scholarly journals Towards comprehensive mental health care: experiences and challenges of psychosocial care in Brazil

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mariá Lanzotti Sampaio ◽  
José Patrício Bispo Júnior
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Patient Care ◽  
Family Support ◽  
Policy Development ◽  
Psychosocial Care ◽  
Community Services ◽  
Framework Analysis ◽  
Psychosocial Model

Abstract Background Recommendations are in place for mental health (MH) care to be developed into a comprehensive, people-centred perspective and organised primarily through community services. In recent decades, Brazil has promoted psychiatric reform aimed at transforming the hospital-centred model into a psychosocial model of MH. However, current political and economic changes threaten this reform. This article analyses the comprehensive MH care offered by a Psychosocial Care Network (Rede de Atenção Psicossocial – RAPS) in Brazil. Methods The study involved semi-structured in-depth interviews with 33 stakeholders (policymakers, health professionals, and MH service users) and direct observation of MH services members of the RAPS. Data were analysed using framework analysis with the following dimensions: mental health services access, long-term mental health care, comprehensive mental health care, and crisis patient care. Results Results indicated progression towards comprehensive MH care provision. We identified MH care provided primarily by community services, featuring an ‘open door’ policy, development of localised actions and a search for autonomy. Deinstitutionalisation principles and the psychosocial model support a comprehensive view of MH by policy makers, MH professionals, and users. However, difficulties in providing comprehensive care remain, with the main challenges being insufficient services offered and difficulties in user access at all levels of care, fragile integration between services, lack of clear definitions of the responsibilities of each service, discontinuity of care, limitations in family support, and fragility in crisis patient care. Conclusion We highlight the need to increase funding and services of RAPS, qualification of staff professional, family support, and development of strategies for integrating services. Support and expansion of MH care depend on strengthening the Brazilian health system, which is in danger of being dismantled.

scholarly journals The mental health care model in Brazil: analyses of the funding, governance processes, and mechanisms of assessment

2017 ◽  
Vol 51 (0) ◽  
Author(s):  
Thiago Lavras Trapé ◽  
Rosana Onocko Campos
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health System ◽  
Community Services ◽  
Care Model ◽  
Unified Health System ◽  
Psychosocial Model ◽  
Governance Processes ◽  
Health Care Model

ABSTRACT OBJECTIVE This study aims to analyze the current status of the mental health care model of the Brazilian Unified Health System, according to its funding, governance processes, and mechanisms of assessment. METHODS We have carried out a documentary analysis of the ordinances, technical reports, conference reports, normative resolutions, and decrees from 2009 to 2014. RESULTS This is a time of consolidation of the psychosocial model, with expansion of the health care network and inversion of the funding for community services with a strong emphasis on the area of crack cocaine and other drugs. Mental health is an underfunded area within the chronically underfunded Brazilian Unified Health System. The governance model constrains the progress of essential services, which creates the need for the incorporation of a process of regionalization of the management. The mechanisms of assessment are not incorporated into the health policy in the bureaucratic field. CONCLUSIONS There is a need to expand the global funding of the area of health, specifically mental health, which has been shown to be a successful policy. The current focus of the policy seems to be archaic in relation to the precepts of the psychosocial model. Mechanisms of assessment need to be expanded.

Coercion in Community Mental Health Care

2016 ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mentally Ill ◽  
Community Care ◽  
Current Knowledge ◽  
Community Services ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Improved Outcome

The use of coercion is one of the defining issues of mental health care and has been intensely controversial since the very earliest attempts to contain and treat the mentally ill. The balance between respecting autonomy and ensuring that those who most need treatment and support are provided with it has never been finer, with the ‘move into the community’ in many high-income countries over the last 50 years and the development of community services. The vast majority of patients worldwide now receive mental health care outside hospital, and this trend is increasing. New models of community care, such as assertive community treatment (ACT), have evolved as a result and there are widespread provisions for compulsory treatment in the community in the form of community treatment orders. These legal mechanisms now exist in over 75 jurisdictions worldwide. Many people using community services feel coerced, but at the same time intensive forms of treatment such as ACT, which arguably add pressure to patients to engage in treatment, have been associated with improved outcome. This volume draws together current knowledge about coercive practices worldwide, both those founded in law and those ‘informal’ processes whose coerciveness remains contested. It does so from a variety of perspectives, drawing on diverse disciplines such as history, law, sociology, anthropology, and medicine and for is explored

scholarly journals Anxious and depressed women's experiences of emotional suffering and help seeking in a Rio de Janeiro favela

2017 ◽  
Vol 22 (1) ◽  
pp. 75-86 ◽  
Author(s):  
Karen Athié ◽  
Christopher Dowrick ◽  
Alice Lopes do Amaral Menezes ◽  
Luanda Cruz ◽  
Ana Cristina Lima ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Help Seeking ◽  
Rio De Janeiro ◽  
Care Service ◽  
Framework Analysis ◽  
Community Based ◽  
Social Rules ◽  
Primary Mental Health Care

Abstract Taking into consideration issues such as stigma and the mental health gap, this study explores narratives of anxious and depressed women treated in a community-based primary care service in a Rio de Janeiro favela about their suffering and care. We analysed 13 in-depth interviews using questions from Kadam's study. Framework analysis studied Access, Gateway, Trust, Psychosocial Issues, and Primary Mental Health Care, as key-concepts. Vulnerability and accessibility were the theoretical references. Thematic analysis found “suffering category”, highlighting family and community problems, and “help seeking category”, indicating how these women have coped with their emotional problems and addressed their needs through health services, community resources and self-help. Women's language patterns indicated links between implicit social rules and constraints to talk about suffering, especially if related to local violence. High medical turnover and overload are barriers for establishing a positive relationship with family physicians and continuity of care is a facilitator that promotes trust, security and adherence. Concluding, to plan community-based primary mental health care of this population, cultural and social factors must be comprehended as well as the work health teams conditions.

scholarly journals Acute wards: problems and solutions

2002 ◽  
Vol 26 (11) ◽  
pp. 428-430 ◽  
Author(s):  
Hugh Griffiths
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Patient Care ◽  
Best Practice ◽  
Collaborative Approach ◽  
Problems And Solutions ◽  
New Challenges ◽  
Measurable Change ◽  
Acute Wards

This paper will outline some of the long-standing problems and new challenges facing acute in-patient care, some of the recommendations for change and various difficulties encountered in trying to improve the situation. It will describe how a collaborative approach (led by the Northern Centre for Mental Health, the Centre for Best Practice in Leicester and both the Northern and Yorkshire and the Trent regional offices) can bring about tangible and measurable change for the better and what lessons there may be for the management and delivery of mental health care in the future.

scholarly journals Paths and detours in the trajectory of the Brazilian psychiatric reform

2021 ◽  
Vol 17 ◽  
pp. e3563
Author(s):  
Rossana Maria Seabra Sade ◽  
Sashi P. Sashidharan ◽  
Maria de Nazareth Rodrigues Malcher de Oliveira Silva
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Policy ◽  
Psychosocial Care ◽  
Public Health Care ◽  
Psychiatric Reform ◽  
Unified Health System ◽  
Psychological Suffering ◽  
Government Documents

This article looks at the principles and guidelines of the Unified Health System as well as the current situation and the limitations and possibilities of Brazilian mental health policy. Based on a review of national and international government documents and the scientific literature from 2015-2020, the study observed positive advances in mental health. However, the psychiatric reform has experienced setbacks, and the balance of mental health care has swung towards hospital-centered treatment. These changes have impeded the implementation of the Psychosocial Care Network, as well as the development of therapeutic practices and strategies focused on the person’s experience, their daily life and their relations with the health promotion network. By questioning the supremacy of medical-psychiatric knowledge in the treatment of “mental illness” in the public health care system, the psychiatric reform cleared a path for the construction of new ways of addressing psychological suffering. These gains are currently at risk, making a wider debate on the current trends in mental health care in Brazil essential.  

scholarly journals Solvability of mental health care in the Family Health Strategy: social representation of professionals and users

2014 ◽  
Vol 48 (6) ◽  
pp. 1060-1066 ◽  
Author(s):  
Maria Salete Bessa Jorge ◽  
Mardênia Gomes Ferreira Vasconcelos ◽  
Euton Freitas de Castro Junior ◽  
Levi Alves Barreto ◽  
Lianna Ramalho de Sena Rosa ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Psychosocial Care ◽  
Family Health ◽  
Social Representation ◽  
Structured Interviews ◽  
Health Strategy ◽  
The Family ◽  
Family Health Strategy

Objective To aprehend the social representations about the solvability in mental health care with users of the Family Health Strategy and professionals of family health teams and of the Center for Psychosocial Care. Method A qualitative study using semi-structured interviews for data collection, and the Alceste software for analysis. This software uses the Hierarchical Descending Classification based on the examination of lexical roots, considering the words as units and providing context in the corpus. Results The representations emerge in two opposing poles: the users require satisfaction with care and the professionals realize the need for improvement of health actions. Although the matricial support in mental health and the home visits are developed, the barriers related to investment in health, continuing education and organization of care persist. Conclusion The different representations enable improvements in customer service, solvability of care and aggregate knowledge and practices in the expanded perspective of health needs in the family, social and therapeutic context.


scholarly journals Nursing Appointment in Mental Health: experience of nurses of the network

2018 ◽  
Vol 71 (suppl 5) ◽  
pp. 2154-2160
Author(s):  
Patrícia Aline de Almeida ◽  
Maria Cristina Mazzaia
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Policy ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Mental Health Policy ◽  
Psychosocial Care ◽  
Work Process ◽  
Multiprofessional Team ◽  
And Performance

ABSTRACT Objective: To know the experience of nurses of the Psychosocial Care Networks on the development of Nursing Appointment in Mental Health. Method: Qualitative study, with interview of 20 nurses, through the analysis of the statements in the search of the meaning core. Results: was unveiled as meaning core: lack of preparation for Mental Health Care, Non-identification of the work of the nurse in Mental Health; and Performance of Nursing Appointment as bureaucratic fulfillment. Final considerations: Nurses understand Nursing Appointment as an individualized and bureaucratic activity, to consider professional regulations, and not as a work process in the multiprofessional work, thus, the Projeto Terapêutico Singular (freely translated as Unique Therapeutic Project) is not cited as a possibility of work process. It was identified necessary space for discussion of actuation and updates of the nurse in Mental Health Care in the health services studied, with emphasis on their performance in a multiprofessional team in consonance with the Mental Health Policy.

scholarly journals Seeking Psychosocial Care After Interpersonal Violence: An Integrative Model

2009 ◽  
Vol 24 (3) ◽  
pp. 322-336 ◽  
Author(s):  
Viola Schreiber ◽  
Babette Renneberg ◽  
Andreas Maercker
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Interpersonal Violence ◽  
Help Seeking ◽  
Traumatic Event ◽  
Psychosocial Care ◽  
Theoretical Models ◽  
Integrative Model ◽  
The Individual

Many people experience a traumatic event at least once in their lifetime. But only a fraction of those traumatized and in need of mental health care receive psychosocial care or treatment. This may be due to barriers people experience within the help-seeking process. The individual help-seeking process is consequently highly relevant for any mental health care for trauma survivors. Understanding why people refrain from asking for help or delay the help-seeking process is central to understanding help-seeking after traumatization. Based on empirical data and theoretical models, an integrative model of individual mental health help-seeking is developed. This integrative model delineates parameters relevant for seeking psychosocial care or refraining from it.

scholarly journals Invisible Experts: A Systematic Review & Thematic Synthesis of Informal Carer Experiences of Inpatient Mental Health Care

2021 ◽  
Author(s):  
Nada Abou Sief ◽  
Lisa Wood ◽  
Nicola Morant
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Health Care ◽  
Mental Health Care ◽  
Inpatient Care ◽  
Community Services ◽  
Informal Carer ◽  
Reference List ◽  
Thematic Synthesis ◽  
Inpatient Mental Health

Abstract Background: The negative impact of caregiving on carers’ physical and psychological wellbeing is well documented. Carers of mental health inpatients face additional burden, and report predominantly negative experiences of inpatient services. It remains unclear why, despite policies intended to improve inpatient experiences. A comprehensive review of carers’ inpatient experiences is needed to understand carer needs. As such, we aimed to conduct a systematic review and thematic synthesis of carer experiences of inpatient mental health care. Methods: We searched MEDLINE, PsycINFO, Embase and CINAHL for qualitative studies examining carer experiences of mental health inpatient care. Searches were supplemented by reference list screening and forward citation tracking of included studies. Results were synthesised using thematic synthesis. Our protocol was registered on PROSPERO (CRD42020197904) and our review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Findings: 12 studies were included from 6 countries. Four themes were identified: the emotional journey of inpatient care, invisible experts, carer concerns about quality of care for their loved one and relationships and partnershipInterpretation: Greater attention must be paid to ensure carers are well-supported, well-informed, and included in care. More emphasis must be placed on fostering positive relationships between carers, service users and staff and in facilitating continuity of care across inpatient and community services to provide carers with a sense of security and predictability. Further research is needed to explore differences in experiences based on carer and service user characteristics and global context, alongside co-production with carers to develop and evaluate future guidelines and policies.

scholarly journals Matrix support, individual therapeutic project and prodution in mental health care

2015 ◽  
Vol 24 (1) ◽  
pp. 112-120 ◽  
Author(s):  
Maria Salete Bessa Jorge ◽  
Alexandre Melo Diniz ◽  
Leilson Lira de Lima ◽  
Jardeliny Corrêa da Penha
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Center ◽  
Narrative Analysis ◽  
Psychosocial Care ◽  
Family Health ◽  
Physical Space ◽  
Systematic Observation ◽  
Support Matrix

The study aimed to understand how to conform the Support Matrix and Individual Therapeutic Project and its relation with the production of mental health care. This is qualitative research conducted in Fortaleza-CE, Center for Psychosocial Care and Center for Family Health. 17 people participated, between professionals and patients. It was used as for dates collecting semi-structured and systematic observation. The findings were analyzed by narrative analysis, grounded theory by Ricoeur. The results reveal themselves excessive referrals, medical-centered, dependence Health Center to support the specialized care, deficiency of physical space, network disconnection, outsourcing and professional unpreparedness of the Health Center as the production difficulties of care. The Support Matrix and Individual Therapeutic Project therefore happen in everyday services, but with difficulties that affect the organization and production of care.

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