De la lectura de lo contingente a la invención: Talleres del Equipo de Niñxs Turno Tarde

Escrito colectivo de quienes forman parte del equipo de Niños Turno Tarde del Centro de Salud Mental N°1, del Gobierno de la Ciudad de Buenos Aires, que pretende transmitir cómo se fue transformando su práctica a partir de la creación de distintos dispositivos de taller, que surgieron como respuesta a la lectura de la contingencia clínica desde su orientación psicoanalítica.Quienes hacen psicoanálisis con niños saben que la infancia es hablada por otros discursos: la familia, la escuela, la medicina, etc. A la consulta suelen llegar traídos por la preocupación de otros, pocas veces por una demanda propia. Como posición ética en el equipo se detienen a evaluar de qué se trata en cada caso. ¿Quién sufre, quién se queja, dónde está alojado el sufrimiento?. (AU)

Taller de radio: una experiencia a viva voz

El presente trabajo tiene como objetivo realizar un análisis y dar cuenta de las distintas actividades e intervenciones desplegadas en el taller de radio perteneciente al dispositivo de hospital de día. Para tal fin se utilizan fragmentos de la obra de Freud y Lacan, así como aportes de autores contemporáneos para llevar adelante una articulación teórico-clínica. La elección del taller como eje del trabajo se debe a la idea de repensar la práctica cotidiana y la posición de los profesionales dentro del dispositivo. (AU)

Supply factors as determinants of treatment costs: clinicians' assessments of a given set of referrals to community mental health centers in Norway.

BACKGROUND: Previous works that uses patterns of prior spending to predict future mental health care expenses (utilization models) are mainly concerned with demand (need) variables. In this paper, we introduce supply variables, both individual rater variables and center variables. The aim is to assess these variables' explanatory power, and to investigate whether not accounting for such variables could create biased estimates for the effects of need variables. METHODS: We employed an observational study design where the same set of referrals was assessed by a sample of clinicians, thus creating data with a panel structure being particularly relevant for analyzing supply factors. The referrals were obtained from Norwegian Community Mental Health Centers (outpatient services), and the clinicians assessed the referrals with respect to recommended treatment costs and health status. RESULTS: Supply variables accounted for more than 10% of the total variation and about one third of the explained variation. Two groups of supply variables, individual rater variables and center variables (institutions) were equally important. CONCLUSIONS: Our results confirm that supply factors are important but ignoring such variables, when analyzing demand variables, do not generally seem to produce biased (confounded) coefficients.

Lessons from an evaluation of major change in adult mental health services: effects on quality.

BACKGROUND: The move from inpatient to community services in mental health has sparked debate internationally but the evidence base for successful service models is sparse. AIM: To evaluate the impact of bed reduction on quality of services when accompanied by redesign of community services. METHODS: Qualitative and quantitative data were collected 6 months before and 6 months after the redesign was implemented. RESULTS: Bed numbers reduced by 35%. Number of admissions and occupied bed days (OBD) reduced; bed occupancy and proportion of detained patients increased. Access to community services improved but quality of assessments did not. Transitions across pathways were rated as difficult by clinicians. There was an overall reduction in staff numbers; staff sickness levels and dissatisfaction with working conditions increased. Service users were generally positive about the redesign but GPs and staff were not. CONCLUSIONS: Multi-faceted evaluation of change in cost-pressured services is feasible and should guide developments to minimise negative effects on quality of care.

Salud mental y programa de servicio de ayuda a domicilio de los servicios sociales de base. Pivotando sobre la rehabilitación / No disponible

El trabajo en el medio de la persona, en ocasiones se convierte imprescindible para alcanzar logros significativos en el proceso de rehabilitación, pero comprometerlos recursos del entorno es clave para alcanzar una plena inclusión de las personas con las que trabajamos. Así surgieron los inicios del trabajo junto al Servicio de Ayuda a Domicilio de los entes locales de nuestra área de actuación. Posteriormente, tras la estela de la confianza y la eficacia demostrada de los tratamientos en el Centro de Rehabilitación Psicosocial de Badajoz, se consideró que, una formación específica en materia de salud mental hacia las auxiliares que trabajan en los Servicios de Ayuda a Domicilio de los Servicios Sociales de Base sería clave para promover la eficacia de estos servicios con la población con dificultades derivadas de una enfermedad mental, disminuyendo el fracaso de estos apoyos, lo que en muchas ocasiones aumenta el estigma hacia la enfermedad mental y, por otro lado, aumenta el deterioro y la utilización de recursos más invasivos y específicos, como por ejemplo los recursos residenciales. De esta forma, se ha desarrollado un programa formativo cuya implantación y evaluación han arrojado datos significativamente positivos y esperanzadores que afianzan la atención de las dificultades de salud mental a través de recursos comunitarios normalizados (AU)

The work in the middle of the people sometimes becomes necessary to achieve significant progress in the rehabilitation process, but commit the resources of the environment is key to achieve full inclusion of people with whom we work. Thus arose the early work by the home help service in local authorities in our area of operation. Later, in the wake of the trust and the proven efficacy of the treatments in the Psychosocial Rehabilitation Center Badajoz, it was considered that specific training in mental health to the aides who work in Home Care Services Basic Social Services would be key to promote the effectiveness of these services to the population with difficulties arising from a mental illness, reducing the failure of this support, which in many cases increases the stigma towards mental illness and on the other hand, increases the degradation and the use of more invasive and specific resources, such as residential resources. Thus, it has developed a training program whose implementation and evaluation data have yielded significant positive and hopeful that secure the attention of mental health difficulties through standardized community resources (AU)

[Early recognition centers for mental disorders - a complementary supply in the german health system]. / Früherkennungszentren für psychische Erkrankungen - ein Komplementärangebot der psychiatrischen Regelversorgung in Deutschland.

OBJECTIVE: Mental disorders are identified and treated too late, because of stigma, deficient information in the population and lack of specific supply in the public health systems. Another problem is the deficient cooperation between psychiatry and child psychiatry. Therefore early recognition centers were founded, in Germany primarily with focus on psychosis and in research settings. METHODS: The early recognition center in Dresden offers a low-threshold and anonym service for young people independent of diagnosis. The multiprofessional team including psychologists, psychiatrists and child psychiatrists applies defined standards. In addition to standard history taking and formally assessing psychopathology, early recognition instruments for psychosis and bipolar disorders are used as appropriate. RESULTS: In 167 out of 192 individuals a structured diagnostic procedure was recommended, 149 persons (89 %) completed the procedure. Thereof 78 (52 %) persons fulfilled criteria for one, 21 (14 %) persons for two and 10 (7 %) persons for three mental disorders. 49 (33 %) persons fulfilled criteria for (Ultra)high risk for psychosis and/or bipolar disorders. CONCLUSIONS: In the majority of cases diagnostic criteria for at least one mental illness was already fulfilled. All diagnosis and stages from prodromal till chronic were represented. The high percentage of subjects fulfilling criteria for (ultra)high risk-constellations offers the chance for early interventions. The implementation of early detection centers for psychiatric disorders seems reasonable and necessary.

The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S.

Racial and ethnic disparities in mental health care access in the United States are well documented. Prior studies highlight the importance of individual and community factors such as health insurance coverage, language and cultural barriers, and socioeconomic differences, though these factors fail to explain the extent of measured disparities. A critical factor in mental health care access is a local area's organization and supply of mental health care providers. However, it is unclear how geographic differences in provider organization and supply impact racial/ethnic disparities. The present study is the first analysis of a nationally representative U.S. sample to identify contextual factors (county-level provider organization and supply, as well as socioeconomic characteristics) associated with use of mental health care services and how these factors differ across racial/ethnic groups. Hierarchical logistic models were used to examine racial/ethnic differences in the association of county-level provider organization (health maintenance organization (HMO) penetration) and supply (density of specialty mental health providers and existence of a community mental health center) with any use of mental health services and specialty mental health services. Models controlled for individual- and county-level socio-demographic and mental health characteristics. Increased county-level supply of mental health care providers was significantly associated with greater use of any mental health services and any specialty care, and these positive associations were greater for Latinos and African-Americans compared to non-Latino Whites. Expanding the mental health care workforce holds promise for reducing racial/ethnic disparities in mental health care access. Policymakers should consider that increasing the management of mental health care may not only decrease expenditures, but also provide a potential lever for reducing mental health care disparities between social groups.

Improving territorial accessibility of mental health services: The case of Spain

Background and Objectives: Citizens choose their health care services not only depending on their needs, but also on where they are located. The location of the services is especially important in the case of mental health due to the specific features of mental disorders. This article provides an analysis of temporal access by road to outpatient mental health centres in Andalusia (Spain) with a view to improving accessibility for the greatest volume of population possible. Methods: Firstly, accessibility by road to the outpatient mental health centres was calculated in terms of time by establishing journey times using the ArcGIS Geographical Information System's (GIS) Network Analyst module. These journey times by road enabled travel times to be established for these sections, temporal accessibility areas to be plotted from each of the outpatient mental health centres and the number of people included in each accessibility area to be calculated. Results: The accessibility analysis enabled the sitting of the centres to be evaluated for 2006, a comparison to be made with 2011 (with six new facilities having been set up since 2006) and new locations for the siting of these six new facilities to be proposed. Conclusions: This study has enabled the optimum territorial locations to be proposed for the six mental health centres created between 2006 and 2011 that would allow travel times to be reduced for the greatest numbers of people possible. It can be stated on the basis of this study that, if territorial criteria had been taken into account, 97,720 inhabitants would have seen their travel times to their nearest mental health centres reduced using the same resources (AU)

Money, case complexity, and wait lists: perspectives on problems and solutions at children's mental health centers in Ontario.

Senior managers of children's mental health centers across Ontario, Canada were interviewed regarding the challenges and solutions of access and delivery of care. The central challenges--funding, case complexity, waitlists, staffing, and system integration--revealed a complex interplay between the policies and financing of children's mental health services and the provision of clinical services at the agency level and within the community. The desire for integration and collaboration was countered by competition for funding and service demands. A need for policies that allow for local solutions while providing leadership for sustained improvements in the ease and timeliness of access to care and effective clinical services emerged.

Organizational capacity needs of consumer-run organizations.

Consumer-run organizations (CROs) are self-help oriented organizations that are run entirely by consumers (people who use or have used mental health services). The current study utilizes an organizational capacity framework to explore the needs of operating CROs. This framework includes four core capacity areas: (1) technical, (2) management, (3) leadership, and (4) adaptive capacity. An analysis reveals that the greatest organizational needs are related to technical and management capacities. Implications are discussed in terms of strategies and activities that CRO leaders and mental health professionals and administrators can use to strengthen the organizational capacity of CROs in their community.

Stressed out.

With mental health services shrinking, emergency departments are deluged by patients they were never designed to handle."The safety net for these poor people is unraveling," says Alicia Boccellari of San Francisco General Hospital. Her hospital and several others are confronting the crisis with little help from the government or private insurers.

Differential access to quality rural healthcare: professional and policy challenges.

Using a national dataset, the influence of the community and individual provider characteristics on the availability of healthcare resources in rural areas was evaluated. Disparities continue to exist in the availability of providers including organizational types of providers such as Community Health Centers and Community Mental Health Centers. A lower percentage of nonmetropolitan counties have such centers, and more rural counties within the general grouping of nonmetropolitan counties have fewer of these organizational resources. A case study on the Southwestern region of Virginia is presented to highlight the impact on health outcomes and an innovative community response to the lack of availability of needed healthcare services.

[Facilities offered by community-oriented professional rehabilitation centres for mentally challenged persons in the Federal Republic of Germany]. / Das Angebot an gemeindenahen beruflichen Rehabilitationsmöglichkeiten für psychisch kranke Menschen in der Bundesrepublik.

OBJECTIVE: Vocational rehabilitation is an important component of community-oriented mental health care. How is the situation of supply with vocational rehabilitation facilities in Germany offering their services to mentally challenged persons? METHOD: Search of a Germany-wide rehabilitation database, supplemented by information from the Federal Working Groups on Vocational Rehabilitation. Cartographical classification of the identified facilities. Analysis of the results in a comparison of the situation in the 16 German States (Länder). RESULTS: The Länder of North Rhine Westphalia, Bavaria, Baden-Wuerttemberg and Lower Saxony offer the greatest number of vocational rehabilitation facilities to mentally challenged persons. In all East German and in some of the West German Länder vocational rehabilitation facilities are restricted to some areas and to certain vocational preconditions. Many of the facilities in these areas are structured as centres and situated in rural areas. Hence, they lack community-orientation. Only North-Rhine Westphalia offers country-wide community-oriented vocational rehabilitation facilities to mentally challenged persons, which are not restricted to certain vocational preconditions. DISCUSSION AND CONCLUSIONS: The supply with vocational rehabilitation facilities for mentally challenged persons has improved during recent years. Nevertheless, the situation in many of the German Länder needs to be improved, particularly in respect of the availability of rehabilitation facilities for younger mentally challenged persons without prior working experience. The implementation of decentralised community-oriented facilities should be favoured in centres, especially in larger sparsely populated areas.

The impact of suicide prevention centers on the suicide rate in the Canadian provinces.

A study by Leenaars and Lester (1995) found that suicide prevention centers in the provinces of Canada in 1985 had a preventive, but nonsignificant, impact on the suicide rates of the provinces. The present study replicated that study for 1994-1998 and found a similar preventive impact, although weak, of suicide prevention centers on the provincial suicide rates.

The geography of mental health in Dunedin, New Zealand.

The process of deinstitutionalization of people with chronic mental disabilities in Western countries has often produced a spatial concentration of ex-psychiatric patients, and of mental health services, in inner city urban neighbourhoods. In this paper, the geography of mental health services and patients in Dunedin is examined, and it is shown that a concentration does exist in one neighbourhood. The history and characteristics of this neighbourhood are described. The key factors in contemporary New Zealand that have generated this spatial pattern are then considered, and Dunedin's centralized mental health geography is contrasted with the North American "zone of dependence" phenomenon. The paper concludes by considering to what extent Dunedin's emergent geography of mental health provides a supportive environment for people with mental illnesses, and exploring the policy implications for health care planners and service providers.