La reorganización de un servicio comunitario de salud mental infantil y juvenil ante la pandemia de covid-19 / The reorganization of a community mental health center for children and youth due to the covid-19 pandemic

La crisis sanitaria causada por la COVID-19 ha forzado una reorganización de los servicios de salud mental. El presente artículo describe una propuesta de reorganización aplicada en una unidad de salud mental infanto-juvenil (atención ambulatoria y comunitaria). Se exponen las estrategias concretas de intervención desarrolladas en las distintas fases de la pandemia según las medidas de restricción sanitarias y los distintos niveles de intervención requeridos (prevención, atención primaria y atención especializada). Además, se compara el número de visitas hechas durante el periodo de Marzo-Julio de 2020 con el mismo periodo en 2019. Concluimos que se ha producido una rápida adaptación del marco asistencial presencial a la metodología telemática mediante una reorganización flexible. Sin embargo, la disminución de la asistencia presencial y la cancelación de grupos terapéuticos han incrementado la presión asistencial notablemente. Se ha observado un incremento de conductas autolíticas y de problemas relacionados con la conducta alimentaria que deberán ser investigados en futuros estudios. (AU)

The heath crisis caused by COVID-19 has required a reorganization of mental health centers. This article describes the reorganization proposal that was applied in a child and adolescent mental health unit (outpatient and community care). The specific intervention strategies developed in the different phases of the pandemic are presented according to the sanitary restriction measures and the different levels of intervention required (prevention, primary care, and specialized care). In addition, the number of visits made during March-July 2020 is compared to the same period in 2019. We conclude that there has been a rapid adaptation from the face-to-face care framework to atelematic approach through a flexible reorganization. However, the decrease in face-to-face assistance and the cancellation of therapeutic groups have significantly increased the pressure of care. A rise in autolytic behaviors and eating pathologies has been observed that should be investigated in future studies. (AU)

Integrating primary care into a community mental health center.

Our initiation of a reverse-integration practice model revealed numerous advantages and rewards, as well as many challenges, for which we found solutions.

The well-being and perspectives of community-based behavioral health staff during the COVID-19 pandemic.

With high levels of burnout, turnover, and secondary traumatic stress, the well-being of the behavioral health workforce was an area of concern prior to the coronavirus disease 2019 (COVID-19) pandemic. How the COVID-19 crisis has impacted social workers, psychologists, psychiatrists, and other behavioral health professionals is unclear but should be examined. A brief survey evaluated the impact of the pandemic on the well-being of 168 behavioral health clinical and administrative staff serving in an urban behavioral health center in the United States. Staff experienced several personal and organizational-related challenges related to work-life balance, emotional distress, and organizational communication. Nevertheless, staff found an abundance of positive experiences when engaging with clients. Supportive, positive feedback and statements of appreciation from clients, colleagues, and supervisors helped staff to feel at their best. The well-being of behavioral health staff may be facilitated by consistent and supportive communication at the team, supervisory, and organizational levels and by involving staff in planning agency policy.

The case for prescribing PrEP in community mental health settings.

Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention modality that is up to 99% effective in preventing HIV acquisition through sex if taken as directed. People with serious mental illness (eg, schizophrenia and bipolar disorder) are at high risk of acquiring HIV due to sexual behaviours, injection drug use, social factors, and structural discrimination that limits access to all types of preventive health services. We seek to show the importance of prioritising access to PrEP for people living with serious mental illness treated in community mental health settings. We describe barriers to prescribing PrEP, including provider attitudes and provider knowledge gaps, patient attitudes and knowledge, and systems issues. We also address the concerns that community mental health clinic administrators might have about taking on the responsibility of offering PrEP. In summary, despite the barriers to prescribing PrEP in these settings, we believe that there is a unique opportunity for community mental health settings to help address the HIV epidemic by facilitating the prescribing of PrEP to the at-risk populations they currently serve.

Adaptations and Innovations to Minimize Service Disruption for Patients with Severe Mental Illness during COVID-19: Perspectives and Reflections from an Assertive Community Psychiatry Program.

Changes to community psychiatry during COVID-19 are unprecedented and without clear guidelines. Minimizing disruption, ensuring quality care to the already vulnerable people with serious mental illness is crucial. We describe and reflect our adaptations and innovations at one community psychiatry program, based on three key principles. In (i) Defining and maintaining essential services while limiting risk of contagion, we discuss such strategies and ways to assess risks, implement infection control, and other creative solutions. In (ii) Promoting health and mitigating physical and mental health impacts, we reflect on prioritizing vulnerable patients, dealing with loss of community resources, adapting group programs, and providing psychoeducation, among others. In (iii) Promoting staff resilience and wellness, we describe building on strength of the staff early, addressing staff morale and avoiding moral injury, and valuing responsive leadership. We also identify limitations and potential further improvements, mindful that COVID-19 and similar crises are likely recurring realities.

Implementing COVID-19 Mitigation in the Community Mental Health Setting: March 2020 and Lessons Learned.

In March 2020, at the beginning of the COVID-19 pandemic, state-funded community mental health service programs (CMHSP) in Michigan, organized into 10 regions known as a "Prepaid Inpatient Health Plan" (PIHP), grappled with the task of developing a modified plan of operations, while complying with mitigation and social distancing guidelines. With the premise that psychiatric care is essential healthcare, a panel of physician and non-physician leaders representing Region 5, met and developed recommendations, and feedback iteratively, using an adaptive modified Delphi methodology. This facilitated the development of a service and patient prioritization document to triage and to deliver behavioral health services in 21 counties which comprised Region 5 PIHP. Our procedures were organized around the principles of mitigation and contingency management, like physical health service delivery paradigms. The purpose of this manuscript is to share region 5 PIHP's response; a process which has allowed continuity of care during these unprecedented times.

Gastos com internações psiquiátricas no estado de São Paulo: estudo ecológico descritivo, 2014 e 2019 / Gasto en hospitalizaciones psiquiátricas en el estado de São Paulo, Brasil: estudio ecológico descriptivo, 2014 y 2019 / Expenditure on psychiatric hospitalizations in the State of São Paulo, Brazil: a descriptive ecological study, 2014 and 2019

Objetivo: Analisar os gastos com internações psiquiátricas no estado de São Paulo, Brasil, nos anos de 2014 e 2019. Métodos: Estudo ecológico descritivo, com análise de dados das internações hospitalares psiquiátricas no estado, obtidos do Sistema de Informações Hospitalares do Sistema Único de Saúde. Resultados: Foram analisadas 115.652 internações ocorridas em 2014, e 79.355 em 2019 (redução de 31,38%). Observaram-se reduções nos valores gastos com internações psiquiátricas (-42,94%), destacando-se as internações de caráter de urgência, de pessoas do sexo feminino (-46,46%), nas idades de 15 a 49 (-36,85%) e mais de 50 anos (-51,54%). Conclusão: As reduções de frequência e de valores gastos com internações psiquiátricas fornecem elementos para a avaliação e alocação de recursos destinados à atenção da saúde mental, no âmbito das internações hospitalares e da utilização de serviços de base comunitária.

Objetivo: Analizar el gasto en hospitalizaciones psiquiátricas en el Estado de São Paulo, Brasil, en los años 2014 y 2019. Métodos: Estudio ecológico descriptivo, con análisis de datos de ingresos hospitalarios psiquiátricos en el Estado de São Paulo, obtenidos del Sistema de Información Hospitalaria del Sistema Único de Salud. Resultados: Se analizaron 115,652 hospitalizaciones ocurridas en 2014 y 79,355 ocurridas en 2019 (reducción del 31.38%). Hubo reducciones en los montos gastados en hospitalizaciones psiquiátricas (-42,94%), con énfasis en hospitalizaciones de urgencia, de pacientes del sexo femenino (-46,46%), en los grupos de edad de 15 a 49 años (-36,85%) y mayores de 50 años (-51,54%). Conclusión: Las reducciones en la frecuencia y los montos gastados en hospitalizaciones psiquiátricas proporcionan elementos para la evaluación y asignación de recursos para la atención de la salud mental, dentro del alcance de las admisiones hospitalarias y el uso de servicios comunitarios.

Objective: To analyze expenditure on psychiatric hospitalizations in the State of São Paulo in 2014 and 2019. Methods: This was a descriptive ecological study, with analysis of data on psychiatric hospital admissions in the State of São Paulo, retrieved from the Hospital Information System. Results: 115,652 hospitalizations that occurred in 2014 and 79,355 that occurred in 2019 were analyzed (reduction of 31.38%). There were reductions in the amounts spent on psychiatric hospitalizations (-42.94%), in particular expenditure on urgency hospitalizations, on female patients (-46.46%), on people aged 15-49 years (-36.85%) and on those aged over 50 years (-51.54%). Conclusion: The reduction in expenditure on psychiatric hospitalizations and the reduction in their frequency provide elements for the assessment and allocation of resources for mental health care, within the scope of hospital admissions and use of community-based services.

[Qualitative Evaluation of the Implementation of Group Psychoeducation for Bipolar Disorder in Clinical Settings in Quebec]. / Évaluation qualitative de l'implantation de groupes psychoéducatifs pour le trouble bipolaire à Québec.

Objectives Bipolar disorder is a chronic condition which significantly impacts the functioning and quality of life of patients with the disorder. Recognized efficacious psychological interventions, such as group psychoeducation, can help better address some of the limitations observed when pharmacotherapy is used alone in the management of bipolar disorder. However, access to these evidence-based interventions seems to be limited for most patients. Indeed, the translation of knowledge acquired through research towards actual clinical settings poses a significant challenge. Assessing the implementation of these efficacious interventions in clinical practice is thus a priority. The objective of this study is to describe the implementation of a psychoeducative intervention, the Life Goals Program (LGP), for the treatment of bipolar disorder in community mental health settings in Quebec City. Methods The LGP was implemented in three different clinical settings located in Quebec City. Fifteen healthcare service providers chosen by their respective clinical site were trained to deliver the intervention. They delivered the treatment to 73 patients with a diagnosis of bipolar disorder. Healthcare service providers filled a log book after each group session, in order to assess whether they had properly delivered the content of the program. At the end of the study, they also participated in a group interview in order to get a better understanding of their experience delivering the intervention and their appreciation of the research process. Results Following qualitative content analysis, four main categories of factors that could influence the implementation of the intervention were identified: 1) healthcare service providers' characteristics (academic training, clinical experience, personality, knowledge of the program, and dynamic between animators); 2) participants' characteristics; 3) organizational context (physical and material environment, staff stability, administrative management and research requirements); and 4) facilitation (perception of research, research team support, and facilitation tools). These categories derived from data analysis coincide with those observed in the literature. The following factors seemed to have had the most impact in the differences observed between sites in the implementation of the LGP: the support offered by the research team; staff stability; and the academic training of healthcare services providers. Conclusion Dissemination and implantation studies can not only help determine factors that are important to consider when implementing a program, but can also help improve and adapt these programs in order to increase acceptability and effectiveness in real world clinical settings.

El terapeuta ocupacional como acompañante terapéutico en el ámbito de la salud mental comunitaria / No disponible

Lo que se explica en este artículo, corresponde a una visión concreta de lo que significa el acompañamiento a personas con una enfermedad mental severa. Esta visión y orientación está basada en la teoría psicodinámica. Se ha teorizado una manera de trabajar específica del terapeuta ocupacional dentro de la atención comunitaria en el ámbito de la salud mental. La intervención domiciliaria que se hace desde la Terapia Ocupacional como acompañante terapéutico está basada en el uso terapéutico del vínculo entre terapeuta y persona, y entre la persona y su comunidad. Dándole a la persona un lugar de protagonismo en la intervención, fomentando la autonomía, la responsabilidad y la creación de un proyecto de vida saludable. Respecto al terapeuta como profesional, se analiza las dificultades con las que se puede encontrar a nivel emocional con la persona a la cual atiende desde una perspectiva transferencial y contratransferencial. Así como la utilidad del uso terapéutico del encuadre que proporciona a la persona coherencia, seguridad y límites

What is explained in this article corresponds to a precise vision of what it means to accompany people with severe mental illness. This view is base on psychodynamic theory. A specific Occupational Therapy way of working in a mental health community setting has been theorized. Home interventions carried out from Occupational Therapy as a therapeutic companion are based on the therapeutic use of the bond between the professional and the person, and between the professional and the community. Offering the client a leading role in the intervention, promoting autonomy, responsibility and the possibility to create a healthy life project. Regarding the therapist as a professional, the emotional issues that may appear, both at a transferential and countertransference level are analysed. As well as the benefits of using a therapeutic setting which offers the client coherence, security and limits

La continuidad asistencial en el daño cerebral adquirido: programa de terapia ocupacional comunitaria en salud mental para personas con daño cerebral adquirido y sus familias / No disponible

El daño cerebral adquirido ocasiona frecuentemente dificultades físicas, cognitivas y sociales que generan deprivación ocupacional. Un gran número de personas afectadas manifiestan alteraciones conductuales y emocionales, ya sea a causa de trastornos mentales previos, del manejo de la situación o por la aparición de un trastorno neurocognitivo posterior u otros asociados. Desde el equipo EASE del Institut Guttmann, se implementa un programa de intervención domiciliaria, con una perspectiva comunitaria en salud mental y daño cerebral adquirido, con el objetivo de favorecer la mejora de la calidad de vida y de la participación ocupacional de las personas con daño cerebral adquirido y sus familias

Acquired brain injury often causes physical, cognitive and social difficulties that lead to occupational deprivation. A great number of affected people show behavioral and emotional disorders, either because of previous psychiatric problems, coping with the situation, or because of the appearance of a later neurocognitive disorder or other associates. From the Institut Guttmann's EASE team, a program of home intervention is developed, with a community perspective in mental health and acquired brain injury. The aim is the improvement of the quality of life and occupational participation of people with acquired brain injury and their families

Implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP): protocol for a cluster randomised controlled trial.

BACKGROUND: Family involvement for persons with psychotic disorders is under-implemented in mental health care, despite its firm scientific, economic, legal and moral basis. This appears to be the case in Norway, despite the presence of national guidelines providing both general recommendations on family involvement and support in the health- and care services, and specific guidance on family interventions for patients with psychotic disorders. The aim of this project is to improve mental health services and the psychosocial health of persons with psychotic disorders and their relatives, by implementing selected recommendations from the national guidelines in community mental health centres, and to evaluate this process. METHODS: The trial is cluster randomised, where 14 outpatient clusters from community mental health centres undergo stratified randomisation with an allocation ratio of 1:1. The seven intervention clusters will receive implementation support for 18 months, whereas the control clusters will receive the same support after this implementation period. The intervention consists of: 1. A basic level of family involvement and support. 2. Family psychoeducation in single-family groups. 3. Training and guidance of health care personnel. 4. A family coordinator and 5. Other implementation measures. Fidelity to the intervention will be measured four times in the intervention arm and two times in the control arm, and the differences in fidelity changes between the arms constitute the primary outcomes. In each arm, we aim to include 161 patients with psychotic disorders and their closest relative to fill in questionnaires at inclusion, 6 months and 12 months, measuring psychosocial health and satisfaction with services. Clinicians will contribute clinical data about patients at inclusion and 12 months. Use of health and welfare services and work participation, for both patients and relatives, will be retrieved from national registries. We will also perform qualitative interviews with patients, relatives, health care personnel and leaders. Finally, we will conduct a cost-effectiveness analysis and a political economy analysis. DISCUSSION: This project, with its multilevel and mixed methods approach, may contribute valuable knowledge to the fields of family involvement, mental health service research and implementation science. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.

Organizational structure, climate, and collaboration between juvenile justice and community mental health centers: implications for evidence-based practice implementation for adolescent substance use disorder treatment.

BACKGROUND: Substance use disorders are prevalent among youth involved with the criminal justice system, however, evidence-based substance use disorder treatment is often unavailable to this population. The goal of this study was to identify barriers to effective implementation of evidence-based practices among juvenile justice and community mental health organizations through the lens of an adopter-based innovation model. METHODS: In this mixed-methods study, qualitative interviews were conducted with n = 15 juvenile justice staff and n = 14 community mental health staff from two counties implementing substance use services for justice involved youth. In addition, n = 28 juvenile justice staff and n = 85 community mental health center staff also completed quantitative measures of organizational effectiveness including the implementation leadership scale (ILS), organizational readiness for change (ORIC), and the implementation climate scale (ICS). RESULTS: Organizationally, staff from community mental health centers reported more "red tape" and formalized procedures around daily processes, while many juvenile justice staff reported a high degree of autonomy. Community mental health respondents also reported broad concern about their capacity for providing new interventions. Staff across the two different organizations expressed support for evidence-based practices, agreed with the importance of treating substance use disorders in this population, and were enthusiastic about implementing the interventions. CONCLUSIONS: While both community mental health and juvenile justice staff express commitment to implementing evidence-based practices, systems-level changes are needed to increase capacity for providing evidence-based services.

Establishing an occupational therapy assessment clinic in a public mental health service: A pragmatic mixed methods evaluation of feasibility, utilisation, and impact.

INTRODUCTION: Employment of occupational therapists in generic roles in public mental health services (PMHSs) constrains capacity to undertake discipline-specific activity meaning consumers may be unable to access valuable occupational therapy assessments and interventions that could promote recovery. Establishing a dedicated occupational therapy clinic has been identified as one way of improving care provided and outcomes for organisations, therapists, and consumers. To inform such developments, this paper reports evaluation of feasibility, acceptability, and sustainability of a pilot clinic established within a PMHS. METHODS: An observational evaluation was used combining quantitative and qualitative data collected from service documents, clinic records, and in semi-structured interviews with 42 stakeholders. Quantitative data were used to describe referrals and flow through the clinic. Framework analysis of qualitative data examined the process and outcomes of referrals and enabled understanding of acceptability, perceived impact and areas for improvement. RESULTS: Substantial ground work, particularly stakeholder engagement, and redistribution of resources enabled establishment and successful operation of an assessment clinic for 12 months. Assessments were completed for 68% of the 100 accepted referrals, with the remainder in process or unable to be completed. Stakeholders agreed that the clinic enabled clinicians' timely access to specialist assessment, improving care for consumers. Occupational therapists valued the opportunity to deploy and develop discipline-specific skills and when there was some impact on work flow of occupational therapists' 'home teams', team managers judged the investment worthwhile. Strong leadership by the discipline lead and support from team managers who enabled allocation of occupational therapists to the clinic were critical to success. CONCLUSION: An occupational therapy assessment clinic can be established and operate successfully within a public mental health setting. Redistribution of resources supported increased efficiency and consumer access to specialist interventions that support their recovery.

A Systematic Review of Organizational and Workforce Interventions to Improve the Culture and Climate of Youth-Service Settings.

Both organizational culture and climate are associated with service quality and outcomes across youth-service settings. Increasing evidence indicates capacity of organizational interventions to promote a positive and effective culture and climate. Less is known about common intervention components across studies and service settings. The current systematic review reviewed 9223 citations and identified 31 studies, across six youth-service settings, measuring changes over time in organizational culture and climate following implementation of an organizational or workforce support intervention. Results highlight the promise of organizational interventions, a need for more comparison and randomized designs, and future directions for maximizing capacity of organizations to promote health for frontline providers and the children they serve.

Experiencia en la atención comunitaria en psicogeriatría. centro de salud mental de adultos / No disponible

INTRODUCCIÓN: Se reflexiona en torno a la evolución de la actividad asistencial realizada en un CSMA, vinculada a la población anciana, desde la perspectiva comunitaria y tras levantar la mirada de la atención asistencial directa para observar, en el sector de la atención primaria, cuáles son las tendencias demográficas en relación al envejecimiento de su censo por municipios y cuál es el impacto al implementar un recurso desde la especializada. DESARROLLO: Se analiza el período comprendido entre 2007 y 2018 con el objetivo de valorar los resultados en la atención de la población mayor de 65 a., en el sector del "Baix Llobregat Nord", tras la instauración del Programa de Soporte de la especializada a la atención primaria añadiendo mejora en la formación y capacitación de los profesionales. Se revisa volumen atendido y vinculado a su CSMA de referencia, influencia en la detección y prevalencias de diagnósticos así como en la evolución de la contención de casos derivados al recurso especializado. CONCLUSIÓN: El análisis de la población anciana de referencia por franjas de edad entre los 65 y más de 80 a. nos per-mite anticipar tendencias y liderar posibles actuaciones estratégicas acordes con nuestro sector o territorio

INTRODUCTION: It reflects in the evolution of the assistance activity carried out in a CSMA, linked to the elderly population, from a community perspective and after looking up direct care to observe, in the primary care sector, what are the demographic trends in relation to the aging of its municipal census and what is the impact of implementing a resource from the specialized. DEVELOPMENT: The period between 2007 and 2018 is analyzed with the aim of assessing the results in the care on the population over 65 years of age in the sector of the "Baix Llobregat Nord", following the establishment of the specialized support programme for primary care by adding improvement in the education and training of professionals. Volume is reviewed atended and linked to its reference CSMA, influence on the detection and prevalence of diagnostics as well as the evolution of the containment of cases derived from the specialized resource. CONCLUSIONS: The analysis of the elderly reference population by age ranges between 65 and more than 80 years old allows us to anticipate trends and lead possible strategic actions in line with our sector or territory

Todo está en el mapa: Atlas Integrales de Salud Mental para la planificación de servicios. Informe SESPAS 2020 / Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020

OBJETIVO: Este artículo revisa y evalúa el uso de los Atlas Integrales de Salud Mental como herramientas de apoyo a la planificación de servicios dentro del modelo de investigación de ecosistemas de atención de salud. MÉTODO: Se describen los tipos de atlas y el procedimiento para su elaboración. Se presentan los realizados en España y se evalúa su impacto en la planificación de servicios de salud mental. Los atlas agregan información sobre las características locales del sistema de atención, la disponibilidad geográfica de recursos recogida mediante el instrumento DESDE-LTC, y su uso. Utilizan un sistema de información geográfica y otras herramientas visuales. Siguen una metodología de abajo arriba con colaboración de personas decisoras de agencias de planificación para su elaboración y validación externa. RESULTADOS: Desde 2005 se han realizado Atlas Integrales de Salud Mental en nueve comunidades autónomas que comprenden alrededor del 65% de la población de España. Los atlas han tenido un impacto desigual en la planificación de servicios, con un mayor impacto en Cataluña, Vizcaya y Guipúzcoa, y Andalucía, donde responsables sociales han participado activamente en su codiseño y su aplicación a la planificación de servicios sociosanitarios. CONCLUSIONES: Los atlas permiten detectar carencias o duplicidades en la atención, monitorizar cambios a lo largo del tiempo, realizar comparaciones nacionales e internacionales, modelar la eficiencia y hacer análisis benchmark. Este conocimiento puede incorporarse a los sistemas de apoyo a la decisión para una más eficaz planificación de los servicios de salud mental basada en evidencia informada

OBJECTIVE: This article reviews the usability of the Integrated Atlases of Mental Health as a decision support tool for service planning following a health ecosystem research approach. METHOD: This study describes the types of atlases and the procedure for their development. Atlases carried out in Spain are presented and their impact in mental health service planning is assessed. Atlases comprise information on the local characteristics of the health care system, geographical availability of resources collected with the DESDE-LTC instrument and their use. Atlases use geographic information systems and other visualisation tools. Atlases follow a bottom-up collaborative approach involving decision-makers from planning agencies for their development and external validation. RESULTS: Since 2005, Integrated Atlases of Mental Health have been developed for nine regions in Spain comprising over 65% of the Spanish inhabitants. The impact on service planning has been unequal for the different regions. Catalonia, Biscay and Gipuzkoa, and Andalusia reach the highest impact. In these areas, health advisors have been actively involved in their co-design and implementation in service planning. CONCLUSIONS: Atlases allow detecting care gaps and duplications in care provision; monitoring changes of the system over time, and carrying out national and international comparisons, efficiency modelling and benchmarking. The knowledge provided by atlases could be incorporated to decision support systems in order to support an efficient mental health service planning based on evidence-informed policy

Vida comunitaria para todas: salud mental, participación y autonomía. Informe SESPAS 2020 / Community life for all: mental health, participation and autonomy. SESPAS Report 2020

El objetivo de este artículo es realizar una reflexión crítica sobre la participación de las personas con un diagnóstico de trastorno mental en la comunidad desde una perspectiva de derechos y de construcción comunitaria de espacios colectivos. En la primera parte se realiza una revisión sobre conceptos básicos como salud mental comunitaria y el significado de participación, entendida como un fin y no como un medio. Se plantea la necesidad de aumentar la participación en espacios comunitarios más allá del circuito clásico de atención a la salud mental, procesos que implican crear y compartir conocimiento de manera colectiva, horizontal y consensuada entre todas las personas implicadas, en especial las propias personas diagnosticadas. En la segunda parte se presenta, como ejemplo, el grupo de mujeres de Radio Nikosia, narrado en primera persona por las propias participantes. Los aspectos destacados del grupo son su horizontalidad, flexibilidad y autoorganización en un espacio fuera del sistema sanitario donde es posible expresarse sin miedo a ser juzgadas. En este grupo se generan procesos de confianza, reconocimiento, alegría, apoyo social y salud. El grupo se reúne quincenalmente y reflexiona sobre diferentes temas escogidos. También se plantean acciones políticas por los propios derechos de las mujeres, como la participación en medios de comunicación, convocatorias feministas, formaciones y charlas. Se ejemplifica que otras formas de hacer salud mental comunitaria son posibles. Los retos son visibilizarlas, sistematizarlas y poder valorar el impacto que tienen en la salud de las personas y la comunidad

The objective of this article is to critically reflect on the participation in community of people with a diagnosis of mental disorder from a human rights and community health perspective. Firstly, we review basic concepts such as community mental health and the meaning of participation, which is understood as an end and not as a mean. It is important to increase the participation of people with a diagnosis in community spaces beyond the classic circuit of mental health care. This implies to create and share knowledge in a collective, horizontal and consensual way among all the people involved, especially the diagnosed people themselves. Secondly, the experience of the group of women of Radio Nikosia is narrated in first person by the participants themselves. The main highlights of the group are its horizontality, flexibility, and that is a self-organized space outside the health system where it is possible to express oneself without fear of being judged. Processes of trust, recognition, joy, social support and health are generated. Members of the group meet fortnightly and discuss on different topics chosen by them, and take part in political actions for women's own rights such as participation in the media, in feminist calls, in training and talks. We exemplify that other ways of doing community mental health are possible. The challenges are to make them visible, to systemize them and to be able to assess the impact they have on the health not only of the participants, but also the community

Evolución y estado del modelo comunitario de atención a la salud mental. Informe SESPAS 2020 / Evolution and status of the community model of mental health care. SESPAS Report 2020

La transición legislativa e ideológica producida en los últimos años en España ha favorecido el desarrollo del modelo comunitario de atención a la salud mental. No obstante, aún persiste una fuerte resistencia a la inclusión de abordajes comunitarios en la atención de las personas con problemas de salud mental y a la implementación de una atención y unos cuidados integrados de enfoque salutogénico. El propósito del siguiente artículo es describir la evolución del modelo comunitario de atención a la salud mental en el sistema nacional de salud español y evaluar su estado actual. Inicialmente se realizó una revisión de los planes y estrategias de salud mental nacional publicados y luego se evaluaron tomando como referencia el Documento de consenso sobre los principios fundamentales y elementos clave de la salud mental comunitaria, que establece los criterios de valoración de la calidad de la atención comunitaria. Ante la falta de planes o estrategias actualizados, se incluyeron informes y recomendaciones internacionales. Los resultados se agruparon en: 1) perspectiva social, en la que se evidencia la controversia sobre la capacidad de las personas usuarias para tomar decisiones a pesar del reconocimiento de sus derechos como agentes morales autónomos; 2) perspectiva de la centralidad de las personas usuarias de los servicios de atención a la salud mental, en la que se plasma la resistencia a la implementación de una atención y unos cuidados comunitarios integrados; y 3) perspectiva profesional en relación con la efectividad de las intervenciones y la red comunitaria de principios de atención, que señala la necesidad de transformar las instituciones para realizar intervenciones comunitarias en salud mental basadas en la evidencia y de manera intersectorial, integral, integrada e integradora

The legislative and ideological transition produced in recent years in Spain has favoured the implementation of the community model of mental health care. However, there is still strong resistance to the inclusion of community approaches in the care of people with mental health problems and to the implementation of integrated care and attention with a salutogenic approach. The purpose of the following report is to describe the evolution of the community model of mental health care in the Spanish National Health System and to assess its current status. Initially, a review of the published national mental health plans and strategies was carried out. Subsequently, the evaluation was carried out taking as reference the Consensus Document on the Fundamental Principles and Key Elements of Community Mental Health, which establishes the criteria for evaluating the quality of community care. In the absence of updated plans or strategies, international reports and recommendations were included. The results were grouped into: 1) social perspective, where the controversy about the capacity of the users to make decisions despite the recognition of their rights as autonomous moral agents is evident; 2) perspective of the centrality of the users of mental health care services, where the resistance to the implementation of integrated community care and attention is expressed; and 3) professional perspective in relation to the effectiveness of the interventions and the community network of care principles, which highlights the need to transform the institutions to carry out community interventions in mental health based on evidence and in an intersectoral, comprehensive, integrated and integrating manner

A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center.

The US government funds integrated care demonstration projects to decrease health disparities for individuals with serious mental illness. Drawing on the Exploration Preparation Implementation Sustainability (EPIS) implementation framework, this case study of a community mental health clinic describes implementation barriers and sustainability challenges with grant-funded integrated care. Findings demonstrate that integrated care practices evolve during implementation and the following factors influenced sustainability: workforce rigidity, intervention clarity, policy and funding congruence between the agency and state/federal regulations, on-going support and training in practice application, and professional institutions. Implementation strategies for primary care integration within CMHCs include creating a flexible workforce, shared definition of integrated care, policy and funding congruence, and on-going support and training.