Asylum Model Research Articles

CARTOGRAPHIC WRITING: Institutional analysis in the context of a psychosocial care center (CAPS) II

This experience report is an institutional analysis based on the experiences of two interns at a Psychosocial Care Center (CAPS) II. Our intention is to raise some questions and reflections about Institutional Psychology and the institutionalities that permeate the service, the tension between the instituted and the instituting, focusing on the language that operates as an institution. The objectives are: to investigate the possible logic of subversion in such a scenario, still permeated by the asylum model; to examine how Institutional Psychology can assist in this subversion; to determine if language, as an institution, can free bodies from such a model. We used the cartography method, where the procedures involved observation, field diary recording, sharing in supervisions, and literature review. Five examples of language observed in the service are used: invalidation of suffering, infantilization, LGBTI+phobia, stereotypes against psychoactive substance users, and re-signification of the language of madness. A discussion is conducted on these five examples based on the results obtained, which point to the importance of Institutional Psychology and the need for training professionals and emancipating users as political subjects. We understand that, with the raised reflections and discussions, room can be opened for transformations. In the final considerations, it is concluded that language has the potential to contribute to reinforcing or liberating the abjection of certain bodies produced by the asylum model. This liberation occurs when there is analysis, redesign, and collaboration with CAPS users.

Mental health crisis situations: the nurse's work in Primary Health Care.

to analyze the nurses' work in Primary Health Care in the face of mental health crisis situations. this is a descriptive-exploratory study with a qualitative approach, supported by the theoretical-interpretive frameworks of behavior analysis and historical-dialectical materialism. The data was collected through a semi-structured interview with twelve Primary Health Care nurses and analyzed using the deductive technique proposed by the Theorical Domains Framework, the methodological reference adopted. the data analyzed made it possible to draw up two themes: "Nurses' work: material and social determinants" and "Nurses' subjective conditions in the face of mental health crisis situations". Nurses' work was guided by the protocol execution of "technical" steps related to clinical psychiatry, with an understanding of the crisis as a "psychiatric outbreak". the study made it possible to analyze the nurse's work in crisis situations, describing the objective and subjective contradictions, their understanding of the crisis phenomenon and the emotional repercussions of this work on the professionals. This situation raises the need for action, organization and political-social mobilization of the nursing category in the fight against the asylum model of care and the consolidation of the Psychiatric Reform perspective. (1) Manicomial protocol action to identify and reduce crisis symptoms. (2) Reducing the experience of crisis as a psychopathological phenomenon. (3) Use of theoretical-critical references aligned with the proposals of psychosocial care. (4) Internationally validated methodological and analytical framework. (5) The need for political and social action on the nursing profession's part.

Process of Deinstitutionalization of Aging Individuals With Severe and Disabling Mental Disorders: A Review.

BackgroundFor more than 60 years, psychiatric services has gradually gone from an asylum model to a community model. This change has led to the emergence of a deinstitutionalization movement. This movement seems to have left behind long-term hospitalized aging individuals with severe and disabling mental disorders. The objective of this article is to conduct a review on the challenges and issues associated with the process of deinstitutionalization among hospitalized aging individuals with severe and disabling mental disorders.MethodsUsing PRISMA statement, the research methodology was carried out in English and French in 16 databases with a combination of 3 lists of keywords. The selection process was then followed by a thematic analysis which aimed at categorizing by theme and classifying the writings selected.ResultsA total of 83 articles published between 1978 and 2019 were selected and organized into six categories: (a) a forgotten population in research and health policies, (b) an economic presentation of the deinstitutionalization process, (c) an improvement in quality of life and global functioning for deinstitutionalized patients (d) from stigmatization to the rejection of elderly psychiatric inpatients from deinstutionalization process, (e) a difficult community-based care offer and a difficult epistemological identification, (f) from the lack of community services to the phenomenon of transinstitutionalization. The current state of scientific research, institutional policies and clinical practices associated with the deinstitutionalization process of SVPTSIH are then commented.ConclusionsRecommendations are proposed to researchers and professionals concerned with the support of long-term hospitalized aging individuals with severe and disabling mental disorders.

Psychosocial Care Center: daily work and articulation with the network in the pandemic

Objective: to analyze the daily work of a Psychosocial Care Center and its articulation with the Psychosocial Care Network in the context of the COVID-19 pandemic. Methods: this is a qualitative study, produced by means of the researcher’s diary and semi-structured interviews with nine health professionals, submitted to thematic-categorical content analysis. Results: the pandemic revealed failures in the management of services, lack of public investment, and the unpreparedness of professionals, intensifying work fragmentation, network disarticulation, non-assistance, and pre-existing asylum practices. Conclusion: the reality of the daily work of psychosocial care services shows that multifaceted actions that consider the complex social process of the psychiatric reform are necessary, especially in the pandemic, seeking the effective institutionalization of the psychosocial care model and the formation of centers of resistance to the established asylum model.

Mental health, art, and deinstitutionalization: an aesthetic-poetic-theatrical account of the city's occupation.

This study aimed to report the experience of an aesthetic, poetic, and theatrical production of the city's occupation from a device of the Psychosocial Care Network to offer space for sociability, production, and cultural intervention. This is an account of an experience from the Social and Cultural Center (CECCO) in Natal, Rio Grande do Norte, Brazil, within madness and mental health deinstitutionalization. The intervention "The Little Prince occupies the Ribeira" was inspired by the work of author Saint-Exupéry. The artistic and creative acts reported occurred in December 2019. We experienced in this intervention the reach of an aesthetic clinic that, when opened to the street and art, expanded and weaved in the territory, instrumentalized by theater, dance, poetry, percussion, crafts, and city's occupation. The movement led the community to "step down from the stage" to the streets and is connected with the twist of the asylum model and the production of the affection clinic that we seek to sustain in the daily service.

The Habitat Differentiation for Fairness: Digital Asylum Model

The Habitat Differentiation for Fairness: Digital Asylum Model

Aplicação do conceito de integralidade em sua dimensão política no discurso da atenção psicossocial

This essay addresses the political dimension of the concept of comprehensiveness in the discourse of the psychosocial care model based on psychiatric reform. It aimed to highlight the use of the principle of integrality in the construction of the psychosocial care model, as well as its advances and setbacks. We start from the premise that the model of psychosocial care appears based on the principle of comprehensiveness in contrast to the hospital-centered model, which is based on Cartesianism, however, it is a process with advances and setbacks. We conclude that although integrality has driven changes in the health system leading to the replacement of the asylum model by the psychosocial model, the presence of this principle in the PNSM discourse is not sufficient to guarantee the continuity of the psychiatric reform process.

Reforma psiquiátrica brasileira e os entraves para a superação do modelo manicomial

O presente artigo tem como objetivo propiciar uma reflexão acerca dos avanços e recuos da Política de Saúde Mental no contexto brasileiro da Reforma Psiquiátrica, enfatizando sobretudo as alterações realizadas entre 2017 e 2019. Constatamos que essas mudanças, realizadas nos governos Temer e Bolsonaro, descaracterizam a política de saúde mental, pois incentivam financeiramente a manutenção e a ampliação do modelo asilar por meio do hospital psiquiátrico e das Comunidades Terapêuticas. A partir da revisão bibliográfica, foi possível estabelecer uma interlocução crítica com teóricos que apreenderam as instituições asilares como funcionais à ordem capitalista e como reprodutoras de desumanidade. A análise documental evidenciou que o embate envolve aspectos políticos e econômicos que interferem diretamente no âmbito social, no qual se processam os serviços de atenção em saúde mental. Palavras-chave: Reforma Psiquiátrica. Alterações. Hospital Psiquiátrico. Comunidades Terapêuticas. Direitos Humanos.

POR UMA POLÍTICA DE SAÚDE MENTAL DA POPULAÇÃO NEGRA NO SUS

The implementation of public policies aimed at the health of the brazilian black population has been insufficient and this contributes to the maintenance of the racial hierarchy established by colonialism. In relation to mental health, the hospital-centered, pathological and centered on medicalization, eugenics and scientific racism, was hegemonic in the beginning of the 20th century, and it is updated on the 21st century through the Therapeutic Communities and the reintegration of hospitals as central elements of the Network of Psychosocial Care (RAPS). Extensive international literature highlights racism as an important producer of persistent suffering, with significant individual and collective damage. However, this has been a neglected topic in the national context, especially in Public Health. The proposition and construction of an effective public policy for the promotion of mental health involves the agreement between the different spheres of government of a racialized mental health policy, the overcoming of institutional racism and the radical break with the asylum model.

Las Redes Comunitarias y Familiares en el tránsito hacia la externación sustentable en el contexto de la reforma del Modelo de Atención de Salud Mental en Uruguay

This article takes as a main topic of discussion the place community and family networks take at the strategy of deinstitutionalization. The project is presented in the context of the Mental Healthcare System of the national integrated health system (SNIS) reform that has been taking place in Uruguay from the Law No. 19.529 of Mental Health (2017) to think about the practices regarding the Mental Healthcare Community Model. This implies giving visibility to the material conditions of existence in people’s daily lives, to individual and collective well-being, to work, housing, education, culture, leisure and enjoyment time, among others. The transition from an asylum model to a model that privileges the community approach, must fi rst consider a change in the public mental health policy that contemplates diff erent actors, including users, their relatives, health workers and the community in general. The reintegration into the social fabric of hospitalized people is central when it comes to thinking about a sustainable discharge, and that is why making social inclusion eff ective will imply changes in the sanitarian practices, in health resources, which allow family and community support, so that those in psychological suff ering can fi nd opportunities to develop their lives outside the psychiatric hospital, being respected in their rights

Nurse's means of work in the articulation of the psychosocial care network.

To analyze nurses' means of work used in the articulation of the Psychosocial Care Network (PCN) Method: An exploratory-descriptive qualitative study conducted at the PCN of a District Health Management in Porto Alegre. The data collection technique used was the semi-structured interview held from October to December 2017. Data was subjected to thematic analysis under the Marxist theory of the Labor Process. The analysis resulted in two thematic categories: Care Management and Care Practices. The first consists of two means of work: team coordination and meetings with the other components of the territory. The second involves three means of work: telephone contacts with PCN services; user referrals in the PCN and matrix support. Final considerations: In view of overcoming the asylum model, nurses' means of work are instruments for producing dialogs aimed at expanding psychosocial care.

Práticas educativas em saúde mental: a escola como espaço para a ruptura dos estigmas sobre a doença mental

<p>Mental illnesses stigmas interfere negatively with social relations. The objective of this article is to report the experience of educational interventions addressed to school audience and the construction of actions that increase the social inclusion of mental disorder people, assuming that the school environment is conducive to breaking paradigms. This is a qualitative study, developed with high school students from a full time school in the municipality of Pesqueira-PE, from 2016 to 2017. The educational interventions were part of the extension project “Interfaces Education, Health and Citizenship: Pathways to Social Inclusion of Psychosocial Care Center’s Patients”. Twenty-two meetings were held, portraying the history of psychiatry, the characteristics of the asylum model and psychosocial care, focusing on social inclusion. There was a significant decrease in stigmas in the group of participating students, evidenced by the expansion of their understanding and adherence to the psychosocial care model. In view of the above, it is important to intensify projects and actions at schools, since the combination of direct contact and health education reinforce the commitment of the community to the social reintegration of the person with a mental disorder.</p>

Da Psiquiatria Tradicional à Reforma Psiquiátrica: O Ambulatório de Saúde Mental como Serviço de Tratamento

O ambulatório é um serviço de saúde antigo no campo da assistência psiquiátrica, criado na época em que o modelo manicomial direcionava o tratamento. Com o tempo, surgiram outras maneiras de se pensar o cuidado de pacientes em sofrimento psíquico. A partir disso, novos serviços foram estabelecidos, com funcionamento e direção de trabalhos diferentes do que o ambulatório tradicional apresentava. O presente artigo visa, então, discorrer acerca das limitações e possibilidades do ambulatório de saúde mental atualmente, enquanto um serviço estratégico da Reforma Psiquiátrica, destacando o trabalho feito no Ambulatório de Saúde Mental de Jurujuba, em Niterói. Realizou-se um levantamento bibliográfico, além da utilização de situações oriundas da observação no momento de realização de estágio curricular no curso de Psicologia da Universidade Federal Fluminense. Concluiu-se que o ambulatório articulado com diretrizes antimanicomiais é primordial para que uma assistência com maior qualidade seja oferecida.

Internamento E(sca)ncarado: coexistência da internação psiquiátrica e a Rede de Atenção Psicossocial

Brazil, since the approval of Law 10.216 of 2001, has prioritized this emphasis and has announced the government's interest in implementing a psychiatric reform, however, the coexistence of asylums and community models has been blatant of the current support to the mental health in the country. The purpose of this article is to present an analysis of the vicissitudes of this process, taking as a case study the offer dynamics of these services, in the capital of Ceara, in the northeast of Brazil, in the period from 2007 to 2016. For this, we conducted a documentary study based on the quantitative data of mental health assistance services that are generated through the National Health Establishment Register (CNESnet, by its Portuguese acronyms) and the Tabnet application; available by the Department of Information Technology of the National Health System (Datasus, by its Portuguese acronyms). For the period under analysis, we noticed an increase in the supply of community-based services with the surge of six new services, hiring of seventy specific professionals for the substitutive care, concomitant to the closure of the activities of three psychiatric hospitals with asylum services. However, we identify that the legislation of substitute services is problematic when it comes to its constitution and perpetuation of the asylum model. Finally, we found that economic factors were the preponderant factors for the closure of hospitals and those remnants increased their offers of available beds and their invoicing.

“De volta à cidade, sr. cidadão!” - reforma psiquiátrica e participação social: do isolamento institucional ao movimento antimanicomial

Resumo O modelo manicomial produziu a exclusão da loucura da vida social, fundado no princípio do isolamento terapêutico, que gerou a institucionalização do louco e sua retirada da cidade e do direito à participação social, com a perda do direito à cidade e da condição de cidadania. Atualmente, a reforma psiquiátrica no Brasil é um dos mais importantes processos de crítica à psiquiatrização da loucura, promovendo uma desconstrução das formas de exclusão social da loucura e o debate na sociedade acerca dos direitos e da cidadania dos sujeitos em sofrimento mental e vulnerabilidade social. Diversas frentes inovadoras, de inclusão pelo trabalho, pela arte-cultura, pela militância política e de ocupação da cidade, têm configurado novas possibilidades de vida e expressão para os sujeitos, numa nova concepção sobre a loucura e a diferença, na qual os sujeitos da diversidade têm direito à cidade e à participação social.

Discurso Jurídico-Moral Humanizador sobre drogas e violência sanitária na saúde da família

RESUMO As mídias influenciam os sentidos entre profissionais e usuários, que podem coadunar com práticas assistenciais que reiteram o modelo manicomial. Por meio da análise de entrevistas realizadas com profissionais da Atenção Primária à Saúde, utilizando-se como material de apoio as notícias sobre o programa Crack, é Possível Vencer publicadas em jornais impressos, observou-se a emergência de uma formação discursiva Jurídico-Moral 'Humanizadora', sistema simbólico compartilhado pelos profissionais que rejeita em sua superfície a intervenção policial e carcerária para substituí-la pela violência sanitária, sustentando a internação compulsória diante da falência do convencimento.

CENTROS DE ATENCIÓN PSICOSOCIAL: COMPARACIÓN ENTRE EL TRABAJO OFRECIDO Y LA LEGISLACIÓN

Os Centros de Atenção Psicossocial foram idealizados para substituir as práticas asilares predominantes nos hospitais psiquiátricos. A avaliação das práticas realizadas nesses serviços tornou-se fundamental na tentativa de garantir a qualidade da assistência ofertada aos usuários e de alcançar as metas do movimento da Reforma Psiquiátrica brasileira. Considerando tais aspectos o objetivo é descrever e analisar o tratamento psicossocial oferecido em quatro centros de atenção psicossocial de um município do nordeste brasileiro. Trata-se de uma pesquisa qualitativa de triangulação metodológica que utilizou a análise documental da legislação vigente e a análise de conteúdo temático (Minayo, 2009) de entrevistas realizadas com profissionais dos serviços, com auxílio do software QDA MINER. Observaram-se processos de trabalho apoiados em pilares asilares: médico centrado e psicofarmacológico e dificuldade dos serviços em planejar ações desenvolvidas no território e focadas nos direitos dos usuários. No plano do cuidado foi percebido o distanciamento entre as práticas cotidianas dos profissionais e as normativas postuladas.

The applicability of the concept of treatment adherence in the context of the Brazilian mental health system

Objective To present reflections on the type of research conducted on a treatment adherence among users of Public Mental Health System in Brazil and discuss the applicability of the concept of adherence to treatment in this context. Method Literature review in SciELO, LILACS, Cochrane Library and PubMed / MEDLINE using the Health Sciences Descriptors (DeCS) treatment, adhesion and “mental health” and the specific vocabulary of the Medical Subject Headings (MeSH) “patient compliance/psychologist” y “mental health”. They were included for review the complete texts and theses published between 2007-2012 in Portuguese, English and Spanish. Results 127 articles were recovered, 32 specifically related to mental health. Eight were excluded for duplicates and after reading the remaining 24 articles were selected for this study 10 conducted in the field of Mental Health in Brazil. No investigations have been identified with focus on adherence to psychosocial treatment offered in public mental health. Conclusions disregard of the mental health legislation and reinforce the asylum model of assistance.

Characteristics of inpatients admitted to National Asylum of Leganés in the early twentieth century (1900–1931)

IntroductionLeganés Psychiatric Hospital has been the subject of several studies about its institutional history, clinical activity and demography of its institutionalized population. The first decades of the twentieth century are the less explored years; however, important events for the development and establishment of the discipline of psychiatry happened in Spain during this period.Objectives/aimsTo describe the sociodemographic and hospitalization characteristics of the patients who were admitted to Leganés National Asylum between 1900 and 1931.MethodsThis is a retrospective case series study. We reviewed medical records found in the Historical Archives of Psychiatric Institute Germain (n = 1043) of inpatients admitted between 1900 and 1931. We analyzed sociodemographic and hospitalization related variables of medical records with SPSS v21. We consultedbibliography, such as asylum documents and diverse primary and secondary literature.ResultsMost inpatients were male, single, with an average age of 38 years, came from home and were admitted as fee-paying boarders. Circa 64% of them remained in the institution until death and the average stay was 7.92 years.ConclusionsEven though the Leganés Asylum was born amidst debate on the asylum model, it did not meet the expectations. Among other reasons, it presented serious architectural deficiencies and was unable to classify inpatients according to the French tradition (agitated, dirty, quiet) or to separate populations, such as minors or criminal inpatients, thus becoming a charity institution asylum instead of a therapeutic mental hospital.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Política Nacional para Álcool, crack e outras drogas no Rio de Janeiro e o retorno da racionalidade punitiva

This article outlines the results of research into public policies on alcohol and other drug use in light of the Brazilian Psychiatric Reform. It departs from the hypothesis that the experience of madness and the narcotization of life are symptoms of the malaise affecting Brazilian civilization, which began building a veritable “prison archipelago” of jails, asylums and shelters for its poor in the nineteenth century, implementing a set of disciplinary proceedings whose effect was to segregate its subjects. The enactment of 2001’s Law 10.216 witnessed a rupture with the asylum model and a consolidation of the psychosocial care model for the treatment of psychological suffering, further revealing a shift in the functioning of the Brazilian state – which had previously served as a tributary of punishment rationale. Despite the dissolution of the asylum model guaranteed by the enforcement of the new law, punitive rationale and its prison archipelago still characterize social ties. The hypothesis shall be developed by means of an analysis of the national policy on alcohol and other drug use, with particular emphasis on the Protocolo do Servico Especializado em Abordagem Social [Specialist Social Approach Protocol] established by the Municipal Council of Rio de Janeiro, Brazil.