Psychiatric Reform Research Articles

Interventi sul caso Giulio

A commentary on Pietro Pellegrini’s paper For the future of the Italian Law no. 180/1978 on psychiatric reform (Psicoterapia e Scienze Umane, 2018, 52, 1: 115-119). Some key aspects of Pietro Pellegrini’s paper are critically examined. It is argued that some of Pellegrini’s comments risk of turning any discussion on the Italian Law no. 180/1978 into an ethical debate on citizenship rights, preventing to see the actual consequences of this Law on the treatment of mental health disorders and the organization of psychiatric services. The actual ethical nature of certain positions is questioned, it is argued that it must be confronted with the suspicion of ideology, on the one hand, and with the need of scientific research and training of mental health professionals, on the other.

Dibattiti. Riflessioni sulla Legge 180: fra etica, ideologia e saperi

Vengono presi in esame criticamente alcuni aspetti dell'intervento di Pietro Pellegrini "Per il futuro della Legge 180" (Psicoterapia e Scienze Umane, 2018, 52,1: 115-119) che rischiano di trasformare qualunque discorso relativo alla Legge 180/1978 in un dibattito etico relativo ai diritti di cittadinanza, impedendo di cogliere anche le conseguenze effettive della Legge sulla gestione dei problemi di salute mentale delle persone e della organizzazione dei Servizi. Viene posta in discussione la effettiva natura etica di talune posizioni, che devono confrontarsi con il sospetto di ideologia da una parte e con i saperi scientifici dall'altra.

Mental health nurses: conceptions about professional qualification in a Psychosocial Care Center

Objective: analyzing the strategies adopted by mental health nurses for professional qualification in a Psychosocial Care Center. Methods: a historical-social study with written documents and interviews with ten health professionals linked to the Psychosocial Care Center. Data analysis followed chronological order of the facts, and the emerging themes were triangulated and based on concepts that support Brazilian psychiatric reforms. Results: for professional qualifications, nurses invested in participating in congresses, seminars and symposiums; conducting study groups in order to develop new practical skills for mental health some nurses participated more frequently in workshops and followed other professionals for better insertion in this new context. Conclusion: the nurses approached interdisciplinary care to reconfigure their practices, investing in intellectual empowerment and faced the challenge of transforming mental health care in a deinstitutionalized practice.

Electroconvulsive therapy: historical construction of nursing care (1989-2002).

to describe the nursing care performed by the nursing team to the person with mental disorder submitted to ECT and to analyze the implications of the Psychiatric Reform in this care. socio-historical study, which uses the Thematic Oral History method. the nursing team is present in a continuous way in the monitoring of people submitted to ECT, performing care before, during and after the same, as well as visualizing the evolution of the technique and also of nursing care itself, however, does not recognize the Psychiatric Reform as agent for this change. the Brazilian Psychiatric Reform triggered a process of humanization of nursing knowledge, influencing the care of the person with mental disorder submitted to ECT, with this, care practices also changed, a law was approved, regulating its practice, and its application was decreasing.

Unified health system and psychiatric reform: challenges and perspectives

espanolEste articulo presenta los cambios en la constitucion del proceso de salud mental y sus similitudes y diferencias con la salud publica en Brasil, especialmente entre los movimientos de la reforma psiquiatrica y la reforma sanitaria. El analisis de las paradojas, las lagunas, callejones sin salida, retos y perspectivas de la construccion de la autonomia de la persona en situacion de peligro grave, discute como las dificultades encontradas en entrelazar desinstitucionalizacion psiquiatrica en campos de las lineas y los conflictos. En este contexto, es esencial para deconstruir y desnaturalizar causan dificultades perspectivas epistemologicas de la autonomia del sujeto, dejando de rescate influencias importantes del pensamiento fenomenologico que pasaron por el proceso de reforma psiquiatrica y continuar con el conocimiento en consideracion de la totalidad de la existencia de los sujetos y cuestion del determinismo sobre la subjetividad. El interrogatorio conjunto de propuestas y reinvencion de las relaciones humanas en los dispositivos sustitutivos permitio la critica a un mestizaje de los conceptos de los manicomios en los propios servicios de salud mental. EnglishThis article presents the transformations in the mental health constitution process and their approximations and distancing with the collective health in Brazil, specially between the Psychiatric and sanitary reform movements. Analyzing the paradoxes, gaps, impasses, challenges and perspectives of the subject autonomy construction in a grave suffering situation, discuss how the difficulties found in the psychiatric deinstitutionalization intertwine themselves on consonance and conflict fields. In this context, it becomes fundamental the deconstruction and denaturalization of the epistemological perspective that difficult the subject's autonomy, fitting to rescue important influences of the phenomenological thought that went through the psychiatric reform process and are still making themselves to be listened in the consideration of the subjects existence totality and in the questioning of the determinism over the subjectivity. The proposals articulation of the human relations questioning and reinvention in the substitutive devices allows the critic to the manicomials conceptions miscegenation in the same mental health services. portuguesEste artigo apresenta as transformacoes no processo de constituicao da saude mental e suas aproximacoes e distanciamentos com a Saude Coletiva no Brasil, em especial entre os movimentos das reformas psiquiatrica e sanitaria. Analisando os paradoxos, lacunas, impasses, desafios e perspectivas da construcao da autonomia do sujeito em situacao de sofrimento grave, discute como as dificuldades encontradas na desinstitucionalizacao psiquiatrica entrelacamse em campos de consonância e conflito. Nesse contexto, torna-se fundamental a desconstrucao e desnaturalizacao das perspectivas epistemologicas dificultadoras da autonomia do sujeito, cabendo resgatar importantes influencias do pensamento fenomenologico que percorreram o processo de reforma psiquiatrica e continuam a se fazer ouvir na consideracao da totalidade da existencia dos sujeitos e no questionamento do determinismo sobre a subjetividade. A articulacao de propostas de problematizacao e reinvencao das relacoes humanas nos dispositivos substitutivos permitem a critica a uma miscigenacao das concepcoes manicomiais nos proprios servicos de saude mental.

Parallels between research in mental health in Brazil and in the field of Global Mental Health: an integrative literature review.

Global Mental Health is a field of teaching, research, and practice whose goal is to improve access to mental health and reduce inequalities in mental health outcomes for all people worldwide, especially proposing action in low- and middle-income countries like Brazil. Given this global scenario and Brazil's progress in health and psychiatric reforms, it is important to investigate the current status of the Brazilian mental health literature and its relationship to Global Mental Health, describing how Brazilian research deals with key topics in the Global Mental Health field. The authors performed an integrative literature review using a qualitative and descriptive approach. The article search was performed for the years 2014 and 2015 in Portuguese and English, using the terms "mental health" and "Brazil", combined with key words corresponding to the principal themes addressed by authors in Global Mental Health. The search yielded 88 articles, which were analyzed according to authorship, periodicals and regions, and the analytical categories of access, primary care, community mental health services, social determinants of health, human rights, and equity. Brazil's mental health research revealed a rich and diverse body of studies, showing parallels with the literature on global mental health, but with limited systematization. Although the review revealed efforts to generate knowledge in this field within Brazil, some barriers may be limiting Brazil's participation in the international debate on Global Mental Health.

Commented Madness Project: Works about the Academical Vision of Concepts in Psychiatry and Mental Health

The present study is an experience report that analyzes the perception of the medical students of Unigranrio, Barra da Tijuca, regarding the performance of the psychiatrist, in the field of specialty practice in primary care and in the psychiatric emergency service, and in relation to the insertion of the non-teaching of medical education, as well as basic themes in mental health, highlighting the feelings about the contact and approach of the patient with mental disorders and self-perception of the medical student's mental health, allowing reflections on the problem of existing non-teaching doctor. It carried out an evaluation in order to bring contributions to mental health education, detecting the presence of erroneous concepts, stereotypes and perceptions related to the subject in the formation of the student, at the same time as it discussed the need of forms of intervention to overcome challenges that involve obstacles and methodologies of mental health teaching in the medical course. The project leads to reflections on teachers and students, the possibility of mobilization at improving the future formation of the doctor, in a view of the magnification and relevance of psychiatry teaching. The construction of the project made it possible to highlight a different perspective for insertion and expansion of mental health to medical students, and for analysis of the Psychiatric Reform process, as well as questions about the need for changes in the medical curriculum formation, about concepts, sensations, misconceptions, prejudices, fears and anxieties related to the care of the psychiatric patient.

The multiprofessional work in the Psychosocial Care Centers of São Paulo State.

Analyze how professionals understood the multi, inter and transprofessionality and how these practices happened in the CAPS (Psychossocial Care Centers) of São Paulo/SP. Qualitative, exploratory, descriptive study, and use of Content Analysis. We interviewed 27 professionals from nine CAPS. Organized in two categories: definition of multiprofessional, interprofessional and transprofessional work in Mental Health; and specific aspects of professions and Conceptions about multi, inter and transprofessional teamwork in daily life. There were difficulties in conceptualizing modalities of disciplinary integration, little problematization in the reality of workers, and questions of specific practices of each area. The devices have been problematized, in which the distancing of Public Policies happen. There is coexistence of the biomedical, of insane asylum and Psychosocial Care paradigms in the discourses and actions of the teams, to compromise the effectiveness of the Psychiatric Reform. The practice was close to the ideas of integration and of auxiliary interdisciplinarity and not of the effective construction of shared therapeutic knowledge and projects.

Clinical guidelines for the management of schizophrenia:Aims and limitations (Ι)

The initiative for the development of national treatment guidelines, dates back to the '90s. In Greece, however, National Clinical Guidelines for the management of schizophrenia were first formulated in 2014 when a Working Group was set up for this purpose by the Greek Ministry of Health. The objective of this Working Group was to provide evidence-based recommendations covering the pharmacological and psychosocial treatment of schizophrenia as well as the development of appropriate treatment services. The Working Group utilized the NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia as the main guide to develop the Greek National Guidelines , and in addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists 2005) , as well as other relevant sources. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. A special effort was made to adapt the international experience to the current Greek landscape with the constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. After the preparation of the draft guidelines, a thorough consultation followed with the relevant stakeholders, including mental health professionals, user associations and representatives of the Greek Ombudsman. Additionally, the Hellenic Psychiatric Association established an Expert Committee in Spring 2016, that contributed with its observations to the final exercise. This article will be followed by two further publications (incorporating the Hellenic Psychiatric Association comments) which include: (1) the summary recommendations regarding the pharmacological, psychological and psychosocial interventions in the treatment of schizophrenia, and (2) the summary recommendations regarding: (a) the role of primary health care service and the role of the family physician in the treatment of schizophrenia (b) the summary recommendations regarding continuity of care and c) the summary recommendations regarding community interventions with documented effectiveness in the treatment of schizophrenia.

Sofrimento mental e dignidade da pessoa humana: os desafios da reforma psiquiátrica no Brasil

A pesquisa investiga a reforma psiquiátrica no Brasil e os desafios para sua concretização, de modo que, inicialmente, se dedica à compreensão do sofrimento mental buscando o relato histórico das terapias para o enfrentamento da questão. Posteriormente, identifica-se o desenvolvimento da legislação nacional para a proteção da pessoa com sofrimento mental e, por fim, a pesquisa investiga os desafios da reforma psiquiátrica caracterizados pela extinção gradativa dos asilos e hospitais psiquiátricos, pelo oferecimento de atenção e cuidado junto da família e da sociedade, por meio do atendimento oferecido pelos Centros de Atenção Psicossocial.

Repercussões Clínicas Associadas à Esquizofrenia Infantil: Relato de Caso

Introdução: A esquizofrenia infantil é um fenômeno raro e grave, tendo como principal característica sintomas psicóticos pré-puberais1-3. Manifesta-se em menos de 1/40.000 crianças1-2 de forma insidiosa e progressiva. Entretanto, cenários pré-mórbidos são observados, como: isolamento social; atraso motor e verbal; déficit de atenção, agressividade e recusa alimentar1-4. Considerando as alterações clínicas que podem associar-se a psicopatologias e/ou ao uso de psicotrópicos, em alguns casos, faz-se necessária a internação hospitalar com o objetivo de tratar tais sintomas. Os leitos psiquiátricos propostos para os Hospitais Gerais tendem a romper com o manicômio, diminuindo o estigma da doença mental; cessar a dicotomia mente/corpo proposta pelo modelo cartesiano e efetivar a Política Pública de Saúde Mental no Brasil. Objetivos: Relatar um caso de esquizofrenia infantil associado às repercussões clínicas desencadeadas pela psicopatologia de base. Expor a importância do processo de trabalho em rede e a atenção à saúde de forma integral dentro do Hospital Geral, tendo como base a Política Nacional de Saúde Mental. Descrição: Adolescente, 17 anos, pré-diagnosticada com esquizofrenia, em tratamento irregular. Apresentou há 10 dias: recusa alimentar e hídrica, isolamento social, agressividade e alterações no sono. Deu entrada no CAPSI onde foi administrado Haldol Decanoato e encaminhada para internação hospitalar, objetivando correção de distúrbios hidroeletrolíticos. Conclusão: Espera-se determinar uma variável que compreenda a condição de base de pacientes psiquiátricos e, elucide a coexistência de processos fisiopatológicos orgânicos. Desse modo, ressaltar a importância de integrar os objetivos da Reforma Psiquiátrica no que tange o acompanhamento terapêutico de pacientes implicados nesse contexto evoluti

The Impact of Dealing with the Late Effects of National Socialist Terror on West German Psychiatric Care.

Health damages and the late effects of NS trauma were largely ignored in German-speaking countries. This paper describes how dealing with the late effects of Nazi terror influenced post-war psychiatry in West Germany and thus the development of the psychiatric reform. As part of a greater overview study of the impulses and framework conditions of the reform-orientated development of post-war psychiatry in West Germany, this analysis is based on a thorough literary and documentary analysis. The sources show that publications by Helmut Paul and Herberg [81] as well as Baeyer et al. [12] can be considered as remarkable milestones. The awareness of psychological late effects of NS persecution was only reluctantly taken up by the scientific community. Nevertheless, this discussion was an essential component of the reform-orientated psychiatry in West Germany in the late 1960s to 1970s.

Interlaced strands: Health psychology in Brazil from an autobiographic perspective.

The presence of psychology in Brazilian Health Settings is closely related to two socio-political movements: for the creation of the Brazilian Unified Health System in 1990 and for Psychiatric Reform. Each had a multidisciplinary stance closely associated with a socially committed approach to healthcare delivery and connected with prior experiences that influenced its policies, among them the National AIDS Programme. These developments are told as a tale that interlaced autobiographical data and the long road to a universal healthcare system that shaped the relationship between psychology and health in the country.

Dibattiti - La fine di un'illusione

A distanza di 40 anni dalla Legge 180/1978 che ha riformato la psichiatria in Italia, vengono esaminati alcuni suoi punti centrali per valutare quanto di fatto siano stati attuati: il superamento del concetto di pericolosità, la limitazione alla cronicità istituzionale, la attenuazione dello stigma, la centralità del lavoro sul territorio e la collocazione del ricovero ospedaliero all'interno dell'ospedale generale. Emerge il mancato raggiungimento di questi obiettivi, per limiti intrinseci alla legge, per limiti profondi nel mondo psichiatrico nel costruire nuovi modelli e per una difficoltà a costituirsi come interlocutori forti all'interno di una gestione della Sanità sempre più frammentata e ospedalizzata.

Books on Utopia Published in Italy in 2016 and During the First Semester of 2017

Books on Utopia Published in Italy in 2016 and During the First Semester of 2017

Impact of the New Mental Health Services on Rates of Suicide and Hospitalisations by Attempted Suicide, Psychiatric Problems, and Alcohol Problems in Brazil.

A sizeable proportion of all suicides have mental health issues in the background. The association between access to mental health care in the community and decreased suicide rates is inconsistent in the literature. Brazil undertook a major psychiatric reform strengthening psychiatric community-based care. To evaluate the impact of the new Brazilian community mental health care units (CAPS-Psychosocial-Community-Centres) on municipal rates of suicide, and hospitalisations by attempted suicide, psychiatric and alcohol problems. We performed robust multivariable negative binomial regression models with fixed effect for panel data from all 5507 Brazilian municipalities. Suicide and hospitalization rates were calculated by sex and standardised by age for each municipality and year from 2008 to 2012. The main variable of interest was municipal CAPS coverage. CAPS municipal coverage was associated with lower suicide rates but this was not statistically significant (RR: 0.981; 95% CI 0.952-1.011). However, increased CAPS coverage was associated with lower hospitalizations for attempted suicide (RR: 0.887; 95% CI 0.841-0.935), psychiatric (RR: 0.841; 95% CI 0.821-0.862), and alcohol problems (RR: 0.882; 95% CI 0.860-0.904). Our results suggest that access to community mental health services seems to reduce hospitalisations due to attempted suicide, psychiatric and alcohol problems but not suicidal rates. Therefore, increased investments in community mental health services in low-middle-income countries might decrease costs associated with potentially avoidable hospitalizations.

On the road to psychiatric reform : Reconstructing the political preparation of the first Enquete Commission of the German Bundestag

The purpose of this paper is to analyze the political preparation of the Enquete Commission of the German Bundestag which aimed at assessing and improving the psychiatric and psychotherapeutic/psychosomatic care in the Federal Republic of Germany. We performed aselective literature review and ahermeneutic analysis of political, parliamentary and administrative records from public archives which reflect and help reconstruct the run-up process to the so-called Enquete of psychiatry. Literature and documents show how individual actors both in the mental health professions and politics bundled activities in the domains of psychiatry and mental health care as well as health/social politics; they helped to implement political, parliamentary and administrative steps leading up to the Enquete of the German Bundestag (1971-1975). In addition, the records and pertinent literature document the social, cultural and political developments in the Federal Republic of Germany which helped initiate the Enquete project. The Enquete was not astraightforward process and was also not tied to any moment. It fits more into the longer-term reform process of psychiatry in the Federal Republic of Germany.

A medida de segurança na contramão da Lei de Reforma Psiquiátrica: sobre a dificuldade de garantia do direito à liberdade a pacientes judiciários

Resumo A medida de segurança, disciplinada pelo Código Penal brasileiro e pela Lei de Execução Penal, segue a lógica da internação como regra, em descompasso com o modelo assistencial em saúde mental disciplinado pela Lei de Reforma Psiquiátrica. Faz-se necessário refletir sobre essa intervenção e consequências em relação aos pacientes dos Hospitais de Custódia e Tratamento Psiquiátrico (HCTP). Assim, a pesquisa realizada objetivou identificar as dificuldades existentes para a desinternação de pacientes do HCTP/Bahia. Para tanto, mediante estudos descritivos e exploratórios, foi realizada pesquisa quantitativa e qualitativa a respeito dos efeitos da medida de segurança executada à luz da legislação penal vigente no HCTP/Bahia. Concluiu-se, por fim, que se faz urgente a revisão do modelo atual de medida de segurança, por dificultar a reintegração do ex-paciente do HCTP à vida em liberdade, e a necessidade de adequação do tratamento legal do infrator com transtorno mental à política de saúde mental traçada na Lei de Reforma Psiquiátrica.

Less well-established forms of knowledge: new positionings in the field of collective mental health

Collective health is a paradigm with a long history in Latin America. Similarly, collective mental health has had an interesting development in certain Latin American countries, even acting to stimulate psychiatric reform. However, both paradigms appear to be encapsulated in specific times and places, among other reasons because of a hegemonic global-scale epistemology that, by imposing a naturalized model of truth, denies other forms of knowledge the opportunity to question not only already-established disease categories, treatment protocols and health policies, but the established order itself. In this article, we reflect on the power of ethnography, as both a form of knowledge and a social relation in itself, to broaden the space available for a possible field of collective health in a context where it is still incipient: Europe. The ethnographic point of view allows us to rethink that which is already accepted, creating permeability in entrenched practices and opening up surprising new possibilities.

Guan (Care/Control): An Ethnographic Understanding of Care for People with Severe Mental Illness from Shanghai's Urban Communities.

This article investigates how the political culture of Guan (care/control) in China is played out across the platforms of the state, the community and the family through the lens of caring for people with severe mental illness in urban Shanghai. Based on ethnographic data collected from six communities in a district of Shanghai, we provide a nuanced understanding of the roles of family members, street committees and other governmental organizations in their daily practices of caring for people with severe mental illness. We show the complicated and intertwined relationships between local governmental agents and the family. We argue that the political culture of Guan, which permeates the everyday life of Chinese people, tends to objectify its subjects and reflects a long history of patriarchy in Chinese society. Without further changing such political cultural arrangements, respect for the agency of mentally ill patients, the effort of bringing humanistic psychiatric reforms to China, will be in vain.