Psychiatric Reform Research Articles

The Performance of the Social Worker in Mental Health in Primary Care From the Perspective of the Interdisciplinary Team

Objective: This study aimed to reflect on the work of the social worker in Mental Health in Primary Care, and to investigate and discuss issues related to the concept of the health team in real qualitative research developed with twelve professionals from three Basic Health Units located in the city of Apucarana, Paraná. Data was collected through semi-structured interviews with guiding questions, which were analyzed using content analysis to this activity. Theoretical Framework: Primary Health Care is considered a reorganization of the care model that was centered on illness and hospital treatment. It is the gateway to the SUS, with actions aimed at health promotion, prevention and rehabilitation. It is also an important space to reaffirm the assumptions of the Psychiatric Reform. Method: This is qualitative research developed with twelve professionals from three Basic Health Units located in the city of Apucarana, Paraná. Data collection was carried out through semi-structured interviews with guiding questions, which were analyzed using content analysis, which allowed the identification of three categories of analysis. Results and Discussion: This study revealed that health professionals are unaware of the role of social workers in mental health in Primary Care. Furthermore, they attribute mental health care almost exclusively to psychologists/psychiatrists, reaffirming the care centered on the hegemonic medical model. However, they can perceive the need for this professional to be part of the health team and how much he or she can contribute through his or her broad perspective and training, which provides critical reflection on work processes. Research Implications: The research highlights the need for social workers to work with health teams on the socio-educational axis for the initial process of deconstructing the concepts of mental health and madness that exist and consolidating the principles of psychiatric reform. Originality/Value: This study seeks to reiterate the need for Public Policies in the area of ​​mental health to be implemented and deployed so that this socio-occupational space is occupied by the professional Social Worker more greatly and that it integrates these multidisciplinary health teams.

Psychedelic Nation? (De)Provincializing the Psychedelic Renaissance from Brazil

Research into the therapeutic potential of psychedelic substances has garnered spectacular international attention. Most of this focuses on research in the Global North. In this article, we examine Brazil's scientific contribution to the psychedelic renaissance. Brazilian psychedelic science thrives thanks to a strong pharmaceutical innovation system and the legal status of ayahuasca, which has allowed it to develop a distinctive, globally relevant research paradigm. Unlike in many countries, this research program is mostly publicly funded through universities, showcasing Latin America's ability to produce competitive science despite oftentimes severe financial limitations. In part shaped by traditions of saúde coletiva, social medicine, psychiatric reform, and harm reduction activism, Brazilian psychedelic science has historically maintained close ties to local communities of knowledge, particularly the ayahuasca churches, some of which have partnered with clinical research laboratories. Drawing on ethnographic research with actors of the Brazilian psychedelic research community we argue that provincializing the psychedelic renaissance means challenging the patent-driven, neoliberal mindset that makes the idea of a shared, publicly funded psychedelic research commons seem impossible. We show that this ideal has nevertheless been quietly put into practice in places like Brazil, at least as long as its universities received adequate public funding.

The mental health care system for children and adolescents in Greece: a review and structure assessment.

The mental health system in Greece faces challenges to complete its transition to a community-oriented model, having significant concerns for child and adolescent care due to lower coverage and service gaps. This component of the mental health system has not been comprehensively evaluated. We conducted a review of the mental health care system for children and adolescents in Greece. For a field assessment, we directly collected data from mental health services to map availability and distribution. We analyzed the needs of human resources using professional register data and the national census. The National Health Care Service (ESY, Εθνικό Σύστημα Υγείας) is the public health system in Greece, characterized by public governance but significant private participation. Although ESY aims for universal care, gaps in population coverage and high user fees create barriers to access. Embedded within ESY, the mental health system is shifting towards a community-oriented structure since the psychiatric reform. For children and adolescents, there is a developing framework for regionalization and community services, including day centers, inpatient facilities, outpatient departments, and school-based psychoeducational facilities. However, services lack coordination in a stepped care model. Patient pathways are not established and primary care rarely involves child mental health, leading to direct access to specialists. Services operate in isolation due to the absence of online registers. There is no systematic performance monitoring, yet some assessments indicate that professional practices may lack evidence-based guidelines. Our mapping highlighted a scarcity of public structures, with an unbalanced regional distribution and many underserved areas. Child and adolescent psychiatrists are predominantly affiliated with the private sector, leading to professional gaps in the public system. Our assessment identifies an established framework for a community-oriented, universally accessible mental health system, yet several barriers impede its full realization. These include an inconsistent primary healthcare system, a shortage of specialists in the public sector, imbalanced service distribution, lack of coordination among providers, underfunding, and absence of quality monitoring. We propose interventions to promote child and adolescent mental health in primary care, coordinate patient pathways, establish standards of care, and monitor performance.

Bad-Mad-Female. Scientific Analyses of Female Violent Crime from the 1960s to the 1990s

While female capital offences have repeatedly caused astir since the beginning of the modern era at the latest, female violent crime has remained amarginal phenomenon in statistical observations for along time. Forensics, with its traditional core disciplines of psychiatry and law, also remained focused on the dangerous male perpetrator for along time in its analysis and theory development beyond infanticide: male forensic scientists analysed male perpetrators of violence.Since the 1960s, there has been an increasing number of scientific contributions on female criminality and its causes in West Germany. Women were now also analysing female criminality from aprofessional as well as from asocially critical perspective; adevelopment that gained significant momentum with the New Women's Movement and Critical Criminology.The article puts an emphasis on the discourse on female violent crime in the "old" Federal Republic of Germany. It starts out by framing the issue of women's violent crime in criminological discourse. Against this background, it examines how gender-specific constructions of criminality developed, especially in the discussion of the "dangerous mentally ill" in forensic discussion forums, how and to what extent which topoi were perpetuated and which were subject to changes. Did the analyses of female scientists differ from those of their male colleagues? What significance did critical or feminist currents or actors have?In view of social change processes (emancipation, psychiatric reform, criminal law reform), the article examines the interpretation of female violence and the connection between gender, dangerousness and mental illness. It focuses on the question of persistence, dynamisation or diversification of gender-specific constructions and normative concepts of normal/crazy in the forensic conflation of "bad and mad".

MULTIDISCIPLINARY APPROACH IN THE CARE OF PSYCHIATRIC OUTBREAKS IN URGENCY AND EMERGENCY SETTINGS: A LITERATURE REVIEW

Introduction: patients diagnosed with psychiatric disorders, before the psychiatric reform, were isolated from society and admitted to asylums, in a coercive manner, without ethical and human support from the multidisciplinary treatment team. Objective: to contribute to reflection on care practices and improvement of care for individuals experiencing a psychiatric outbreak directed to the urgent and emergency care network. Method: a theoretical, descriptive, exploratory literature review was carried out in the Virtual Health Library (BVS). The inclusion criteria were articles published between 2019 and 2023, complete, available online, free of charge in national or international journals, in the Portuguese language. Results: seven articles responded to the proposed methodological compliances and criteria and encouraged discussion on the research topic. Conclusion: patients in a psychiatric outbreak were directed to the Emergency Care Units (UPA), but the reception according to law 10.216/2011 is not done with mastery, given that there is a lack of professional qualifications in the multidisciplinary team and difficulties related to the physical structure from the emergency room to specific reception.

Improving cooperation between Hospital and the Community Mental Health Services of Nicosia

Abstract In order to accelerate psychiatric reform in Cyprus we took advantage of JA Implemental during the pilot implementation of Belgium best practices on facilitating the transfer of mental patients from mental hospital to the community mental health services. A multidisciplinary network has been organized between Athalassa Mental Hospital, that is the only mental hospital in the Republic of Cyprus performing 700 patients admissions yearly, and the Community Services of sector 1 and sector 2 of Nicosia Community Mental Services. The network meets regularly in order to facilitate therapeutic culture change in the direction of increasing the percentage of hospital patients that are motivated and prepared to be voluntarily moved for care by the community multidisciplinary teams. This is going to facilitate discharges from hospital, decrease duration of hospitalizations, decrease the frequency of hospitalizations and revolving door readmissions. This increased cooperation is being built on the basis of administrational procedures and clinical protocols that are based on multidisciplinary consensus. The evaluation starts multidisciplinarily in the hospital. A liaison community mental nurse takes part I the evaluation and motivation of the patients before the discharge from the hospital. A written informed consent process takes place in the hospital for the voluntary admission in the community mental health care setting. Also an effort is being made for early written referrals and appointments for community psychiatrist, psychologist, social worker and occupational therapist. This pilot action plan is going to increase cooperation of the mental hospital with the community mental health services, to decrease stigmatization and reform therapeutic culture to the direction of treatment in the community and recovery approach, according to Belgium best practices included in the JA Implemental project.

MENTAL HEALTH-ILLNESS PROCESS IN THE CONCEPTION OF PSYCHOLOGY GRADUATES

The objective was to understand, based on the narratives of students from an undergraduate psychology course, the social representation regarding the mental health and illness process. This is narrative research carried out at a public university in Bahia. Data collection took place online, using an electronic form made available in 2021, for data analysis dialectical hermeneutics was used. 34 students participated in the study. The results were presented in two empirical categories: biomedical model in the mental health and illness process and social determinants model in the mental health and illness process. The students narrated their social representation about the mental health and illness process, both from a perspective that favors the biomedical model and based on the psychosocial care model. Considering the analysis carried out, there is an urgent need for undergraduate courses in Psychology and other courses in the health field to review their curricula in order to meet the precepts of the Brazilian Psychiatric Reform, making use of mandatory and optional components with active methodologies of teaching-learning that address the topic, thus aiming to resolve stigmatized conceptions in the field of mental health and prepare professionals who base their work on the precepts of psychosocial care.

Mental Health In Primary Care: Development Of An Educational Guide For Health Professionals

This article presents the creation of an educational guide aimed at health professionals, focusing on mental health care in primary care in a municipality in southwest Paraná, Brazil. The guide aims to provide clear and accessible guidance on mental health care practices, addressing topics such as Psychiatric Reform, the stigma associated with mental disorders, and management strategies in the context of primary care. The development of the guide was based on a literature review and national guidelines, resulting in a practical tool for health professionals' daily work.

Psicanálise e saúde mental infanto-juvenil: uma reflexão sobre o lugar da subjetividade nos CAPSi

The aim of this article is to discuss the work of the mental health teams in the Child and Adolescent Psychosocial Care Centers (CAPSi), in order to consider subjectivity as a factor of inclusion. The methodology used was based on applied psychoanalysis. Franco Basaglia's contributions were revisited in order to understand his influence on the Psychiatric Reform in Brazil and to elucidate the current practice of CAPSi. The current impasses in the field of subjectivity in the Psychiatric Reform are discussed and it is proposed to locate transversal surfaces that articulate the presence of a psychoanalytic approach to subjectivity in psychosocial care. The conclusion is that it is important to discuss a psychoanalytic approach to subjectivation in public mental health services, so that treatment in these services is not polarized between biological reductionism and psychosocial care.

Humanization of nursing in the context of psychiatric hospitals: perspectives and challenges

In the beginning of psychiatry, the asylum was considered the ideal model for treatment in the area of mental health, where care was based on isolation in prisons, highlighting the lack of humanization and consequently, mistreatment. Psychiatric Reform emerged in Brazil in 1970, with the aim of reverting to the dehumanized form of care, through movements carried out by recently trained professionals in the area of Brazilian psychiatric care. The general objective of this study was to analyze recent literature on the humanization of nursing professionals in the context of psychiatric hospitals. The methodology used was an integrative, qualitative literature review, using publications in the Portuguese language and published between 2013 and 2023, in the databases: Virtual Health Library (VHL) and Scientific Eletronic Library (SCIELO), with the following descriptors: Nursing Care, “Hospitals, Psychiatric”, and Humanization of Assistance. The result was an initial sample of 231 articles and a final sample of eight publications. It is concluded that qualified assistance in the institucional environment is still essential, with the nursing professional being on of the main responsible for this process, considering that the current therapeutic approach to psychiatry is being increasingly directed to the extra-hospital context, becoming further studies on this topic are necessary.

The Effects of a Large-Scale Mental Health Reform: Evidence from Brazil

This paper studies the Brazilian Psychiatric Reform, which reorganized the public mental health care provision by introducing mental health centers (CAPS) as a community-based substitute for inpatient care. Our research design exploits the rollout of CAPS in a difference-in-differences framework. We show that these centers increased outpatient mental health care production and reduced psychiatric hospitalizations. These reductions were more pronounced for long-stay admissions and among patients with schizophrenia. We find that the savings implied by fewer admissions do not offset the cost of the policy. Also, the reform did not reduce mental health mortality and it increased violent crimes. (JEL H51, I12, I18, O15)

Treatment of mental patients in the presence of the Brazilian Psychiatric Reform: family members’ perceptions

Objective: To apprehend family members’ perceptions on treatment of mental patients in the presence of the Brazilian Psychiatric Reform.Methodology: Qualitative exploratory research carried out in 2010 at a psychiatric hospital in Paraná State/Brazil. Ten family members of mental patients were the subjects. Data were collected by means of a semistructured interview and analyzed through thematic analysis.Results: From the analysis, three categories emerged: Treatment of mental patients in the presence of the Brazilian Psychiatric Reform; Outpatient Mental Health Services; Family members’ physical and emotional distress.Discussion: The families perceived a new way of treating mental patients based on social reinsertion with the participation of a multiprofessional team.Conclusion: More support is deemed necessary on the part of mental patients’ families mediated by Brazilian public policies.

The blind spots of psychiatric reform in Greece.

The blind spots of psychiatric reform in Greece.

PSYCHIATRIC DEINSTITUTIONALIZATION IN BRAZIL

The Brazilian Psychiatric Reform is a movement that seeks to transform the mental health care model, promoting the deinstitutionalization and social inclusion of people with mental disorders. In this context, Therapeutic Residences represent an alternative to psychiatric institutionalization, offering residential support for individuals who face these disorders and need family or community support, aiming for their social reintegration. This experience report seeks, therefore, to share the experience of a team from the Family Health Strategy in the city of Rio de Janeiro-RJ after one year of monitoring residents of a Therapeutic Residence.

No-Restraint Committed General Hospital Psychiatric Units (SPDCs) in Italy-A Descriptive Organizational Study.

This study describes and explores the application of no-restraint policies in General Hospital Psychiatric Units (GHPUs) in Italy, a country pioneering in deinstitutionalization and psychiatric reform. The research aims to assess the organizational characteristics and effectiveness of no-restraint practices, contributing to the global discourse on humane psychiatric care. Following a purposive sampling approach, a nationwide descriptive study was conducted involving a detailed online survey distributed to 24 GHPUs actively engaged in or aspiring toward no-restraint practices. The survey, comprising 60 items across seven sections, gathered comprehensive data on the structural, organizational, and operational dimensions of the units, along with the prevalence and management of restraint episodes. Results reveal a significant commitment to no-restraint policies, with 14 GHPUs reporting zero restraint incidents in 2022. Despite variations in infrastructure and staffing, a common thread was the implementation of systematic procedures and risk management training aimed at reducing coercive practices. The study identified a correlation between the use of exclusive garden spaces and an increased incidence of restraints, suggesting nuanced factors influencing restraint practices. The findings underscore the viability and ethical alignment of no-restraint practices within psychiatric care, highlighting the crucial role of organizational protocols and training. This research adds empirical weight to the advocacy for restraint-free environments in mental health settings, signaling a paradigm shift toward more humane and rights-respecting psychiatric care.

PSYCHOSOCIAL EFFECTS OF THE SOIL SUBSIDENCE DISASTER (ONGOING), CAUSED BY SALGEMA EXTRACTION, IN THE CITY OF MACEIÓ/AL

The present study addresses mental health and psychosocial care in disaster contexts, focusing on the case of soil subsidence in Maceió, Alagoas. Initially, the gap in knowledge and intervention in this field in Brazilian public policies stands out. Disasters are defined as adverse events, natural or human, that affect vulnerable ecosystems, causing human, material and environmental damage. The disaster in Maceió began in 2018, caused by the disorderly extraction of salgema, leading to soil instability and affecting several neighborhoods. The response involved Civil Defense actions, compensation from the responsible company (BRASKEN) and relocation of the affected population. In addition to material damage, there were emotional and social losses, and it is essential to consider the psychosocial effects. Forced relocation, in particular, can cause social disconnection and increase stress, anxiety and depression. Psychosocial care requires a holistic approach, integrating specialized services with the health network and promoting emotional support and adaptation to changes. The psychosocial care network in Maceió has proven insufficient to meet the demand presented, therefore requiring the expansion of services. It is essential, therefore, to face the challenges of mental health requires public policies aligned with the principles of the SUS and Psychiatric Reform, in addition to a sensitive approach to the needs of affected communities.

French Psychiatry and Alcoholism in the 1950s and 1960s: The Paradoxes of Outpatient Care

Summary This article examines the place of alcoholic patients in French psychiatry in the 1950s and 1960s, an era of incipient psychiatric reform. Relying on medical literature, national and department archives, as well as hitherto unexploited patient files from one of the first anti-alcoholic consultations opened in the early 1950s in Paris, it shows how new therapies and drugs, such as disulfiram, revived the interest of psychiatrists for alcoholism and enabled the outpatient treatment of alcoholics. However, the study of patient trajectories reveals that ambulatory care did not substitute itself for hospitalisation. The article then analyses how the psychiatrist–patient relation was transformed in the framework of the consultation, and included new stakeholders such as social workers and family members. It finally explains why therapeutic enthusiasm gave way, at the end of the 1960s, to increasing doubts concerning the role of the psychiatrist in the cure of alcoholism.

Qualified Listening to Relatives of Users at a Psychosocial Care Center

Introduction. The Psychiatric Reform introduced a new people-centered care model to replace psychiatric hospitals: the Psychosocial Care Center. Qualified listening can be used to achieve the integrality and humanization of the health care provided. It allows for the appreciation of content, the respect of its uniqueness, empathy, and the promotion of a space in which freedom of expression is provided. Objective. To identify the understanding of qualified listening from the perspective of the relative of a person with a mental disorder at a Psychosocial Care Center. Method. Qualitative, descriptive, exploratory study. Ten relatives over the age of 18 participated, contributing to the production of information. Data was obtained through the triangulation method, through semi-structured individual and collective interviews, observation, and field diary records. Results. For relatives, qualified listening translates into clarifying the illness, understanding the family’s painful situation and providing help and support during the psychosocial rehabilitation process. Discussion and conclusion. Listening constitutes a means of consolidating care networks, through the strengthening of bonds and co-responsibility, in a centered and expanded family-user logic model.

MATRICIATION IN MENTAL HEALTH: Conceptions, changes and difficulties of primary care professionals

The objective was to analyze the conceptions of professionals from Primary Care teams in a municipality in southeastern Brazil, regarding matrix support in mental health. This is a qualitative research study. Data were collected through semi-structured interviews and subjected to the content analysis technique. In total, six professionals from different categories participated in the research. The results demonstrated that matrix support is presented by some reference teams as a favorable strategy for improving mental health care and by others as a proposal with low resolution, which ended up being converted into an inspection apparatus and expansion of the power of experts. The need to promote the regularity of productive matrix support meetings is highlighted, encouraging this strategy towards health promotion and deinstitutionalization, due to its ability to cover Primary Care in discussions and actions around Psychiatric Reform.

Franco Basaglia and the Italian mental health act: a law aimed to restore the rights of citizenship.

The psychiatric reform act passed in Italy in 1978 - which was born in the wake of Franco Basaglia's work - had among its main aims the restoration of dignity and rights to people suffering from mental disorders and the closure of asylums and other totalizing institutions. On the centenary of Basaglia's birth, we must reason on the state of social and health care not only in the field of mental health. In fact, the rights of women seeking for abortion, the rights of the LGBTQIA+ community, the prison population, and migrants are also on the take. If the one led by Franco Basaglia in Italy was a revolution, it cannot be said to have been accomplished until the rights of citizenship are restored to all the people to whom these same rights are not recognized.