Mental Health Care Network Research Articles

Centro de atenção psicossocial: panorama das publicações de 1997 a 2008

Os Centros de Atenção Psicossocial (CAPS) se caracterizam como serviços estratégicos na articulação da rede de atenção à saúde mental e têm sido implantados gradualmente, a partir das transformações que ocorreram na assistência psiquiátrica brasileira, considerando-se o movimento de desinstitucionalização do doente mental, a reabilitação psicossocial e a reforma psiquiátrica. Por se tratar de serviços que determinam uma história recente de atenção à saúde mental, merecem ser sistematicamente estudados. Assim, este trabalho tem por objetivo analisar as publicações científicas relacionadas aos CAPS produzidas entre 1997 e 2008. Este estudo se caracteriza pela natureza descritiva, quantitativo-qualitativa, em que se realizou pesquisa bibliográfica com consulta às bases de dados LILACS e SciELO. Os resultados evidenciaram o predomínio de trabalhos publicados em periódicos científicos, sendo prevalentes as temáticas relacionadas aos serviços que compõem a rede de saúde mental, a organização, a avaliação e os projetos desenvolvidos nos CAPS, a análise teórica a respeito da reforma psiquiátrica e os estudos clínicos, socioantropológicos e epidemiológicos. A investigação demonstrou a relevância da identificação dos principais aspectos da produção científica relativa aos CAPS considerando-se o contexto da reforma psiquiátrica e as novas formas de atendimento em saúde mental, possibilitando a apreensão de uma visão panorâmica sobre esse campo.

Mental health care network: the interaction importance between the primary

Introduction: The effectiveness of the mental health care network is necessary to the implementation of actions that provide the formation of the web links that promotes psychosocial and quality of life of individuals who have mental disorders. Objective: To develop a theoretical essay on the Brazilian Psychiatric Reform, legislation on mental health in Brazil and the services regulated by this as well as the importance of structuring the network of mental health care, emphasizing the interplay between the specialized services of mental health care and the role of primary health care in building this network. Materials and Methods: We searched the literature published in the last 10 years, written in Portuguese, as well as specific mental health descriptors. Results: The theoretical research pointed to the need of an expanded mental health view, including mental suffering, sheltering the User and promoting their best conveyance, recognizing the role that its territory has in the process, guiding an important and strategic relationship in the health care network articulation. Conclusion: Thus, it is necessary to promote the integration and interaction between the sectors and stakeholders in the mental health care network and primary care, involving health services, management and social participation, both in achieving the care and the mental health care, as in the production and regulation of the health services network.

Primary Care Gains Popularity as MH Screening Site

Primary Care Gains Popularity as MH Screening Site

Mental Health Care Policies and Services in Switzerland

This article summarises the recent development of Swiss mental health policies and services. The last three decades have been characterised by a strong emphasis on the socio psychiatric approach Bachmann, 1995; Ciompi, 1997, 1994,1987a, 1987b). The establishment of a decentralised, patient and community focused mental health care network, integrating different therapeutic methods under a uniform administration is the base concept of the emerging movement (Ernst, 1998;Bachmann, 1995,Ciompi, 1994, 1987b). Achievements and problems of mental health care provision are outlined. A more proactive role for mental health care professionals in policy is proposed to contribute to the solution of present injustices. The situation in Switzerland can, however, be considered to correspond to that in a range of other countries. Since the Swiss mental health care system has been strongly influenced by international developments it might be seen to portray Europe on a small scale (Ciompi, 1994; 1987b). Not only in Europe but in all industrialised countries experts presently perceive difficulties in mental health care delivery in an astonishingly similar way (Ernst, 1998). Globally the similarity of mental health needs appears to be much greater than is the case for physical health. The delivery of mental health care might thus be considered as a world-wide issue requiring an international response (Ernst, 1998).

A falácia da adequação da cobertura dos Centros de Atenção Psicossocial no estado do Rio Grande do Sul

Introdução: A análise dos resultados da expansão da rede de atenção à saúde mental para a população brasileira tem utilizado como medida de desfecho o indicador de cobertura dos Centros de Atenção Psicossocial (CAPS), que considera adequada a existência de um CAPS para cada 100 mil habitantes. O Rio Grande do Sul encontra-se classificado em terceiro lugar no ranking nacional, com índice de 0,7 CAPS/100.000 habitantes. Este estudo objetivou testar a variabilidade de cobertura de cada região para verificar se esse índice global representava as realidades regionais. Método: Foram utilizados dados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e dados populacionais do ano de 2009 disponibilizados pelo site do Departamento de Informática do Sistema Único de Saúde do Ministério da Saúde. Foram calculados os indicadores de cobertura para as 19 regionais de saúde, sendo gerado índice de cobertura resultante da razão entre o indicador observado e o esperado de acordo com a população de cada região geográfica analisada. Resultados: Analisada a variabilidade de cobertura de cada região, foi evidenciada a ocorrência de sete regiões com cobertura insuficiente, representando 49% da população do estado com cobertura inadequada. Conclusão: O estudo demonstrou que o uso do índice global é falacioso, pois não representa as realidades regionais, sendo que cerca de metade das regiões com excesso de cobertura mascaram as regiões deficientes. Isso sugere que as análises de cobertura devem ser realizadas por áreas geográficas para identificar carências regionais e fornecer subsídios para a extensão da rede de forma igualitária para usuários de diferentes regiões do estado.

P03-175 - The Delphi exercise in Poland (as an exemple of all the within country Delphi exercises)

ObjectiveThe Delphi exercies carried out in Poland constituted part of DEMoB.inc project founded by EC and conducted within 10 European countries. Polish part of Delphi exercise fulfils major method's assumptions and aims to define items of long-term psychiatric care in recovery model of treatment.MethodsDelphi method has not been widely applied in research across Poland. Method is characterized by defined panel of experts (EP), information flow, regular feedback and participants’ anonymity. Delphi has proven prognostic potential in health care, social sciences, new technologies and policy forecasting. However informality of EP selection and limited complex forecasts with multiple factors and downward responses-rate tendencies in following rounds constitute its crucial shortcomings. Criticized basic statistics has been lately overcome by implementation of sophisticated fuzzy logic theory. Three stages Delphi exercise has been carried out in four groups of respondents: service users, carers, advocates and professionals. Wide range of EP representatives has promoted indication of diverse elements of care within partner sites.ResultsPolish mental health care network varies from developed European countries. Out of 11 initially appointed domains only 2 (SPHRandA; SMA) have been underrepresented. Advocates achieved significant consensus in the largest number of items: 23 out of 104 which covered 9 domains whereas professionals in the lowest number: 11 out of 130 which covered only 4 domains. Moreover domains supported with advocates’ opinions fully overlapped with domains pointed by service users. The surprising outcome might be due to diversity of professions in “professional group”, differences in occupational responsibilities and work experience.

Saúde mental no Programa Saúde da Família: caminhos e impasses de uma trajetória necessária

The focus of this study is mental health care in the Brazilian Family Health Program (FHP), with the complexity of such care as the main premise. The objectives were to analyze the actual conditions of mental health care in FHP services in Cuiabá, Mato Grosso State, describing the dynamics of such care and identifying situations and instruments used by different health professionals in dealing with problems of mental distress in the community. By means of a descriptive exploratory methodology, the discourses of eight health teams were studied, using content analysis. The study concluded that the demand for care for individuals with mental distress was not recorded on the patient charts, nor was it part of a proposal for individual or family interventions; some measures were taken according to a lay concept of 'mental illness' and treatment, while referral to the specialized mental health care network was frequently used, despite its precariousness, thus reflecting the need for continuing training in mental health.

A Novel Network for Mentoring Family Physicians on Mental Health Issues Using E-mail

Family practitioners are significant providers of mental health care and routinely report difficulty acquiring timely support in this area. The Collaborative Mental Health Care Network assembled groups of family practitioners and provided them with mental health practitioner mentors. This article addresses communication in the Network, its effect on family practitioners, and the role e-mail plays. This descriptive study utilizes two sources of data: a quality assurance survey administered to family practitioners in the Network and a sampling of e-mail correspondence between family practitioners and mental health and addiction mentors, examined qualitatively. Family practitioners in the Network requested consultation on pharmacotherapy (53%), psychotherapy (34%), treatment review (27%), and diagnosis (24%). Satisfaction with the Network was high, with 88% of family practitioners reporting an improvement in ability to provide mental health care. E-mail analysis suggests that mentors convey information directly and indirectly and that a knowledge hierarchy, but not a power hierarchy, develops. The trusted relationship between the mentee and mentor is an important context for effective education. This model of mentoring is highly satisfactory to family practitioners and correlates with increased confidence in caring for patients with mental health issues. E-mail is a promising strategy for effective feedback and support between family practitioners and specialists.

Rede de atenção à saúde mental de base comunitária: a experiência de Santo André

Os distúrbios psiquiátricos constituem um grave problema de saúde pública. Por muitos anos, a única terapêutica disponível ao portador de transtornos mentais era a internação em hospitais psiquiátricos. Hoje a Organização Mundial da Saúde recomenda os serviços de base comunitária como modelo de tratamento em saúde mental. Assim, o objetivo é descrever as características de uma rede de atenção à saúde mental de base comunitária no município de Santo André, SP. Foi realizado um estudo retrospectivo do tipo descritivo, em dados secundários do período de 1987 a 2006. O estudo incidiu sobre o histórico, a infra-estrutura, os recursos humanos, a produção, as práticas e processos de trabalho dos serviços de saúde mental de Santo André. Foram analisados documentos do Programa Municipal de Saúde Mental, da Secretaria Municipal de Saúde, da Prefeitura de Santo André, da Associação José Martins de Araújo Júnior/Organização Social De Volta Para Casa. A Secretaria Municipal de Saúde proveu meios para uma transformação dos serviços de saúde mental no período estudado, partindo de um atendimento exclusivamente manicomial para uma rede de serviços de saúde mental com modelo centrado na comunidade, focando a doença no aspecto psicossocial e com abordagem por equipe multiprofissional. Estas ações no município de Santo André forarm corroborativas aos esforços da sociedade civil e o pleno desenvolvimento da mudança do modelo hospitalocêntrico.

L’exemple d’un dispositif de soins en psychiatrie du sujet âgé au sein du Réseau pour la promotion de la santé mentale Yvelines-Sud

The goal of the Mental Health Care Network of the Yvelines-Sud region (RPSMYS) is to reorganise mental health care on the basis of a partnership and thus to improve care for people within this field. Its sphere of activity is both well-defined and wide ranging: it does not replace the existing health care offer, but it is required for situations in which there are no satisfactory answers despite a well identified need or when the level of interdependence between the different actors is high or in situations where compartmentalisation is stronger.

Accès et continuité des soins pour les troubles mentaux les plus fréquents : les consultations de soins partagés du RPSM 78

Difficulties in access to care for patients presenting common mental health disorders (more especially depressive disorders) and worrying indicators relating to the quality of care could be analyzed as resulting from poor collaboration between primary care (general practitioners) and the specialized care system. An example of a shared mental health care consultation developed by the “Mental Health Care Network of the Yvelines-Sud region” is presented, including its procedure and its evaluation, over a period of seven years of care. The indicators highlight the relevance of such care and the satisfaction of professionals and of patients involved.

Reforma psiquiátrica no Rio Grande do Sul: uma análise histórica, econômica e do impacto da legislação de 1992

Os autores apresentam uma análise da reforma psiquiátrica do Rio Grande do Sul, utilizando uma perspectiva histórica e uma abordagem por três vertentes: a psiquiatria institucional; os desenvolvimentos na área extra-hospitalar; e as políticas de saúde implementadas ao longo dos anos. A partir do referencial adotado, foi revisada a experiência brasileira e a do Rio Grande do Sul em particular, tendo como fontes: os bancos de dados MEDLINE e Lilacs e documentos oficiais do Ministério da Saúde e da Secretaria Estadual de Saúde do Rio Grande do Sul. Hoje, após 14 anos da promulgação da Lei Estadual nº 9716, que dispõe sobre a reforma psiquiátrica no Rio Grande do Sul e determina a substituição progressiva dos hospitais psiquiátricos por uma rede de atenção integral em saúde mental, nota-se que o número de leitos psiquiátricos foi reduzido em 35%, e a proposta de implantação da rede "alternativa" de assistência ao doente mental não foi implementada da forma preconizada, tampouco de maneira igualitária. Tendo em vista que os atuais desafios, tais como o fenômeno da "porta giratória" e o paciente crônico, refletem a necessidade de extensão dos cuidados primários e secundários, a experiência do Rio Grande do Sul permite pôr em discussão a possibilidade de modificação da estratégia, de tal modo que, ao invés de tentar estruturar um "sistema dentro do sistema", como hoje está colocado, possa-se tirar melhor proveito da integração da saúde mental aos programas-eixo do SUS, como o Programa de Saúde da Família e o Programa de Agentes Comunitários de Saúde.

Regional planning implementation and its impact on integration of a mental health care network.

This article questions the effectiveness of a managerial tool in changing a health-care system. The process of implementing regional planning and its impact on creating integrated service networks is examined, using a case study and a multi-dimensional analytic model. This model highlights the influence of contextual, structural, cultural and dynamic factors on forming networks. The regional planning developed in the province of Québec (Canada), aimed at a major transformation of the mental health-care system. In each district, organizations working with people who have serious mental disorders were mobilized to plan and implement a more coordinated, continuous and diversified supply of services, under the direction of a regional health body. This study outlines the limitations of regional planning as a tactic for transforming the system. It recommends instead developing more diversified integration strategies to further the process of forming integrated service networks within a complex system. In conclusion, a brief discussion deals with the difficulties related to the study of systemic change implementation.

Needs for mental health care and service provision in single homeless people

Specific problems in sampling methodology, case-finding strategies and a standardised needs assessment in mentally ill homeless people have contributed to their being neglected as a mental health care clientele. We assessed a representative sample of homeless people (n=102) in the highly industrialised city of Mannheim (Germany) regarding their prevalence of mental disorders (using the SCID) and their needs for mental health care (using the NCA). We found high prevalences, with 68.6% of all assessed homeless persons having a current mental disorder. Thus, needs for mental health care were very common, with unmet needs predominating in all problem areas, which was supported by a very weak service utilization. Thus, even in a region with a comprehensive community mental health care network, like the study area, mentally ill homeless people are widely under-provided. Results suggest that the traditional shelter system for homeless people carries most of the mental health care burden for their clientele and must be supported by adequate interventions from community-based mental health care services. A closer connection of both sectors and a better co-ordination of the care offers seems to be a prerequisite for helping to reduce unmet mental health care needs in this specific high-risk group.

FC10.05 Do community based mental health care networks neglect mentally ill homeless people?

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JCAHO mental health care network accreditation as a performance improvement project.

In June 1995 the Southeastern Area of the Massachusetts Department of Mental Health became the third health care network, and first mental health care network, to be accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) under its new network standards. This paper provides a brief overview of how the Southeastern Area network prepared for and went through the JCAHO survey. The author shows how the effort undergoing the accreditation procedure helped improve the performance of the network. To help other organizations considering JCAHO network accreditation, specific aspects of the survey process are presented, including preparing documents, understanding key concepts emphasized by JCAHO, and preparing staff for participation in the survey interviews.

Considerations in the design of mental health benefits under National Health Insurance.

The existing insurance coverage for mental health benefits provides incentives for hospital as compared with community care and reinforces a medical approach to psychological disability. Moreover, the structure of benefits favors the affluent as compared with the disadvantaged and provides little assistance for the community integration of the chronic mental patient. In considering mental health benefits under National Health Insurance we must be careful to avoid reinforcing these patterns. It is suggested that NHI include a mental health resource development fund intended for building a stronger network of community mental health care and that the pattern of insurance benefits under NHI be consistent with developing psychiatric services on a capitation basis.