Determinants of treatment disengagement among those at risk of suicide referred to primary mental health care services in Western Sydney, Australia.

OBJECTIVE: Continued engagement with primary mental health services has been associated with the prevention of subsequent suicidal behaviour; however, there are few studies that identify determinants of treatment disengagement among those at risk of suicide in primary care settings. This study investigated determinants of treatment disengagement of those at risk of suicide who were referred to primary mental health care services in Western Sydney, Australia. METHOD: This study used routinely collected data of those referred for suicide prevention services provided through primary mental health care services between July 2012 and June 2018. Associations between sociodemographic, diagnostic, referral- and service-level factors and treatment non-attendance and early treatment cessation were investigated using a series of multivariable generalised estimation equations. RESULTS: There were 1654 suicidal referrals for 1444 people during the study period. Those identified with a risk of suicide were less likely to never attend treatments (16.14% vs 19.77%), but were more likely to disengage earlier from subsequent service sessions (16.02% vs 12.41%), compared to those with no risk of suicide. A higher likelihood of non-attendance to any primary mental health care service sessions was associated with those aged 25-44, lower socioeconomic status, a presentation for substance use and a referral from acute care (either emergency department or hospital). Among those who attended an initial treatment session, younger age (18-24 years) and a longer waiting time for an initial follow-up appointment were associated with a higher likelihood of early treatment cessation from primary mental health care services. CONCLUSION: These findings can inform potential strategies in routine primary mental health care practice to improve treatment engagement among those at risk of suicidal behaviour. Youth-specific interventions, behavioural engagement strategies and prompt access to services are policy and service priorities.

Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist's view.

BACKGROUND: More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care. METHODS: An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chi-squared tests were conducted to analyze the data. RESULTS: Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers. CONCLUSIONS: Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.

Access to mental health care in El Salvador: a case study of progress toward decentralization.

OBJECTIVE: To assess the need for decentralization of psychiatric services in El Salvador, based on country-specific evidence, and to generate baseline measures the government and researchers could use to monitor and measure future progress toward decentralization. METHODS: Observations were made and psychiatric outpatients and their families/caregivers (n = 453) surveyed with a cross-sectional instrument at the National Psychiatric Hospital (Hospital Nacional General y de Psiquiatría "Dr. José Molina Martínez") in the capital city of San Salvador. Findings were compared with national census data to determine barriers to psychiatric care in a largely centralized system. The following data were collected: department of origin, travel time to hospital, time in hospital, costs, and qualitative comments about accessing services. Descriptive statistics and regression were used to assess the data. Government reports on all psychiatric outpatient consultations provided nationwide in 2015 (n = 61 010) at 10 regional hospitals were also reviewed and compared to population data to determine the proportion of the population of each hospital service area (department or group of departments) that received a psychiatric outpatient consultation. RESULTS: Households from the half of the country (7 out of 14 departments) farthest away from the National Psychiatric Hospital (42% of the general population) spent twice as much time and three times as much money to access the hospital's psychiatric outpatient services, resulting in severe hardship on both patients and families/caregivers. CONCLUSIONS: This report estimates that 45% of those with mental health needs in the seven departments farthest away from the National Psychiatric Hospital departments are still not accessing services compared to the seven departments nearest the hospital. The results of this study support the World Health Organization's call for governments to fully implement community-based mental health systems. This is the first study to assess progress toward decentralization of psychiatric services in El Salvador.

Patterns of Health Care Service Utilization by Individuals with Mental Health Problems: a Predictive Cluster Analysis.

This study aimed at identifying and characterizing clusters of mental health service users based on various characteristics in a sample of individuals with mental health problems. Data were collected in the epidemiological catchment area of South-West Montreal, Quebec in 2011 and 2014. Among the 746 participants who reported experiencing a mental health problem (high psychological distress and/or a mental disorder), 29% had used mental health services. A Two-Step cluster analysis was carried out to generate participant profiles based on their visit to mental health professional. Four clusters were identified: 1) young males with high quality of life and social support and who were less likely to have mental health problems and to utilize mental health services; 2) older females living with a partner and having a family doctor who were less likely to have mental health problems and to utilize mental health services; 3) single females with generalized anxiety disorder and somatic illness who were more likely to utilize mental health services, and 4) depressed females with high psychological distress, low quality of life and social support who were likely to utilize mental health services. The results reinforce the importance to develop programs that target the specific needs of subgroups of people experiencing mental health problems, given their considerable heterogeneity.

Perceptions of Mexican women regarding barriers in mental Heath Services in primary care.

BACKGROUND: The recent mental health care reforms in Mexico call for the regular evaluation of the services provided. This involves analyzing the opinions of those who utilize them on a daily basis, particularly women, since they are the main health service users. This study explores the barriers to mental health care perceived by a group of women attending primary care centers. METHOD: A qualitative methodological approach was chosen. The participants were purposively selected, using the snowball technique. Semi-structured interviews were analyzed using the thematic analysis. RESULTS: Three sets of factors representing barriers to care were identified in the participants' discourse. The first is linked to systemic barriers such as a lack of familiarity with the way the service operates, and irregularities in the consultations and appointment schedules that are not always geared to women's needs. The second concerns the social stigma associated with emotional and/or mental disorders and their care while the third involves the characteristics of psychologists and their professional work. CONCLUSIONS: In order to overcome some of the barriers identified, users should be given information on the work of mental health professionals, which would help dispel certain misconceptions and sensitize them to the importance of this type of treatment in achieving overall health. There is also a need to make psychologists aware of the living conditions and socio-cultural context of the women who attend these health facilities.

The Expanding Relevance of Routinely Collected Outcome Data for Mental Health Care Decision Making.

Evidence shows that routine outcome monitoring (ROM) and feedback using standardized measurement tools enhances the outcomes of individual patients. When outcome data from a large number of patients and clinicians are collected, patterns can be tracked and comparisons can be made at multiple levels. Variability in skills and outcomes among clinicians and service settings has been documented, and the relevance of ROM for decision making is rapidly expanding alongside the transforming health care landscape. In this article, we highlight several developing core implications of ROM for mental health care, and frame points of future work and discussion.

Changes in psychiatric services dynamics during the COVID-19 pandemic: Recognizing the need for resources shift.

With the significant impact of COVID-19 pandemic on the health, and the functioning of health care system, it has become increasingly important to understand changes in the ways health services were utilized and the factors influencing it. Drop in psychiatric admissions was seen during the pandemic, but also an increase in acute hospitalizations and emergency visits. Our aim was to analyze changes in out- and in-patient services utilization in the largest Croatian psychiatric institution during the first year of the pandemic, observed through the lens of the stringency index, and compare it to the pre-pandemic year. Along with an overall drop in hospitalizations, but a unit-specific rise in hospitalization, we have observed a non-significant overall drop in regular outpatient visits, and a significant drop coinciding with strictest epidemiological measures. There was also a significant increase in emergency visits coinciding with epidemiological measures that failed to return to pre-pandemic values, pointing to an expected significant and prolonged burden on emergency services. Simultaneous analysis of changing dynamics of mental health care service utilization during the pandemic helps us identify specific points of increased burden, and help us plan for early and flexible resources shift in order to adequately respond to evolving challenges.

Mental disorder and first-time marriage formation among non-Western migrant women: A national register study.

PURPOSE: Studies show that there is a mental health selection into marriage among the general population. This study explored the association between mental disorder and marriage formation among non-Western migrant women living in Norway, and whether the association varied with region of origin, income, education and having a dependent child. METHODS: Using linked national register data, we followed 49,329 non-Western never married migrant women aged 18-60 living in Norway between 2006 and 2014. As a proxy for mental disorders, we investigated whether outpatient mental health service use was associated with marital formation using discrete time logistic regression analyses. RESULT: Overall, outpatient mental health service use was associated with lower odds of marital formation, even after controlling for sociodemographic factors. Interaction analyses suggested that the relationship was weaker for South Asian women, who had the highest odds of marriage formation, compared with Sub-Saharan African women, who had the lowest. The relationship was also stronger for women with children and women with low incomes. CONCLUSION: Mental health selection effects may depend on the universality of marriage. Since marriage may be associated with psychosocial and economic benefits, it is important to identify and treat mental disorder among non-Western migrant women, particularly those with childcare responsibilities and low income.

Referral patterns to primary mental health services in Western Sydney (Australia): an analysis of routinely collected data (2005-2018).

BACKGROUND: Regionally-specific approaches to primary mental health service provision through Primary Health Networks (PHNs) have been a feature of recent national mental health reforms. No previous studies have been conducted to investigate local patterns of primary mental health care (PMHC) services in Western Sydney. This study is designed to (i) understand the socio-demographic and economic profiles (ii) examine the inequalities of service access, and (iii) investigate the service utilisation patterns, among those referred to PMHC services in Western Sydney, Australia. METHODS: This study used routinely collected PMHC data (2005-2018), population-level general practice and Medicare rebates data (2013-2018) related to mental health conditions, for the population catchment of the Western Sydney PHN. Sex- and age-specific PMHC referrals were examined by socio-demographic, diagnostic, referral- and service-level factors, and age-specific referrals to PMHC services as a percentage of total mental health encounters were investigated. RESULTS: There were 27,897 referrals received for 20,507 clients, of which, 79.19% referrals resulted in follow-up services with 138,154 sessions. Overall, 60.09% clients were female, and median age was 31 years with interquartile ranged 16-46 years. Anxiety and depression were the predominant mental health condition, and 9.88% referred for suicidal risk. Over two-thirds of referrals started treatments during the first month of the referral and 95.1% of the total sessions were delivered by face to face. The younger age group (0-24) had greater referral opportunities as a percentage of total visits to a general practitioner and Medicare rebates, however demonstrating poor attendance rates with reduced average sessions per referral compared with older adults. CONCLUSION: Children and young adults were more likely to be referred to PMHC services than older adults, but were less likely to attend services. Further research is needed to identify the strategies to address these differences in access to PMHC services to optimise the effectiveness of services.

Identification of Children of Parents With Mental Illness: A Necessity to Provide Relevant Support.

Background: The main objective of this study was to identify and describe core life circumstances of children with mentally ill parents (COPMI) and their parents. Knowledge about COPMI aged 0-17 years is necessary, as assessment of the risk and protective factors in their lives provide solid background for preventive interventions. Methods: Participants (N = 422) were parents of minor children (N = 589) receiving treatment in the clinic for psychiatric illness and substance abuse at the University Hospital of Northern Norway. Data was drawn from electronic patient journals. Results: A total of 286 mothers and 136 fathers participated in the study, and 46.3% were single parents. Parents had 1-7 children (M = 2.24; SD = 1.02). Most parents had one diagnosis (n = 311, 73.7%), and mood disorders was the most frequent type of diagnosis. The largest proportion of parents had serious mental disorders (n = 185; 46.0%), and a large proportion of the sample was affected by disorders of moderate severity (n = 156; 38.8%). The mean age of the children was 8.6 years (SD = 4.97), and 432 children (74.6%) had one or more siblings. The large majority of children had access to adult resource persons other than the mentally ill parent (n = 424; 94%), but 6% of the children (n = 27) did not. About three quarters of the children (76.2%, n = 526) were living with the mentally ill parent (n = 401), and 170 children (32.5%) lived with a single parent with a mental health disorder and siblings, full time or part of the time. The odds that parents had informed their children about the treatment/hospitalization and condition was higher the older the child was (p < 0.001), and the youngest children rarely got necessary information about this. Discussion: Risk and protective factors associated with the children's ages, access to resource persons, information about the parent's health problems and treatment are discussed in relation to different preventive steps for COPMI.

Welfare State Replacements: Deinstitutionalization, Privatization and the Outsourcing to Immigrant Women Enterprise.

The U.S. government has a long tradition of providing direct care services to many of its most vulnerable citizens through market-based solutions and subsidized private entities. The privatized welfare state has led to the continued displacement of some of our most disenfranchised groups in need of long-term care. Situated after the U.S. deinstitutionalization era, this is the first study to examine how immigrant Filipino women emerged as owners of de facto mental health care facilities that cater to the displaced, impoverished, severely mentally ill population. These immigrant women-owned businesses serve as welfare state replacements, overseeing the health and illness of these individuals by providing housing, custodial care, and medical services after the massive closure of state mental hospitals that occurred between 1955 and 1980. This study explains the onset of these businesses and the challenges that one immigrant group faces as owners, the meanings of care associated with their de facto mental health care enterprises, and the conditions under which they have operated for more than 40 years.

Moderate to severe psychological distress, disability, and non-receipt of past year visits to a mental health professional.

BACKGROUND: Studies of mental health care received by persons with disabilities who make up a significant group of the U.S. population are limited. OBJECTIVE: This cross-sectional study examined the relationship between disability and non-receipt of past year visits to a mental health professional among individuals with moderate to severe psychological distress. METHODS: Study participants included a nationally representative sample of 5,566 people with moderate to severe psychological distress, extracted from 2011 to 2013 Integrated Health Interview using the 6-item Kessler Psychological Distress Scale. Self-reported disability domains included vision, hearing, mobility, upper body self-care difficulty, learning difficulty, communication difficulty, and cognition difficulty. RESULTS: Sixty-four percent of participants reported a disability. Logistic regression analyses showed that (adjusting for nativity, other mental health conditions, and chronic pain) people aged 18-64 years old with disabilities have significantly lower odds (OR = 0.52, p < 0.001) of unmet mental health care services than people without disabilities. However, foreign-born respondents have significantly higher odds (OR = 2.91; p < 0.001) of unmet mental health care services than U.S. born Americans. After controlling for gender, other mental health conditions and chronic pain, people aged 65 and above with disabilities have higher non-significant odds (OR = 1.34, p = 0.361) of unmet mental health care services than people without disabilities. Additionally, females have significantly higher odds (OR = 1.63, p = 0.039) than males. CONCLUSIONS: Findings indicate the importance of identifying demographic characteristics associated with an increased risk for psychological distress and increased unmet mental health care services among people with and without disabilities.

Pathways to care in subjects at high risk for psychotic disorders - a European perspective.

Evidence-based decisions on indicated prevention in early psychosis require large-scale studies on the pathways to care in high-risk subjects. EPOS (The European Prediction of Psychosis Study), a prospective multi-center, naturalistic field study in four European countries (Finland, Germany, The Netherlands and England), was designed to acquire accurate knowledge about pathways to care and delay in obtaining specialized high risk care. Our high risk sample (n=233) reported on average 2.9 help-seeking contacts, with an average delay between onset of relevant problems to initial help-seeking contact of 72.6 weeks, and between initial help-seeking contact and reaching specialized high risk care of 110.9 weeks. This resulted in a total estimated duration of an unrecognized risk for psychosis of 3 ½ years. Across EPOS EU regions, about 90% of care pathway contacts were within professional health care sectors. Between EPOS regions, differences in the pathways parameters including early detection and health-care systems were often very pronounced. High-risk participants who later made transition to a full psychotic disorder had significantly longer delays between initial help-seeking and receiving appropriate interventions. Our study underlines the need for regionally adapted implementation of early detection and intervention programs within respective mental health and health care networks, including enhancing public awareness of early psychosis.

Da prescrição à escuta: efeitos da gestão autônoma da medicação em trabalhadores da saúde / From prescription to listening: effects of gaining autonomy and medication on health workers

Resumo O uso de psicotrópicos e os direitos relacionados à escolha dos tratamentos prescritos vêm ganhando espaço na literatura. Este artigo deriva de uma pesquisa qualitativa na qual se interveio em 10 serviços de saúde (Atenção Primária e Secundária) de dois municípios (Campinas e Amparo, SP). Seguindo os princípios da Reforma Psiquiátrica Brasileira de incluir os usuários nas decisões dos seus tratamentos, utilizou-se a gestão autônoma da medicação (GAM) como estratégia de intervenção; ela é originária do Canadá, e propõe "empoderar" usuários quanto ao uso de medicamentos em seus projetos terapêuticos. Este trabalho avalia a percepção dos trabalhadores que moderaram grupos de GAM. A partir de entrevistas semiestruturadas com esses moderadores, antes e depois da intervenção, construíram-se narrativas sob os preceitos da hermenêutica gadameriana. Os trabalhadores que experimentaram a estratégia assumiram papel mais crítico quanto a suas práticas clínicas, e identificaram, na metodologia horizontal, grupal e direcionada para a escuta de valorização da voz dos usuários, uma experiência capaz de promover uma clínica mais flexível e propícia à construção conjunta de ações. A experimentação da GAM nesta pesquisa permitiu analisá-la em relação a outros referenciais brasileiros da saúde coletiva, como a educação popular e a medicina centrada na pessoa, operando uma interessante hibridação cultural.

Abstract The use of psychotropic drugs and rights related to the choice of prescribed treatments has been gaining ground in literature. This article reports aspects of a qualitative research that intervene in 10 health services (primary and secondary care) at two Brazilian cities (Campinas and Amparo, in São Paulo). Following the principle of Brazilian Psychiatric Reform, defending users' rights to decide about their treatment, we worked with the gaining autonomy and medication (GAM). GAM comes from Canada and proposes to "empower" users regarding the use of drugs in their therapeutic projects. This article aims to evaluate the impact's perception of the workers moderators of the GAM groups. Semi-structured interviews were conducted with the GAM Group's moderators before and after the intervention, narratives were constructed under the precepts of Gadamer's hermeneutics. Workers who experienced the strategy took a more critical role in relation to their clinical practices, and identified, in the horizontal methodology, group and directed to listening for the appreciation of the voice of users, an experience that could promote a more flexible clinic and conducive to the joint construction of actions. GAM's experimentation in the this research allowed to analyze it in relation to other Brazilian references to the field of collective health such as popular education and person-centered medicine, operating an interesting cultural hybridization.

Access to mental health care in El Salvador: a case study of progress toward decentralization / Acceso a la atención de salud mental en El Salvador: un estudio de caso de progreso hacia la descentralización / Acesso à saúde mental em El Salvador: um estudo de caso sobre o progresso em direção à descentralização

ABSTRACT Objective To assess the need for decentralization of psychiatric services in El Salvador, based on country-specific evidence, and to generate baseline measures the government and researchers could use to monitor and measure future progress toward decentralization. Methods Observations were made and psychiatric outpatients and their families/caregivers (n = 453) surveyed with a cross-sectional instrument at the National Psychiatric Hospital (Hospital Nacional General y de Psiquiatría "Dr. José Molina Martínez") in the capital city of San Salvador. Findings were compared with national census data to determine barriers to psychiatric care in a largely centralized system. The following data were collected: department of origin, travel time to hospital, time in hospital, costs, and qualitative comments about accessing services. Descriptive statistics and regression were used to assess the data. Government reports on all psychiatric outpatient consultations provided nationwide in 2015 (n = 61 010) at 10 regional hospitals were also reviewed and compared to population data to determine the proportion of the population of each hospital service area (department or group of departments) that received a psychiatric outpatient consultation. Results Households from the half of the country (7 out of 14 departments) farthest away from the National Psychiatric Hospital (42% of the general population) spent twice as much time and three times as much money to access the hospital's psychiatric outpatient services, resulting in severe hardship on both patients and families/caregivers. Conclusions This report estimates that 45% of those with mental health needs in the seven departments farthest away from the National Psychiatric Hospital departments are still not accessing services compared to the seven departments nearest the hospital. The results of this study support the World Health Organization's call for governments to fully implement community-based mental health systems. This is the first study to assess progress toward decentralization of psychiatric services in El Salvador.

RESUMEN Objetivo Evaluar la necesidad de la descentralización de los servicios psiquiátricos en El Salvador con base en la evidencia específica del país y generar medidas de referencia que podrían ser utilizadas por el gobierno y los investigadores para monitorear y medir el progreso futuro hacia la descentralización. Métodos Se realizaron observaciones, y se encuestaron pacientes psiquiátricos ambulatorios y sus familiares/cuidadores (n = 453) con un instrumento de corte transversal en el Hospital Nacional Psiquiátrico (Hospital Nacional General y de Psiquiatría "Dr. José Molina Martínez") en la capital, San Salvador. Los hallazgos se compararon con los datos del censo nacional para determinar las barreras en el acceso a la atención psiquiátrica en un sistema en gran medida centralizado. Se recopilaron los siguientes datos: departamento de origen, tiempo de viaje al hospital, tiempo en el hospital, costos y comentarios cualitativos sobre el acceso a los servicios. Se usaron estadísticas descriptivas y regresión para evaluar los datos. También se revisaron informes gubernamentales sobre todas las consultas psiquiátricas ambulatorias proporcionados a nivel nacional en 2015 (n = 61 010) en 10 hospitales regionales, y estos se compararon con datos poblacionales para determinar la proporción de la población de cada área de servicio hospitalario (departamento o grupo de departamentos) que efectuó una consulta psiquiátrica ambulatoria. Resultados Los hogares de la mitad del país (7 de los 14 departamentos) más alejados del Hospital Psiquiátrico Nacional (42% de la población general) gastaron el doble de tiempo y tres veces más dinero para acceder a los servicios psiquiátricos ambulatorios del hospital, lo que resultó en dificultades económicas severas tanto para los pacientes como para sus familias/cuidadores. Conclusiones Este informe estimó que el 45% de las personas con necesidades de salud mental en los 7 departamentos más alejados del Hospital Nacional Psiquiátrico aún no tienen acceso a los servicios en comparación con los 7 departamentos más cercanos al hospital. Los resultados de este estudio respaldan el llamado de la Organización Mundial de la Salud para que los gobiernos implementen por completo sistemas de salud mental basados en la comunidad. Este es el primer estudio en evaluar el progreso hacia la descentralización de los servicios psiquiátricos en El Salvador.

RESUMO Objetivo Avaliar a necessidade de descentralização dos serviços psiquiátricos em El Salvador com base em provas específicas do país e gerar medições de referência que poderiam ser usados pelo governo e pesquisadores para monitorar e medir o progresso futuro no sentido da descentralização. Métodos Observações foram feitas, e foram pesquisados pacientes psiquiátricos ambulatoriais e suas famílias/cuidadores (n = 453) com uma ferramentas de seção transversal no Hospital Psiquiátrico Nacional (National Hospital Geral e Psiquiatria "Dr. Jose Molina Martinez") na capital, São Salvador. Os resultados foram comparados com dados do censo nacional para determinar as barreiras ao acesso à assistência psiquiátrica em um sistema amplamente centralizado. Os seguintes dados foram coletados: departamento de origem, tempo de deslocamento para o hospital, tempo no hospital, custos e comentários qualitativos sobre o acesso aos serviços. Para avaliar os dados foram utilizadas estatística descritiva e regressão. Também foram analisados relatórios do governo sobre todas as consultas psiquiátricas ambulatoriais a nível nacional em 2015 (n = 61 010) em 10 hospitais regionais, e comparados com os dados da população para determinar a proporção da população de cada área de serviço hospitalar (departamento ou grupo de departamentos) que recebeu uma consulta psiquiátrica para pacientes ambulatoriais. Resultados As pessoas da metade do país (7 dos 14 departamentos) mais afastada do Hospital Psiquiátrico Nacional (42% da população geral) gastaram o dobro do tempo e três vezes mais dinheiro para acessar os serviços psiquiátricos ambulatoriais do hospital, o que resultou em privação severa para pacientes e familiares/cuidadores. Conclusões Este relatório estimou que 45% das pessoas com necessidades de saúde mental nos 7 departamentos mais distantes do Hospital Psiquiátrico Nacional ainda não têm acesso aos serviços em comparação com os 7 departamentos mais próximos do hospital. Os resultados deste estudo apoiam o apelo da Organização Mundial de Saúde para que os governos implementem totalmente os sistemas de saúde mental baseados na comunidade. Este é o primeiro estudo a avaliar o progresso em direção à descentralização dos serviços psiquiátricos em El Salvador.

Ressignificando a Prática Psicológica: o Olhar da Equipe Multiprofissional dos Centros de Atenção Psicossocial / Resignifying the Psychological Practice: the Perspective of the Multidisciplinary Team of the Psychosocial Health Centers / Resignificando la Práctica Psicológica: la Visión del Equipo Multiprofesional de los Centros de Atención Psicosocial

Resumo O estudo objetivou compreender a prática psicológica através do olhar das equipes de saúde mental. Foi realizado um estudo qualitativo, utilizando a técnica de entrevista semiestruturada e observação sistemática, tendo como participantes dez profissionais de dois Centros de Atenção Psicossocial de uma cidade do Rio Grande do Sul. As entrevistas e as observações foram analisadas através da Análise de Conteúdo Temática. O profissional da Psicologia foi apontado como participativo no serviço, indicando mudanças em relação ao fazer psicológico. Foi evidenciada a importância do profissional da Psicologia como um ator que faz o elo equipe-família-sociedade. A escuta foi apontada como uma especificidade da Psicologia dentro da Instituição. Conclui-se que a prática psicológica retrata novas maneiras de fazer Psicologia na Saúde Mental....(AU)

Abstract The study aimed to comprehend the practice of psychology through the perspective of mental health care teams. A qualitative study was carried out, using semi-structured interviews and systematic observation. Ten health care professionals of two Psychosocial Health Centers of a city in Rio Grande do Sul participated in the study. Interviews and observation were analyzed using Thematic Content Analysis. The psychology professional was pointed out as participatory in the service, highlighting changes regarding the psychological practice. The importance of the psychology professional was evidenced, characterized as a professional whose work relates to the linkage among health care team-family-society. The understanding was highlighted as a specific practice of psychology within the institution. In conclusion, the psychology practice portrays new ways of working with psychology in Mental Health Care....(AU)

Resumen El estudio tuvo como objetivo comprender la práctica psicológica a través de la visión de los equipos de salud mental. Fue realizado un estudio cualitativo, utilizando la técnica de entrevista semiestructurada y observación sistemática, teniendo como participantes diez profesionales de dos Centros de Atención Psicosocial de una ciudad del estado de Rio Grande do Sul. Las entrevistas y las observaciones fueron analizadas a través del Análisis de Contenido Temático. El profesional de la psicología fue indicado como participativo en el trabajo, indicando cambios en relación al quehacer psicológico. Fue evidenciada la importancia del profesional de la psicología como un actor que crea el eslabón equipo-familia-sociedad. La escucha fue señalada como una especificidad de la psicología dentro de la institución. Se concluye que la práctica psicológica retrata nuevas formas de hacer psicología en la Salud Mental....(AU)

Hacia una atención comunitaria en salud mental para personas con esquizofrenia en Colombia / Towards a community mental health care for people with schizophrenia in Colombia

Resumen La atención en salud mental con base en la comunidad ha mostrado ser eficaz y acertada para el servicio de salud a personas con trastornos mentales severos como la esquizofrenia, evidencia que es menos clara en el sistema de salud de Colombia, donde se presentan debilidades, tanto en la prevención como en la rehabilitación, a pesar de que directrices nacionales le dan importancia al contexto social con relación a la enfermedad. Como aporte a la discusión sobre la atención para personas que viven con esquizofrenia, se realizó una revisión de tema con el objetivo de identificar experiencias en servicios de salud mental comunitaria, en relación con su pertinencia para estas personas en el ámbito nacional. Se buscaron artículos en Scientific Electronic Library Online (SciELO), Medline with Full text, Science Direct y documentos de la Organización Mundial de la Salud, Organización Panamericana de la Salud y Ministerio de Salud y Protección Social. Se hallaron pocas experiencias en atención comunitaria para personas con esquizofrenia en Colombia y teniendo en cuenta su importancia para la salud pública a nivel mundial, se realiza un llamado de atención hacia la construcción e implementación de estos modelos en el contexto colombiano.

Abstract Mental health care based on the community has shown to be effective and successful for the health care service to people with severe mental disorders such as schizophrenia, evidence that is less clear in the health care system in Colombia, where weaknesses are present, both for prevention and rehabilitation, although national guidelines give importance to the social context in relation to the disease. As a contribution to the discussion on providing care for people living with schizophrenia, a topic review was conducted with the aim of identifying experiences in community mental health care services, in relation to their relevance to these people at the national level. Articles were searched on Scientific Electronic Library Online (SciELO) Medline with Full text, Science Direct and documents of the World Health Organization, Pan American Health Organization and the Colombian Ministry of Health and Social Protection. Few experiences in community care for people with schizophrenia in Colombia were found and given its importance to public health worldwide, a call for attention is made towards the construction and implementation of these models in the Colombian context.

A Gestão Autônoma da Medicação: uma intervenção analisadora de serviços em saúde mental / Autonomous Medication Management: an analytical intervention in mental health care services

Em um contexto de altas taxas de medicalização da população e face ao uso pouco crítico de medicamentos psiquiátricos em serviços de saúde mental, este artigo reporta aspectos de uma pesquisa qualitativa que teve a oportunidade de intervir em práticas de cuidado em três grandes cidades do Brasil. Seguindo o princípio da Reforma Psiquiátrica brasileira da defesa dos direitos do usuário em participar das decisões sobre seu tratamento, a pesquisa interveio nos centros de atenção psicossocial (CAPS) buscando o "empoderamento" dos usuários em relação ao uso de medicamentos em seus projetos terapêuticos. Foram realizados entrevistas e grupos focais. A partir desse material registrado, o artigo analisou algumas situações que atestaram, entre outras, a dificuldade de evitar o uso do poder sobre os usuários por via da administração de medicamentos psicotrópicos. Também se percebeu, nos serviços pesquisados, pouco diálogo sobre os medicamentos e a existência de espaços de estigmatização onde os direitos dos usuários são inibidos ou aceitos com cautela.

In a context of high rates of medicalization of the population and in light of the scantly critical use of psychiatric medications in mental health services, this paper reports aspects of a qualitative study that had the opportunity to intervene in care practices in three major Brazilian cities. Following the principle of Brazilian Psychiatric Reform championing users' rights to participate in decisions about their treatment, the research intervened in psychosocial care centers (CAPS) seeking the empowerment of the users regarding the use of drugs in their therapeutic projects. Interviews were conducted and focus groups set up. From this recorded material, the paper analyzed some situations that, among other things, attested to the difficulty of avoiding the exercise of power over users via the administration of psychotropic drugs. Little dialogue about drugs, and the existence of stigmatization spaces where user rights are inhibited or "accepted with caution," was also detected in the services surveyed.