ATLAS.ti software. Results the thematic category Potential of group interventions contemplated four subcategories that approached aspects related to the physical structure, material resources, user aspects, professionals and work processes. Final considerations and implications for practice the power of the practice with groups was present in much of the care in the services researched with the identification of numerous therapeutic factors for users. The interventions increased the fluidity of the work processes, which is why they need to be more widespread and implemented by multidisciplinary teams in mental health services.

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Grupo de Atención al Paciente , Procesos de Grupo , Servicios de Salud Mental , Grupos de Autoayuda , Investigación Cualitativa , Acogimiento , Atención a la Salud Mental , Rehabilitación Psiquiátrica/psicología , Relaciones Interprofesionales
Lancet Psychiatry ; 9(1): 59-71, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34921796


BACKGROUND: There have been no trials of task-shared care (TSC) using WHO's mental health Gap Action Programme for people with severe mental disorders (psychosis or affective disorder) in low-income or middle-income countries. We aimed to evaluate the efficacy and cost-effectiveness of TSC compared with enhanced specialist mental health care in rural Ethiopia. METHODS: In this single-blind, phase 3, randomised, controlled, non-inferiority trial, participants had a confirmed diagnosis of a severe mental disorder, recruited from either the community or a local outpatient psychiatric clinic. The intervention was TSC, delivered by supervised, non-physician primary health care workers trained in the mental health Gap Action Programme and working with community health workers. The active comparison group was outpatient psychiatric nurse care augmented with community lay workers (PSY). Our primary endpoint was whether TSC would be non-inferior to PSY at 12 months for the primary outcome of clinical symptom severity using the Brief Psychiatric Rating Scale, Expanded version (BPRS-E; non-inferiority margin of 6 points). Randomisation was stratified by health facility using random permuted blocks. Independent clinicians allocated groups using sealed envelopes with concealment and outcome assessors and investigators were masked. We analysed the primary outcome in the modified intention-to-treat group and safety in the per-protocol group. This trial is registered with, number NCT02308956. FINDINGS: We recruited participants between March 13, 2015 and May 21, 2016. We randomly assigned 329 participants (111 female and 218 male) who were aged 25-72 years and were predominantly of Gurage (198 [60%]), Silte (58 [18%]), and Mareko (53 [16%]) ethnicity. Five participants were found to be ineligible after randomisation, giving a modified intention-to-treat sample of 324. Of these, 12-month assessments were completed in 155 (98%) of 158 in the TSC group and in 158 (95%) of 166 in the PSY group. For the primary outcome, there was no evidence of inferiority of TSC compared with PSY. The mean BPRS-E score was 27·7 (SD 4·7) for TSC and 27·8 (SD 4·6) for PSY, with an adjusted mean difference of 0·06 (90% CI -0·80 to 0·89). Per-protocol analyses (n=291) were similar. There were 47 serious adverse events (18 in the TSC group, 29 in the PSY group), affecting 28 participants. These included 17 episodes of perpetrated violence and seven episodes of violent victimisation leading to injury, ten suicide attempts, six hospital admissions for physical health conditions, four psychiatric admissions, and three deaths (one in the TSC group, two in the PSY group). The incremental cost-effectiveness ratio for TSC indicated lower cost of -US$299·82 (95% CI -454·95 to -144·69) per unit increase in BPRS-E scores from a health care sector perspective at 12 months. INTERPRETATION: WHO's mental health Gap Action Programme for people with severe mental disorders is as cost-effective as existing specialist models of care and can be implemented effectively and safely by supervised non-specialists in resource-poor settings. FUNDING: US National Institute of Mental Health.

Trastornos Mentales/economía , Trastornos Mentales/terapia , Servicios de Salud Mental/economía , Servicios de Salud Mental/organización & administración , Evaluación de Resultado en la Atención de Salud , Adulto , Anciano , Análisis Costo-Beneficio , Etiopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Desarrollo de Programa , Población Rural , Método Simple Ciego , Organización Mundial de la Salud
Multimedia | Recursos Multimedia | ID: multimedia-9539


Según datos de la Organización Mundial de la Salud, el suicidio fue la segunda causa de muerte de jóvenes de entre 15 y 29 años en todo el mundo en el año 2016. Asimismo, más del 79% de los suicidios en todo el mundo tuvieron lugar en países de ingresos bajos y medianos. Por otra parte, en América Latina, el 6,54% de la población padece demencia, cifra que se cuadruplicará hacia 2050. Más aún, se espera que la prevalencia de la demencia en la región sea mayor que en los países desarrollados, producto del envejecimiento de la población. Estas son solo algunas de las cifras asociadas a condiciones de salud mental, uno de los programas más importantes de salud pública pero que, sin embargo, se encuentra desatendido en muchos de los países de América Latina. Algunas de las posibles causas es que existen muchos estigmas y barreras culturales en cuanto a algunas de estas condiciones y enfermedades, sumado a la falta de una promoción y oferta adecuada que permita llegar de forma temprana a todos los estratos de la población. Este rezago se traslada también a la Salud Mental Digital, área de la salud digital aplicada a las intervenciones de salud mental, teniendo una baja adopción en la práctica clínica y un poco mayor en la terapéutica. No obstante, la pandemia de COVID-19 ha puesto sobre la mesa la relevancia de la salud mental y la necesidad de incrementar la inversión en el acceso a toda la población a la atención en salud, así como también se ha acelerado el uso de la salud mental digital como una alternativa la continuidad de servicio a los pacientes. En el webinar del mes de octubre de RECAINSA, conversamos con un grupo de expertos sobre las intervenciones que se vienen realizando en América Latina en cuanto a salud mental digital, así como los principales retos encontrados y las estrategias para superarlos.

Telemedicina , Salud Mental , Servicios de Salud Mental/organización & administración , Consulta Remota , Sistemas de Información en Salud , COVID-19/psicología , México , Argentina , Atención a la Salud Mental
Vínculo ; 18(3): 94-97, set.-dez. 2021. ilus
Artículo en Portugués | LILACS, Index Psicología - Revistas | ID: biblio-1347953


O CAPSij é um equipamento do Sistema Único de Saúde (SUS) de Saúde Mental, destinado ao atendimento de situações de sofrimento psíquico grave e/ou persistente e de vulnerabilidade social, na Infância e Adolescência. O acompanhamento dos casos é conduzido pela equipe do serviço, composta por profissionais provenientes de diversas áreas, tais como: Psicologia, Serviço Social, Terapia Ocupacional, Enfermagem e Psiquiatria. O presente trabalho foi realizado em um Capsij, localizado na região sudeste da cidade de São Paulo e atendido por: uma psicóloga, uma terapeuta ocupacional e uma enfermeira da equipe. Trata-se de uma adolescente e sua família, que ao longo de dois anos, foram inseridas em diversos dispositivos terapêuticos do serviço. Sua história de vida é marcada pelo abandono e adoção por figuras parentais ambivalentes. As principais queixas se referiram a tentativas de suicídio, uso de drogas e fugas de casa. Ao longo do acompanhamento, foi observado um reposicionamento subjetivo da adolescente, que passou a se utilizar de suas habilidades artísticas, como novas possibilidades de laço social. Além de uma maior disponibilidade materna para acolher e cuidar da filha adotiva.

CAPSij is a piece of equipment of the Unified Health System (SUS) of Mental Health, intended to attend to situations of severe and / or persistent psychological distress and social vulnerability in childhood and adolescence. The follow-up of cases is conducted by the service team, composed of professionals from various areas, such as: Psychology, Social Work, Occupational Therapy, Nursing and Psychiatry. The present work was carried out in a Capsij, located in the southeastern region of São Paulo city and attended by: a psychologist, an occupational therapist and a team nurse. This is a teenager and her family, who over two years, were inserted in various therapeutic devices of the service. Her life story is marked by abandonment and adoption by ambivalent parental figures. The main complaints referred to suicide attempts, drug use and homelessness. During the follow-up, a subjective repositioning of the adolescent was observed, which started to use her artistic skills as new possibilities for social bonding. In addition to greater maternal availability to welcome and care for the adopted daughter.

CAPSij es un equipo del Sistema Unificado de Salud (SUS) de Salud Mental, destinado a atender situaciones de angustia psicológica grave y / o persistente y vulnerabilidad social en la infancia y la adolescencia. El seguimiento de los casos es realizado por el equipo de servicio, compuesto por profesionales de diversas áreas, tales como: psicología, trabajo social, terapia ocupacional, enfermería y psiquiatria. El presente trabajo se llevó a cabo en un Capsij, ubicado en la región sureste de la ciudad de São Paulo y contó con la asistencia de: un psicólogo, un terapeuta ocupacional y una enfermera del equipo. Esta es una adolescente y su familia, que durante más de dos anos, se insertaron en varios dispositivos terapêuticos del servicio. La historia de su vida está marcada por el abandono y la adopción de figuras parentales ambivalentes. Las principales quejas se referían a intentos de suicidio, uso de drogas y personas sin hogar. Durante el seguimiento, se observó un reposicionamiento subjetivo de la adolescente, que comenzó a utilizar sus habilidades artísticas como nuevas posibilidades de vinculación social. Además de una mayor disponibilidad materna para acoger y cuidar a la hija adoptada.

Humanos , Femenino , Adolescente , Grupo de Atención al Paciente , Suicidio , Personas sin Hogar , Adopción , Núcleo Familiar , Maltrato a los Niños , Vulnerabilidad Social , Niño Adoptado , Distrés Psicológico , Servicios de Salud Mental
Vínculo ; 18(3): 25-33, set.-dez. 2021.
Artículo en Portugués | LILACS, Index Psicología - Revistas | ID: biblio-1347944


O presente artigo visa a compartilhar uma experiência de trabalho com um grupo operativo que ocorre em um serviço público de saúde mental, a saber, um Centro de Atenção Psicossocial (CAPS). Esse grupo é composto por sujeitos que apresentam quadros psicopatológicos considerados graves e que estão em situação de vulnerabilidade social. Partindo disso, pretende-se, neste escrito, realizar uma análise dos aspectos considerados avanços e ganhos conquistados ao longo do desenvolvimento do grupo, bem como abordar os desafios de sustentar um coletivo como esse em uma instituição de saúde da rede pública. Abordar-se-á, assim, as particularidades do processo grupal com os usuários da saúde mental, fomentando uma reflexão sobre as possibilidades de obter alguma melhora, apesar da gravidade dos sintomas. Tal experiência revela a potência que um trabalho grupal tem para resgatar e favorecer singularidades, elevar a autoestima e devolver o direito à voz a sujeitos que, por muito tempo, foram silenciados e escamoteados por diagnósticos de transtorno mental. Grupos operativos enriquecem o cotidiano dos pacientes e fortalecem a união, promovendo identificações e aprendizagens que, por sua vez, possibilitam mudanças e transformações.

This article aims to share a work experience with an operative group that takes place in a public mental health service, namely, a Psychosocial Care Center. That group is composed of subjects who have psychopathological conditions considered severe and who are in a situation of social vulnerability. Based on this understanding, it is intended, in this writing, to carry out an analysis of the aspects considered advances and gains achieved during the development of the group, as well as to discuss the challenges of sustaining a collective such as this in a public health institution. Thus, the particularities of the group process with mental health users will be approached, promoting a reflection on the possibilities of obtaining some improvement, despite the severity of the symptoms. Such experience reveals the power that group work has to rescue and favor singularities, raise self-esteem and give back the right to voice to subjects who, for a long time, were silenced and concealed by diagnoses of mental disorder. Operative groups enrich the patients' daily lives and strengthen the union, promoting identifications and learning that, in turn, enable changes and transformations.

Este artículo tiene como objetivo compartir una experiencia laboral con un grupo operativo que tiene lugar en un servicio público de salud mental, a saber, un Centro de Atención Psicosocial. Ese grupo está compuesto por sujetos que tienen condiciones psicopatológicas consideradas graves y que se encuentran en una situación de vulnerabilidad social. En base a esta comprensión, se pretende, en este escrito, producir un análisis de los aspectos considerados avances y logros alcanzados durante el desarrollo del grupo, así como discutir los desafíos de mantener un colectivo como este en una institución de salud pública. Así, se abordarán las particularidades del proceso grupal con usuarios de salud mental, promoviendo una reflexión sobre las posibilidades de obtener alguna mejora, a pesar de la gravedad de los síntomas. Tal experiencia revela el poder que tiene un trabajo grupal para rescatar y favorecer las singularidades, elevar la autoestima y devolver el derecho de voz a los sujetos que, durante mucho tiempo, fueron silenciados y abrumados por los diagnósticos de trastorno mental. Los grupos operativos enriquecen la vida cotidiana de los pacientes y fortalecen la unión, promoviendo identificaciones y aprendiendo que, a su vez, permiten cambios y transformaciones.

Humanos , Autoimagen , Poder Psicológico , Vulnerabilidad Social , Rehabilitación Psiquiátrica , Procesos de Grupo , Trastornos Mentales , Servicios de Salud Mental
Rev. SPAGESP ; 22(2): 89-103, jul.-dez. 2021. ilus
Artículo en Portugués | LILACS, Index Psicología - Revistas | ID: biblio-1340815


RESUMO O estudo analisou as perspectivas das famílias usuárias do Benefício de Prestação Continuada (BPC) acerca do Acompanhamento Familiar realizado por psicólogos em uma cidade do interior de Minas Gerais. Participaram oito familiares de pessoas com transtornos mentais que recebiam o BPC e que faziam acompanhamento nos oito CRAS da cidade. Empregou-se um roteiro de entrevista semiestruturada e os dados foram submetidos à análise de conteúdo de Bardin. Os resultados demonstraram que os familiares desconheciam tanto o serviço de Acompanhamento Familiar quanto seus Direitos Sociais e, consequentemente, não desenvolviam a Autonomia. Constatou-se que, embora os psicólogos não desenvolvessem atendimentos clínicos, evidenciou-se a necessidade de que psicólogos realizem atendimentos em contextos terapêuticos para acolhimento das demandas emocionais desses familiares.

ABSTRACT This research analyzed the perspective of families benefiting from the Continued Payment Benefit (BPC) about the family care assistance service performed by psychologists in a city in the interior of Minas Gerais. Participants were eight families of individuals diagnosed with mental disorders that received BPC and were inserted into eight CRAS unities. The instrument used was a semistructured interview script. Data were submitted to content analysis in thematic modality from Bardin. Results showed that family members were unaware of both family care assistance service and their Social Rights. Consequently, they had not developed autonomy. Moreover, although the psychologists did not perform clinical care, the need for them to develop therapeutic assistance to embrace the emotional demands of family members was evident.

El Estudio analizó perspectivas de familias que utilizan Beneficio Pago Continuo (BPC) sobre Apoyo Familiar realizado por psicólogos en una ciudad del interior de Minas Gerais. Participaron ocho familiares de personas con trastornos mentales que recibieron el BPC y fueron seguidos de ocho CRAS de la ciudad. Se utilizó un guión de entrevista semiestructurado y los datos se sometieron a análisis de contenido en modalidad temática de Bardin. Los resultados mostraron que los familiares desconocían tanto el servicio de Apoyo Familiar como sus Derechos Sociales, en consecuencia, no desarrollaron autonomía. Se encontró que, si bien los psicólogos no brindaron atención clínica, se evidenció la necesidad de que los psicólogos brinden atención en contextos terapéuticos para cuidar de las demandas emocionales de estos familiares.

Humanos , Servicio Social , Cuidadores , Continuidad de la Atención al Paciente , Enfermos Mentales , Chaperones Médicos , Servicios de Salud Mental
Vínculo ; 18(2): 1-12, jul.-dez. 2021. ilus
Artículo en Portugués | LILACS, Index Psicología - Revistas | ID: biblio-1341791


O presente artigo tem como objetivo compartilhar a experiência de um Grupo Psicoterapêutico de Mulheres, trabalho de psicoterapia grupal realizado em um Centro de Atenção Psicossocial (CAPS). Ao relatar a história do grupo de mulheres, pretendemos abordar as seguintes temáticas: os desafios da clínica na rede de atenção psicossocial e como o grupo de mulheres enfrentou os fracassos e se tornou um espaço de elaboração de luto, fortalecimento de singularidades, bem como de abertura para novas possibilidades de vida; desta forma, reafirmando o potencial dos grupos terapêuticos para sustentação da clínica nos dispositivos públicos de saúde. Percebemos que o potencial terapêutico do grupo de mulheres consiste em proporcionar um lugar de contar e recontar suas histórias. Neste espaço, elas podem compartilhar identificações e integrar-se nas diferenças. Permite-se falar de suas perdas, dores, estigmas e da relação com o fracasso. O processo psicoterapêutico favorece processos de elaboração e ressignificação, tornando possível vislumbrar e, inclusive, construir um recomeço. Pretende-se que esta reflexão vá ao encontro de outros terapeutas de grupo, em outros serviços de saúde, tecendo assim uma rede de reflexões e conhecimento sobre a clínica e a temática de grupos e instituições.

This article aims to share the experience of a Psychotherapeutic Group for Women, a group psychotherapy work carried out in a Psychosocial Care Center (CAPS). In reporting the history of the group of women, we intend to address the following themes: the challenges of the clinic in the psychosocial care network and how the group of women faced the failures and became a space for the elaboration of mourning, strengthening of singularities, as well as openness to new life possibilities; thus, reaffirming the potential of the therapeutic groups to support the clinic in public health devices. We realized that the therapeutic potential of the group of women is to provide a place to tell and retell their stories. In this space, they can share identifications and integrate themselves into differences. It allows you to talk about your losses, pains, stigmas and the relationship with failure. The psychotherapeutic process favors processes of elaboration and reframing, making it possible to see and even build a new beginning. It is intended that this reflection will meet other group therapists, in other health services, thus weaving a network of reflections and knowledge about the clinic and the theme of groups and institutions.

Este artículo tiene como objetivo compartir nuestra experiencia con el Grupo de Mujeres, que es un trabajo de psicoterapia grupal realizado en un Centro de Atención Psicosocial. Al informar su historia, pretendemos abordar los desafíos de la clínica en la Red de Atención Psicosocial y cómo tal grupo se enfrentó a los fracasos para convertirse en un espacio para la elaboración del dolor, el fortalecimiento de las singularidades y la apertura a nuevas posibilidades de vida, reafirmando el potencial de los grupos terapéuticos para apoyar la clínica en dispositivos de salud pública. Encontramos que el potencial terapéutico del Grupo de Mujeres es proporcionar un lugar para contar y volver a contar historias. En este espacio, sus participantes pueden compartir identificaciones y agregar diferencias. En él, ellas se permiten hablar sobre sus pérdidas, dolores y estigmas y sobre su relación con el fracaso. El proceso psicoterapéutico favorece la elaboración y la reformulación, lo que permite vislumbrar e incluso construir un nuevo comienzo. Pretendemos que esta reflexión resuene entre otros terapeutas grupales, en otros servicios de salud, tejiendo así una red de reflexiones y conocimientos sobre la clínica y el tema de grupos e instituciones.

Humanos , Femenino , Psicoterapia , Grupos de Autoayuda , Aflicción , Procesos Psicoterapéuticos , Rehabilitación Psiquiátrica , Servicios de Salud Mental
J Ment Health Policy Econ ; 24(4): 117-124, 2021 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-34907901


BACKGROUND: Certificate of need (CON) laws require would-be healthcare providers to obtain the permission of a state board before opening or expanding. 35 US states operate some type of CON program, though they vary widely in the specific services or equipment they target, with 25 states requiring CON for psychiatric services. AIMS OF THE STUDY: We provide the first empirical estimates on how CON affects the provision of psychiatric services. METHODS: We use Ordinary Least Squares regression to analyze 2010-2016 data on psychiatric CON from the American Health Planning Association together with data on psychiatric facilities and services from the National Mental Health Services Survey. RESULTS: We find that CON laws targeting psychiatric services are associated with a statistically significant 0.527 fewer psychiatric hospitals per million residents (20% fewer) and 2.19 fewer inpatient psychiatric clients per ten thousand residents (56% fewer). Psychiatric CON is also associated with psychiatric hospitals being 5.35 percentage points less likely to accept Medicare. Our estimates for CON's effect on the number of inpatient psychiatric beds per ten thousand residents and the likelihood of psychiatric hospitals accepting Medicaid, private insurance, or charity care (no charge) are negative but not statistically significant. DISCUSSION: CON laws may substantially reduce access to psychiatric care. A limitation of our study is that there is almost no variation in which states have psychiatric-related CON laws during the time period of our data (New Hampshire is the only state to change its psychiatric services CON requirement in this period, repealing its CON program entirely in 2016). This precludes the use of preferred econometric techniques such as difference-in-difference. IMPLICATIONS FOR HEALTH POLICIES: Our results indicate that CON laws may reduce access to inpatient psychiatric care. State policymakers should consider whether CON repeal could be a simple way of enhancing access to psychiatric care. IMPLICATIONS FOR FURTHER RESEARCH: While hundreds of articles have examined the effects of CON laws, we believe ours is the first to provide empirical estimates of their effects on mental health care specifically. We hope it is not the last.

Certificado de Necesidades , Servicios de Salud Mental , Anciano , Humanos , Pacientes Internos , Medicaid , Medicare , Estados Unidos
Cien Saude Colet ; 26(12): 5977-5985, 2021 Dec.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34909990


This paper addresses a local the Unified Health System (SUS) management experience that managed to implement networked care and took work as a determinant of cross-sectional health through the integrated action between actors in PHC and the Psychosocial Care and Occupational Health Networks. We monitored one automotive industry worker, whose work activity led him to illness due to inhalation of chemical substances. The theoretical framework and the analysis method are based on the recognition of the user-guide as an investigation strategy. The user-guide biography uncovered distress from the concrete life of the working man. The organic aspects that trigger a mental disorder have been trivialized or neglected in various services, in the understanding of the illness process that originated in their work. According to current work-related mental health studies, the results confirm the need for a contextualized work clinic, integration between services, intersectoral interventions per SUS guidelines, and public Mental Health and Occupational Health policies.

Servicios de Salud Mental , Atención Primaria de Salud , Estudios Transversales , Política de Salud , Humanos , Masculino , Salud Mental
Trials ; 22(1): 920, 2021 Dec 14.
Artículo en Inglés | MEDLINE | ID: mdl-34906222


BACKGROUND: Emotional dysregulation (ED) constitutes a relevant factor involved in the onset and maintenance of many mental disorders. Targeting ED during adolescence could be a determinant both to identify high-risk individuals and to promote preventive interventions. This study will aim to evaluate the impact of a brief Dialectical Behavioral Therapy (DBT)-based intervention for adolescent students by measuring changes in emotional regulation skills and impulsive behaviors. Moreover, alterations in biological features related to stress response and inflammation will be assessed as potential biological variables associated with ED. METHODS: This is a randomized trial. A total of 20 classes of adolescent students will be recruited among high schools in Brescia, a city in northern Italy. They will be randomized to the psychoeducational intervention (experimental group) or to a control condition (control group). The intervention will be based on DBT Skills Training for Emotional Problem Solving for Adolescents, and will consist of four monthly, 2-h sessions (for a total of 8 h) scheduled during regular school time. Participants will be assessed at baseline, post-intervention, and at 3 and 6 months of follow-up. The primary outcome measures will be represented by changes in the use of emotional regulation skills and by changes in the frequency of impulsive behaviors. Salivary samples will be collected at baseline and post-intervention to explore possible biological features underlying ED. DISCUSSION: Data from the present project will offer the opportunity to better understand the complex phenomenon of ED. Repeated assessment will cover several domains (emotional, behavioral, social, biological) as potential factors associated with ED. Moreover, it will be possible to establish the effect of the proposed intervention, thus helping to improve knowledge on the impact of school-based universal preventive programs. Finally, the current trial will propose an integrated screening and intervention-based model. Ultimately, this could reduce barriers to youths' mental health care by fostering collaboration between schools and mental health services. TRIAL REGISTRATION: NCT04349709 . Registered on April 16, 2020.

Regulación Emocional , Trastornos Mentales , Servicios de Salud Mental , Adolescente , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Servicios de Salud Escolar , Instituciones Académicas
Riv Psichiatr ; 56(6): 300-307, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34927624


Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that often persists into adulthood. The Italian situation regarding the clinical management of childhood ADHD shows some criticalities, despite the high prevalence rate: diagnostic assessments are often inaccurate, protocols for transition from childcare services are almost non-existent and the Italian National Registry for ADHD in childhood was drawn up only in 2007, hence the first specialized services were created later than the rest of Europe. On the basis of these issues, we investigated the Italian situation with regard to disorders in adulthood, comparing the different European operational models, assuming that these critical issues are reflected in the clinical management of the disorder in adulthood. In fact, unlike other European countries, there are no official guidelines governing the clinical management of the disorder in adulthood and evidence-based pharmacotherapies, available in most European countries, are off-label or not allowed in Italy. The aim of the study is to evaluate the current state of knowledge and working method in relation to adult ADHD in the Italian background and to identify the main evaluation and treatment pathways in Italian Mental Health Services. The study is also an attempt to clarify which services are operational on the Italian territory, with the aim of improving the quality of interventions for the clinical population. Three hundred thirty-eight services have been identified in all Italian Regions and Autonomous Provinces, including Mental Health Centres (CSM), Pathological Addition Services (SERD), Psychiatric Diagnosis and Treatment Services (SPDC). An ad-hoc survey with closed-ended questions was administered by telephone to each selected centre and the results were compared with the European literature.

Trastorno por Déficit de Atención con Hiperactividad , Servicios de Salud Mental , Adulto , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/terapia , Europa (Continente) , Humanos , Italia/epidemiología , Salud Mental
PLoS One ; 16(12): e0261818, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34962945


OBJECTIVE: Our project aims to provide: an overview of the impact of the COVID-19 pandemic on the field of mental health professionals in 23 countries;a model of recommendations for good practice and proposals for methods and digital tools to improve the well-being at work of mental health professionals and the quality of services offered during crisis and post-crisis periods;an in-depth ethics review of the assessment of the use of numerical tools for psychiatry professionals and patient support, including teleconsulting. METHODS: This is a large international survey conducted among 2,000 mental health professionals in 23 countries over a 12-month period. This survey will be based on 30 individual interviews and 20 focus group sessions, and a digital questionnaire will be sent online to 2,000 professionals based on the criteria of gender, age, professional experience, psychiatric specialty, context of work in psychiatry, and geographical location. Regarding the development of telepsychiatry during the COVID-19 pandemic, a pilot study on the use of digital tools will be carried out on 100 clients of psychiatry professionals in France and Belgium. DISCUSSION-CONCLUSION: This study will contribute to the co-construction of an international organization and monitoring system that takes into account psychiatric health professionals as major resources to fight against the COVID-19 pandemic and to develop efficient processes for preparing and anticipating crises by reducing psychosocial risks as much as possible. This project also aims to design tools for remote medicine and to develop the use of numerical tools for monitoring and supporting professionals and helping professionals to build the conditions for satisfactory operational work during crises and post-crisis situations, using adapted organizational methods. Our ongoing research should support professionals in the search for existing concrete solutions to cope with emergency work situations while maintaining an optimal quality of life.

COVID-19/epidemiología , COVID-19/psicología , Servicios de Salud Mental/organización & administración , Salud Mental , Pandemias , Práctica Profesional , Psicoterapeutas/psicología , SARS-CoV-2 , Bélgica/epidemiología , COVID-19/virología , Femenino , Francia/epidemiología , Humanos , Masculino , Proyectos Piloto , Calidad de Vida/psicología , Encuestas y Cuestionarios , Telemedicina/métodos
PLoS One ; 16(12): e0261163, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34928994


New Zealand's rate of suicide persistently exceeds the global average. The burden of suicide in New Zealand is disproportionately borne by youth, males and Maori (NZ indigenous people). While the demographic characteristics of suicide decedents are established, there is a need to identify potential points of contact with health services where preventative action could take place. This paper aims to determine if suicide deaths in New Zealand were likely to be preceded by contact with health services, and the type and time frame in which these contacts took place. This study utilised a whole-of-population-cohort of all individuals age 15 years and over, who were alive on March 5th 2013, followed up to December 2015. Associations between the odds of suicide, demographic factors, area-based deprivation, and the timing of last contact with primary, secondary, and tertiary services were analysed using univariate and multivariate logistic regression. Contact with a health service in the 6 Months prior to death was associated with the highest odds of suicide. Over half of the suicide decedent population (59.4%) had contacted primary health services during this period. Large proportions of the suicide decedent population contacted secondary and tertiary services in the 6 Months prior to death, 46.5% and 30.4% respectively. Contact with primary, secondary and tertiary services in the prior 6 Months, were associated with an increased odds of suicide of 2.51 times [95% CI 2.19-2.88], 4.45 times [95% CI 3.69-4.66] and 6.57 times [95% CI 5.84-7.38], respectively, compared to those who had no health services contact.

Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud , Suicidio/estadística & datos numéricos , Suicidio/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Factores de Tiempo , Adulto Joven
Artículo en Inglés | MEDLINE | ID: mdl-34948711


Listening to the voices of adolescents and young adults regarding their lived experiences could be a way to identify important skills and abilities for adaptive and positive behaviour that will enable youth to deal effectively with the demands and challenges of everyday life. Hence, the aim with the current study is to explore the experiences and understandings of the life situation among adolescents and young adults of today, by making their voices heard in regards to mental health and help-seeking behaviour. A total of 6 group interviews were conducted with 22 adolescents and young adults (13 girls and 9 boys) ages 17-25 (M = 18.6 years). Data analysis was conducted using qualitative content analysis and resulted in two categories and five subcategories. The first category, Life challenges, included views on the sources of mental health, how to manage different types of relationships, and thoughts on accepted ways to express mental health problems. The second category, The need of present adults, highlighted important aspects for seeking help, such as an expressed need to be seen and heard by adults including parents, school staff, and other professionals as well as a need for adults' increased availability. The challenges to students' well-being and mental health are many, and there are no simple solutions. Based on the results in this study, life skills training should include elements to enhance the development of individual coping strategies, to be applied when life feels tough and when the body is experiencing stress reactions. Further, to minimize the risk of self-stigma and the internalization of negative stereotypes and self-blame, life skills training should include elements to increase knowledge of structural factors that have effects on the life situation as well as parents, school personnel, and other important adults.

Servicios de Salud Mental , Salud Mental , Adolescente , Adulto , Femenino , Humanos , Masculino , Instituciones Académicas , Estigma Social , Estudiantes , Adulto Joven