Mental Health Care Network Research Articles

The collaborative management of antipsychotic medication and its obstacles: A qualitative study

Antipsychotic medication is the primary treatment for psychotic conditions such as schizophrenia and schizoaffective disorders; nevertheless, its administration is not free from conflicts. Despite taking their medication regularly, 25–50% of patients report no benefits or perceive this type of treatment as an imposition. Following in the footsteps of a previous initiative in Quebec (Canada), the Gestion Autonome de la Médication en Santé Mentale (GAM), this article ethnographically analyses the main obstacles to the collaborative management of antipsychotics in Catalonia (Spain) as a previous step for the implementation of this initiative in the Catalan mental healthcare network. We conducted in-depth interviews with patients (38), family caregivers (18) and mental health professionals (19), as well as ten focus groups, in two public mental health services, and patients' and caregivers' associations. Data were collected between February and December 2018. We detected three main obstacles to collaboration among participants. First, different understanding of the patient's distress, either as deriving from the symptoms of the disorder (professionals) or the adverse effects of the medication (patients). Second, differences in the definition of (un)awareness of the disorder. Whereas professionals associated disorder awareness with treatment compliance, caregivers understood it as synonymous with self-care, and among patients “awareness of suffering” emerged as a comprehensive category of a set of discomforts (i.e., symptoms, adverse effects of medication, previous admissions, stigma). Third, discordant expectations regarding clinical communication that can be condensed in the differences in meaning between the Spanish words “trato” and “tratamiento”, where the first denotes having a pleasant manner and agreement, and the second handling and management. We conclude that these three obstacles pave the way for coercive practices and promote patients' de-subjectivation, named here as the “total patient” effect. This study is the first GAM initiative in Europe.

WORK PROCESS AND MENTAL HEALTH CARE FLOW IN PRIMARY HEALTH CARE

ABSTRACT Objective: to know the work process and mental health care flow in Primary Health Care from the perspective of Family Health Strategy professionals. Method: a descriptive and qualitative study developed in six of the 34 Basic Health Units in a city in northwestern Paraná. Twenty-nine Family Health Strategy professionals participated in the study. Data were collected from February to June 2018 through an open, single, individual and recorded interview. The statements were transcribed in full, and the resulting material was organized in the IRaMuTeQ® software and subjected to thematic content analysis. Results: from participants’ reports, it was possible to create a service flowchart, and after the data processing steps in the software, together with content analysis, three categories emerged. The importance of community health workers’ work, family presence, referring patients to therapeutic groups and a specialized network, assistance provided to individuals in times of acute disorder and patient referral to the unit stood out. Conclusion: it can be understood that the mental health care network in Primary Health Care is complex and there is a need for communicability between services, as disarticulation generates ambiguities in continuity of care.

Using Mental Health Indicators to Improve Health Care Management: A Web-based Approach.

Mental health indicators are essential for monitoring people's mental health status, developing mental health policies, and evaluating the performance of such policies. The aim of this paper is to describe the development of a web-based tool for mental health indicators capable to support the management of Brazilian mental health care networks. The SISAM is a web information system responsible for management and provision of mental health information in Brazil and it was chosen as the use case of this study. The indicators were developed as a decision support web tool for public health managers. The tool is able to calculate 11 indicators related to inpatient care. A descriptive analysis of all indicators is presented using SISAM data from 2017. The results generated by the tool are promising and could provide improvements on care monitoring, evaluation of possible trends and investments in prevention and promotion in mental health care.

Recovery for all in the community; position paper on principles and key elements of community-based mental health care

BackgroundService providers throughout Europe have identified the need to define how high-quality community-based mental health care looks to organize their own services and to inform governments, commissioners and funders. In 2016, representatives of mental health care service providers, networks, umbrella organizations and knowledge institutes in Europe came together to establish the European Community Mental Health Services Provider (EUCOMS) Network. This network developed a shared vision on the principles and key elements of community mental health care in different contexts. The result is a comprehensive consensus paper, of which this position paper is an outline.With this paper the network wants to contribute to the discussion on how to improve structures in mental healthcare, and to narrow the gap between evidence, policy and practice in Europe.Main textThe development of the consensus paper started with an expert workshop in April 2016. An assigned writing group representing the workshop participants built upon the outcomes of this meeting and developed the consensus paper with the input from 100 European counterparts through two additional work groups, and two structured feedback rounds via email.High quality community-based mental health care: 1) protects human rights; 2) has a public health focus; 3) supports service users in their recovery journey; 4) makes use of effective interventions based on evidence and client goals; 5) promotes a wide network of support in the community and; 6) makes use of peer expertise in service design and delivery. Each principle is illustrated with good practices from European service providers that are members of the EUCOMS Network.ConclusionsDiscussion among EUCOMS network members resulted in a blueprint for a regional model of integrated mental health care based upon six principles.

The multidisciplinary team's perception on the structure of mental health services: phenomenological study.

To understand the multidisciplinary team`s perception in relation to the mental health services` organizational structure in the city of Cascavel-Paraná. It is exploratory, descriptive, qualitative study with Alfred Schütz's Social Phenomenology approach. The information was collected through a semi structured interview with professionals of those services, between May and July 2016 and analyzed from the social phenomenology`s assumptions. From the analysis, the following categories were identified: the mental health care network`s organizational structure; care actions in the context of the mental health services` organizational structure and; expectations regarding the mental health care network. The multidisciplinary team has knowledge about the structural and organizational format of mental health services and has expectations of improvements regarding the future of mental health care in the city.

Contextos e Negociações: ética em pesquisa etnográfica na rede de assistência em saúde mental em Campinas

O município de Campinas é reconhecido por sua Rede de assistência em saúde mental construída em parceria com o Serviço de Saúde Dr. Cândido Ferreira (SSCF). A literatura antropológica sobre ética em pesquisa aponta para uma relação de submissão do modo de fazer etnografia às normas biomédicas que fundamentam a avaliação de pesquisas das ciências humanas em instituições de saúde. O objetivo do artigo é mostrar o processo de autorização para a realização de minha pesquisa de campo no Serviço Residencial Terapêutico (SRT), gerido pelo SSCF. Com isso, apresento a problemática atual sobre ética em pesquisa, as negociações do início de minha pesquisa de campo e como a produção de um saber antropológico é determinada por uma relação ética com os interlocutores de pesquisa.

An eHealth Platform for the Support of a Brazilian Regional Network of Mental Health Care (eHealth-Interop): Development of an Interoperability Platform for Mental Care Integration.

BackgroundThe electronic exchange of health-related data can support different professionals and services to act in a more coordinated and transparent manner and make the management of health service networks more efficient. Although mental health care is one of the areas that can benefit from a secure health information exchange (HIE), as it usually involves long-term and multiprofessional care, there are few published studies on this topic, particularly in low- and middle-income countries.ObjectiveThe aim of this study was to design, implement, and evaluate an electronic health (eHealth) platform that allows the technical and informational support of a Brazilian regional network of mental health care. This solution was to enable HIE, improve data quality, and identify and monitor patients over time and in different services.MethodsThe proposed platform is based on client-server architecture to be deployed on the Web following a Web services communication model. The interoperability information model was based on international and Brazilian health standards. To test platform usage, we have utilized the case of the mental health care network of the XIII Regional Health Department of the São Paulo state, Brazil. Data were extracted from 5 different sources, involving 26 municipalities, and included national demographic data, data from primary health care, data from requests for psychiatric hospitalizations performed by community services, and data obtained from 2 psychiatric hospitals about hospitalizations. Data quality metrics such as accuracy and completeness were evaluated to test the proposed solution.ResultsThe eHealth-Interop integration platform was designed, developed, and tested. It contains a built-in terminology server and a record linkage module to support patients’ identification and deduplication. The proposed interoperability environment was able to integrate information in the mental health care network case with the support of 5 international and national terminologies. In total, 27,353 records containing demographic and clinical data were integrated into eHealth-Interop. Of these records, 34.91% (9548/27,353) were identified as patients who were present in more than 1 data source with different levels of accuracy and completeness. The data quality analysis was performed on 26 demographic attributes for each integrable patient record, totaling 248,248 comparisons. In general, it was possible to achieve an improvement of 18.40% (45,678/248,248) in completeness and 1.10% (2731/248,248) in syntactic accuracy over the test dataset after integration and deduplication.ConclusionsThe proposed platform established an eHealth solution to fill the gap in the availability and quality of information within a network of health services to improve the continuity of care and the health services management. It has been successfully applied in the context of mental health care and is flexible to be tested in other areas of care.

Proposal of an ontology for Mental Health Management in Brazil

Mental illness represent a large part of public health problems worldwide. Additionally, mental health managers need to make decisions based on complex data from dispersed sources with low levels of standardization and integration. This generally hinders knowledge extraction and its use as a reference to provide useful indicators and reports for efficient decision making. In this context, the interoperability between Information Systems is an essential characteristic to establish the capacity of communication, exchange and reuse of information for the generation of knowledge. In order to reduce the data complexity and to assist in the data interpretation, Semantic Web technology can be used. It classifies the stored information with metadata and give them meaning and thematic through the use of ontologies. Therefore, given the importance of mental health and the need for quality data, this article aims to specify and develop an ontology capable of consuming, integrating, analyzing and making available data of a regional mental healthcare network.

Madrid Study (Spain) on the Prevalence and Characteristics of Outpatients With Dual Disorders

Although dual disorders (DD), addiction, and other mental disorders (MDs) are common in patients using mental health and addiction treatment services, they are not routinely screened for and diagnosed by most health experts. The aim of this article was to present the most relevant findings from the Madrid study on DD in a clinical sample from the Community of Madrid mental health and substance misuse service care networks. The sample consisted of 837 outpatients from Madrid: 208 patients from mental health services and 629 from substance misuse services. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate Axis I MDs and the Personality Disorder Questionnaire (PDQ4+) to evaluate personality disorders (PDs). DD cases were those in which there was a current diagnosis of an addictive disorder (excluding nicotine addiction) and another MD including PDs. The DD prevalence rate was 61.8%. There were differences in the prevalence figures for the 2 types of service: 36.1% in mental health services and 70.3% in substance misuse services. Among dual diagnosis patients there were fewer male individuals, a higher rate of unemployment, and higher figures for alcohol and cannabis dependence than among addicts only (n=194). There were differences in several sociodemographic characteristics, and dual diagnosis patients were associated with diagnoses of bipolar disorders, agoraphobia, generalized anxiety disorder, and posttraumatic stress disorder. They also presented a greater suicide risk and had more PDs than patients with MD diagnoses only, excluding substance use disorders (n=126). There is a high prevalence of DDs among those seeking treatment, more so in substance misuse services than in mental health services, and they have different characteristics that suggest greater severity. These findings could be of help in planning care service policies for these patients.

Optimal Network for Patients with Severe Mental Illness: A Social Network Analysis

It is still unclear what the optimal structure of mental health care networks should be. We examine whether certain types of network structure have been associated with improved continuity of care and greater social integration. A social network survey was carried out, covering 954 patients across 19 mental health networks in Belgium in 2014. We found continuity of care to be associated with large, centralized, and homophilous networks, whereas social integration was associated with smaller, centralized, and heterophilous networks. Two important goals of mental health service provision, continuity of care and social integration, are associated with different types of network. Further research is needed to ascertain the direction of this association.

A web-based information system for a regional public mental healthcare service network in Brazil

BackgroundRegional networking between services that provide mental health care in Brazil’s decentralized public health system is challenging, partly due to the simultaneous existence of services managed by municipal and state authorities and a lack of efficient and transparent mechanisms for continuous and updated communication between them. Since 2011, the Ribeirao Preto Medical School and the XIII Regional Health Department of the Sao Paulo state, Brazil, have been developing and implementing a web-based information system to facilitate an integrated care throughout a public regional mental health care network.Case presentationAfter a profound on-site analysis, the structure of the network was identified and a web-based information system for psychiatric admissions and discharges was developed and implemented using a socio-technical approach. An information technology team liaised with mental health professionals, health-service managers, municipal and state health secretariats and judicial authorities. Primary care, specialized community services, general emergency and psychiatric wards services, that comprise the regional mental healthcare network, were identified and the system flow was delineated. The web-based system overcame the fragmentation of the healthcare system and addressed service specific needs, enabling: detailed patient information sharing; active coordination of the processes of psychiatric admissions and discharges; real-time monitoring; the patients’ status reports; the evaluation of the performance of each service and the whole network. During a 2-year period of operation, it registered 137 services, 480 health care professionals and 4271 patients, with a mean number of 2835 accesses per month. To date the system is successfully operating and further expanding.ConclusionWe have successfully developed and implemented an acceptable, useful and transparent web-based information system for a regional mental healthcare service network in a medium-income country with a decentralized public health system. Systematic collaboration between an information technology team and a wide range of stakeholders is essential for the system development and implementation.

Mental health care network: the views of coordinators of the Family Health Strategy (FHS).

This study aimed to analyze the opinions of the coordinators of the Family Health Strategy (FHS) on the mental health care network in the city of Pelotas/RS. Descriptive and exploratory study with a qualitative approach, carried out with six FHS coordinators, in 2012. Semi-structured interview was used in data collection, and the results were evaluated using the thematic analysis. The network designed by the coordinators consists of few formal services and is focused on the Psychosocial Care Centers (CAPS). The informal network has a greater number of care units. Exchange of information related to joint responsibilities in the care is scarce, with lack of dialogue. The coordinators have scarce knowledge on the formal care network and on care focused on the ESF and CAPS. They also recognize the importance public policies that value and expand the informal care spaces in the territory.

Development and proposal of a reference tool for semi-structured interviews for the characterization of the management in mental health networks

In 2011, Brazil’s mental health care networks were instituted; nevertheless, standardized arrangements or indicators for network evaluation and management were not established. Hence, a proposed model to evaluate municipal and regional management of such networks was elaborated. One of its steps consists of semi-structured interviews aiming the network management knowledge. Therefore, this paper aimed the development and validation of a reference tool for conducting interviews focusing on assessment of mental health care network management. Methods comprised definition of interest topics, questions elaboration for each topic, preliminary script preparation, script validation, script adequacy and definition of final script. Thus, the developed script consisted of 29 questions and 8 follow-up questions divided over 8 topics (interviewee characterization, legislation, decision-making processes, network structure, management participants, information systems, indicators, and knowledge of external experiences). The script also added individualized field reports and interview planning and execution guidelines. After validation, it was concluded that chosen topics were relevant and appropriate, despite minor modifications; and estimated average interview time remained close to prior established. Therefore, the developed tool can assist collecting information to help managers evaluate the network and improving population health. Moreover, the tool could be used in other localities or adapted for other networks.

Mental health care reforms in Belgium: organisational integration through the development of networks

Belgium is going through a structural reform of the mental health care system. Key of the reform is is a policy strategy with the ambition to deinstitutionalise the mental health care provision (reduction of beds) through a balanced care approach and by means of establishing regional multisectorial mental health care networks. Each network will cover a range of activities ( 5 functions from prevention over ambulatory care, over housing and social care, over rehabilitation,...) The government program was launched in 2012. This contribution will provide a state of the art process evaluation of the implementation of multisectorial networks. The methodological approach used is grounded in realist evaluation and takes into account knowledge from implementation science. We will report findings of 19 networks. Data were mainly collected through qualitative datacollection techniques. This contribution will highlight the facilitating and hampering factors when implementing interorgansation networks in mental health care: Particular attention will be paid to the governance of these networks and the impact of intsitutional fields in which different sectors operate on the establishment of networks. Based on the empirical analysis we wil present a number of lessons learned, reflections and recommendations on how the organisational and multisectorial intergration of mental health care could become more effective, and we will stress the importance of a context-sensitive approach in order to adress the issue of integration of care.

Reporting of work-related mental disorders among workers in Bahia: a descriptive study, 2007-2012

to describe characteristics of work-related mental disorder (WRMD) cases in the State of Bahia, Brazil, 2007-2012. this was a descriptive study using Bahia Surveillance and Health Protection Superintendents Office data kept on the Notifiable Diseases Information System (Sinan). 211 cases of WRMD were reported, 97.0% in the Worker's Health Reference Centers (CEREST), with more reported cases in 2011 (n=63; 29.9%); slightly more than half the cases were found among men (n=108; 51.2%), the majority aged 18-49 (n=167; 79.1%), in formal jobs (n=179; 84.8%) and among service workers and sales persons (n=48; 22.7%); the most reported disorder was post-traumatic stress (n=51; 24.2%). almost all cases were reported in CEREST; despite underreporting, the characterization of cases is relevant for informing the construction of a network of mental health care in Occupational Health.

Community psychiatry in Mozambique – a transcultural journey

Historically the psychiatric clinical practice in Mozambique evolved from an eminently reclusive care setting (colonial period) to a phase where the patients were rapidly deinstitutionalized into their communities (post-independence years). In 1990, in order to restructure the mental health care network, the National Mental Health Plan was approved. Its main goal was to promote a semi-open treatment setting, activating the community role in the rehabilitation and social reintegration of the psychiatric patient. To cope with the scarcity of human resources, a three-year technical degree was created, training medical technicians in psychiatry. Presently, there are two specialized psychiatric hospitals, one in Maputo and another in Nampula. Through the description of our 3-month community psychiatry internship in Mozambique, we intend to depict the country's mental health care reality. Our internship took place in Sao Joao de Deus Mental Health Centre, the psychiatric hospital located in Nampula, which is responsible for the country's northern region. Besides offering in-patient and ambulatory treatment, it also aims to intervene at a community level. We will address the hospital's community intervention project, the developed activities, the most commonly observed pathologies, the cross-cultural relevant aspects, as well as the challenges we had to face in a harsh environment. As one would expect, the social and medical realities we encountered were quite different from the ones we are used to, forcing us to adapt constantly in order to surpass challenges of a multiple nature. Nonetheless, these were also the circumstances that turned this experience into something unique, extremely enriching and certainly unrepeatable.

Proposal of an Evaluation Model for Mental Health Care Networks Using Information Technologies for its Management

The Brazilian public health system instituted the mental health care networks in 2011. Thus, the goal of this paper is to describe the research methods used as basis for a proposal of an evaluation model of municipal and regional management of a Mental Health Care Network that comprises computerized information systems and specific indicators. Proposed steps include: Review of Brazilian legislation on management in mental health care networks, Formulation of questions about how is mental health care management in the region; Semi-structured interviews with stakeholders about the performance of the network; Study of existing indicators in mental health field used in universal public health systems; Selection of indicators for implementation and availability in a web information system; Monitoring the system's access to obtain indicators’ usage; Another set of semi-structured interviews to evaluate effective use of the provided indicators in management of mental health care. The results obtained will be evaluated qualitatively and quantitatively to compare the final overview with the initial one, regarding mental health care network management, and if the use of computerized indicators influenced it. The use of the proposed methods in specific localities will enable expansion of local knowledge improving management and health care quality.

Stigma and prejudice: the experience of crack users.

Objectiveto evaluate the stigma and prejudice experienced by crack users in their social context. Methoda qualitative study developed through the Fourth Generation Evaluation, conducted with four interest groups (ten users, eleven families, eight employees, and seven managers), components of the mental health care network. For data collection, we used observation and individual interview. The analysis was performed through the constant comparative method. Resultscrack users suffer prejudice and are stigmatized as those who do not fit in the systems established by society (without family links, formal employment and dwelling), and are thus excluded. They exhibit undisciplined behavior and, therefore, are discriminated, marginalized and considered as criminals, losing their uniqueness and living in vulnerable situations. Conclusionthe evaluation process emphasized the need to demystify the social imaginary that demonizes the chemically dependent, being thus important to develop public policies with actions focused on health, prevention, information and combat to stigma.

Testing a model of facilitated reflection on network feedback: a mixed method study on integration of rural mental healthcare services for older people

ObjectiveTo test a management model of facilitated reflection on network feedback as a means to engage services in problem solving the delivery of integrated primary mental healthcare to older people.DesignParticipatory...

Tecendo práticas intersetoriais em saúde mental para pessoas em sofrimento psíquico

Doi: 10.5902/2179769213562 Objective: to understand the inter-sector practices of social inclusion developed in the mental health care network to people in psychic suffering, in the municipality of Campina Grande/Paraiba/Brazil. Method: a qualitative, exploratory and descriptive research conducted with four professionals through semi-structured interviews, recorded from June to July 2010. The produced material was analyzed through content analysis, proposed by Bardin. Results: the Psychiatric Reform discourse towards deinstitutionalization, social inclusion and achievement of citizenship has impelled professionals working in substitute services to seek inter-sector partners, such as: National Service for Industrial Training (SENAI), Culture and Living Center, Young Citizen Center and Reference Centers for Social Assistance (CRAS). Conclusion: inclusive practices are effective strategies for psychosocial rehabilitation and contribute to the development of public policies and comprehensiveness of mental health care.