RESUMO
Eight community mental health care centres (initiated by the South-Eastern Europe Stability Pact) in Albania, Bosnia-Herzegovina, Croatia, Macedonia, Moldova, Montenegro and Romania were evaluated. Characteristics of patients, patient reported outcomes and patient views of care were assessed in 305 psychiatric patients. Patient characteristics varied across centres, with most patients having long term psychotic disorders. Treatment satisfaction and therapeutic relationships were rated favourably. Subjective quality of life mean scores were rather low, with higher satisfaction with health and dissatisfaction with the financial and employment situation. Being unemployed was the only factor associated with poor quality of life and lower treatment satisfaction. Most developing centres target patients with persistent psychotic disorders. Care appears highly valued by the patients. The findings encourage establishing more centres in the region and call for employment schemes for people with mental illnesses.
Assuntos
Centros Comunitários de Saúde Mental/organização & administração , Serviços Comunitários de Saúde Mental/organização & administração , Transtornos Mentais/terapia , Satisfação do Paciente , Qualidade de Vida , Adolescente , Adulto , Idoso , Centros Comunitários de Saúde Mental/estatística & dados numéricos , Estudos Transversais , Europa Oriental , Feminino , Humanos , Entrevistas como Assunto , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Relações Profissional-Paciente , Psicoterapia , Análise de Regressão , Fatores Socioeconômicos , Desemprego , Adulto JovemRESUMO
Social values and concepts have played a central role in the history of mental health care. They have driven major reforms and guided the development of various treatment models. Although social values and concepts have been important for mental health care in the past, this Personal View addresses what their role might be in the future. We (DG, PH, and SP) did a survey of professional stakeholders and then used a scenario planning technique in an international expert workshop to address this question. The workshop developed four distinct but not mutually exclusive scenarios in which the social aspect is central: mental health care will be patient controlled; it will target people's social context to improve their mental health; it will become virtual; and access to care will be regulated on the basis of social disadvantage. These scenarios are not intended as fixed depictions of what will happen. They could, however, be useful in guiding further debate, research, and innovation.