Access to treatment for those with alcohol, crack or other drug dependency problems--a case study in the municipality of Rio de Janeiro, Brazil.

Changes in psychiatric policies has meant more emphasis on the protection of the individual's rights, tougher regulations and disincentives regarding involuntary patient admissions, and the creation of a community network to support individuals needing help. The differing socioeconomic status of those requiring treatment coupled with guidelines issued by the Health Ministry has meant that more support and care is now being directed towards individuals and families. The rise in public awareness of the problems in these areas has aided in the changes that have taken place. Due to a lack of community public services, this has led to the proliferation of different types of services all with differing standards of care and has fueled the public debate surrounding involuntary patient admissions. Our analysis in relation to treatment for those with alcohol, crack and other drugs problems in the municipality of Rio de Janeiro, states that there are gaps related to access for all-day public services and a lack of psychiatrists in multi-disciplinary teams. There are many new and untried serviced offered by the private sector, religious bodies and public shelters which have arisen in the wake of the rise in people that need help. We took note of the development and progress of these new projects as well as the policy recommendations from the Government.

Acesso aos serviços de atenção em álcool, crack e outras drogas – o caso do município do rio de Janeiro, Brasil / Access to treatment for those with alcohol, crack or other drug dependency problems - a case study in the municipality of Rio de Janeiro, Brazil

Resumo A reforma psiquiátrica enfatizou garantias individuais, restrições a internações involuntárias, desincentivo a internações psiquiátricas e formação de redes comunitárias de atenção. A diversificação de clientelas e as normativas do Ministério da Saúde se adaptaram às necessidades de suporte aos indivíduos e familiares e às demandas decorrentes crescentes da agenda de atenção aos usuários de drogas. A escassez de serviços públicos comunitários favoreceu a difusão de serviços com práticas clinicamente não padronizadas e o debate sobre internações involuntárias. Analisamos a oferta de serviços de atenção em álcool, crack e outras drogas no município do Rio de Janeiro e observamos barreiras de acesso para serviços públicos especializados e de caráter comunitário de 24 horas e escassez de psiquiatras nas equipes multiprofissionais. Há uma difusão experimental de serviços privados, religiosos ou não, e de abrigos públicos, em resposta às novas demandas. O processo observado configura uma trajetória de experimentalismo na política setorial e são efetuadas recomendações sobre políticas governamentais.

Abstract Changes in psychiatric policies has meant more emphasis on the protection of the individual's rights, tougher regulations and disincentives regarding involuntary patient admissions, and the creation of a community network to support individuals needing help. The differing socioeconomic status of those requiring treatment coupled with guidelines issued by the Health Ministry has meant that more support and care is now being directed towards individuals and families. The rise in public awareness of the problems in these areas has aided in the changes that have taken place. Due to a lack of community public services, this has led to the proliferation of different types of services all with differing standards of care and has fueled the public debate surrounding involuntary patient admissions. Our analysis in relation to treatment for those with alcohol, crack and other drugs problems in the municipality of Rio de Janeiro, states that there are gaps related to access for all-day public services and a lack of psychiatrists in multi-disciplinary teams. There are many new and untried serviced offered by the private sector, religious bodies and public shelters which have arisen in the wake of the rise in people that need help. We took note of the development and progress of these new projects as well as the policy recommendations from the Government.

[Harm reduction policies in Brazil: contributions of a North American program]. / Políticas de redução de danos no Brasil: contribuições de um programa norte-americano.

Given the rapid spread of the HIV epidemic and the need to control its transmission among intravenous drug users (IDU), harm reduction strategies have been incorporated in many countries, including Brazil. Considering these aspects and taking into account the emergence of drugs as a core concern on the government's agenda, especially crack cocaine, this article presents some of the contributions acquired from observing and recording the practices of an American model of research and care for IDUs, namely the UFO (You Find Out) Study. Issues such as participants' access and adherence, financing difficulties, sustainability and outcome evaluation were considered. The study involved documental research, systematic observation and interviews with key informants. Some of the UFO features that could contribute to the formulation of harm reduction policies in Brazil are highlighted. The UFO appears to be a successful example of harm reduction initiatives that successfully contact and guarantee the commitment of that risk group, ensuring its access to health services and reducing risks associated with drug use.

Politicas de reducao de danos no Brasil: contribuicoes de um programa norte-americano / Harm Reduction Policies in Brazil: contributions of a north american program

Considerando a disseminação da epidemia de HIV e o controle de sua transmissão entre usuários de drogas injetáveis (UDI), estratégias de redução de danos foram incorporadas em diversos países, incluindo o Brasil. Considerando a emergência das drogas como tema central na agenda governamental, especialmente o crack, o presente artigo registra e discute as práticas observadas em um programa de pesquisa e atenção aos UDI: o UFO. Foram considerados aspectos tais como acesso e adesão do usuário, dificuldades de financiamento, sustentabilidade e avaliação de resultados. As etapas do estudo envolveram pesquisa documental, observação sistemática e entrevistas com informantes-chave. Destacamos características do UFO que poderiam contribuir para políticas de redução de danos no cenário brasileiro. O programa estudado se apresenta como um exemplo exitoso de iniciativas de redução de danos, obtendo sucesso no acesso e adesão desse grupo, favorecendo seu acesso aos serviços de saúde e prevenção de riscos associados ao uso de drogas. .

Given the rapid spread of the HIV epidemic and the need to control its transmission among intravenous drug users (IDU), harm reduction strategies have been incorporated in many countries, including Brazil. Considering these aspects and taking into account the emergence of drugs as a core concern on the government's agenda, especially crack cocaine, this article presents some of the contributions acquired from observing and recording the practices of an American model of research and care for IDUs, namely the UFO (You Find Out) Study. Issues such as participants' access and adherence, financing difficulties, sustainability and outcome evaluation were considered. The study involved documental research, systematic observation and interviews with key informants. Some of the UFO features that could contribute to the formulation of harm reduction policies in Brazil are highlighted. The UFO appears to be a successful example of harm reduction initiatives that successfully contact and guarantee the commitment of that risk group, ensuring its access to health services and reducing risks associated with drug use.

Políticas e inovação em atenção à saúde mental: limites ao descolamento do desempenho do SUS / Policies and innovation in mental healthcare: limits to decoupling from the performance of the SUS

Analisamos a política brasileira de saúde mental quanto aos aspectos normativos, de demanda, de oferta e de financiamento. Concluímos que a sustentabilidade das inovações da reforma psiquiátrica depende de melhor financiamento e de integração dos serviços comunitários à rede de atenção primária, do desempenho geral do SUS e da redução de serviços exclusivos e autônomos na atenção primária. Existe elevada e crescente pressão de demanda medida em DALY e carga de doença. A redução dos leitos psiquiátricos observada acompanhou a redução sistêmica, porém com redução seletiva para as internações psiquiátricas. Os CAPS apresentam limites institucionais devido ao modelo adotado de administração pública direta e da capacidade de governo municipais. Dados secundários disponíveis revelam que: (i) o SUS tem poder quase monopsônico em serviços ambulatoriais e hospitalares em geral; (ii) os profissionais de saúde mental são predominantemente vinculados ao SUS; (iii) os serviços de saúde mental têm característica predominantemente extra-hospitalar; (iv) um número residual de CAPS dispõem de leitos diários; e (v) o financiamento federal para estas inovações é reduzido.

We studied Brazilian policies on mental health with respect to normative, supply and demand and financing aspects. We concluded that the sustainability of innovations in psychiatric reform depends on enhanced financing and integration with primary care community services, on the overall performance of SUS and the reduction of autonomous and exclusive services in primary care. There is high and rising pressure in demand for services measured in DALY and the incidence of disease. The reduction observed in psychiatric beds was accompanied by the systemic reduction, though with selective reduction for psychiatric hospitalizations. CAPS services have institutional limits due to the model adopted of direct public administration and local government capacity. Secondary data available show that: (i) SUS has a virtual monopoly on general outpatient and hospital services; (ii) mental health specialists belong mostly to SUS; (iii) most mental health services are outpatient services; (iv) few CAPS have day-bed services available; and (v) there is reduced federal financing for these innovations.

[Policies and innovation in mental healthcare: limits to decoupling from the performance of the SUS]. / Políticas e inovação em atenção à saúde mental: limites ao descolamento do desempenho do SUS.

We studied Brazilian policies on mental health with respect to normative, supply and demand and financing aspects. We concluded that the sustainability of innovations in psychiatric reform depends on enhanced financing and integration with primary care community services, on the overall performance of SUS and the reduction of autonomous and exclusive services in primary care. There is high and rising pressure in demand for services measured in DALY and the incidence of disease. The reduction observed in psychiatric beds was accompanied by the systemic reduction, though with selective reduction for psychiatric hospitalizations. CAPS services have institutional limits due to the model adopted of direct public administration and local government capacity. Secondary data available show that: (i) SUS has a virtual monopoly on general outpatient and hospital services; (ii) mental health specialists belong mostly to SUS; (iii) most mental health services are outpatient services; (iv) few CAPS have day-bed services available; and (v) there is reduced federal financing for these innovations.

Trends in methamphetamine use in young injection drug users in San Francisco from 1998 to 2004: the UFO Study.

AIMS: To describe temporal trends in methamphetamine use among young injection drug users (IDU) in San Francisco. DESIGN AND METHODS: Secondary analysis of cross-sectional baseline data collected for a longitudinal study of young IDU from 1998 to 2004. Participants were 1445 young IDU (<30 years old) who reported injection in the previous month, English-speaking, and recruited by street outreach methods. We examined trends for: lifetime (ever) and recent (30-day) methamphetamine use, including injected and non-injected, and by age group and sexual risk behaviour [men who have sex with men injecting drug users (MSM-IDU), male IDU (non-MSM) and female IDU]. RESULTS: In 1998, 1999, 2000, 2001, 2003 and 2004 we interviewed 237, 276, 431, 310, 147 and 44 participants, respectively. Overall, median age was 22 years [interquartile range (IQR) 20-25], 30.3% were women and median duration of injecting was 4.4 years (IQR 2-7). Prevalence of methamphetamine use was high, with 50.1% reporting recent injection, but overall there were no temporal increases in reported 'ever' injected use. Recent methamphetamine injection (past 30 days) increased significantly, and peaked at 60% in 2003. MSM-IDU had higher methamphetamine injection ever (92.3%) and recently (59.5%) compared to heterosexual male (non-MSM) IDU (81.6% and 47.3%, respectively) and to female IDU (78.4% and 46.1%, respectively). CONCLUSIONS: Despite reports of ubiquitous increases in methamphetamine use, there were no significant increases in 6 years in ever injecting methamphetamine overall among young IDU. MSM-IDU who reported the highest methamphetamine use overall reported some increases in recent injected use. The methamphetamine 'epidemic' was probably under way among young IDU earlier than other populations.