Primary care mental health: nurses' activities in the psychosocial care network.

OBJECTIVE: to describe and analyze the role of expert nurses in mental health in the Family Health Strategy. METHOD: a qualitative study, with 20 Basic Health Units nurses of Teresina, Piauí. The information was collected through semi-structured interviews from March to May 2017 and analyzed using the content analysis method. RESULTS: it was found that the conceptions of the mental health disease process were based on the biological model, there was little communication between mental health and basic network, nurses did not feel qualified to work mental health and there were few mental health actions in Primary Care. Final considerations: it becomes urgent to implement public policies that articulate mental health and Primary Care, raising awareness and continuing education for nurses.

Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru.

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.

Benchmarking Community-Based Couple Therapy: Considering Measurement Reactivity.

Couple therapy has been shown to be effective in randomized clinical trials; however, results from naturalistic couple therapy have been less consistent. This study utilized a benchmarking approach to compare the effectiveness of couple therapy in a community-based setting with findings from efficacy treatments, such as treatment within randomized clinical trials. The current study is the largest couple therapy sample published to date (N = 3,347 couples). Clients in couple therapy were asked to provide initial and weekly ratings of symptomology on the Outcome Questionnaire (OQ-45.2). We found that treatment effect sizes found at community clinics were smaller than efficacy studies (i.e., the benchmark). However, when taking into account measurement reactivity, the effect sizes were comparable. This is the first benchmarking study for community-based couple therapy, allowing for meaningful comparisons and understanding of outcomes in real-world couple therapy. Implications for the field are offered in terms of evaluating community-based psychotherapy studies with benchmarking for couple therapy. Results of this study provide clinicians and researchers a way to meaningfully compare couple therapy outcomes, accounting for differences in community-based practices and randomized clinical trials. This benchmark also underscores the impact of measurement sensitivity, an issue commonly overlooked in psychotherapy research and practice.

Se ha demostrado que la terapia de pareja es eficaz en los ensayos clínicos aleatorizados, sin embargo, los resultados de la terapia de pareja naturalista han sido menos consecuentes. Este estudio utilizó un enfoque comparativo para comparar la eficacia de la terapia de pareja en un entorno basado en la comunidad con hallazgos de los tratamientos de eficacia, como los tratamientos dentro de los ensayos clínicos aleatorizados El presente estudio es la muestra más grande de terapia de pareja publicado hasta la fecha (N = 3347 parejas). Se pidió a los pacientes en terapia de pareja que proporcionen calificaciones iniciales y semanales de la sintomatología en el cuestionario para evaluación de resultados (OQ-45.2).Descubrimos que los tamaños del efecto de los tratamientos hallados en las clínicas comunitarias fueron más pequeños que los de los estudios de eficacia (p. ej.: el estudio comparativo). Sin embargo, cuando se tomó en cuenta la reactividad a la medición, los tamaños del efecto fueron comparables. Este es el primer estudio comparativo para la terapia de pareja basada en la comunidad, el cual permite comparaciones significativas y comprensión de los resultados en la terapia de pareja en el mundo real. Se ofrecen las implicancias para el área en cuanto a la evaluación de los estudios de la psicoterapia basada en la comunidad con evaluación comparativa de la terapia de pareja. Los resultados de este estudio proporcionan a los clínicos y a los investigadores una manera de comparar significativamente los resultados de la terapia de pareja, así como de explicar las diferencias en las prácticas basadas en la comunidad y en los ensayos clínicos aleatorizados. Esta evaluación comparativa también subraya el efecto de la sensibilidad a la medición, una cuestión comúnmente pasada por alto en la investigación y la práctica de la psicoterapia.

[Factors associated with perception of improvement by users of Centers for Psychosocial Care in the South of Brazil]. / Fatores associados à percepção de melhora por usuários de Centros de Atenção Psicossocial do Sul do Brasil.

This study aimed to investigate factors associated with perceived improvement among users of Centers for Psychosocial Care. This was a cross-sectional study of 1,493 users of Centers for Psychosocial Care in the South of Brazil. Users' perceived improvement was assessed by Perceived Change Scale - Patients (PCS-Patients). Associated factors were investigated using logistic regression guided by a hierarchical model, with statistical significance set at p < 0.05. Factors associated with the outcome were: state where the Center for Psychosocial Care was located, paid work, diagnosis of schizophrenia, age at diagnosis < 18 years, longer time attending the center, ease of access, and involvement in the evaluation. The factors that actually involve improvement in users include those pertaining to characteristics of the illness and aspects related to services in the implementation of mental health policies and their organization.

Satisfaction with mental health community services among patients' relatives.

OBJECTIVE:: This study aims to assess the satisfaction of family members of patients of mental health community services through a tested, validated and previously applied scale in order to allow comparison of results. METHODS:: The results were obtained by applying the scale SATIS-BR to 1242 relatives of patients of 40 mental health community services in Brazil. The average scores of the three subscales of the SATIS-BR scale were compared using the Wilcoxon test. To measure statistical significance for each item of the scale, the Friedman test was applied, considering significant p-value < 0.05. RESULTS:: The average overall satisfaction score was 4.35 with a standard deviation (SD) of 0.44, with a range varying from 1 to 5. The subscale with the highest score refers to the "Results of Treatment", what presents scores of 4.54 with SD of 0.66. As for the other subscales, which refer to "Reception and Staff Competence" and "Service Privacy and Confidentiality" had scores of 4.25 (SD: 0.51) and 4.17 (SD: 0.51). CONCLUSION:: The high level of satisfaction with the service among families of patients highlights the potential of these services and their contribution to the advance of a model of mental health community care, as it seems to be the global trend. The different results between the scales further suggest that the family distinguishes different aspects of the service and evaluates separately, providing a good reference for evaluation studies.

Satisfaction with mental health community services among patients' relatives / Satisfação com serviços comunitários de saúde mental entre os familiares dos pacientes

ABSTRACT: Objective: This study aims to assess the satisfaction of family members of patients of mental health community services through a tested, validated and previously applied scale in order to allow comparison of results. Methods: The results were obtained by applying the scale SATIS-BR to 1242 relatives of patients of 40 mental health community services in Brazil. The average scores of the three subscales of the SATIS-BR scale were compared using the Wilcoxon test. To measure statistical significance for each item of the scale, the Friedman test was applied, considering significant p-value < 0.05. Results: The average overall satisfaction score was 4.35 with a standard deviation (SD) of 0.44, with a range varying from 1 to 5. The subscale with the highest score refers to the "Results of Treatment", what presents scores of 4.54 with SD of 0.66. As for the other subscales, which refer to "Reception and Staff Competence" and "Service Privacy and Confidentiality" had scores of 4.25 (SD: 0.51) and 4.17 (SD: 0.51). Conclusion: The high level of satisfaction with the service among families of patients highlights the potential of these services and their contribution to the advance of a model of mental health community care, as it seems to be the global trend. The different results between the scales further suggest that the family distinguishes different aspects of the service and evaluates separately, providing a good reference for evaluation studies.

RESUMO: Objetivo: Este estudo objetivou avaliar a satisfação dos familiares de pacientes de serviços comunitários de saúde mental através de uma escala testada, validada e aplicada anteriormente, a fim de permitir a comparação de resultados. Métodos: Os resultados foram obtidos através da aplicação da escala SATIS-BR em 1242 familiares de pacientes de 40 serviços comunitários de saúde mental no Brasil. Os escores médios das três subescalas da escala SATIS-BR foram comparados pelo teste de Wilcoxon. Para medir a significância estatística para cada item da escala, o teste de Friedman foi aplicado, considerando-se como significância valor de p < 0,05. Resultados: A pontuação satisfação global média foi de 4,35, com desvio padrão (DP) de 0,44, em uma escala que varia de 1 a 5. A subescala com maior pontuação se refere aos "Resultados do Tratamento", que apresentou escore de 4,54 com DP de 0,66 . Quanto as outras subescalas, que se referem a "Recepção e Competência da Equipe" e "Privacidade e Confidencialidade do Serviço" as pontuações foram de 4,25 (DP: 0,51) e 4,17 (DP: 0,51) respectivamente. Conclusão: O elevado nível de satisfação com o serviço entre os familiares dos pacientes destaca o potencial desses serviços e a sua contribuição para o avanço de um modelo comunitário de atenção à saúde mental. Os resultados diferentes entre as escalas sugerem ainda que o familiar distingue os diversos aspectos do serviço e os avalia separadamente, constituindo uma boa referência para estudos de avaliação.

School-Based Disaster Recovery: Promotion of Children's Mental Health Over the Long Haul.

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).

Fatores associados à percepção de melhora por usuários de Centros de Atenção Psicossocial do Sul do Brasil / Factors associated with perception of improvement by users of Centers for Psychosocial Care in the South of Brazil / Factores asociados a la percepción de mejora por parte de usuarios de Centros de Atención Psicosocial del sur de Brasil

Este estudo objetivou investigar os fatores associados à melhora percebida pelos usuários de Centros de Atenção Psicossocial (CAPS). Estudo transversal, realizado com 1.493 usuários de CAPS do Sul do Brasil. A melhora percebida pelos participantes foi avaliada pela Escala de Mudança Percebida - Pacientes (EMP-Pacientes). Para investigação dos fatores associados, muniu-se de uma regressão logística guiada por um modelo hierárquico que considerou como associação um valor de p < 0,05. Os fatores associados ao desfecho foram: estado de alocação do CAPS, possuir trabalho remunerado, diagnóstico de esquizofrenia, menor idade quando diagnosticado, maior tempo de frequência no serviço, facilidade de acesso e envolvimento na avaliação. Entre os fatores que efetivamente tencionam melhora nos usuários, destacam-se aqueles referentes às características da doença e os aspectos relativos aos serviços quanto à execução das políticas de saúde mental e quanto à organização deles.

This study aimed to investigate factors associated with perceived improvement among users of Centers for Psychosocial Care. This was a cross-sectional study of 1,493 users of Centers for Psychosocial Care in the South of Brazil. Users' perceived improvement was assessed by Perceived Change Scale - Patients (PCS-Patients). Associated factors were investigated using logistic regression guided by a hierarchical model, with statistical significance set at p < 0.05. Factors associated with the outcome were: state where the Center for Psychosocial Care was located, paid work, diagnosis of schizophrenia, age at diagnosis < 18 years, longer time attending the center, ease of access, and involvement in the evaluation. The factors that actually involve improvement in users include those pertaining to characteristics of the illness and aspects related to services in the implementation of mental health policies and their organization.

Este estudio tuvo como objetivo investigar los factores asociados a la mejora percibida por los usuarios de Centros de Atención Psicosocial. Estudio transversal, realizado con 1.493 usuarios de Centros de Atención Psicosocial del sur de Brasil. La mejora percibida por los participantes se evaluó mediante la Escala de Cambios Percibidos - Pacientes (EMP-Pacientes, por sus siglas en portugués). Para la investigación de los factores asociados, se hizo uso de una regresión logística guiada por un modelo jerárquico que consideró como asociación un valor de p < 0,05. Los factores asociados al desenlace fueron: estado de asignación del Centro de Atención Psicosocial, tener trabajo remunerado, diagnóstico de esquizofrenia, menor de edad cuando se es diagnosticado, mayor tiempo de frecuencia en el servicio, facilidad de acceso y participación en la evaluación. Entre los factores que efectivamente prevén mejora en los usuarios, se destacan aquellos referentes a las características de la enfermedad y los aspectos relativos a los servicios, en cuanto a la ejecución de las políticas de salud mental y respecto a la organización de los mismos.

[Proposal to address the mental health problems detected after the February 27, 2010 earthquake]. / Propuesta para abordar los problemas de salud mental detectados en el proceso diagnóstico de la Delegación Presidencial para la reconstrucción tras el terremoto del 27 de febrero de 2010.

One of the most important topics mentioned by people from places affected by the February 27th, 2010 earthquake to the Presidential Delegation for the Reconstruction, was the urgent need of mental health care. Given the enormous individual and social burden of mental health sequelae after disasters, its treatment becomes a critical issue. In this article, we propose several actions to be implemented in Chile in the context of the process of recovery and reconstruction, including optimization of social communication and media response to disasters; designing and deployment of a national strategy for volunteer service; training of primary care staff in screening and initial management of post-traumatic stress reactions; and training, continuous education and clinical supervision of a critical number of therapists in evidence-based therapies for conditions specifically related to stress.

Propuesta para abordar los problemas de salud mental detectados en el proceso diagnóstico de la Delegación Presidencial para la reconstrucción tras el terremoto del 27 de febrero de 2010 / Proposal to address the mental health problems detected after the February 27, 2010 earthquake

One of the most important topics mentioned by people from places affected by the February 27th, 2010 earthquake to the Presidential Delegation for the Reconstruction, was the urgent need of mental health care. Given the enormous individual and social burden of mental health sequelae after disasters, its treatment becomes a critical issue. In this article, we propose several actions to be implemented in Chile in the context of the process of recovery and reconstruction, including optimization of social communication and media response to disasters; designing and deployment of a national strategy for volunteer service; training of primary care staff in screening and initial management of post-traumatic stress reactions; and training, continuous education and clinical supervision of a critical number of therapists in evidence-based therapies for conditions specifically related to stress.

Global mental health reforms: Challenges in developing a community-based program for maltreated children and adolescents in Brazil.

This column describes the planning and development of The Equilibrium Program (TEP) for multiply traumatized and neglected children and adolescents with mental and general medical problems in São Paulo, Brazil. The program is a partnership between university faculty, various service providers, the courts, and the city government. In the first step, child psychiatry faculty from the University of São Paulo visited central-city areas and group shelters to talk to street youths to better understand their needs. A nearby community sports center building was chosen to be a center where youths could access services and engage in recreational activities and where the work of family integration could be facilitated. A multidisciplinary team conducts an in-depth assessment and creates an intervention plan, overseen by a case manager. Challenges to implementing such programs are discussed.

Retention in mental health care of Portuguese-speaking patients.

We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005-2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients.

The relationship between symptomatic changes and perceived improvement among patients treated in Brazilian community mental health services.

Perceived improvement has been proposed as an important patient-reported outcome measure in mental health services evaluation. One advantage of this measure is that it can indicate whether other outcome measures, as pre-post differences in symptoms, correspond to a noticeable impact in patients' lives, as assessed by themselves. This study investigated the association between observer and self-reported symptomatic changes and perceived improvement by patients treated in two Brazilian outpatient mental health services. Significant and positive correlations were found between perceived improvement scores and both pre-post differences, obtained in observer-reported and patient-reported symptom scores. Nevertheless, scores of perceived improvement showed to be more correlated to patient-reported than to the observer-rated symptomatic change score. In addition, a greater correlation was found between perceived improvement scores and post-treatment symptom scores, compared to pre-treatment. These results suggest that an improvement in symptom severity, measured by pre-post differences scores, corresponds to the patient perception that he is actually better than before. However, the correlations found were moderate, suggesting that other factors may also be related to perceived improvement and must be investigated in further studies.

Evaluation of the network of psychosocial care centers: between collective and mental health.

OBJECTIVE: To analyze the assistance, management and workers' education models of a network of psychosocial healthcare services (CAPS). METHODS: This is a qualitative evaluation research, supported by the Gadamerian hermeneutics, carried out in the city of Campinas, Southeastern Brazil, in 2006-2007. Data were collected through 20 focus groups in centers known as CAPS III, with different groups of stakeholders (workers, municipal managers, users, family members and local managers). After the transcription of each group's recorded material, narratives were constructed following Ricoeur's theoretical framework. At the second stage of the focus groups, these narratives were presented to the participants, who could contest, correct and validate them. The preliminary results were discussed in workshops, with the aim of developing a good practice guide in CAPS III. RESULTS: The study identified strong points and weaknesses concerning the care provided during the crisis, articulation with the primary care network, formulation of therapeutic projects, management and organization in reference teams, educational background and psychological distress. CONCLUSIONS: The network of psychosocial care centers in Campinas stands out due to its originality in the implementation of six CAPS III and to its efficacy in providing comprehensive assistance to users and family members in the moment of crisis and in rehabilitation. The organization in reference technician and/or team prevails, as well as the development of therapeutic projects. Night teams reduction is the most important problem and the main source of workers' stress. The professionals' education proved to be insufficient to deal with the challenges faced by these services.

[Prevention of mental retardation: knowledge and perception by health professionals]. / Prevenção da deficiência mental: conhecimento e percepção dos profissionais de saúde.

This article aimed to evaluate the prevention of mental disability in primary healthcare services in Maringá, Paraná, Brazil. The sample consisted of 90 male and female physicians from different fields, namely gynecology and obstetrics, pediatrics, general practice, and family health, as well as 66 male and female nurses. A multiple-choice questionnaire was filled out by the subjects themselves from August to December 2003. Qualitative variables were compared using the chi-square test at 5% significance level. Partial data relating to both the perception and knowledge of health professionals concerning mental disability were as follows: 75% were unable to choose the correct alternative on prevalence; 25% did not know how the genome contributes to etiology; 37% were unaware of prevention for mental disability; 28% were not confident in providing orientation on the teratogenic effect of ethanol; 35% demonstrated insecurity in orienting patients on amniocentesis. The data showed that participants had an unsatisfactory perception of the relevance of mental disability within the overall population disease profile, and that they need more information on the respective genetic and environmental issues.

The Psychosocial Care Center on the users point of view.

The present study has as its aim to describe the daily work of a psychosocial care center and to aprehend how the users cared by such service experience the offered therapeutic process. Semi-structured interviews were carried out with eleven users of the Psychosocial Care Center, located in the countryside of São Paulo state. The data were submitted to Theme Analysis, based on Minayo. The themes which came from the data analysis, allowed the configuration of three topics. In the first one, the user experiences the treatment on an organicist focus of the care, assessed by the medical professional value, in the medicine-based approach and the symptom control. The second topic brings the perception of the space in CAPS as a helping scenario of social exchanges. And the third topic is about the therapeutic process as being towards the daily life of the users. Based in these data, we could reflect on the directions of the new facilities in mental health, the CAPS.

A enfermagem e o cuidar na área de saúde mental: [revisão] / Nursing and caring for in the area of mental health: [revision] / La Enfermería en el cuidar en el área de la salud mental: [revisión]

Este trabalho descreve os aspectos político-sociais que envolveram a reforma da assistência psiquiátrica, enfocando o processo de desinstitucionalização e a importância da enfermagem além de constituinte da equipe interdisciplinar. Objetiva analisar o processo de assistência de enfermagem ao doente mental em serviços externos ao hospital. Constitui-se de revisão bibliográfica em periódicos nacionais no período de 1999 a 2001. As autoras discutem sobre o comprometimento dos trabalhadores na área de saúde mental, com a "desconstrução"/construção a cerca do cuidado, fazendo-se necessária uma abordagem humanizada por meio do relacionamento interpessoal de pacientes, enfermeiros e as equipes responsáveis pela assistência ao doente mental.

This study describes the sociopolitical aspects that involved the psychiatric assistance reform, focusing the deinstitutionalization process and the importance of nursing beyond a component of the interdisciplinary team. It aims to analyze the process of nursing assistance to the mentally sick in services outside the hospital. It is a bibliographical review of national periodicals from 1999 to 2001. The authors discuss workers' engagement in the area of mental health, with the "deconstruction"/construction about care, making necessary a humanized approach by way of the interpersonal relationship of patients, nurses and the teams responsible for giving assistance to the mentally sick.

Este trabajo describe los aspectos político-sociales que involucraron la reforma de la asistencia psiquiátrica, enfocando el proceso de desinstitucionalización y la importancia de la enfermería además de constituyente del equipo interdisciplinar. Objetiva analizar el proceso de asistencia de enfermería al enfermo mental en servicios externos al hospital. Se constituye de revisión bibliográfica en periódicos nacionales en el período de 1999 a 2001. Las autoras discuten sobre el compromiso de los trabajadores en el área de salud mental, con la "desconstrucción"/construcción acerca del cuidado, haciéndose necesario un abordaje humanizado por medio de la relación interpersonal de pacientes, enfermeros y los equipos responsables por la asistencia al enfermo mental.

[Nursing and caring for in the area of mental health]. / Aenfermagem e o cuidar na área de saúde mental.

This study describes the sociopolitical aspects that involved the psychiatric assistance reform, focusing the deinstitutionalization process and the importance of nursing beyond a component of the interdisciplinary team. It aims to analyze the process of nursing assistance to the mentally sick in services outside the hospital. It is a bibliographical review of national periodicals from 1999 to 2001. The authors discuss workers' engagement in the area of mental health, with the "deconstruction"/construction about care, making necessary a humanized approach by way of the interpersonal relationship of patients, nurses and the teams responsible for giving assistance to the mentally sick.

Translating research into action: reducing disparities in mental health care for Mexican Americans.

This article describes a case study in which epidemiologic research findings were translated for multiple stakeholders and applied to reduce disparities in mental health services for Mexican Americans in Fresno County, California. The aims of this evidence-based process were to educate the community and mobilize action, translate research for multiple stakeholders to inform practitioners and policy makers about the need for improved mental health care for minorities, and effect regional policy changes to increase and improve the availability, accessibility, and appropriateness of mental health care for Mexican Americans. Through this process, a community-driven and consumer-oriented model evolved, which resulted in the allocation of resources to expand mental health services in rural areas of Fresno County. The authors discuss the process of translating research into action, key antecedents to an effective outcome, and lessons learned from the process.