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1.
BMC Health Serv Res ; 21(1): 951, 2021 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-34507575

RESUMO

BACKGROUND: There is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other factors, such as population socioeconomic status and access to primary care services. METHODS: This is a cross-sectional ecological study using Public Health England data. The unit of analysis was the population served by clinical commissioning groups (CCGs), National Health Service (NHS) catchment areas. The analysis explored associations between area characteristics and the number of people in contact with mental health services using regression modelling. Explanatory variables included age, gender, prevalence of severe mental illness (SMI), prevalence of common mental disorder (CMD), index of multiple deprivation (IMD), unemployment, proportion of the population who are Black and Minority Ethnic (BAME), population density, access to and recovery in primary care psychological therapies. Unadjusted results are reported, as well as estimates adjusted for age, prevalence of CMD and prevalence of SMI. RESULTS: The populations of 194 CCGs were included, clustered within 62 trusts (NHS providers of mental health services). The number of people in contact with mental health services showed wide variation by area (range from 1131 to 5205 per 100,000 population). Unemployment (adjusted IRR 1.11; 95% CI 1.05 to 1.17; p < 0.001) and deprivation (adjusted IRR 1.02 95% CI 1.01 to 1.04; p < 0.001) were associated with more people being in contact with mental health services. Areas with a higher proportion of the population who are BAME (IRR 0.95 95% CI 0.92 to 0.99 p = 0.007) had lower service use per 100,000 population. There was no evidence for association with access to primary care psychological therapies. CONCLUSIONS: There is substantial variation in the use of mental health services by area of England. Social factors including deprivation, unemployment and population ethnicity continued to be associated with the outcome after controlling for the prevalence of mental illness. This suggests that there are factors that influence the local population use of mental health services in addition to the prevalence of mental disorder.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Estudos Transversais , Inglaterra/epidemiologia , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Medicina Estatal
2.
Bull World Health Organ ; 99(9): 674-679, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475604

RESUMO

Problem: Mental ill health in the United Kingdom of Great Britain and Northern Ireland has been a major driver of labour market exclusion through sickness absence, reduced productivity and job loss. Approach: A government-supported programme for improving access to psychological therapies was launched in 2008 and expanded across England in 2010. The aim was to provide evidence-based treatments for people with common mental disorders through three principal strategies: (i) routine session-by-session outcome monitoring; (ii) integration with the wider care system; and (iii) delivery of psychological therapies as part of a stepped-care approach. Local setting: Access to effective psychological therapies was previously low in the United Kingdom. In 2010, only about 35% of people with moderately severe mental disorders were in specialist or non-specialist treatment. Relevant changes: The accessibility of quality mental health services has increased, as has the efficiency of the country's mental health system. The numbers of people entering treatment have increased steadily from 0.43 million in 2012-2013 to 1.09 million in 2018-2019. The recovery rate of patients in treatment increased from 42.8% to 52.1% during 2012-2018. The number of people moved off sick pay and benefits rose from 3683 to 18 039 over the same period. Lessons learnt: A clinical guideline on psychological therapies is a prerequisite for increasing the accessibility and efficiency of mental health services. An integrated approach allows mental health services to have better reach. Routine collection of patient-level outcome data plays an important role in the value and function of the mental health care system.


Assuntos
Acesso aos Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Qualidade da Assistência à Saúde , Eficiência Organizacional , Humanos , Transtornos Mentais/epidemiologia , Saúde Mental , Irlanda do Norte , Avaliação de Processos e Resultados em Cuidados de Saúde , Reino Unido
3.
Rev Bras Enferm ; 75(1): e20201011, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495129

RESUMO

OBJECTIVE: to understand how religiosity can influence the health of individuals diagnosed with mental disorders, based on comprehensive care. METHODS: this is an integrative literature review, with the inclusion of articles in Portuguese, English and Spanish, between 2010 and 2018. RESULTS: the critical analysis and qualitative synthesis of the 24 selected studies were categorized into two subtopics: The influence of religiosity in promoting comprehensive mental health care; Mental health versus religiosity: influencing conditions for effective access to comprehensive care. FINAL CONSIDERATIONS: a positive influence of religiosity was identified in the lives of individuals diagnosed with mental disorders; however, evidence shows that health teams do not feel comfortable and prepared to work with religiosity as an expression of spirituality. This being one of the dimensional aspects of health, it can be inferred, on the results, the existence of this gap in the comprehensive care approach.


Assuntos
Transtornos Mentais , Terapias Espirituais , Humanos , Transtornos Mentais/terapia , Saúde Mental , Religião , Espiritualidade
4.
Rev Med Suisse ; 17(749): 1534-1536, 2021 Sep 08.
Artigo em Francês | MEDLINE | ID: mdl-34495591

RESUMO

The social and professional measures suggested to beneficiaries of the Insertion Income have demonstrated their effectiveness. However, presence of mental disorders complicates their implementation, causing difficulties for both beneficiaries and social services. The integration of psychiatrist as medical advisors, as for the canton of Vaud, helps to support the role of medical advisors. Psychiatric intervention aims to strengthen the detection of mental conditions and to improve the relationship between the social worker and his·her beneficiary. The integration of a consultation-liaison psychiatry model in the role of medical consultant seems to bring undeniable advantages and avoidance of stigmatization and chronicization of mental disorders.


Assuntos
Transtornos Mentais , Psiquiatria , Feminino , Humanos , Transtornos Mentais/terapia , Encaminhamento e Consulta , Integração Social
5.
Rev Med Liege ; 76(9): 701-708, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34477343

RESUMO

The current health care crisis, induced by the coronavirus pandemic, is at the origin of significant global changes within our societies and profoundly modifies the health care sector as well, especially in the field of mental health. Nowadays, this latter is particularly poorly equipped in financial and human resources. Without major and immediate changes, the mental health sector will not be able to cope with the expected exponential rise of care needs, exacerbated by the rapid deterioration of mental health in the general population and among health care providers. We intend to illustrate the potential role and benefit of new technologies, able to solve the imbalance. Without any possible doubt, the health care crisis has provided a formidable momentum for their arousal, but we still have to determine their accessibility, feasibility, efficacy and efficiency by running controlled clinical trials.


Assuntos
COVID-19 , Transtornos Mentais , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Saúde Mental , Pandemias , SARS-CoV-2
6.
Artigo em Russo | MEDLINE | ID: mdl-34486860

RESUMO

Currently, the characteristic of dynamics of morbidity of mental disorders of population of the Russian Federation is its increasing simultaneously with changing in structure of contingents in the direction of decreasing number of patients subjected to dispensary monitoring. The study of influence of medical organizational factors on morbidity of mental disorders demonstrated the role of provision with psychiatrists in dynamics of prevalence of mental disorders. The improvement of management of patients with mental disorders should be supported by appropriate resources and adaptation of mental service to actual conditions, in particular, solving the problem of manpower deficiency of psychiatrists.


Assuntos
Transtornos Mentais , Psiquiatria , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Morbidade , Prevalência , Recursos Humanos
7.
Nervenarzt ; 92(9): 963-971, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34477896

RESUMO

To raise awareness that families with a mentally ill parent face special challenges and the correct handling of it, need to be considered more in health care. The simple question "how are you as a parent and your children?" is often not asked but this question is important so as not to endanger the healing process, to identify the need for assistance and to break the potential vicious circle for children. Awareness of the problem in the psychiatry of adults can support the care of affected persons and their children.


Assuntos
Filho de Pais Incapacitados , Transtornos Mentais , Pessoas Mentalmente Doentes , Psiquiatria , Adulto , Criança , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Pais
8.
BMC Psychiatry ; 21(1): 433, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479529

RESUMO

BACKGROUND: The system of secure care for young people in England and Wales comprises youth justice, welfare and mental health facilities. Empirical studies have failed to investigate the system as a whole. The National Adolescent Study in 2016 was the first to provide comprehensive system wide information. This paper, derived from that data set, addresses equity of service provision for young men and women in secure care who have mental health problems. METHODS: The detained census population of English young people in 2016 was 1322 and detailed data were available on 93% of this population, including 983 young men and 290 young women. The descriptive census data were interrogated to identify associations between gender, other sociodemographic and clinical variables, using Chi-square and Fisher's exact tests. RESULTS: Numerically more young men in secure care than young women in secure care warrant a psychiatric diagnosis but young women had a 9 fold increase in the odds of having a diagnosis compared with the young men. The pattern of mental health diagnoses differed significantly by gender as did the legislative framework under which females and males were placed. This different pattern of secure care placement continued to differ by gender when the nature of the mental health diagnosis was taken into account. CONCLUSIONS: No definitive explanation is evident for the significantly different placement patterns of young men and young women with the same mental health diagnoses, but the anticipated consequences for some, young men and some young women are important. Proper explanation demands an examination of process variables outwith the remit of this study. The lack of routine scrutiny and transparent processes across secure settings could be responsible for the development of these differential placement practices; these practices seem at odds with the duty placed on public services by the Equality Act.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Adolescente , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Saúde Mental , Fatores Sexuais
9.
BMC Psychiatry ; 21(1): 432, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479537

RESUMO

BACKGROUND: The majority of people with mental illness do not seek help at all or only with significant delay. To reduce help-seeking barriers for people with mental illness, it is therefore important to understand factors predicting help-seeking. Thus, we prospectively examined potential predictors of help-seeking behaviour among people with mental health problems (N = 307) over 3 years. METHODS: Of the participants of a 3-year follow-up of a larger community study (response rate: 66.4%), data of 307 (56.6%) persons with any mental health problems (age-at-baseline: 16-40 years) entered a structural equation model of the influence of help-seeking, stigma, help-seeking attitudes, functional impairments, age and sex at baseline on subsequent help-seeking for mental health problems. RESULTS: Functional impairment at baseline was the strongest predictor of follow-up help-seeking in the model. Help-seeking at baseline was the second-strongest predictor of subsequent help-seeking, which was less likely when help-seeking for mental health problems was assumed to be embarrassing. Personal and perceived stigma, and help-seeking intentions had no direct effect on help-seeking. CONCLUSIONS: With only 22.5% of persons with mental health problems seeking any help for these, there was a clear treatment gap. Functional deficits were the strongest mediator of help-seeking, indicating that help is only sought when mental health problems have become more severe. Earlier help-seeking seemed to be mostly impeded by anticipated stigma towards help-seeking for mental health problems. Thus, factors or beliefs conveying such anticipated stigma should be studied longitudinally in more detail to be able to establish low-threshold services in future.


Assuntos
Comportamento de Busca de Ajuda , Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Saúde Mental , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Estigma Social
10.
BMC Psychiatry ; 21(1): 440, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488702

RESUMO

BACKGROUND: The evaluation of treatment outcomes is important for service providers to assess if there is improvement or not. The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) was developed for this use in child and adolescent mental health services. Outcome measurement in routine mental health services is limited. This paper evaluates the psychometric properties of the self and clinician rated versions of the HoNOSCA for routine use in child and adolescent mental health services in Kenya. METHODS: Using a prospective design, the clinician- and self-rated versions of the HoNOSCA and the Paediatric Symptom Checklist (PSC) were administered at the Youth Centre at the Kenyatta National Hospital in Nairobi. Initial ratings were obtained from adolescents 12-17 years (n = 201). A sample of 98 paired ratings with 2 follow-ups were examined for measurement of change over time. RESULTS: Our findings showed good reliability with the self-rated version of the HoNOSCA score, correlating well with the self-reported version of the PSC (r = .74, p < .001). Both versions correlated well at follow-up and were sensitive to change. Using factor analysis, the maximum likelihood factoring and Promax rotation resulted in a four-factor structure, which with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.8 explained 54.74% of total variance. CONCLUSION: The HoNOSCA appears to be of value, and easy to use in routine settings. Our findings suggest further investigation with a larger sample.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Adolescente , Criança , Humanos , Quênia , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Padrões de Referência , Reprodutibilidade dos Testes
11.
J Transl Med ; 19(1): 343, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376209

RESUMO

Mental disorders widely contribute to the modern global disease burden, creating a significant need for improvement of treatments. Scalp stimulation methods (such as scalp acupuncture and transcranial electrical stimulation) have shown promising results in relieving psychiatric symptoms. However, neuroimaging findings haven't been well-integrated into scalp stimulation treatments. Identifying surface brain regions associated with mental disorders would expand target selection and the potential for these interventions as treatments for mental disorders. In this study, we performed large-scale meta-analyses separately on eight common mental disorders: attention deficit hyperactivity disorder, anxiety disorder, autism spectrum disorder, bipolar disorder, compulsive disorder, major depression, post-traumatic stress disorder and schizophrenia; utilizing modern neuroimaging literature to summarize disorder-associated surface brain regions, and proposed neuroimaging-based target protocols. We found that the medial frontal gyrus, the supplementary motor area, and the dorsal lateral prefrontal cortex are commonly involved in the pathophysiology of mental disorders. The target protocols we proposed may provide new brain targets for scalp stimulation in the treatment of mental disorders, and facilitate its clinical application.


Assuntos
Transtorno do Espectro Autista , Transtorno Bipolar , Transtornos Mentais , Transtorno Bipolar/diagnóstico por imagem , Transtorno Bipolar/terapia , Humanos , Transtornos Mentais/diagnóstico por imagem , Transtornos Mentais/terapia , Neuroimagem , Couro Cabeludo
12.
J Health Care Poor Underserved ; 32(3): 1225-1235, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421027

RESUMO

There have been significant advances in the diagnosis and treatment of psychiatric disorders; however, racial disparities continue to create inequity in mental health care. In this commentary, we explore mental health disparities disfavoring African Americans in the psychiatric literature. We discuss how discrimination over time has resulted in a difference of perception, misdiagnoses, and conflicts in patient care. The literature reviewed reveals a pattern wherein African Americans are more likely to be misdiagnosed for all types of mental illness compared with other ethnicities due to fallacies perpetuated throughout the history of African Americans. In addition, the aggregation of current information and research on the current COVID-19 pandemic will justify future research on the epidemic of police brutality and shootings of unarmed African Americans. If we address this issue, we will reduce medical mistrust and ultimately reduce racial health inequities.


Assuntos
Afro-Americanos , Disparidades em Assistência à Saúde , Transtornos Mentais/terapia , Racismo , COVID-19/etnologia , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Transtornos Mentais/etnologia , Padrões de Prática Médica , Psiquiatria/história , Racismo/história
13.
Pan Afr Med J ; 39: 58, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422181

RESUMO

The use of social media to increase awareness on mental health is rapidly gaining momentum globally. However, despite evidence of a growing trend in social media use in sub Saharan Africa, little has been reported on tapping the potential of social media within a mental health practice to not only increase awareness but also facilitate linkage to specialist care. We describe one such mental health practice and its process of integration of the different social media platforms to promote mental health and increase linkage to specialist care. We further highlight the challenges and practical implication of social media use in the Kenyan setting. We conclude by advocating for this integration to raise awareness and also encourage peer support for persons with mental health problems and recommend research that measures the impact of such interventions in sub-Saharan Africa.


Assuntos
Serviços de Saúde Mental/organização & administração , Saúde Mental , Mídias Sociais , Humanos , Quênia , Transtornos Mentais/terapia , Grupo Associado , Apoio Social
16.
BMC Res Notes ; 14(1): 320, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419155

RESUMO

OBJECTIVES: Peer support is rapidly being introduced into mental health services internationally, yet peer support interventions are often poorly described, limiting the usefulness of research in informing policy and practice. This paper reports the development of a peer support intervention that aims to improve outcomes of discharge from inpatient to community mental health care. People with experiential knowledge of using mental health services-peer workers and service user researchers-were involved in all stages of developing the intervention: generating intervention components; producing the intervention handbook; piloting the intervention. RESULTS: Systematic review and expert panels, including our Lived Experience Advisory Panel, identified 66 candidate intervention components in five domains: Recruitment and Role Description of Peer Workers; Training for Peer Workers; Delivery of Peer Support; Supervision and Support for Peer Workers; Organisation and Team. A series of Local Advisory Groups were used to prioritise components and explore implementation issues using consensus methods, refining an intervention blueprint. A peer support handbook and peer worker training programme were produced by the study team and piloted in two study sites. Feedback workshops were held with peer workers and their supervisors to produce a final handbook and training programme. The ENRICH trial is registered with the ISRCTN clinical trial register, number ISRCTN 10043328, and was overseen by an independent steering committee and a data monitoring committee.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Aconselhamento , Humanos , Pacientes Internados , Transtornos Mentais/terapia , Saúde Mental
17.
Pan Afr Med J ; 38: 389, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381533

RESUMO

Introduction: despite the high prevalence and significant burden of mental disorders, they remain grossly under-diagnosed and undertreated. In low-income countries, such as Mali, integrating mental health services into primary care is the most viable way of closing the treatment gap. This program aimed to provide a mental health training intervention to rural general practitioners (GPs), to organize community awareness activities, and to evaluate the impact on mental health knowledge and through the number of new patients diagnosed with mental disorders and managed by these general practitioners. Methods: a pre-test/post-test design and the monthly monitoring of the number of new patients diagnosed with mental disorders by the trained GPs were used to evaluate the effect of the training interventions (two face-to-face group training workshops followed by individual follow-up supervisions) and of the community awareness activities. Results: the mean knowledge score of the 19 GPs who completed the initial 12-day group training raised from 24.6/100 at baseline, to 61.5/100 after training (p<0.001), a 150% increase. Among them, sixteen completed the second 6-day group training with a mean score increasing from 50.2/100 to 70.1/100 (p<0.001), a 39.6% improvement. Between July 2018 and June 2020, 2,396 new patients were diagnosed with a mental disorder by the 19 GPs who took part in the program. Conclusion: despite limited data regarding the effect of the community awareness component at this stage, the findings from this study suggest that the training intervention improved GPs' knowledge and skills, resulting in a significant number of new patients being identified and managed.


Assuntos
Fortalecimento Institucional , Clínicos Gerais/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Competência Clínica , Clínicos Gerais/educação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mali , Transtornos Mentais/diagnóstico , Saúde Mental , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração
18.
Artigo em Inglês | MEDLINE | ID: mdl-34444622

RESUMO

There is an increasing call for recovery-oriented services but few reviews have been undertaken regarding such interventions. This review aims to synthesize evidence on recovery services to improve the lives of adults living with severe mental illness. An integrative review methodology was used. We searched published literature from seven databases: Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, Web of Science, and Scopus. Mixed-methods synthesis was used to analyse the data. Out of 40 included papers, 62.5% (25/40) used quantitative data, 32.5% used qualitative and 5% (2/40) used mixed methods. The participants in the included papers were mostly adults with schizophrenia and schizoaffective disorder. This review identified three recovery-oriented services-integrated recovery services, individual placement services and recovery narrative photovoice and art making. The recovery-oriented services are effective in areas such as medication and treatment adherence, improving functionality, symptoms reduction, physical health and social behaviour, self-efficacy, economic empowerment, social inclusion and household integration. We conclude that mental health professionals are encouraged to implement the identified recovery services to improve the recovery goals of consumers.


Assuntos
Transtornos Mentais , Adulto , Pessoal de Saúde , Humanos , Transtornos Mentais/terapia
19.
Undersea Hyperb Med ; 48(3): 247-253, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34390629

RESUMO

Demyelination throughout the brain stem and spinal cord caused by acute carbon monoxide (CO) poisoning has not been previously reported. Magnetic resonance imaging (MRI) has revealed that acute CO poisoning primarily affects the subcortical white matter of the bilateral cerebral hemispheres and basal ganglia. Here we report the case of a patient with delayed neuropsychological sequelae (DNS) due to acute CO poisoning. A 28-year-old man was admitted to our department following a suicide attempt by acute CO poisoning. After a six-month pseudo-recovery period, he was diagnosed with DNS, with MRI evidence of demyelinating change of the bilateral cerebral peduncles. Demyelination was identified throughout the brain stem, expanding from the bilateral cerebral peduncles to the medulla oblongata, occurring approximately six months after poisoning. One and a half years after acute CO poisoning, demyelination of the cervical and thoracic spine was observed, most notable in the lateral and posterior cords. It is evident that previously published research on this topic is extremely limited. Perhaps in severe cases of acute CO poisoning the fatality rate is higher, leading to fewer surviving cases for possible study. This may be because a more severe case of acute CO poisoning would result in the higher likelihood of secondary demyelination. This research indicates that clinicians should be aware of the risk of secondary demyelination and take increased precautions such as vitamin B supplementation and administration of low-dose corticosteroids for an extended period of time in order to reduce the extent and severity of demyelination.


Assuntos
Encefalopatias/etiologia , Tronco Encefálico , Intoxicação por Monóxido de Carbono/complicações , Doenças Desmielinizantes/etiologia , Doenças da Medula Espinal/etiologia , Adulto , Encefalopatias/diagnóstico por imagem , Encefalopatias/terapia , Tronco Encefálico/diagnóstico por imagem , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/terapia , Doenças Desmielinizantes/diagnóstico por imagem , Doenças Desmielinizantes/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtornos Mentais/etiologia , Transtornos Mentais/terapia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/terapia , Tentativa de Suicídio , Fatores de Tempo
20.
Nervenarzt ; 92(9): 941-947, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34345930

RESUMO

BACKGROUND: The United Nations Convention on the Rights of Persons with Disabilities and the Federal Participation Act state that all human beings have the right to choose where to live. This human right is compromised by the institutional limitations of the community psychiatric system, where persons with severe mental illnesses and with intensive support needs are often housed in closed (i.e. physically locked) living contexts. How can the concept of person-centered care help to solve this conflict? OBJECTIVE: Description of the nationwide situation of closed residential facilities and discussion of the person-centered approach as a solution to the problem of closed living contexts. METHODS: Summary of current knowledge on the structural and procedural data of closed residential facilities in Germany, which were collated within the framework of the "Coercive measures in the psychiatric care system-Collation and reduction" (ZIPHER) study. RESULTS: The empirical data indicate a great need for regionally based care of the target group and a lack of individual arrangements as alternatives to closed living contexts. The necessity for regional care obligations is highlighted by the example of Mecklenburg-Western Pomerania. CONCLUSION: The avoidance and reduction of closed accommodation can primarily be achieved by individual arrangements within the framework of person-centered and flexible proposal landscapes. For this the service providers of integration assistance, including the psychiatric hospitals, must be committed to the care of all people in their region. An appropriate accompaniment and refunding by the service provider are also necessary.


Assuntos
Pessoas com Deficiência , Transtornos Mentais , Alemanha , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Assistência Centrada no Paciente , Instituições Residenciais
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