Mental Health Care Network Research Articles

MCT bij ouderen

The number of elderly in our society is increasing. Psychiatric problems are common in this population. For adults aged 18 to 65, there already is psychiatric crisis home treatment for patients experiencing a psychiatric crisis at home. However, this did not yet exist in Belgium for adults over the age of 65. Since the 1st of November 2021, people over 65 who are experiencing a psychiatric crisis in the region of the Ghent-Eeklo-Flemish Ardennes Mental Health Care Network (PAKT) can rely on psychiatric crisis home treatment. For this reason, it was investigated whether this treatment is effective and cost-effective. There are currently no studies available on this subject. For this reason, different sub-aspects were considered. The effectiveness and cost-effectiveness of long-term psychiatric home treatment teams in elderly & adults and of psychiatric crisis home treatment teams (MCT) in adults older than 18 years were assessed. Finally, we looked for the characteristics of adults who were included for psychiatric crisis care at home and whether these are present in adults older than 65 years. Since there are no studies on MCT in the elderly, it is not possible to draw conclusions on the subject. However, a general trend is noted in the studies whereby the treatment always appears to be effective and often also cost-effective. However, further research is needed to confirm that this will also be the case for MCT for the elderly in Belgium.

Mental health care networks

Mental health care networks

Addressing Mental Health Needs in Low- and Middle-Income Countries: The case of São Caetano do Sul, Brazil.

São Caetano do Sul, a city in southeastern Brazil, boasts exemplary social indicators and healthcare services, with a population of 162,763 and a density of 9,736.03 inhabitants/km². Allocating 25% of its budget to healthcare, the city's mental healthcare services adhere to the National Mental Health Policy. Structured services include a CAPS-II, CAPS-AD, outpatient teams, and teams in various locations. Initiatives since 2000 include inaugurating a CAPS-AD in 2006, a psychiatric emergency service in 2010, and a CAPS-II in 2016, relocating CAPS-AD in 2019, and establishing the Cuca Legal Project in 2022. São Caetano do Sul has a Mental Health Risk Classification Protocol to aid clinical decision-making. Developing care lines for various groups, it offers programs like smoking prevention, school psychology, and obesity support. Collaborating with community centers, these facilities serve as teaching environments. The mental health care network focuses on five axes: Communication, Care, Prevention, Management, and Education, with specific proposed actions and competencies. Despite progress, challenges remain. Expanding access, reducing stigma, and implementing robust monitoring are crucial. São Caetano do Sul's experience offers valuable insights for similar urban settings in LMICs developing mental health programs.

The “CELL” initiative as an instrument for integrated care in Limburg (Flanders): a provincial living lab approach

Introduction: The primary care system in Flanders (Belgium) was substantially reoriented and restructured. At local level Primary Care Zones (PCZs) were installed to support better coordination and connect care and welfare organizations with local authorities. The province of Limburg counts 8 active PCZs and is one of the five provinces of Flanders. The province boasts an interesting mining history, forests and historic towns. Collaboration and exchange between primary care actors and knowledge institutions (universities of applied sciences and universities) offers opportunities to translate and implement evidence-based concepts and innovations in the sector. Vice versa, the sector's practical knowledge feeds scientific research and education in the knowledge institutions.
 Description: Limburg has a well-established tradition of collaboration between the healthcare and welfare sector and the knowledge institutions (Hasselt University and University Colleges PXL and UCLL). The PCZs and knowledge institutions aim to further strengthen this existing collaboration and embed it in the Health Campus Limburg (as a tangible meeting ground for primary care in Limburg). This creates a unique partnership between practice (healthcare & welfare), knowledge (research and education) and campus development (innovation ecosystem). The initiative - called 'CELL' was launched on October 5th of 2022 in Hasselt. A charter was signed by 17 Limburg organizations. In addition to 6 PCZs, the 3 knowledge institutions and Health Campus Limburg, the 2 Limburg hospital networks (South-West and North-East Limburg), the 3 mental healthcare networks (Reling, Noolim, Ligant), the palliative care network (Pallion) and the Logo Limburg (prevention network) also joined. The 3 knowledge institutes will collaborate intensively within the CELL initiative in the coming years to strengthen primary care in Limburg. CELL aims to facilitate integrated care at a regional level through innovation processes and projects. Limburg can act as a testing ground (Living Lab) for Flanders to test, monitor and implement innovations in the fields of population management, digitization, community-oriented care, etc.
 Discussion: The CELL initiative is embedded in the Hasselt University Fund and together with the partner organizations the first 2 years of funding is insured. At this point the governance structure is realized and the PCZs performed a needs assessment to establish their annual action plan. CELL will identify the main common denominators in order to accomplish joint initiatives. CELL will not operate parallel to the PZCs, but act as a supportive and academic umbrella. CELL is open to work with all organizations in- and outside the region, that share the same goals. It strives towards a good cooperation and exchange with the Flemish government and its organizations (including the Flemish Institute for Primary Care, VIVEL).
 Conclusion: The interaction between the PCZs themselves and the collaboration with knowledge institutions thus contribute to the further development of high-quality integrated care and welfare and offers opportunities to translate and implement new concepts and (digital) innovations in the sector. This directly benefits citizens and patients in the province of Limburg.

Community mental health care network: an evaluative approach in a Brazilian state

In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a community mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of this care network in Minas Gerais, the second most populous state of Brazil, generating indicators that can enhance the strategic management of the public health system in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas Gerais was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of services like ‘Family Health Strategy,’ ‘Expanded Family Health Center,’ and ‘Psychosocial Care Centers’ but a lack of ‘Beds in General Hospitals’ destinated to mental health care, ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals.’ In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in Psychosocial Care Centers,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of the mental health care network in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of mental health care networks are scarce throughout the Brazilian territory, a fact also found in Minas Gerais, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.

Respect for human rights as a component of organisational well-being: factor structure analysis in three countries of Latin America

People with psychosocial disabilities are often discriminated against and experience violations of their human rights. With the QualityRights program, World Health Organisation highlights that one of element founding the quality of services is the respect for users’ rights, in the belief that there is no quality of care without respect for human rights and vice versa. To date, studies explored the issue mainly in Europe. In this sense, the purpose of the study is to verify if the perception of respect for patients’ rights is a component of organisational well-being for mental health workers in three countries of Latin America (Argentina, Colombia, Peru). A random sample representative of professionals working in three mental healthcare networks in Argentina, Colombia, and Peru was enrolled (n = 310). Each health worker completed a questionnaire on sociodemographic data and the Well-Being at work and respect for human rights (WWRR). The WWRR consists of seven items on satisfaction at work, beliefs about users’ satisfaction in received care, the satisfaction of work’s organisation, respect of users’ and staff’s human rights, adequacy of resources, and perceived needs of resources in the mental health service. The principal components analysis of the instrument was carried out with Varimax rotation and Kaiser normalisation (including all components with Eigen value > 1). The total explained variance was 67.2%. Item 6 saturated in one single factor, and the first five items saturated in factor 1 with factor loadings ranging from 0.52 to 0.86. Parallel test suggested a one-factor structure as acceptable. The results show in three countries of Latin America that the more workers perceive that the human rights of users are respected, the more satisfied they are of own work. This article confirms previous observations in Italy, North Macedonia, Tunisia and Palestine.

Solidariedade, militância e saúde mental em tempos de pandemia

Based on digital network narratives, we analyzed various forms of solidarity actions negotiated by users of the mental health care network to deal with the problems arising from the Covid-19 pandemic in a context of ultra-neoliberal economy. If, on the one hand, the increase in psychosocial suffering was evident, on the other hand, the coping strategies organized by those people were astounding, many of them being developed and managed by themselves. Among these strategies, there is the activation and creation of social networks for specific purposes depending on the problem to be solved. Prioritizing the notion of “gift,” these strategies updated the illusio of militancy of the users involved in them. However, the physical distance between the network members and the organization of dialogue in a virtual space make difficult the interaction dynamics in favor of the establishment of interpersonal bonds and conflict resolution.

PERCEPÇÕES DE ENFERMEIROS DE UNIDADES BÁSICAS DE SAÚDE QUANTO A ATUAÇÃO FRENTE AOS CASOS DE DEPRESSÃO

ABSTRACT Objective: To understand how nurses deal with depression in basic health units. Method: Qualitative research was carried out in 2020 through an open interview with 15 nurses working in basic health units in a municipality in the Brazilian Midwest region. The interviews were subjected to content analysis. Results: It was possible to see that nurses have multifactorial difficulties in dealing with cases of depression. However, they point out strategies that indicate ways to qualify their clinical practice, such as the importance of professional training and strengthening teamwork, so they are prepared and qualified to offer effective and humanized nursing care to people with depression. Conclusion: Even in the face of the challenges that have arisen, the continuity of nursing actions aimed at patients with depression and other mental disorders is fundamental, especially in contexts with a weakened mental health care network.

PROTOCOLS FOR MENTAL HEALTH CARE IN PRIMARY-LEVEL SERVICES: SUBSIDIES FOR TRANSFORMING THE ASSISTANCE PROVIDED

Objective: to analyze the repercussions on mental health care due to the implementation of Care Conduct Protocols in a Basic Health Unit from Juiz de Fora (Minas Gerais – Brazil). Method: a historical-social study carried out in 2018, having as direct sources written documents and oral testimonies analyzed according to the assumptions of the Psychiatric Reform. Results: the following categories are presented: a) Reorganization of mental health care through the implementation of Conduct Protocols; b) Referral and counter-referral process between Basic Health Units and specialized mental health care services; and c) Transformation of mental health care. Conclusion: the protocols organized the mental health care network, supporting multiprofessional training, introducing Primary Health Care as a gateway to welcoming, treatment and monitoring in territorial mental health.

Psychiatric emergency units in Brazil: a cross-sectional study.

This study aimed to identify the infrastructure (e.g., availability, resources, and staff), basic metrics, and problems (e.g., network, overcrowding, resources, and infrastructure) of the psychiatric emergency services in Brazil. This is a cross-sectional study assessing psychiatric services (n=29) listed by the Brazilian Psychiatric Association in 2019. Almost all the units reported 24 h/7-day availability having psychiatrists, nurses, and social workers, with 8.8 (SE=2.2) and 2.8 (SE=0.3) consultations and hospitalizations per day, respectively. Separated room for contention was reported by the minority of the services (38%). The most commonly reported problems were insufficient structure for child/adolescent care (83%), increasing patient demand (72%), housing referral for homeless (72%), excessive prescription demand (69%), short-term room overcrowding (59%), court orders for inpatient treatment (59%), lack of vacancies for inpatients hospitalization (59%), and referral to primary care (56%). Similar to the United States, the Brazilian psychiatric emergency units are decreasing and encompass the shortcomings of the Brazilian mental health care network.

Indicadores de saúde mental para a Rede de Atenção Psicossocial brasileira: uma proposta

Objective: to propose Mental Health Indicators aimed at management of the Mental Health Care Network, starting with convergence of their use, in countries with public health organization. Method: an exploratory analysis of the indicators adopted and used in these countries, from the detailed analysis of their respective normative documents, considering the World Health Organization guidelines. After selection of the indicators, the Mental Health Matrix was adopted as a suggestion for their development and application in the Brazilian Psychosocial Care Network. The matrix was prepared in two dimensions, respecting the inclusion and exclusion criteria for the indicators studied, as follows: geographical (national/regional, local, individual), and time (entry, process and results). Results: the analysis indicates 41 indicators that presented diverse evidence regarding their use. All were allocated in the Mental Health Matrix, contributing as a metric to analyze the purpose of the Mental Health services, in the levels and phases of each dimension. Conclusion: the indicators selected, distributed in the different Mental Health Matrix dimensions, are being made available for their use in management and in the clinical practice, as well as for scientific studies and, in the future, to be used as definers of Mental Health policies.

Mental Health Indicators for the Brazilian Psychosocial Care Network: A proposal.

to propose Mental Health Indicators aimed at management of the Mental Health Care Network, starting with convergence of their use, in countries with public health organization. an exploratory analysis of the indicators adopted and used in these countries, from the detailed analysis of their respective normative documents, considering the World Health Organization guidelines. After selection of the indicators, the Mental Health Matrix was adopted as a suggestion for their development and application in the Brazilian Psychosocial Care Network. The matrix was prepared in two dimensions, respecting the inclusion and exclusion criteria for the indicators studied, as follows: geographical (national/regional, local, individual), and time (entry, process and results). the analysis indicates 41 indicators that presented diverse evidence regarding their use. All were allocated in the Mental Health Matrix, contributing as a metric to analyze the purpose of the Mental Health services, in the levels and phases of each dimension. the indicators selected, distributed in the different Mental Health Matrix dimensions, are being made available for their use in management and in the clinical practice, as well as for scientific studies and, in the future, to be used as definers of Mental Health policies.

EFFECTS OF SOCIAL STIGMA ON TUBERCULOSIS CARE: CASE STUDIES IN MAHA SARAKHAM PROVINCE, THAILAND

Tuberculosis (TB) is a public health issue that relies on the participation of health networks and the care of tuberculosis patients systematically and effectively. This study aimed to investigate the effects of social stigma on continuous tuberculosis patient care. This qualitative research study employed a case study approach to investigate the effects of social stigma on the continuous tuberculosis patient care in Maha Sarakham Province, Thailand. The current study also explored tuberculosis patients’ health service information. An interview form was used as a research instrument to collect data. Interviews were conducted to collect the data from 42 tuberculosis patients and eight members of the tuberculosis caregiver community network. The research results revealed that the tuberculosis patients who received ongoing consultations and treatments from public health officers could develop positive incentives and expectations of the tuberculosis treatments. Family members had improved their supportive skills and could lower the stigma of their household patients. Consequently, people in the community built a network of mental health care and social support to reduce the stigmatization of tuberculosis patients. Counseling skills and knowledge of patient care are essential in caring for mental health patients. When people who are close to the patients develop essential skills for patient care, the stigmatization of tuberculosis patients can be reduced.

428 - Reflections on geriatric psychopharmacology in Portugal

Background:The most common psychiatric illnesses include depressive and anxiety disorders. However, the gap between therapeutic indication and pharmacological consumption is evident, with anxiolytics and antidepressants being some of the most prescribed drugs for the general population and, in particular, for the elderly. However, several of these psychotropic drugs are part of the list of potentially inappropriate medications for the elderly. Thus, the question arises: is the appropriate care being given to older patients, in this domain?Research objective:This work aims to reflect on the current structure of the mental health care network for elderly patients, focusing on consumption patterns among thevarious categories of psychotropic drugs and their physiological impact, taking into account the particularities of the target population.Method:A non-systematic review of the literature is presented. Bibliographic selection was carried out through keyword research in MEDLINE, Google Scholar and also by cross-referencing between articles.Results:In Portugal it was possible to infer that the consumption of anxiolytics and antidepressants increased ans was in line with the European trend. On the other hand, there has been a downward trend in the consumption of sedatives and hypnotics, opposite to the general trend in Europe. Due to changes related to pharmacokinetics and pharmacodynamics, older patients are more susceptible to the development of adverse reactions, the prevalence of potentially inappropriate medications is high in the context of mental health care. Switching drugs such as benzodiazepines, certain antipsychotics, tricyclic antidepressants and first-generation antihistamines significantly reduced the risk of adverse reactions.Discussion:Mental health care policies must be aligned with the conscious use of psychotropic drugs in the elderly population, at risk of the main objective, their well- being and care, being compromised.

Community mental health care in Mexico: a regional perspective from a mid-income country

BackgroundAccess to mental health care is a worldwide public health challenge. In Mexico, an unacceptably high percentage of the population with mental disorders does not receive the necessary treatment, which is mainly due to the lack of access to mental health care. The community mental health care model was created and has been implemented to improve this situation. In order to properly plan and implement this model a precise situational diagnosis of the mental health care network is required, thus this is a first approach to evaluate the community mental health networks in the state of Jalisco.MethodsTwo components from the EvaRedCom–TMS instrument were used including a general description and accessibility of the community mental health care network. A geographic and economic accessibility evaluation was carried out for the different regions of the state ranging from scattered rural to urban communities using information gathered from health institutions, telephone interviews and computer applications.ResultsJalisco’s community mental health network includes a total of 31 centers and 0.64 mental health workers for every 10,000 inhabitants > 15 years of age. The mean transportation cost required to access mental health care was 16.25 USD per visit. The time needed to reach the closest mental health center in 7 of the 13 analyzed regions was more than 30 min and the mean time required to reach a prolonged stay center was 172.7 min with transportation cost (taxi, private and public transport) of 22.3 USD. Some marginalized regions in the state have a mean 114 min required to reach the closest mental health care center and 386 min to reach a prolonged stay center.ConclusionsThis first approach to evaluate the mental health networks in Mexico showed that there are multiple barriers to access its care including an unfavorable number of human resources, long distances, and high costs. The identification of Jalisco’s mental health network deficiencies is the first step towards establishing a properly planned community mental health care model within the country.

The Quality Mental Health Care Network: A roadmap to improving quality mental healthcare in Canada.

Although there are numerous quality of care frameworks, little attention has been given to the essential concepts that encompass quality mental healthcare. HealthCareCAN and the Mental Health Commission of Canada co-lead the Quality Mental Health Care Network (QMHCN), which has developed a quality mental healthcare framework, building on existing provincial, national, and international frameworks. HealthCareCAN conducted an environmental scan, key informant interviews, and focus groups with individuals with lived experiences to develop the framework. This article outlines the findings from this scan, interviews and focus groups.

Mental healthcare in Brazil: a multifaceted study in four large cities

This study aimed to assess characteristics of healthcare networks in four large Brazilian cities (Campinas, Fortaleza, Porto Alegre, and São Paulo), in the provision of mental healthcare. The following outcomes were used: (i) place of identification of the mental health problem; (ii) mental healthcare in primary care; (iii) pharmaceutical care in mental health; and (iv) social rehabilitation. This is a mixed-methods study with a concurrent and sequential approach, conducted with 10 administrators and 1,642 users of Centers for Psychosocial Care (CAPS, in Portuguese) in the four cities. The study showed the persistence of high-complexity services such as hospitals as the site for initial identification of mental health problems in Campinas (40% of users) and Fortaleza (37%); low proportion of mental health treatment in primary care (Fortaleza, 23%); differences between cities in psychotropic medication prescription in primary care (Porto Alegre, 68%; São Paulo, 64%; Campinas, 39%; Fortaleza, 31%) and in shortages of prescribed medication (higher in Fortaleza, 58%; lower in Campinas, 28%); and overall frailty in enabling return to work (lower in São Paulo, 17%; higher in Campinas, 39%), with better overall results regarding religion and leisure activities (higher in São Paulo, 53% and 56%, respectively). The study contributes to the discussion of the Brazilian scenario of mental healthcare, with evidence of persistent inequalities in the national context, pointing to gaps in some mental healthcare network configurations with the potential for better performance and longitudinal follow-up.

Saúde Mental de Crianças e Adolescentes: A Rede na Clínica-Escola

O presente trabalho objetiva compreender a configuração da rede de cuidado em saúde mental da infância e adolescência em Quixadá, Ceará, partindo dos pacientes atendidos na clínica-escola de psicologia do Centro Universitário Católica de Quixadá. Trata-se de uma pesquisa documental e de natureza quantitativo-exploratória. Os dados foram analisados a partir do modelo estatístico descritivo. A clientela é, predominantemente, de meninos, de 4 a 12 anos, residentes no município de Quixadá e que não estão e nem estiveram em outros serviços de saúde, educação ou assistência social para tratar da queixa apresentada. Diante disso, acreditamos que a clínica-escola tem um grande valor social, dando o suporte aos equipamentos da rede, uma vez que a rede formal de cuidados não possui uma instituição de referência nesse tipo de atendimento.

PMH52 HOW TO PRIORITIZE HEALTH RESEARCH TOPICS: CAN A MCDA APPROACH FULFILL THIS NEED?

Public resource allocation for research can be a challenge for many countries, especially for developing ones. Included in a project sponsored by the Brazilian Ministry of Health, this study aimed to rank relevant research topics to assist public health policies. A Multiple Criteria Decision Analysis using an Analytic Hierarchy Process (HPA) model was developed to select topics for research projects in mental health. Relevant themes were raised in a first workshop with policymakers from different sectors of the Ministry of Health. HPA criteria were selected by facilitators, according to specificities of Brazilian context. In a second workshop, twenty stakeholders weighted those criteria, scored and ranked the proposed themes. The group of stakeholders was composed by 5 society representatives, 5 health professionals, 5 mental health researchers and 5 policymakers. Twelve mental health issues in the public health system were combined into four domains: mental health care network, mental disorders epidemiology, health technology assessment, and information systems. In descending order of weighting, the six established criteria within HPA framework were: health impact, feasibility, contribution to technology incorporation, rational use of resources, contribution to clinical decision-making, social interest. The first three ranked themes were: elaboration of clinical guidelines, health technology assessment of public health interventions, and epidemiology of mental health disorders. CONCUSIONS: Research topics prioritization in a scenario of restricted budget is a complex process and should be based on a rational, structured and transparent methodology that takes into account both objective and subjective aspects. HPA method seems to be suitable for this purpose. This is an innovative initiative in Brazil, seeking to improve transparency and to strength the contribution of different health care stakeholders in decision-making process.

Política de saúde mental, ensino em enfermagem e dificuldades na prática assistencial

Este trabalho tem o objetivo de analisar a formação dos enfermeiros oriundos de instituições de ensino públicas e privadas, da cidade de São Paulo considerando as transformações propostas pela Política Nacional de Saúde Mental e pela Reforma Psiquiátrica brasileira. Pesquisa de abordagem qualitativa, descritiva-exploratória, com uso do referencial metodológico da análise documental e da análise de conteúdo. Realizou-se entrevistas com os docentes responsáveis pelas disciplinas de Saúde Mental e foi elaborada a análise documental dos Projetos Político-Pedagógicos que norteiam os cursos de enfermagem pesquisados. Foram identificados problemas que interferem na qualidade do ensino ofertado principalmente no que se refere as práticas de estágios nos serviços substitutivos, dos quais destacam-se a desarticulação e a inadequação do funcionamento da rede de atenção em saúde mental; a deficiência no número de serviços para atender a demanda da população e das escolas. Além disso, há dificuldades na contratualização com a gestão da saúde para estabelecer os campos de prática devido a terceirização do setor e na associação da teoria dada, em sala de aula, com as práticas desenvolvidas nas unidades de assistência. Percebeu-se que as instituições de ensino não ofertavam formação na graduação em enfermagem alinhadas às transformações propostas pela Política Nacional de Saúde Mental e pelos pressupostos da Reforma Psiquiátrica.