Mental Health Care Network Research Articles

ICommunity@ East: an integrated community mental health and dementia support network in Singapore

Aim: This paper describes the establishment of iCommunity@East: An Integrated Community Mental Health (CMH) and Dementia Support Network in Singapore. Background: Mental wellness is an emerging area of need, given our fast ageing population. . The current prevalence rate for dementia is 6%(1) and 5.7%(2) for depression amongst seniors in the community. Coupled with our growing number of seniors and shrinking old-age support ratio, there will be a growing number of seniors (and their caregivers) who will require support to enable them to age in place. Therefore, we need a more extensive, community-based and preventive approach to better support the mental health (MH) of the community. A population survey which interviewed 2,558 elderly living in East region was conducted in 2011. The outcome showed that 1 out of 10 elderly is not able to live independently and about 14.6% show signs of depression or dementia. This survey also projected that almost 30% of elderly will require health or social services. Current gaps: The gaps of the existing MH system are: i) services are overly driven by the acute care sector where the expertise reside, ii) limited number of community MH service providers who lack support and development and iii) insufficient integration across sectors. Good CMH care is associated with higher self-reported quality of life and service satisfaction ratings among service users. Meeting the needs The iCommunity@East is a pilot project to address these gaps in the Eastern region, Singapore. It is a community based MH care network that integrates MH with social services and medical system so that elderly with/at risk of dementia or mental illness are supported to continue staying at home.

Matrix Support: a bibliographical study

This article presents a bibliographical review of matrix support in mental health. A search was conducted in the Virtual Health Library and the LILACS, SciELO and Google Scholar databases using the key words: "matrix support in mental health." Fourteen articles were located with the desired characteristics, which indicates that only a restricted number of publications are in circulation. The articles were analyzed with respect to their structural and methodological aspects, which revealed the absolute predominance of the use of qualitative methods and health professionals as the target research population. The same articles were then analyzed for their theoretical discussions. Among other issues, the importance of matrix support to enhance the primary health care teams provided to people suffering from psychic distress is highlighted. However, there is still considerable confusion regarding the proposal of the matrix support and shared responsibilities between teams of reference and mental health professionals, which emphasizes the need for training of these professionals, as well as better coordination and organization of the mental health care network.

The network of mental health care from the family health strategy service

The Family Health Strategy Service (FHSS) is an important ally in the mental health system, contributing to the completeness and effectiveness of care. This study aimed to discuss the mental health care network as compared to the daily routine of an FHSS. It is an evaluative study with a qualitative methodological approach. It was developed in an FHSS in Porto Alegre-RS, Brazil. Data was collected between July and December of 2010 through interviews with 16 workers and ten relatives. We identified important resources in primary health care, such as partnerships with academia. However, the constitution of this care is still based on specialty, following the logic of patient referral. Our intention for this study was to contribute to the operationalization of the mental health care network, consolidating the partnership with the FHSS and developing activities in the territorial space, raising awareness, demystifying health care service in the area, and countering the perception that it is uniquely specialized.

Early intervention in psychosis: a feasibility study financed by the Italian Center on Control of Maladies

In November 2005 the Italian Center on Control of Maladies, a department operating under the Ministry of Health, financed a project aimed at evaluating the feasibility of a protocol of intervention based on the early intervention in psychosis (EIP) model within the Italian public mental health-care network. The study was carried out between March 2007 and December 2009. It involved five centres operating under the Departments of Mental Health of Milan (Programma 2000), Rome (area D), Grosseto, Salerno (Nocera) and Catanzaro (Soverato). Enrolment lasted 12 months, at the end of which 43 patients were enrolled as first-episode psychosis (FEP), and 24 subjects as ultra high-risk (UHR) patients. Both FEP and UHR samples included a preponderance of male patients. A family history of psychosis was rarely reported in both samples. The FEP incidence rate was lower than expected on the basis of international estimates of the incidence of schizophrenia but within the expected figure for the estimated Italian rates in three centres out of five. Overall, the study proved that an EIP centre can be established within the public Department of Mental Health to reach a good fraction of the cases in need of treatment. Since then, several studies have been set up to assess the feasibility of EIP in the Italian public mental health sector in Lombardy and Tuscany, and in 2012 the Emilia-Romagna Regional Authority started an educational plan aimed at implementing the EIP model in all the Mental Health Departments in the region.

¿Hay lugar para el consentimiento informado en los tratamientos de las personas con psicosis?: una reflexión sobre el tratamiento de las psicosis

Informed consent (IC) in Mental Health care is unusual, especially for psychotic patients. However, current legislation, statements of professional associations, patient organizations and deontological codes advocate informed consent and patients' autonomy, also for people with psychosis. Patients and their relatives usually are unaware of the scope, limits and risks of drug treatment and the existence of other approaches. The reasons for the IC’s lack can be found in the peculiarities of these patients, but also on the assumption that psychosis impacts the core of the person, and therefore they are unfit of understanding and consent. Today there are two different ways to receive the patient with psychosis problems: first, the mainstream whose objective is to block the process and reverse psychotic symptoms principally using antipsychotics drugs, and another one, that includes various clinic models, that receive psychotic person with their difficulties, proposing to build a framework of understanding for their experiences. The outcomes don’t reveal superiority for the mainstream model, rather the opposite. When listening to the users, they clearly opt for their autonomy and right to choose, rejecting coercive models. Informed consent is a right that empowers the patients and also a recovery factor for many of them. Its implementation will require significant changes in the training of professionals and in the current Mental Health Care networks.

Accreditation Models of Mental Health Care: A Systematic Review

Purpose: To identify accreditation models in mental health and their effects on performance of health plans and health facilities. Methods: We conducted a free search in Databases of PubMed , Scopus , EMBASE , PsycINFO and Google Scholar up to March 2014 ,searching for “mental health” and “accreditation” in keywords, titles , abstracts and all indexed fields . Inclusion criteria were English or Persian language of of the articles, and Presentig accreditation models in mental health (processes or effects). Exclusion criteria were manuals of accreditation ,guidelines of accreditation,revisions of standards and Interview with pioneers. Results: Seven models of accreditation in mental health were determined. They were Peer or professional accreditation, The Memory Services National Accreditation Programme (MSNAP), Accreditation of acute in-patient mental health services (AIMS), Psychiatric Liaison Accreditation Network (PLAN), Electroconvulsive Therapy accreditation Service (ECTAS), psychiatric intensive care unit (AIMS-PICU), JCAHO Mental Health Care Network .All models used self-review and external peer review in collection of related data. Five accreditation models clearly focused on Continous Quality Improvement projects. Conclusion: Upon results of this systematic review, it is concluded that there are various accreditation models in mental health care . there arent enough researches about accreditation impacts on community mental health . It is recommended that a study be conducted about accreditation effect on efficiency and effectiveness of health programs and mental health care.

Pathways to care in subjects at high risk for psychotic disorders — A European perspective

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

Atendimento a usuários de drogas na perspectiva dos profissionais da estratégia saúde da família

O artigo objetivou avaliar o atendimento a usuários de drogas no contexto da rede de atenção em saúde mental a partir de uma Estratégia Saúde da Família no município de Porto Alegre-RS. O método foi qualitativo (Pesquisa Avaliativa de Quarta Geração) e os dados foram coletados no período de setembro de 2010 a março de 2011, por meio de entrevistas e observações de campo. Os sujeitos desse estudo foram 19 trabalhadores. Os resultados revelaram (des)conexões do serviço com outros pontos de atenção de saúde mental do município estudado, além de evidenciar precariedade de estratégias voltadas ao atendimento dos usuários de drogas. Este estudo poderá gerar dispositivos que vislumbrem uma real transformação nas práticas em saúde, além da consolidação de uma rede de cuidados que considera os indivíduos em seu contexto social.

Rede de atenção em saúde mental na perspectiva dos coordenadores de serviços de saúde

Trata-se de um estudo descritivo exploratório com abordagem qualitativa, que teve como objetivo compreender como coordenadores de serviços de saúde, envolvidos no cuidado dos sujeitos em sofrimento psíquico, percebem a organização da rede de atenção em saúde mental de Santa Maria, Rio Grande do Sul, Brasil. Os dados foram coletados por meio de entrevista semiestruturada e de vinhetas nos meses de abril e maio de 2008. Participaram da pesquisa dez coordenadores de serviços de saúde. Os dados foram trabalhados mediante análise temática e, posteriormente, agrupados em três núcleos de sentido: o entendimento dos fluxos assistenciais; o funcionamento da rede; e as dificuldades e potencialidades vislumbradas. Evidenciou-se uma rede em processo de construção, destacando-se a existência de movimentos que visam à melhoria da articulação entre os serviços e consequente qualificação da assistência para os usuários da rede de cuidado em saúde mental. Propõe-se um estreitamento das relações entre os serviços, intensificando a articulação entre a atenção primária, os serviços substitutivos e a atenção hospitalar. Destaca-se o papel da gestão nesse processo, considerando a necessidade de envolvimento de diferentes setores para a efetivação de um serviço de atenção à saúde mental mais qualificado.

Mental health and criminality: A Sri Lankan perspective

Recent mass killings in the United States by a perpetrator apparently having a mental disorder have led to questions about the efficiency of mental health services in that country. Sri Lanka has yet to encounter such mental health related catastrophes. However a less than comprehensive provision of specialised services in Child Psychiatry and Forensic Psychiatry, a lack of a formal community mental health care network and the ready availability of weapons which are a residue of years of armed conflict suggests that its potential for such an event remains high. Sri Lanka Journal of Psychiatry Vol 3(2) December 2012 Page 1-2 DOI: http://dx.doi.org/10.4038/sljpsyc.v3i2.5129

Acompanhamento terapêutico, clínica e atenção psicossocial: uma relação possível? Reflexão crítica segundo a hermenêutica dialética de Jügen Habermas

A reflexão sobre como se organiza a oferta terapêutica nos serviços extra-hospitalares da rede pública de saúde mental tem mostrado que a organização do trabalho coloca o saber médico-psicológico como componente privilegiado dos programas terapêuticos, impõe uma cisão teórico-prática entre o tratamento clínico-medicamentoso-psicológico e as estratégias de reabilitação psicossocial, e elegem os primeiros como dispositivo central de seus programas, em detrimento das ações psicossociais. À luz da Teoria da Ação Comunicativa de Jürgen Habermas situa-se o problema como consequência de extrema tecnificação das práticas terapêuticas, selecionadas, ideologicamente, segundo uma racionalidade instrumental, na qual as práticas respondem a imperativos técnicos, ignorando o elemento humano e social, provocando uma dicotomização entre a clínica e a atenção psicossocial, como se fossem práticas dissociadas nos projetos terapêuticos. Aponta-se para a prática do Acompanhamento Terapêutico como possibilidade concreta de reunião dessas esferas da ação dissociadas e de superação da dicotomização entre clínica e atenção psicossocial.

DESAFIOS NA CONSTRUÇÃO DE UMA REDE DE ATENÇÃO EM SAÚDE MENTAL

Esta pesquisa do tipo estudo de caso e de abordagem qualitativa teve como objetivo apresentar e discutir os desafios encontrados para estruturar uma Rede de Atenção em Saúde Mental em um município do Rio Grande do Sul, Brasil. Os dados foram coletados por meio de análise documental, observações não-participantes e grupo focal. A análise foi realizada com base na análise de conteúdo. Dos resultados emergiram os eixos temáticos Entendimento duvidoso sobre a rede por parte dos componentes da Comissão de Saúde Mental; O trabalho identificado como distinto do trabalho real em Saúde Mental; O distanciamento do nível de atenção terciária com a rede (internação hospitalar) e A falta de proximidade entre as instituições formadoras e os serviços de saúde mental do município. Evidenciou-se neste estudo a necessidade de investir no desenvolvimento dos trabalhadores de saúde para o trabalho em rede, sobretudo na Enfermagem, para expandí-lo na organização da saúde mental.

Fora de cena: a loucura, o obsceno e o senso comum

Throughout European history, madness has been associated with two states: movement and confinement. These apparently contradictory states converge in an obscene state, in the etymological sense of the word: offstage. In this article, based on data from ethnographic work in the Barcelona mental health care network, it is argued that "being ob-scene" results when madness challenges hegemonic social processes of inculcation and persuasion that induce acceptance of behavioral patterns considered appropriate, and lead patients to identify with the interests of therapists. Madness defies not reason, as it is widely supposed, but common sense understood as a cultural system. Its refractory nature leads to the stigmatizing management of madness in expert systems that seeks to subsume the experience of affected persons in predictable nosological categories.

Práticas inclusivas na rede de atenção à saúde mental: entre dificuldades e facilidades

Objective: This study aimed to identify facilities and difficulties of professionals working in the mental health network to develop practices of social inclusion with mental disorder patients. Materials and Methods: This is an empirical research, with a descriptive nature - interpretive and qualitative, performed in the mental health care network of the municipality of Campina Grande/Paraiba/Brazil with 19 professionals, from June to July 2010. The empirical material was analyzed by using the content analysis technique, thematic and categorical type, in accordance to the resolution 196/96 of the National Health Council. Results: Among the difficulties, the financial, material and structural resources appeared as a factor that impedes progress in the consolidation of the users' social inclusion, being necessary intersectoral strategies. The prejudice and the stigma represent a challenge in the psychosocial attention. As facilities, stand out the professionals availability to work with this segment, besides the training in continuous education that has allowed exchanges of knowledge, basing the interdisciplinarity required for the process of team work. Conclusion: In this context, there is a need for caution from the managers facing the difficulties identified, since this fact can interfere directly in the care that is being offered to users. However, the facilities found in the study, beyond the borders of mental health care, is a fact that consolidates the psychiatric reform, even in a gradually way in this country.

Helping and hindering: Perceptions of enablers and barriers to collaboration within a rural South Australian mental health network

To evaluate clinicians' perceptions of what helps and hinders the delivery of mental health care across a service network in a rural setting. Qualitative, semistructured interviews were conducted with 10 individuals who work in one rural mental health care service network. A regional centre in rural South Australia involving representatives of the mental health team, general practice, hospital, community health and nongovernment organisations. Clinicians' perceptions of barriers and enablers to working within their mental health care network were explored. Participants showed a strong shared commitment to effective mental health care delivery and a good understanding of the services that each offers. Interview data suggested that working relationships between local services could be perceived as stronger when a personal or historical element is recognisable. Similarly, the notion of familiarity and community involvement were perceived as facilitators in this network. A perceived barrier for participants was the failure to attract staff with mental health experience, leading to dependence upon the dedication and commitment of existing service providers. Collaboration is especially necessary in rural areas, where access to health care services is known to be difficult. The informality of relationships between service providers was shown to be the main facilitator in the network. This is both a strength as it promotes the communication between services and service providers that is essential for successful collaboration, yet is also a threat to the sustainability of the network based on the difficulties of staff recruitment and retention to rural settings.

When policy makers consult professional groups in public policy formation: Transversal consultation in the Belgian Mental Health Sector

This contribution focuses on a policy consultation process: the “transversal consultation”. Launched in 2007 in the Belgian Mental Health Sector, this consultation had to capture the experience-based knowledge of service users and professionals involved in local projects aimed at experimenting working conditions in mental health care networks. This policy challenges the existing hospital-centred model of care, characterized by a medical approach and professional specialization, by promoting instead a pluridisciplinary approach in mental health care networks.In this contribution, a case of this transversal consultation process is analysed by relying on a theoretical framework drawn from the Sociology of Organizations and the Sociology of Public Action. The analysis emphasizes the strategic use that is made of the consultation process, and stresses the gap observed between its formal objective and its perceived outcome: more than producing experience-based knowledge about mental health care networks, the transversal consultation challenged power relations sustaining the current organization of the mental health system. It shortly discusses, as a conclusion, the outcome of the initiative.

La red de atención a la salud mental correspondiente al hospital universitario Príncipe de Asturias en Madrid (España)

Se describe la estructura y funcionamiento de una red pública de atención a la salud mental que cubre una población de 450.000 habitantes de la zona metropolitana este de Madrid. Se trata de una red que funciona como parte de un sistema público, universal y gratuito en el momento del pago, aunque tiene varios financiadores y parte de los proveedores son instituciones de titularidad privada que se financian mediante un concierto con la administración pública. Integra 26 dispositivos en los que trabajan 229 profesionales asignados a equipos interprofesionales. Además de las funciones asistenciales, la red desarrolla labores de docencia e investigación.

APOIO MATRICIAL: UM CAMINHO DE FORTALECIMENTO DAS REDES DE ATENÇÃO À SAÚDE EM PALMAS-TO

Objective: This study aims to report the experience of the matrix support in Family Health Teams, with the purpose of contributing to the mental health care network. Material and methods: First, there was a situational diagnosis of CAPS II, which reinforced the need to integrate the health care network through the matrix support. The free discussion was the method adopted to conduct the visits of matrix support in the FHTs. Results: Given the concerns of health professionals, information was provided as regards management of users with mental disorders, diagnosis and possibilities of intervention and referral for each case. In general, the questions reflected a lack of specialized technical support to cope with the demands on mental health, which are present in everyday health practices, especially when related to chronic conditions or crises. Conclusion: It is concluded that lack of communication and of a close relationship between FHTs and CAPS II significantly undermines the functioning of the mental health network and, consequently, the quality of care given to users of mental disorders and to their families. This project was recognized for its relevance and was institutionalized in the practices of mental health services in Palmas-TO, emphasizing the need for deployment of the NASF - Support Center for Family Health. DESCRIPTORS Health Care Mental Health. Humanization of Assistance.

Unequal and inadequate involvement possibilities in mental health care networks

Background/Objectives: Nowadays, involvement and participation of mental health service users are considered to be ethical practices and health care systems around the world are increasingly emphasising the value of participatory approaches. However, in Belgian mental health care, involvement is scarcely out of the egg. A positive change happened in 2007, when the Belgian Federal Government initiated experimental care networks for persons with complex and chronic mental health problems. These networks were aimed at providing needs-based care, at promoting rehabilitation in society and at ensuring continuity of care. The Katholieke Universiteit Leuven and the Interregional Association for Guidance and Health (AIGS) were asked to conduct a study about involvement possibilities in these networks. The research was based on a whole-systems view on the complex concept of involvement. The main question of the study was: to what extent can service users and carers be involved in treatment decisions? Furthermore, we investigated the fulfilment of determinants for involvement such as communication and information provision, support and training, and procedures for involvement.

FC21-02 - Mental health and social care collaboration: A Cross-national whole network analysis of organisational partnerships in Europe

IntroductionSocially marginalised people with mental health disorders have complex needs that require integrated care. However, mental health and social care sectors are fragmented, and inter-organisational collaboration is challenging.AimA cross-national whole Network Analysis was carried out to detect and interpret patterns of relations between mental health and social care services in several European cities and assess their levels of care integration, following Leutz's levels: linkage, coordination and full integration.MethodData on referrals and service routine meetings were collected in deprived areas of 14 European cities and processed within a Social Network Analysis approach. Structural indicators included degrees, components and overlapping cliques, betweenness centrality and centralisation and brokerage roles. Patterns of collaboration were compared across cities.ResultsFew cities had full integrated services. Whole networks had relatively low densities, including denser sub-networks of similar services. The linkage across sectors remained weaker than the linkage within sectors. Services situated in broker positions were not always integrated nor commissioned for care coordination. The centrality of these services was higher when the linkage density was lower.ConclusionsAlthough differences between structural patterns of mental health and social care networks mainly depend on national care integration policies, the study revealed structural gaps in the achievement of these patterns, whatever the policy model. This could explain why different systems are basically facing the same problems in service delivery despite these differences. These gaps constitute potential weaknesses in the quality of mental health and social care integration at the system level.