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1.
Psicol. ciênc. prof ; 39(2,n.esp): 74-86, ago.-nov. 2019.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1050374

RESUMO

Este artigo busca problematizar a noção de território na saúde mental por meio da experiência de trabalhadores, usuários e pesquisadores no município de Santa Maria-RS. Trabalhamos com pesquisa de documentos do campo da saúde e da saúde mental, buscando identificar o modo que a noção de território é apresentada nesses textos. Descrevemos e analisamos uma experiência desenvolvida por diversos atores sociais envolvidos na experiência ocorrida em Santa Maria, a partir de dois movimentos. O primeiro é o de usuários em direção à academia, e o segundo, o do cuidado em saúde do serviço de referência para além dos muros. A experiência de trânsito dos diferentes atores sociais em vivências de multiterritorialidades revelou-se um importante vetor de mudança subjetiva e institucional. Vimos em ambos a emergência de uma reivindicação por um direito mais extenso do que o simples acesso aos serviços públicos de saúde. Buscava-se também um "direito à cidade", ou mesmo um trânsito além dela. Enfim, uma busca pela ampliação da experiência de multiterritorialidade e as transformações decorrentes dela...(AU)


This article seeks to problematize the notion of territory in mental health through the experience of workers, users, and researchers in the field of mental health in the municipality of Santa Maria/RS. We work with the research of documents of the field of health and mental health, trying to identify the way that the notion of territory is presented in these texts. We describe and analyze an experience developed by several social actors involved in the experience that occurred in Santa Maria / RS, from two movements. The first is that of users towards academia, and the second is that of the health care of the referral service beyond the walls. The experience of transit of the different social actors in multi-territorial experiences has proved to be an important vector of subjective and institutional change. We have seen in both movements the emergence of a claim for a more extensive right than simple access to public health services. A "right to the city," or even a transit beyond it. Finally, a search for the amplification of the multi territoriality experience and the transformations arising from it...(AU)


Este artículo busca problematizar la noción de territorio en la salud mental por medio de la experiencia de trabajadores, usuarios e investigadores en el municipio de Santa Maria/RS. Trabajamos con la investigación de documentos del campo de la salud y de la salud mental, buscando identificar el modo que la noción de territorio es presentada en esos textos. Describimos y analizamos una experiencia desarrollada por diversos actores sociales involucrados en la experiencia ocurrida en Santa Maria/RS, a partir de dos movimientos. El primero es de los usuarios hacia la academia, y el segundo es del cuidado en salud del servicio de referencia más allá de los muros. La experiencia de tránsito de los diferentes actores sociales en vivencias de multiterritorialidades se ha revelado un importante vector de cambio subjetivo e institucional. Vimos en ambos la emergencia de una reivindicación por un derecho más extenso que el simple acceso a los servicios públicos de salud. Se buscaba también un "derecho a la ciudad", o incluso un tránsito más allá de ella. En fin, una búsqueda por la ampliación de la experiencia de multiterritorialidad, y las transformaciones resultantes de ella...(AU)


Assuntos
Humanos , Adulto , Política Pública , Territorialidade , Saúde Mental , Pessoalidade , Desinstitucionalização , Grupos Minoritários , Serviço Social , Serviços Comunitários de Saúde Mental , Funções Essenciais da Saúde Pública , Direitos Humanos
2.
Ghana Med J ; 53(2): 92-99, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31481804

RESUMO

Background: Over the past few decades, there has been an emphasis on the de-institutionalisation of psychiatric care with a focus on community care. With Quality of Life (QoL) as an outcome measure, this study compared the QoL of patients with schizophrenia attending a psychiatric hospital and a community psychiatric centre. Design: This was a cross-sectional study in two psychiatric facilities. Methods: Data were obtained through a socio-demographic and clinical questionnaire; the QoL was assessed with the WHOQOL-BREF and patient satisfaction with care with CPOSS. Total and domain scores of WHOQOL-BREF for each group were calculated and compared with each other and other group characteristics. Diagnosis of schizophrenia was based on ICD-10. Results: Participants from the two centres did not differ significantly on any of the socio-demographic characteristics measured. Similarly, there was no significant difference in their overall mean WHOQOL-BREF scores as well as the mean WHOQOL-BREF of domain scores. However, the married and females from both centres significantly had higher mean WHOQOL-BREF scores than their male counterparts. Patients in remission for more than two years or those on a single type of medication (either oral or depot preparation) from both centres significantly had higher mean WHOQOL-BREF score compared with those who had less than two years of remission or on both oral and depot preparations. Conclusion: Overall QoL of patients managed at the two centres was comparable, with similar socio-demographic as well as clinical variables influencing QoL. This suggests that patients with schizophrenia can be well managed at community psychiatric centres. Funding: None declared.


Assuntos
Centros Comunitários de Saúde Mental , Hospitais Psiquiátricos , Qualidade de Vida , Esquizofrenia , Adulto , Assistência Ambulatorial , Desinstitucionalização , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Adulto Jovem
3.
Disabil Health J ; 12(4): 712-717, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31262701

RESUMO

BACKGROUND: Legislation and court decisions in the United States mandate the right to least restrictive community living and participation for people with disabilities, yet little research has examined differences in participation across institutional and community settings, or over time in the community post-transition. OBJECTIVE: As part of a multi-site participatory action research project examining participation, we examined the differences in quality of life in institutional and community living environments among people with disabilities. METHODS: We conducted surveys with adults with disabilities between 18 and 65 years-old that transitioned from institutions to the community in the United States within the last five years. This paper reports on findings for a diverse sample of 150 participants. RESULTS: We found significant differences between ratings of institutional and community experiences, with increased reports of satisfaction, personal safety, service access, and participation in community settings. We also found significant improvements in community integration and inclusion after transition to community living, although barriers to transportation and activity access often remained. CONCLUSIONS: This study of insider experiences of previously institutionalized people with disabilities illuminates important understandings of community participation, integration, and quality of life for the disability community in the United States.


Assuntos
Participação da Comunidade , Pessoas com Deficiência , Habitação , Vida Independente , Institucionalização , Satisfação Pessoal , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desinstitucionalização , Feminino , Instalações de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Instituições Residenciais , Segurança , Inquéritos e Questionários , Transportes , Estados Unidos , Adulto Jovem
4.
Vínculo ; 16(1): 1-16, jan.-jun. 2019.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1014762

RESUMO

A história da atenção à saúde mental é marcada pela presença das instituições totais e existência de práticas que cerceavam direitos e reduziam a autonomia dos sujeitos. O advento da reforma psiquiátrica brasileira e da Luta Antimanicomial trouxeram várias mudanças no cenário de trabalho com o sujeito psicótico. À vista disso, o presente trabalho tem por objetivo discutir como têm ocorrido os processos de desinstitucionalização na atualidade, assim como investigar de que maneira os novos modelos de atenção adotados nos Centros de Atenção Psicossocial (CAPS) contrastam com as formas de tratamento que eram oferecidas nas instituições totais. Trata-se de um relato de experiência de caráter qualitativo- descritivo realizado dentro de um CAPS localizado em uma cidade do interior de Minas Gerais. Elaborou-se um panorama histórico e teórico que embasou as observações realizadas durante as visitas técnicas. Como resultado, foram estabelecidos quatro eixos temáticos. Esses visaram articular o usuário do CAPS com: (1) os profissionais; (2) as oficinas terapêuticas; (3) a sociedade e (4) a instituição. As análises realizadas apontaram que o CAPS aqui relatado tem caminhado em direção ao resgate do sujeito, considerando em sua atuação a promoção de autonomia e a retomada da subjetivação e socialização do mesmo.


The history of mental health care is marked by the presence of total institutions and the existence of practices that curtail rights and reduce the autonomy of the subjects. The advent of the Brazilian psychiatric reform and of the anti-asylum movement brought several changes in the work scenario with the psychotic subject. In view of this, the present work aims to discuss how the deinstitutionalization processes have taken place in the present day, as well as to investigate how the new models of attention adopted in the Psychosocial Care Centers (CAPS) contrast with the forms of treatment that were offered in the total institutions. This is a qualitative-descriptive experience report carried out within a CAPS located in a city in the interior of Minas Gerais. A historical and theoretical panorama was elaborated that based the observations realized during the technical visits. As a result, four thematic axes have been established. These aimed at articulating the CAPS user with: (1) the professionals; (2) the therapeutic workshops; (3) society and (4) the institution. The analyzes carried out indicated that the CAPS reported here has been moving towards the rescue of the subject, considering in its action the promotion of autonomy and the resumption of subjectivation and socialization of the same.


La historia de la atención a la salud mental está marcada por la presencia de las instituciones totales y la existencia de prácticas que cercaban derechos y reducían la autonomía de los sujetos. El advenimiento de la Reforma Psiquiátrica brasileña y antimanicomial trajo varios cambios en el trabajo de ajuste con el sujeto psicótico. A la vista de ello, el presente trabajo tiene por objetivo discutir cómo han ocurrido los procesos de desinstitucionalización en la actualidad, así como investigar de qué manera los nuevos modelos de atención adoptados en los Centros de Atención Psicosocial (CAPS) contrastan con las formas de tratamiento que se ofrecían en las instituciones totales. Se trata de un relato de experiencia de carácter cualitativo-descriptivo realizado dentro de un CAPS ubicado en una ciudad del interior de Minas Gerais. Se elaboró un panorama histórico y teórico que basó las observaciones realizadas durante las visitas técnicas. Como resultado, se establecieron cuatro ejes temáticos. Estos destinado para articular el usuario CAPS con: (1) los profesionales; (2) los talleres terapéuticos; (3) la sociedad y (4) la institución. Los análisis realizados apuntaron que el CAPS aquí relatado ha caminado hacia el rescate del sujeto, considerando en su actuación la promoción de autonomía y la retomada de la subjetivación y socialización del mismo.


Assuntos
Saúde Mental , Reforma dos Serviços de Saúde , Desinstitucionalização , Serviços de Saúde Mental
5.
Soc Psychiatry Psychiatr Epidemiol ; 54(11): 1411-1417, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31041468

RESUMO

PURPOSE: Over the past 50 years, deinstitutionalization changed the face of psychiatry. However, outpatient treatment in the community does not always fit the needs of those who left institutions and sometimes leads to frequent re-hospitalizations, a mechanism known as the "revolving door" phenomenon. The study aim was to identify different typologies of hospitalization trajectories. METHODS: Records of 892 inpatients from the Department of Psychiatry of Lausanne University Hospital were analyzed over a 3-year period with discrete sequential-state analysis. RESULTS: Trajectories could be split between atypical users (4.9% of patients totalling 30.6% of hospital days) and regular users. Within the atypical users group, three categories were identified: "Permanent stays" (3 patients totalling 6.3% of hospital days), "long stays" (1.7% patients/8.6% hospital days) and "revolving door" stays (2.9% patients/15.8% hospital days). The remaining 95.1% of the patients were classified into "unique episodes" (70.0% patients/24.5% hospital days) and "repeated episodes" (25.0% patients/44.9% hospital days). Diagnoses of schizophrenia were overrepresented among heavy users. CONCLUSIONS: Most patients went through a unique or low number of brief hospital admissions over the 3 years of the study. While the shift of previously institutionalized individuals towards high users of psychiatric hospital seems limited, this phenomenon should not be neglected since 4.9% of patients use about a third of hospital beds. Early identification of problematic profiles could allow the implementation of relapse prevention strategies and facilitate the development of alternatives to hospitalization such as assertive community treatment or housing first programs.


Assuntos
Desinstitucionalização/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Modelos Estatísticos , Adulto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/epidemiologia
6.
Nord J Psychiatry ; 73(4-5): 211-218, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31070510

RESUMO

Background: As a result of deinstitutionalization of psychiatric treatment and care, many people with severe mental illness have been offered supported accommodation. However, research on this costly intervention in Norway has been scarce. Aims: The aim of this study was to prospectively investigate the clinical and demographic factors associated with allocation to supported accommodation for people with schizophrenia. Methods: The study was a prospective cohort study of 334 people with schizophrenia acutely admitted to Haukeland University Hospital between 2005 and 2010. Information concerning allocation to supported accommodation in their residential municipalities was collected retrospectively. Univariate and multivariate statistical methods were used to assess the association of clinical and demographical variables with allocation to supported accommodation. Results: Supported accommodation was allocated to 29.6% of the participants during the study period. Age, gender, implementation of compulsory mental health care, substance abuse, symptom burden and suicidality were not associated with allocation to supported accommodation. Functional impairment, especially difficulties with activities of daily living, experiencing exacerbation in the course of chronic disease, being medicated and of Norwegian origin, favoured supported accommodation. Conclusions: Our results supported the hypothesis that people with severe mental illness presenting the greatest need for supported accommodation, based on functional difficulties and exacerbation of chronic disease were allocated supported accommodation. Symptom burden was not associated with allocation. Clinical implications: Further research is needed to examine the impact of supported accommodation on the outcomes for people with schizophrenia.


Assuntos
Atividades Cotidianas/psicologia , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Apoio Social , Adulto , Estudos de Coortes , Desinstitucionalização/métodos , Feminino , Habitação , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia
7.
Intellect Dev Disabil ; 57(2): 112-126, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30920914

RESUMO

Over the last 5 decades, the state institution census has decreased 85% in the United States. Despite these radical shifts away from institutionalization, people with intellectual and developmental disabilities (IDD) continue to struggle to be meaningfully included in the community. For these reasons, the aim of this study was to explore if and how residence type affects attainment of quality of life outcomes of people with IDD in the United States. To do so, we analyzed Personal Outcome Measures® interviews from approximately 1,350 people with IDD. Findings suggest much of what has historically been considered deinstitutionalization of people with IDD is transinstitutionalization, particularly with provider-owned or -operated settings. A systemic overhaul is needed to create an effective community infrastructure.


Assuntos
Deficiências do Desenvolvimento , Habitação/classificação , Deficiência Intelectual , Qualidade de Vida , Adolescente , Adulto , Idoso , Desinstitucionalização , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
8.
Gen Hosp Psychiatry ; 58: 51-58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30913417

RESUMO

OBJECTIVES: Evidence regarding the relationships between patient, hospital, and regional factors and early unplanned readmission (short-term outcome) in patients with bipolar disorder is lacking. This study aimed to examine risk factors associated with early unplanned readmission in patients with bipolar disorder. METHOD: We retrospectively analyzed adult bipolar patients (ICD-10; F31) between April 2012 and March 2014 in the Japanese Diagnosis Procedure Combination database. We examined factors affecting the 30-day unplanned readmission using multivariable logistic regression analysis. RESULTS: A total of 2688 patients admitted to psychiatric beds were included. Multivariate analysis showed that unchanged or exacerbation discharge outcome (adjusted odds ratio [aOR]: 1.93; 95% confidence interval [CI]: 1.06-3.51, p = 0.031), unplanned or urgent admission settings (aOR: 1.51; 95% CI: 1.00-2.26, p = 0.048), physical comorbidity (chronic pulmonary disease) (aOR: 4.74; 95% CI: 1.30-17.29, p = 0.018), presence of psychiatric acute-care beds (aOR: 1.72; 95% CI: 1.02-2.87, p = 0.040), and intermediate-level hospital psychiatric staffing (aOR: 1.82; 95% CI: 1.14-2.91, p = 0.012) were significantly associated with higher early unplanned readmission, while higher density of psychiatrists in the area (aOR: 0.50; 95% CI: 0.29-0.87, p = 0.014) was significantly associated with lower early unplanned readmission. CONCLUSIONS: The results suggest that not only careful management of high-risk patients but also consideration of functional differentiation in psychiatric inpatient care, psychiatric resource allocation, and follow-up support for patients with bipolar disorder are needed for reducing the early unplanned readmission rate.


Assuntos
Transtorno Bipolar/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Transtorno Bipolar/terapia , Estudos de Coortes , Desinstitucionalização/estatística & dados numéricos , Feminino , Humanos , Japão , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
9.
Can Bull Med Hist ; 36(1): 184-193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30901233

RESUMO

This paper proposes a historiographical discussion based on the article « Les contrecoups de la déshospitalisation psychiatrique. L'exemple du parcours transinstitutionel de Françoise ¼. Françoise's transinstitutional journey presented in the collective publication La fin de l'asile ? Histoire de la déshospitalisation psychiatrique dans l'espace francophone au XXe siècle, gives me the opportunity to reveal the subtext of this article, and to describe the method and the historical reasoning that gave life to the psychiatric journey of an anonymous person named Françoise. This process is organized around three main points: my positioning as a researcher, the issues related to my narrative approach, and a statement on my historical reasoning in an interdisciplinary perspective. Influenced and inspired by the work of Alain Corbin, George Duby, Roy Porter, Natalie Zemon Davis and Arlette Farge, my approach focusses on the feelings and emotions hidden in historical sources. I remain connected to a subjective intuition, and stay away from positivist reflexes. Based on my research experience with psychiatric records, my conclusion explores the renewal of historical writing , in which I suggest that it is possible to write the history of ordinary people while telling stories with sensitivity.


Assuntos
Desinstitucionalização/história , Historiografia , Hospitais Psiquiátricos/história , História do Século XX , Humanos , Ontário
10.
Int J Law Psychiatry ; 62: 45-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30616853

RESUMO

In Italy, following the closure of psychiatric hospitals in 1978 and the release of psychiatric patients into community care, there was a mismatch between common psychiatric patients and the convicted mentally ill who were sentenced to serve in state forensic psychiatric hospitals. The recent closure of such structures following the Prime Minister's Decree of April 1, 2008, fostered the need to create new structures. These are called "REMS," and they are based in the community and led by psychiatrists and healthcare staff who may rely on the collaboration of public security staff. This act completed a course of progressive deinstitutionalization of all psychiatric patients. However, some problems remain, and persons regarded as "partially mentally disabled" at the time of crime perpetration must serve part of their sentence in prison and the rest in the aforementioned structures or in psychiatric rehabilitation communities, depending on their claimed "social dangerousness." Psychiatric services now face the ambiguity of treating persons who are considered dangerous by court orders, while the civil law criteria for involuntary hospitalization is based only on the need of care. The complete closure of forensic hospitals may be considered a decisive step forward in the humanization of society, but there are still some issues to address to make it work better. The implementation of multidisciplinary teams and effective psychotherapy, psychoeducational, and rehabilitation interventions can help.


Assuntos
Psiquiatria Legal , Serviços Comunitários de Saúde Mental/história , Desinstitucionalização/história , Psiquiatria Legal/história , Psiquiatria Legal/legislação & jurisprudência , Psiquiatria Legal/métodos , História do Século XX , História do Século XXI , Hospitais Psiquiátricos/história , Humanos , Defesa por Insanidade/história , Itália
11.
Int J Law Psychiatry ; 62: 50-55, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30616854

RESUMO

BACKGROUND: In Italy the Law 9/2012 prescribed the total closure of forensic psychiatric hospitals (OPGs) and the conversion to a care model based on residential units in the community employing only clinical personnel (Residenze per l'Esecuzione delle Misure di Sicurezza - REMS) and fully integrated in public mental health services. The aim of this study is to report sociodemographic, clinical and criminological characteristics of patients admitted in Volterra REMS since it opened on 01/12/15 up to 31/12/17. METHODS: Sociodemographic and clinical information was collected from official documents (clinical files, ward reports) and from patients' personal health records. Psychiatric diagnoses were made by REMS psychiatrists according to the DSM-5 criteria. Criminological information was obtained from patients' criminal records. RESULTS: Volterra REMS patients' characteristics are similar to those of samples of OPGs patients (unmarried socially disadvantaged males with an average age of 40, no offsprings, low education, high rates of Schizophrenia Spectrum Disorders and medical comorbidity). However, the REMS model presents a very high turnover rate: during the study period 61 patients were admitted while 32 were discharged. Being assisted by public mental health services before committing the crime increased the probability of discharge. In non-EU patients long acting injectable antipsychotics were used more frequently than in community ones. Substance-Related Disorders are the main psychiatric comorbidity and resulted as being more frequent in bipolar patients than in other patients. CONCLUSIONS: Due to the high patients' turnover, we expect a progressive change in sociodemographic, clinical and criminological features of the REMS population. The REMS model provides a return for mentally disordered criminals to the care of local public mental health services which are recovering after many years some of their most challenging patients ensuring their deinstitutionalization and reintegration into society.


Assuntos
Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Criminosos/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Adulto , Criminosos/psicologia , Desinstitucionalização/estatística & dados numéricos , Feminino , Humanos , Itália , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia
12.
Int J Offender Ther Comp Criminol ; 63(3): 471-499, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30117346

RESUMO

In Circles of Support and Accountability (CoSA), trained volunteers support an individual convicted for sexual offenses to reintegrate safely into the community. Developed in Canada, CoSA has been established in many jurisdictions with a growing number of volunteers; however, little is known about whether the training and support provided meets volunteer needs. Using a mixed-methods approach, the aim of the present research was to explore New Zealand CoSA volunteer experiences of the training and support they received and their perceptions about what contributed to the effective operation of a circle. In total, 18 volunteers took part in an interview and 23 volunteers completed a questionnaire. The findings found a mixed response to the training and support received, whereby some volunteers thought the training and support was adequate, whereas other felt the training support they received was inadequate. Findings also illustrate that adequate training, having access to a circle coordinator, selecting the right volunteers and core member, clear communication, and setting up boundaries were important factors in maintaining an effective circle. Findings are discussed in terms of implications for the training and support offered to current and future volunteers, as well as for maintaining the effectiveness of future circles.


Assuntos
Agentes Comunitários de Saúde/organização & administração , Delitos Sexuais/prevenção & controle , Apoio Social , Voluntários/psicologia , Canadá , Participação da Comunidade , Desinstitucionalização , Feminino , Humanos , Masculino , Gestão de Riscos , Delitos Sexuais/estatística & dados numéricos
13.
J Hist Med Allied Sci ; 74(1): 107-126, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30339237

RESUMO

There is a rich literature on the deinstitutionalization movement in the US but few, if any, parallel histories of state mental hospitals. Under attack from the 1950s on, state hospitals dwindled in size and importance. Yet, their budgets remained large. This paper offers a case study of one such facility, Indiana's Central State Hospital, between 1968 and 1994. During these years, local newspapers published multiple stories of patient abuse and neglect. Internal hospital materials also acknowledged problems but offered few solutions. In 1984, the US Department of Justice intervened, charging Central State with having violated patients' civil rights, the first such action filed under the 1980 Civil Rights of Institutionalized Persons Act. Although Indiana signed a consent decree promising major reform, long-lasting change proved elusive. Civil and criminal lawsuits proliferated. In 1992, as Central State continued to attract negative attention, Indiana Governor Evan Bayh ordered the troubled hospital closed. His decision promised to save the state millions of dollars and won plaudits from many, but not all, mental health advocates. Even as the last patients left in 1994, some families continued to challenge the wisdom of eliminating Indiana's only large urban mental hospital, but to no effect.


Assuntos
Direitos Civis/história , Desinstitucionalização/história , Fechamento de Instituições de Saúde/história , Hospitais Psiquiátricos/história , Hospitais Estaduais/história , Institucionalização/história , Serviços de Saúde Mental/história , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , História do Século XX , Humanos , Indiana , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
14.
Interface (Botucatu, Online) ; 23: e170950, 2019.
Artigo em Português | LILACS | ID: biblio-984553

RESUMO

O Serviço Residencial Terapêutico (SRT) compõe a estratégia de desinstitucionalização na Rede de Atenção Psicossocial (RAPS), sendo um instrumento de recuperação de cidadania. O objetivo deste estudo foi conhecer a compreensão dos moradores de SRT de uma cidade paulista sobre "saúde" e "cuidado à saúde". De natureza qualitativa, utilizou o grupo focal narrativo e contou com a participação de dez moradores. Para eles, saúde é ser feliz e sentir prazer; e o cuidado à saúde extrapola as ações nos diferentes pontos da RAPS. A sua rede de cuidados inclui diversificados espaços de trocas sociais em estabelecimentos comerciais, de lazer e de cultura. Concluiu-se que as ações dos profissionais no cuidado à saúde devem ressignificar papéis e mediar relações sociais, contratuais e de poder, na concretização de novos planos de vida na cidade, constituindo-se como um projeto de felicidade.(AU)


The Therapeutic Residential Service (SRT) is a deinstitutionalization strategy part of the Psychosocial Care Network (RAPS) in Brazil and is an instrument that contributes to the recovery of citizenship of mental health patients. The aim of the present study was to learn about how SRT residents in a city of the state of São Paulo understand "health" and "health care". This was a qualitative study that used narrative focus groups and included ten residents. According to them, health means being happy and feeling pleasure, and health care goes beyond the actions of the different RAPS points of care. Their care network includes different spaces for social exchanges in commercial, leisure and cultural facilities. In conclusion, the actions of healthcare professionals must serve to re-signify roles and mediate social, contractual and power relationships in order to realize new plans for life in the city, constituting itself as a project for happiness.(AU)


El Servicio Residencial Terapéutico (SRT) compone la estrategia de desinstitucionalización en la Red de Atención Psicosocial (RAPS), siendo un instrumento de recuperación de ciudadanía. El objetivo de este estudio fue conocer la comprensión de los moradores de SRT de una ciudad del Estado de São Paulo sobre "salud" y "cuidado de la salud". De naturaleza cualitativa, utilizó el grupo focal narrativo y contó con la participación de diez moradores. Para ellos, salud es ser feliz y sentir placer y el cuidado de la salud extrapola las acciones en los diferentes puntos de la RAPS. Su red de cuidados incluye espacios diversificados de intercambios sociales en establecimientos comerciales, de ocio y cultura. Se concluyó que las acciones de los profesionales en el cuidado de la salud deben dar nuevo significado a papeles y mediar relaciones sociales, contractuales y de poder en la concreción de nuevos planes de vida en la ciudad, constituyéndose como un proyecto de felicidad.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Serviços Comunitários de Saúde Mental , Desinstitucionalização , Serviços de Saúde Mental
15.
J Ment Health Policy Econ ; 21(3): 131-142, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30530873

RESUMO

BACKGROUND: There is a scarcity of tested instruments for measuring mental health services and costs. The Client Sociodemographic Service Receipt Inventory (CSSRI) is the most used tool in economic evaluation in mental health in Europe; it was translated into five languages, and it was mainly used to evaluate deinstitutionalisation process in mental health system reform. AIMS OF THE STUDY: To translate and adapt to the Brazilian healthcare system, and to test its inter-rater reliability, validity and its feasibility in a deinstitutionalized sample of psychiatric hospital living in residential facilities. METHOD: The translation and adaptation of CSSRI to Brazilian context was done by a focus group with eight experts on public mental health services, covering all the available Brazilian healthcare services. Decisions on the extent of conceptual overlap between British and Brazilian version were discussed until reaching expert consensus. The inter-rater reliability and applicability of this version, called ``Inventário Sociodemográfico de Uso e Custos de Serviços - ISDUCS'', was tested in a sample of 30 subjects with moderate to severe mental disorders living in residential facilities. Because the lack of medical record or another source, ISDUCS's validity was assessed using Kappa coefficient agreement to compare between resident`s answers and their professional carers`answers. RESULTS: The same structure of the original instrument was kept, with an additional list of items for costing consumable services. The main modifications were on items related to education, occupational status and on detailed descriptions of public health services. The agreement between two mental health raters was good to excellent for the majority of items, with Kappa coefficient ranged from 0.6 to 1.0. Because 43% of the sample was unable to answer questions about regularly taken medications and consultations with health professionals, an exploratory analysis was done to identify potentially related variables. Greater severity of psychiatric symptoms and lower independent living skills were related to the inability to answer these questions. Agreement between residents and carers was good to excellent for socio and demographic variables, living situation and occupational status, income, visits to a psychologist, occupational therapists and social workers. CONCLUSION: ISDUCS is the first tool for economic evaluation including mental health services translated and adapted to Brazilian context. Despite the widespread use of CRSSI among people with schizophrenia in Europe, this study found that greater severity of symptoms led to high rate of missing responses. Inter-rater reliability was excellent as a whole. Small sample size didn't allow generalisation of results of this preliminary testing. IMPLICATIONS FOR HEALTH PROVISION AND USE: ISDUCS may be suitable for people with mental illness but requires additional sources of information such as carers and medical records. ISDUCS could be used for monitoring health service use in general practice. IMPLICATIONS FOR HEALTH POLICIES: Despite some limitations, this instrument was used to measure mental health service costs in three Brazilian studies, generating data for supporting local mental health policies, for boosting empirical research in the country and for supporting modelling studies. IMPLICATIONS FOR FURTHER RESEARCH: It should be tested further in other health settings and samples.


Assuntos
Análise Custo-Benefício , Custos Diretos de Serviços/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Transtornos Mentais/economia , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Fatores Socioeconômicos , Adulto , Idoso , Brasil , Estudos Transversais , Desinstitucionalização/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Instituições Residenciais/economia , Adulto Jovem
16.
Rev. enferm. UFSM ; 8(4): 1-11, out.-dez. 2018.
Artigo em Português | BDENF - Enfermagem | ID: bde-34395

RESUMO

Objetivo: refletir acerca das redes sociais de apoio formais e informais nocuidado à pessoa com transtorno mental centrado no paradigma psicossocial. Método: estudoteórico-reflexivo tendo como base epistemológica a Reforma Psiquiátrica Brasileira, queredireciona o modelo assistencial em saúde mental. Resultados: a família é fonte primária derecurso na rede social de apoio informal e, por vezes, é a chave para a efetividade do cuidadofornecido pela rede social de apoio formal. É importante que os serviços desenvolvamestratégias de apoio para que a pessoa com transtorno mental e sua família possam esclarecersuas dúvidas e minimizar os desafios que envolvem o cuidado em saúde mental. Conclusões:a rede social de apoio é um aspecto que necessita ser valorizado pelo profissional de saúde,pois a partir dela é possível planejar o cuidado em saúde mental.(AU)


Aim: to reflect on the formal and informal social support networks in the carefor the person with mental disorder centered on the psychosocial paradigm. Method: atheoretical-reflective study based on the epistemological Brazilian Psychiatric Reform, whichredirects the care model in mental health. Results: the family is the primary source of socialnetwork resource in informal support and is sometimes the key to the effectiveness of the careprovided by the formal social support network. It is important that the services developsupport a strategy so that the person with mental disorder and his/her family can clarifyhis/her doubts and minimize the challenges that cover mental health care. Conclusions: thesocial support network is an aspect that needs to be valued by the health professional, since itenables mental health care planning.(AU)


Objetivo: reflexionar sobre las redes sociales de apoyo formal e informal en elcuidado da las personas con trastornos mentales centrado en el paradigma psicosocial.Método: estudio teórico y reflexivo, con base epistemológica basada en la ReformaPsiquiátrica Brasileña, la cual presenta redirección del modelo de atención en salud mental.Resultados: la familia es la principal fuente de recursos en el apoyo en las redes socialesinformales y, a veces, es la clave para la eficacia de la atención prestada por la red social deapoyo formal. Es importante que los servicios desarrollen estrategias de apoyo para que lapersona con trastornos mentales y su familia puedan aclarar sus dudas y minimizar los retosrelacionados a la atención de salud mental. Conclusiones: la red de apoyo social es unaspecto que debe ser valorada por el profesional de la salud, ya que desde ella se puedeplanificar el cuidado de la salud mental.(AU)


Assuntos
Apoio Social , Desinstitucionalização , Família , Saúde Mental , Enfermagem
17.
Rev. Asoc. Esp. Neuropsiquiatr ; 38(134): 515-545, jul.-dic. 2018.
Artigo em Espanhol | IBECS | ID: ibc-176433

RESUMO

Desde que apareció como rama de la medicina en la estela de la ilustración y la Revolución Francesa, la psiquiatría ha experimentado importantes transformaciones en el marco de diferentes cambios socioeconómicos y políticos ocurridos en las sociedades occidentales. En este contexto más amplio, puede observarse una tensión recurrente entre el interés del individuo y el del cuerpo social en su conjunto. Esta fricción está íntimamente relacionada con una serie de dinámicas contrapuestas que han marcado el desarrollo de la psiquiatría y la atención a la salud mental: humanización versus disciplina, emancipación versus coerción, inclusión versus exclusión y ciudadanía democrática versus sometimiento político. Este artículo aporta un análisis conceptual y una panorámica histórica de las ambivalentes relaciones entre la psiquiatría y la atención a la salud mental, por un lado, y la política, más en concreto, el desarrollo de la noción moderna de ciudadanía, por otro


Since its emergence as a branch of medicine in the wake of the Enlightenment and French Revolution, psychiatry has experienced significant transformations against the background of different socio-economic and political changes In Western societies. In this wider context we see a recurring tension between the interest of the individual and that of the social body as a whole. This friction is closely related to opposing dynamics in psychiatry and mental health care: humanisation versus disciplining, emancipation versus coercion, inclusion versus exclusion, and democratic citizenship versus political subjection. This article provides a conceptual analysis and an historical overview on the ambivalent relations between on the one hand psychiatry and mental health care and on the other politics, and, more particularly, the development of the modern understanding of citizenship


Assuntos
Humanos , Transtornos Mentais/psicologia , Defesa do Paciente/tendências , Integração Comunitária/psicologia , Individualidade , Direitos Civis/tendências , Desinstitucionalização/tendências , Participação da Comunidade , Política , Transtornos Psicóticos , Hospitais Psiquiátricos/história , Coerção
18.
Washington, D.C.; OPS; 2018-12. (OPS/NMH/18-052).
em Espanhol | PAHO-IRIS | ID: phr-49681

RESUMO

[Introducción]. El taller de desinstitucionalización se realizó en Lima, Perú, entre el 12 y 13 de septiembre del 2018. Representantes gubernamentales de 12 países de la región asistieron a la reunión, entre los que se encontraron: Argentina, Belice, Brasil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Jamaica, Perú, República Dominicana, y Trinidad y Tobago . Representantes de la Oficina Regional de la OPS/OMS también participaron en la reunión. Los objetivos de la reunión fueron: 1. Realizar un taller regional sobre desinstitucionalización con actores de toda la región que trabajan en este campo. 2. Revisar el estado del arte y la situación de desinstitucionalización en las Américas. 3. Identificar los pasos a seguir para definir, promover y mejorar el proceso de desinstitucionalización en la Región. 4. Desarrollar un plan de trabajo y orientar a los participantes hacia las actividades y estrategias de desinstitucionalización regional y apoyar las formas que permitan a los países alcanzar estos objetivos.


Assuntos
Saúde Mental , Atenção Primária à Saúde , Serviços de Saúde Mental , Serviços Comunitários de Saúde Mental , Desinstitucionalização , Américas
19.
Intellect Dev Disabil ; 56(5): 374-388, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30273525

RESUMO

Using the family resilience model, we examined the association between empowerment, family member age, length of institutionalization, and resilience among family members of relatives with intellectual and developmental disabilities (IDD) following deinstitutionalization. Participants included 56 family members whose relatives with IDD recently transitioned to community living. Results strongly indicate empowerment plays a key role in positive family adaptation. Thus, following a relative's move from an institution to the community, empowerment is a promising form of protection that holds potential to increase family resilience. The results of the current study support the family resilience model as a foundation for future research regarding how families navigate significant transitions throughout the lifespan. Implications for practice and policy are provided.


Assuntos
Deficiências do Desenvolvimento , Família/psicologia , Deficiência Intelectual , Resiliência Psicológica , Adulto , Idoso , Desinstitucionalização , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Literatura de Revisão como Assunto , Apoio Social
20.
Harm Reduct J ; 15(1): 48, 2018 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-30241532

RESUMO

BACKGROUND: Take-home naloxone (THN) programmes are an evidence-based opioid overdose prevention initiative. Elevated opioid overdose risk following prison release means release from custody provides an ideal opportunity for THN initiatives. However, whether Australian prisoners would utilise such programmes is unknown. We examined the acceptability of THN in a cohort of male prisoners with histories of regular injecting drug use (IDU) in Victoria, Australia. METHODS: The sample comprised 380 men from the Prison and Transition Health (PATH) Cohort Study; all of whom reported regular IDU in the 6 months prior to incarceration. We asked four questions regarding THN during the pre-release baseline interview, including whether participants would be willing to participate in prison-based THN. We describe responses to these questions along with relationships between before- and during-incarceration factors and willingness to participate in THN training prior to release from prison. RESULTS: Most participants (81%) reported willingness to undertake THN training prior to release. Most were willing to resuscitate a friend using THN if they were trained (94%) and to be revived by a trained peer (91%) using THN. More than 10 years since first injection (adjusted odds ratio [AOR] 2.22, 95%CI 1.03-4.77), having witnessed an opioid overdose in the last 5 years (AOR 2.53, 95%CI 1.32-4.82), having ever received alcohol or other drug treatment in prison (AOR 2.41, 95%CI 1.14-5.07) and injecting drugs during the current prison sentence (AOR 4.45, 95%CI 1.73-11.43) were significantly associated with increased odds of willingness to participate in a prison THN programme. Not specifying whether they had injected during their prison sentence (AOR 0.37, 95%CI 0.18-0.77) was associated with decreased odds of willingness to participate in a prison THN training. CONCLUSION: Our findings suggest that male prisoners in Victoria with a history of regular IDU are overwhelmingly willing to participate in THN training prior to release. Factors associated with willingness to participate in prison THN programmes offer insights to help support the implementation and uptake of THN programmes to reduce opioid-overdose deaths in the post-release period.


Assuntos
Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Adulto , Estudos de Coortes , Desinstitucionalização , Overdose de Drogas/prevenção & controle , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/psicologia , Transtornos Relacionados ao Uso de Opioides/reabilitação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto , Prisioneiros/psicologia , Prisões , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/reabilitação , Vitória
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